The second item on the agenda is our historic and groundbreaking ask the health secretary session. I warmly welcome the Cabinet Secretary for Health and Wellbeing and Geoff Huggins, who is accompanying him to participate in the session.
Smoking
Thanks very much, convener. It certainly is an honour to ask the first question, and this is an innovation. I understand that the approach is, a bit like the Public Petitions Committee, new to Parliaments.
I congratulate the committee on this historic innovation. This is absolutely the kind of thing that the Parliament should be doing from time to time. I am glad to be the first cabinet secretary to participate in such an event and I thank the committee for prior notice of the questions.
Thank you for that answer. I know that the Government was, at one time, very keen on implementing the measure but there seems to have been some delay in getting to where we are. Can you explain to the committee why there has been a delay and when we are likely to see standardised packaging?
We have been looking at all the evidence and, as I said, the most recent evidence—the very substantive evidence published by the University of Stirling—was only completed in September this year. We are very much an evidence-led Government so before we introduce any new legislation, we like to be absolutely sure that the evidence is there—as much as it can be—that the legislation will achieve its purpose.
Mr Williams asks for some details and, reading between the lines, I think that he is saying that the measure will have an effect on his business and that the effect will be passed on to individuals. What benefit do you anticipate? What impact will the measure have on people’s health, particularly that of young people? What impact will it have on budgets? Will it free up any money by seeing fewer people presenting at hospital?
In general, the evidence is that the fewer people who smoke and the more that we can reduce the incidence of smoking, the better the health outcomes. We have already seen the rapid impact of the legislation on smoking in public places that the Parliament pioneered. That legislation had a strong impact on the incidence of ill health, particularly childhood asthma, from the time when it was introduced. That legislation continues to mean a long-term benefit to the health of the nation.
Thank you for that. I will go on to the second part of the question.
I thought that that was the second part of the question. I remind members and the cabinet secretary of my call for brevity in the questioning.
I am sorry about that. Those were my questions; this is the second part of Mr Williams’s question. He asks whether the cabinet secretary can convince him that the Government is doing all that it can to combat the illicit trade in tobacco, which is directly harming his business and fuelling a wholly unregulated black economy.
Along with the United Kingdom Government, we are doing everything that we possibly can to reduce the incidence of illicit trade. Indeed, a report published in March by the UK all-party parliamentary group on smoking and health contained evidence that showed that enforcement agencies do not rely on pack design to test whether packs are illicit but use a number of other security features found in existing packaging, including coded numbers and anti-counterfeit marks, all of which would be present on standardised packs. Plain packaging would neither increase the illicit tobacco trade nor make things easier for those who engage in it.
I had a supplementary to that, convener, but I will pass for the moment.
Other members want to get in on the back of Mr Williams’s question, Gil.
I confess that I am a smoker. I started when I was 12 and still smoke now. However, I totally agree with this measure and previous measures that have been taken—and, indeed, other smokers to whom I have spoken feel the same—but when will it be introduced? Furthermore, what will be on the pack? Will it just have the name of the cigarette at the top?
It will also have the coding that I have already mentioned. We intend to introduce the necessary legislation within the next year to 18 months.
A year to 18 months?
Yes. The Cabinet still has to finalise the next set of bills that will come before the Parliament. This particular legislation will be included but the exact timing of its introduction will depend on a range of other matters.
Let us press on.
Sport and Wellbeing
The next question is from Stephen Morrison of Glasgow, who raises the age-old issue of inactivity continuing to blight the health of the nation. What more can we do or different measures can we take to ensure more participation in sporting activity?
I totally agree with the question’s premise that we need to do much more to get many more people in all age groups much more active. I will mention some of the things that we are doing. For a start, we are developing a new national walking strategy that will build on Government investment in the core path network, as well as specific interventions such as paths for all that support people in walking.
You will be aware that in its community sport report the committee focused rightly on the tens of thousands of sterling volunteers who run our sports clubs and deliver sporting activity daily, nightly and weekly in our communities. Although we are very proud of those people, we also noted figures that show that volunteering in Scotland lags quite a bit behind that in our European competitors. For example, Finland has a 16.5 per cent participation rate in volunteering, Ireland has 15 per cent and the Netherlands has about 11 per cent—I could go on and on if I had the time. However, information from sportscotland suggests that Scotland lags behind England, Wales and Northern Ireland with regard to the participation of volunteers. What do we need to do to encourage greater participation in volunteering and support volunteers?
In addition to all the initiatives—we are certainly not short of initiatives—my colleague Shona Robison has announced a £10 million legacy programme for the Commonwealth games, part of which will address the issue of increasing participation of volunteers, which you rightly highlight. We have to get across the message that physical activity is critical, and not just for its own sake, because the three big killers in Scotland are still cancer, stroke and heart attack and all the evidence shows that even half an hour of walking a day goes a long way towards preventing heart attacks, strokes and even cancers. We are doing everything that we possibly can, but I agree that we need to do more. That is the purpose of the additional £10 million in the legacy fund.
That £10 million is very close to the figure for the lottery funding that was announced in August. Are you talking about the same pocket of funding? That is a re-announcement, is it not?
Which fund did you mention?
The lottery fund—the legacy money.
Yes. It is the same £10 million.
I thought so.
We use the participation rates that you mentioned in your earlier question to monitor progress. Although those rates are low compared to other European countries, I understand that they have been rising in recent years. However, they are nowhere near where they need to be, which is exactly why we are undertaking all these initiatives.
We do not have time to pursue this, but I point out that the number of people taking certificates was higher in 2010, 2011 and 2012, but is dropping off now.
I welcome the walking strategy. Scottish Natural Heritage has published a map of some of the longer routes in Scotland, such as the west Highland way, but accessing those walks by public transport is an issue. Is it possible to tie that information together and make sure that it is available, so that people can get to the walks by public transport? They can break a walk down and do part of it; they do not have to do the whole route.
I am certainly happy to take up that issue with Keith Brown, the Minister for Transport and Veterans, to ensure that there is a proper, joined-up approach. Long walks on routes such as the west Highland way are part and parcel of what we are encouraging people to do.
Bob Doris has a question on cardiac rehabilitation services.
In fact, I have a supplementary on sport and wellbeing, but I knew that my question was next, so I waited patiently. I have a request to make.
The objective is both to get more people cycling and cyclists cycling more. The greater the number of people who cycle, the better that will be for the environment and for people’s health, and the less crowded the roads will be. Similarly, cyclists cycling more will have the same benefits.
Cardiac Rehabilitation Services
The question on cardiac rehabilitation services is from Jeff Holt. I do not know which part of the country Jeff comes from, but it might be quite useful to find out, because he has had a positive experience of cardiac rehabilitation services after unfortunately suffering a heart attack. Although his experience has been positive, he is concerned that such services might not be widely available to people with heart failure across the country. The support that the national health service provided to Mr Holt in the form of cardiac rehabilitation services meant that he had a positive experience, but he would like more information on how we can ensure that that high-quality approach is rolled out consistently throughout the country.
We have had quite a lot of success in tackling heart disease. Since 1995, there has been a 60 per cent reduction in premature deaths from coronary heart disease across Scotland. That is a substantial reduction, but we want to go further.
You mentioned that access to cardiac rehabilitation services increased from 45 to 60 per cent, which is, of course, to be welcomed. Do you anticipate that when the new SIGN guidelines that you mentioned feed into the health boards, that figure will increase to 70 or 80 per cent? Do you have a specific target for increasing access to cardiac rehabilitation?
We do not have a specific target of 70 or 80 per cent. The objective must be to reach 100 per cent eventually, because that will ensure that whoever is affected by heart disease will receive the appropriate rehabilitation. A further step change is how I would describe the way forward.
You expect to see an increase without having a specific benchmark.
Absolutely.
I do not know whether you have the information with you or whether you will have to write to the committee with it, but is there any geographical variation in access to services? Clearly, there must be if the figure is 60 per cent—that does not cover the whole country. I know that in the north of Glasgow, which is the region that I represent, many of my constituents are for a variety of reasons far more at risk of cardiac arrest, for example, than people in other areas. How is NHS Greater Glasgow and Clyde, which might have the greater burden in that regard, performing in relation to access to cardiac rehabilitation services?
There is wide variation in the Greater Glasgow and Clyde area as well as variation among the 14 territorial boards. Of course, some of that is to do with the incidence of chronic heart disease, which is much higher in areas of poverty and deprivation and areas where more people smoke or have other bad habits. We try to tailor services so they are where they are most needed but I will provide for the committee a detailed breakdown of how the 60 per cent that we have been talking about pans out between boards and, where I can, provide information about the Greater Glasgow and Clyde area.
Recent research from the University of Edinburgh, which was part-funded by the British Heart Foundation, examined scanning techniques that can identify the build-up of significant fatty plaques and—we hope—predict those who are most likely to suffer a cardiac arrest. As a result of those techniques, preventative measures can be taken, such as the identification of the need for a stent much earlier in the patient journey or prescribing high-dose medication to lower the risk. That research needs to be peer-reviewed and a bit more work has to be done on it, but what pathway would the Scottish Government use to feed some of that positive research from an excellent Scottish university into making such services a reality for my constituents?
The development that was announced yesterday is exciting but we need to be realistic: it will take five to 10 years to undertake the necessary work to ensure that those measures can become part of mainstream activity in preventing heart disease. Given the amount of work that still has to be done on that project, I do not want to raise any expectations that those measures are going to be available next year or even the year after.
I do not have another question, convener, but simply note the important point that the cabinet secretary is making. When any new developments emerge, the Scottish Government will work in partnership with research institutions to see how they might be brought into mainstream provision in the NHS. If that takes 10 years, so be it, but the important point is that the planning starts now.
Absolutely. We want to speed some of these processes along as much as we possibly can.
The committee is also dealing with the budget at the moment. Does the chief scientist have more or less money to spend on research this year?
If you look at the budget—in fact, you have asked that question—
I am asking it again.
Aye. The research and development budget line is slightly down. However, I will make two points. First, we are leveraging in funding, particularly from European programmes, which means that the overall spend is greater. Secondly, a lot of R and D goes on that is not in the R and D line.
I think that you have answered my question: less money is being spent on R and D.
I have a question from Robin Lattimore MBE, who is from Banchory. Mr Lattimore says that in the past Grampian NHS Board has relied on funding from various external sources, including the Big Lottery Fund, the British Heart Foundation Scotland and the change fund, for its heart failure nursing service. Given that heart disease is a national clinical priority, will you address Mr Lattimore’s concern that the board is likely to discontinue the service?
I emphasise the importance of heart failure nurses in supporting the care of people with acute heart failure. We want to ensure that NHS boards have the full spectrum of heart failure services in place to meet the demands posed by the increasing incidence of heart failure. Ultimately, it is for the boards to ensure that services, including the provision of heart failure nurses, meet the needs of their local population.
You mentioned that it is for individual boards to ensure that appropriate services are in place. What about the national picture of provision of acute heart failure services? Is service provision patchy? Is the national picture similar to the position in Grampian?
Provision of those services is not patchy but will depend on the scale of the problem locally, given variations in the incidence of heart disease. As I said, there is a very high correlation between the incidence of heart disease and the level of poverty and deprivation in an area. Compared with Glasgow, for example, Grampian—particularly the urban areas—does not have high levels of poverty and deprivation, so heart failure resulting from those factors tends to be much lower. Although the population profile differs, improvement in heart failure services is nevertheless required, which is why Grampian is investing in those services.
Medical Devices
Elaine Holmes from Newton Mearns asks why it is not mandatory for clinicians to report adverse incidents involving transvaginal mesh implants to the Medicines and Healthcare products Regulatory Agency. On the same issue, Ann Boni from Edinburgh would like to know why a national register has not been implemented in view of the numerous complications that are due to use of transvaginal mesh.
Convener, I am going to give a reasonably detailed answer on this because it has been the subject of much discussion. As you will know, I have had quite a number of meetings with patients’ representatives on the issue, so I want to put some of the important facts on the record.
Will that be used as a national register, so that everything will be on the register?
Yes.
Will that include those who have not had adverse incidents?
The register will be for adverse incidents; we are investigating very closely the number of adverse incidents. One of the problems is that many of the procedures are done in the private sector, rather than the national health service, which means that there is a different dimension to tracking incidents. Regulation is a reserved matter, but that is not an excuse; it is why we need to work very closely with the MHRA. It is the MHRA, rather than the Scottish Government, that decides on regulations.
Okay. What steps are you taking to ensure that other women are not fitted with the mesh and face similar complications? Are they being advised of the concerns that have been raised? Are they being fully informed before they have treatment?
The chief medical officer for Scotland has written to all health boards, to all general practitioners and to a range of other people informing them of the scale and nature of the problem and to ensure that any woman who is referred for the procedure is made absolutely aware of the risks.
If there are no supplementary questions, I will bring in Malcolm Chisholm.
Mine are separate questions, but they are on the same subject. The first one is from Kathleen Parrish, although I do not think that it is in the cabinet secretary’s power to do what she asks, although the MHRA might be able to do it. When is it expected that mesh devices will be removed from the market in order to avoid further damage? I presume that that is an issue for the MHRA, but what discussions have you had with MHRA about that?
We have been discussing that with the MHRA for a number of months and have already set up a working group to address the issues that have been raised by women who have been affected by complications arising from mesh surgery. That will include a care pathway for surgeries for complications.
I think that you have partly answered my second question, which is from Fiona Mowat in Wishaw. She wants to know how the Scottish Government plans to support mesh victims. Perhaps you could give a bit more detail around what you have said already, and perhaps more about what you mean by “a robust approach”, which rather suggests that you are being critical of the MHRA and how it has acted until now. I am not objecting to that, but what might a more robust approach involve?
Regulation of the procedures, the devices and sale of the devices, especially in the private sector, needs to be toughened up. We have made it clear to women who have been affected by the devices that if rectification is required and there is a clinical need for it, it can and will be supplied by the national health service. The chief medical officer has made it clear to all the health boards that that is what should happen.
Okay.
Rare and Long-term Conditions
I have a number of questions about the important issue of support for people who have rare diseases and conditions. My question comes from Patricia Osborne from Dundee, on behalf of the Brittle Bone Society. You are probably aware that it is the only charity in the United Kingdom that supports people who have a genetic bone condition called osteogenesis imperfecta, which is characterised by fragile bones that break easily. Ms Osborne’s first question is this: over the next 10 years, how will the Scottish Government monitor improvements in the care of children and adults who live every day with rare diseases and conditions?
An estimated total of more than 6,000 rare diseases that at least one person has or has had in the UK have been identified. We are talking about a very large number of rare diseases. It is probably only in recent years that the need to do something more for people who have rare diseases has come over the horizon and moved nearer the top of the health agenda. That is quite right, because although we focus on diseases that affect many thousands of people—heart disease, stroke, and cancer—people who are affected by rare diseases might suffer as badly or worse than people who have more common ailments.
Thank you for that response, and for drawing our attention to when the UK rare diseases strategy will be published. I was going to ask you about that in one of my follow-up questions.
As you probably know, the “Wheelchair and seating services modernisation: Action Plan” was launched four years ago. It contained 53 actions relating to service improvement, and formed the basis of our wheelchair and seating services modernisation project.
Thank you.
That work is done primarily through the person-centred care collaborative. The point of that—not just in relation to this question, but in relation to other ways in which we want to ensure patient involvement—is to ensure that patients and end users are involved in looking at how we will take things forward. I hope that the person who submitted the question, who is from Dundee, I think, is involved in the Tayside group.
As members have no supplementary questions on that, we will move on to the next area, starting with a question from Nanette Milne. She has not asked a question yet, so I will allow her to do that, and I will then ask Richard Lyle and Colin Keir to put their questions to the cabinet secretary together, so that we can push on.
Mental Health
Good morning, cabinet secretary. This question is from Fiona Sinclair from Ayrshire, on behalf of Autism Rights. Should people with learning disabilities or autism be included in the provisions of the mental health acts even when they do not have a mental illness? Do you agree that for them to be included is discriminatory, and do you support the Millan committee’s and the McManus report’s recommendation that the situation be reviewed?
Nanette Milne is probably aware that there is a long-standing debate on the subject going way back to Bruce Millan’s review of mental health services in Scotland. Malcolm Chisholm, I think, commissioned that excellent review.
As you said, the issue goes back quite a long way. I think that the initial report was produced in 2001 and was followed in 2003 by legislation. At that time, there was a recommendation for an early review. I think that Fiona Sinclair will be disappointed to hear that you do not have current plans for that review. Can you put a timescale on when a review might take place?
We are not setting our face against a review; we are saying that we have no plans at the moment to change people’s status. We are looking at and will look at the case for a review. As I said, I have not set my face against it, but I would need to see justification for it, because it is clear that changing the status would have fairly radical implications for delivery of services and the cost of that delivery, which may not be to the advantage of people with autism or, indeed, of people who suffer from mental health problems. We are not saying no to a review, but at the present time, we are not saying yes, either.
Thank you for those answers. I suspect that you might hear a bit more from Autism Rights in the near future.
I am happy to meet anyone or to ask Michael Matheson, who takes the lead on the matter, to meet people. We are a listening Government, so if people feel strongly about the issue and can persuade us, we will approach matters with an open and fair mind.
We have an additional couple of questions on that, from Richard Lyle and Colin Keir.
I actually have a question from Autism Rights, so you are getting a question from it earlier than you thought that you would, cabinet secretary. Do you agree that the issues need to be aired in public and that the Scottish Government should have published on its website the responses to its consultation on the mental health strategy?
We made the information publicly available in the Scottish Government library, but I am happy to ensure that it goes on the website. I do not see why we should not put it on the website; indeed, I did not realise that it was not there until the question came in. Putting the information on the website is not a big issue; it is already in the Scottish Government library.
Autism and the other conditions that you mentioned are coming to the fore more and more. Do you agree that autism and those other conditions have been increasing in the past 20 years, or have we just recognised the conditions more in children?
In the latest statistics, there is a bit of a plateau in the numbers of people who are being diagnosed with autism, but I think that parents, teachers and GPs are much more aware of the possibility of autism than they were 20 or 30 years ago, so the diagnosis rate has substantially increased.
I know that you have a very open-door policy; indeed, diary pressures notwithstanding, you have been able to see people who have contacted me for help. Will you—as I think you already have done—give an undertaking to meet Autism Rights?
Depending on diary dates, either I or Michael Matheson will have that meeting. If we want to have it earlier rather than later, it might be better if Mr Matheson were involved. However, we both have an open-door policy. In fact, Michael Matheson has been doing sterling work on autism and had a very successful meeting with the local group in my constituency, Hope for Autism, which covers North Lanarkshire, about improving the quality of services. As I have said, we both have an open-door policy because we want to hear at first hand about where services are not being delivered to the required quality, standard or quantity.
You might have partly answered this question already, but Margaret McCool of South Lanarkshire has asked whether in the foreseeable future more of the health budget will be put towards mental health issues and whether there will be more publicity on where help can be obtained.
As I have said, we are actually spending three to four times the average global spend of the total health budget on mental health. Many years ago, mental health services were the NHS’s Cinderella service and, to be fair to my predecessors, including Malcolm Chisholm, we have all shared the agenda of ensuring that mental health is given the resources that it needs. Mental health problems, which cover a wide range of different conditions, require the same level of support to meet need as any other health problem.
We visit health boards twice a year—just yesterday, I was in Ayrshire and Arran for our autumn visit—and, given some of the media reporting that we have seen, we have decided to ask boards whether there have been any reductions in mental health spend. The objective behind these meetings, which involve clinicians and managers, is to find out what is going on, and we have found not only in Ayrshire and Arran yesterday but last week in Tayside that people are continuing to work on making efficiencies and to ensure that services are working effectively. A lot of that is often about taking out of the system additional loops that patients have to go round and which they do not really welcome.
This is my first meeting as a member of the Health and Sport Committee—I have come from the Justice Committee.
You have been promoted, Colin. This is a far better committee.
One of the issues that came up was how we are dealing with people with mental health issues in the justice system, particularly those on short-term visits to prison, and how the finances are being allocated towards looking after such people who perhaps should not be in prison but would be better dealt with outside?
I have had recent experience of this at a constituency level. There is an issue around the transition from prison to community when prisoners are discharged, irrespective of how long their sentence is, and the continuation of their psychiatric care. We need to tighten up on that area to make sure that, when a prisoner who is already under psychiatric supervision—I am not referring to secure supervision, just mental health supervision—leaves prison, there is a continuum of care and the transition between prison and the community is better managed. There is a general issue there, which we will address.
Care Visits
Kevin Toshney in Dundee asks what the cabinet secretary’s views are on 15-minute care calls for older people.
Fifteen-minute sessions can be the building blocks for an agreed package of care and, in some cases, they may be what the client wants. Clearly, for more complex cases a 15-minute visit would not be sufficient time to provide appropriate support. Packages should be designed and delivered to reflect the client’s needs and promote their rights.
Do you think that the 15-minute calls are acceptable? We heard evidence of 10-minute visits to prepare and provide someone with their lunch. Is that acceptable?
It is not acceptable if the purpose of the visit requires substantially more time than that.
You mentioned the national care standards, which were identified in the committee’s inquiry. We look forward to the review. There is a bit of a delay. We had a commitment that it was coming along. Can procurement or commissioning play a part in addressing this issue?
Inevitably, that must be the case, and the Association of Directors of Social Work will obviously be looking into that. I had a meeting with the directors two weeks ago, so I know that the allegations surrounding 15-minute care visits are a key area that will be considered in the work that the ADSW is undertaking. I hope that the ADSW will be able to give some facts about the situation, because there is a lot of anecdotal evidence for and against 15-minute visits. We need to get to the bottom of the issue, and the purpose of the ADSW review is to do exactly that.
That is particularly interesting, because people might think that all visits must be for only 10 minutes, but we know that not all visits can be done in 10 or 15 minutes, as some will take longer. Has any work been done to require local authorities and providers to provide information so that we can establish to what extent 10-minute or 15-minute visits are being used? Regarding continuity of care, do we know whether people are receiving increasing numbers of different carers going in over a week or month or whatever? Have you commissioned any work to establish the extent of that problem?
At the moment, that information is not collected centrally. The ADSW review will consider whether we need to monitor the issue more closely and collect information centrally.
When do you expect the review to be published?
Fairly early in 2014.
Do members have any other supplementaries on that issue?
As you know, cabinet secretary, I was previously a councillor in North Lanarkshire. Do you agree with me that the whole system of care visits is run by councils, so the provision of extra care to people is dependent on each council’s adaptation of the system? Even before I came to this place, issues were raised with me about people not getting enough time. We also had a situation in the tower blocks in Motherwell where carers were jumping in and out of—well, not jumping out of but going into—different tower blocks and crossing over, which was totally crazy. We tried to get the council to resolve that. Do you agree that the issue is entirely down to councils?
Social care is a council-run function. Obviously, under the integration agenda—I am the cabinet secretary with responsibility for social care—I want to ensure that people are receiving the social care, as well as the healthcare, that they need. That is why I have asked the ADSW to undertake that piece of work. I think that we will need to pay more attention to the issue in future. Once we see the outcome of the review of the national care standards and once we have decided the national outcomes that are to be achieved by the integrated health and social care partnerships, we will need to be very clear that those standards must be met. The issue relates to people’s needs and should not be dictated by other factors.
On the issue of the amount of time provided for care visits, I was previously in correspondence with Glasgow City Council and Cordia (Services) LLP regarding how they report and quantify care visits. I cannot quite remember the specifics, but I remember that there was a lack of clarity in the reporting. I make no judgment about Glasgow City Council in relation to that, but it was not clear how much time was spent inside people’s homes and how much time was spent travelling to and from people’s homes, so there was possibly a double counting of the care provided if travel time was being included in the figures reported. I am not saying that Glasgow City Council did that, but there was a lack of clarity in how things were reported. Some consistency across the country on how such stats are reported would be helpful. I do not think that Glasgow City Council intended to obscure the data, but there seems to be no consistency in how the time is reported.
What matters to me as cabinet secretary is not so much how much time people spend with each end user but what the outcomes are and whether people are getting the service that they require. Some services can be delivered in 15 minutes, but some services obviously take a lot longer. If you are making someone’s lunch, it will take a lot longer than 15 minutes. If you are getting some people out of bed in the morning, I suspect that it will take a lot longer than 15 minutes. Although it might be important for the purposes of performance monitoring and checking on things to keep a record of how much time is spent with end users, the key issue is the outcomes of the service that they receive. That is key, because you cannot achieve the outcomes if you are not spending enough time with the end user.
I apologise; I think that there was a lack of clarity in my question. The point that I was trying to make was that if a local authority is reporting 10,000 hours of care in the community in people’s homes, irrespective of how many service users there are and how long each visit is, it should ensure that travelling time is not included in the reporting. Also, reporting should be consistent throughout the country, to allow for national monitoring.
Absolutely. If I was managing a council’s resources, I would still want to know what the travelling time was, but that would be for management and resource efficiency reasons. I would want to know precisely how much time was spent with the end user. For other reasons, councils should also monitor how much time is being spent travelling.
Pharmacy Applications
I have a question from Alan Kennedy: the cabinet secretary has agreed that pharmacy applications are adversely affecting patients in rural areas and is carrying out a review of such legislation; will the cabinet secretary direct that the review should include specific legislative change to encourage approval of applications where a community’s patients support co-located GP and pharmacy practices, and that such applications must not be overturned by objections from pharmacists operating outwith the neighbourhood of the GP practices concerned?
I am looking at two things as part of the review. One is the criteria for approving pharmacy applications. As you know, there are currently major concerns about an application in Uist; there are also concerns in rural Stirlingshire and other parts of Scotland. I do not think that the current legislative framework is fit for purpose, so we are reviewing it. I hope to be able to go out to consultation on the issue very soon.
I welcome that. One of my concerns is that there appears to be a rush of applications, because people know that the review is coming and things will change—applications are certainly being discussed; whether they all come forward is another matter. Is there a way of putting through emergency legislation now, to call a moratorium on new applications, so that we can leave things as they are until the new regulations come through? We also need to allow the regulations to be properly consulted on, so that they are fit for purpose, because we do not want to rush through new legislation that might have unintended consequences, given that the area is quite complex.
I absolutely agree. I have said this in the Parliament: if I had the legal power to call a moratorium on applications and consideration of applications—and we have explored every possible way for me to do that—I would have exercised that power and had a moratorium. I do not have the legal power to do that. Had I the legal power, I would definitely have imposed a moratorium until we have reviewed the rules.
Can we not legislate on the small matter of giving you the power to call a moratorium, and then do the rest of it?
The regulations will be secondary legislation, whereas giving me the power to call a moratorium would require primary legislation. Given that it would take much longer to get primary legislation than it would to change the existing position through secondary legislation, there is no great advantage in doing as you suggest.
If there are no supplementary questions from members, I need to bring this part of the meeting to a close. The cabinet secretary has a Cabinet meeting to attend. Cabinet secretary, we will pass the remaining questions to your department and complete their consideration in that way. Thank you for your attendance. This was an interesting exercise and I hope that we can discuss how to take forward and improve the approach.
I am happy to send you the answers to the questions that we did not get to. You can then circulate them to the committee and place them in the Scottish Parliament information centre, so that they are made available to the people who took the trouble to submit questions.
Yes. We did not have any public participation in the meeting. However, I must apologise to the people who submitted questions and attended the meeting but did not hear their questions being asked. The cabinet secretary notified the committee that he would have to be away for half past 10 this morning. He stayed much longer than that. I apologise. I think that we have done well in getting through 12 questions and supplementaries, but we will review the meeting and discuss with the cabinet secretary’s office and committee clerks how best we can improve the process and ensure that there is enough time. We will ensure that there is a response to everyone, through the cabinet secretary’s co-operation.
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