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Agenda item 6 is on contacts from outside organisations. A lot of organisations continue to approach the committee and I know that members also have meetings with organisations in the area of health and community care.
Members indicated agreement.
The Multiple Sclerosis Society of Great Britain and Northern Ireland has requested to make a presentation on multiple sclerosis.
I suggest that we revisit that, because I believe that the Health Technology Board for Scotland is examining care and treatment. Also, a Scottish needs assessment programme report is due. Can we look at what those people recommend, and talk to the MS Society after that?
We will defer the matter into the new year for further development. We can flag it up to our researchers in SPICe that we will probably come back to the issue in the first half of next year, and they should pick up any research or work that they can on it.
Two weeks ago, the first meeting took place to set up a cross-party group on cancer. Richard Simpson may wish to say something about that, because he organised the meeting. There are other cross-party groups, such as the cross-party group in the Scottish Parliament on palliative care, so we could get information from the cross-party groups.
I was going to say that, and add that I imagine that when the health plan is published, we will want to consider how it interacts with national priorities for the delivery of health care. If we put that on our programme, we might want organisations to make presentations to us. It depends on how we consider the health plan, if indeed we decide to do it.
I take the point about the cross-party group, but the roles of cross-party groups and of parliamentary committees are different. The letter from Macmillan Cancer Relief makes a couple of good points. One is a reiteration of the fact that cancer is one of the key priorities, and that there is an opportunity to discuss issues of concern before the cancer plan is published in March. The committee must look at the issues of concern, and take a view. The question is, do we do that before the plan, or after? The committee has a clear role to play.
That was my point. The first that I heard of a cancer plan was when I read the letter from Macmillan Cancer Relief. I presume that it is separate from the health plan. Is it a new initiative? The question is whether we gather information and then feed our points into the cancer plan or simply respond to it. I did not know anything about the cancer plan until I read the letter that I have in front of me.
We should have a presentation from both groups, and that should be given before the cancer plan is published. We could do something ourselves later. We could also gather evidence from the four or so cross-party groups whose remits concern cancer in some way or another—including chronic pain. I would recommend that we act before the plan comes out. It is a huge issue.
Is there a consultation process before the plan comes out? Can we suggest that we have an input into it?
We would need clarification on that. I pointed out to the Cancer Research Campaign that periodically the committee has had informal briefings, and has pulled together a number of practitioners and organisations from various fields. Such briefings have always been very useful to members, and have given the organisations and practitioners concerned an opportunity to speak bluntly and plainly to committee members.
As a matter of principle, we should be trying wherever possible to influence Government initiatives before the relevant publications come out, rather than waiting to respond to them. I was aware that the cancer plan was scheduled to come out before March, but given that the timetable for the health plan slipped, it is possible that the cancer plan's timetable has also slipped.
Following on from the point about hearing from the cancer charities, of which there are about four, I think that the breakthrough scientific research carried out at the Roslin Institute would be worth hearing about.
That relates to the point that I was making. If we chose to have an informal briefing, as we have occasionally done in the past, we could open that up to a larger number of organisations and practitioners than we would if we took formal evidence in committee. Our committee time will be quite precious in the early part of the year, because of our consideration of the forthcoming regulation of care bill. If members felt that an informal briefing was the best option, we could open that up to other organisations, which members could suggest.
Such a session should be held as formal evidence taking, rather than an informal briefing. That is not to diminish the importance of informal briefings but, given the importance of the plan, I would like evidence to be heard in a more formal setting.
On purely practical lines, I agree that evidence should be taken formally, given the vastness of the subject. Perhaps we could suggest to the major bodies concerned that they get together first, to simplify things and to save time. That would avoid duplication and ensure that major, separate points were made. The organisations would benefit from co-operating before coming before us as witnesses. That would save their time and ours—we have had some rather repetitive evidence in the past.
I have some concerns. The regulation of care bill will be the committee's major preoccupation in January and February. If we are to tackle cancer and repeat what the Executive is doing in taking evidence from all those groups, we cannot do it in a half-hearted way; it must be done properly. That will require us to take evidence over several weeks, otherwise we will produce a half-baked report.
Committee members have the paper on the timetable for the regulation of care bill; it is very tight.
I have seen a paper on the forward work plan of the committee. It might be useful to have a discussion on it at some point.
We intend to have weekly meetings in the early part of next year, as we will be examining legislation. If we also want to consider other matters, that precludes fortnightly meetings.
This issue might have been discussed before I was on the committee. What are the committee's plans for considering the health plan when it is published on Thursday?
We need to start by clarifying the precise nature of the plans: are they finalised, or will the cancer plan, for example, be a draft set of proposals for further consultation? If the latter is true, we should take evidence on that plan when it is published. It is crucial that we examine the first Scottish health plan. We must set aside time in the spring to do that and to hear the reactions to it—the newspapers are talking about it already. Some huge changes will be proposed, and we need to debate the subject.
I am sorry if I did not make myself clear. I assumed that the committee would examine the health plan at some point. That will be a significant document in regard to what we want to happen in the Scottish health service, and we will have to comment on it. The question is where the cancer plan fits in. We need clarification on that, which the clerks will provide.
Some time ago—in September, I think—when we were considering the joint future group and the ministerial statement on personal care, we asked for an idea of when the Executive intended to issue the plans, so that we could co-ordinate our work and not be bounced into them. Parliament is often presented with things that we have not even heard of. We are constantly reacting rather than being proactive. I thought that one of the features of the Scottish Parliament was that committees worked together, fed into plans, had a say in the consultation process, and then scrutinised the outcome. In fact, we are being kept almost in the dark. The debate then becomes very confrontational. Committee members seek to be stakeholders and to make an input into the plans. Rather than being bounced into being reactive, we should be able to feed into the plans in a positive, helpful manner.
I suggest that we write to the minister to reiterate the points that Mary Scanlon and Nicola Sturgeon have made, which echo the points that we made previously to the minister. As a result of those protestations, some months ago, we received forward work plans from the Executive. However, the clerk informs me that in reply to our most recent request for information, we received a bland paragraph about modernising the NHS, which gave no dates. We will pursue that matter.
Can we discuss our own work plan at the next meeting?
Yes. We discuss the work plan periodically, and I will bring it forward to the January meeting.
When you write to the Executive, would you care to add that committee membership will be cut in the new year, unless there is some intervention to change that? Today's discussion on our heavy work load makes a good case for committee membership not to be cut, so that we have enough people to continue, for instance, with our reporter system.
Shall we arrange for an informal briefing from Macmillan Cancer Relief and the Cancer Research Campaign, which we could open up to other organisations as well? Members should e-mail me or the clerk with other individuals or organisations that they think it would benefit us to hear from. We will have that briefing as early in the new year as we can. After the briefing, we will decide whether to take any further oral evidence. By that time, we will have information on the timing and remit of the cancer plan, and we will able to feed into that, if time allows. Do members agree to all that?
Members indicated agreement.
We move now to possible inquiry topics. We have received a letter from Professor John Fabre of Guy's, King's and St Thomas' School of Medicine on the subject of elective ventilation for organ donation. Richard Simpson is our organ donation reporter.
I continue to have discussions with a number of organisations. I have been in communication with Professor John Fabre and Mr Engeset in Aberdeen, who is especially keen on this subject. I suggest that we do not have a specific inquiry on it. I have another two meetings arranged. I hope to meet Lord Hunt to discuss the UK's approach, which has yet to be settled. As members know, the minister has announced the intention of beefing up the opt-in system, and we will see what happens with that.
A range of options in that area could benefit from a committee-style approach.
I have met people from the Scottish renal group—physicians, nurses and technicians. I have met the transplant co-ordinators, who have been extremely helpful. I will meet intensive care unit nurses early in January. There will be a national meeting of ITU nurses at the beginning of March, but that will be after the report is out. Things are moving forward quite well.
We shall pass this particular letter to Richard Simpson as part of his continuing inquiry.
Members indicated agreement.
Previously, the committee has taken the view that questions of local provision, of acute services reviews and so on, should not be dealt with at this committee, unless they were relevant to national strategic issues that we felt could benefit from committee work. Are there any comments on the Glasgow royal infirmary request? Are members happy to follow the same line as before?
Members indicated agreement.
Iain Smith asked about exemption from prescription charges.
I understood that the list of medicines that were exempt was decided by Westminster. Is Iain Smith saying that that is a devolved matter?
Richard Simpson may be able to clarify that.
Prescription charges fall within the remit of the Scottish Parliament; they are not a reserved matter.
Did you say prescription charges?
Yes. Prescription charges relate to exemption and, as I understand it, we can determine our own exemptions. I raised the matter with the minister in August 1999 and indicated that in due course I would want to discuss in committee and in the Parliament the whole area of prescription exemption and charges. Members may know that the matter was also raised in the Finance Committee during discussions on the budget, as the sums involved are netted off within the health budget and are not specified. That lack of clarity was disturbing.
I would support that.
I am happy to support that, but I would prefer to raise the matter with the minister formally. I do not see why we cannot write to her about it. We have received a formal request about the issue and I think that we should treat it formally by writing to the minister and asking whether the Executive has any plans in that area. We should also flag up the issue with the researchers, saying that we would appreciate any background research that is available.
I think that you are missing the point. What Cathy Jamieson is concerned about is the whole issue of somebody challenging the system whereby opticians are able to make any recommendation without there being any recourse for the individual other than through their MSP. That takes us back to our previous discussions about the ombudsman. This is another issue that falls in that area.
We can link that into our previous points about the ombudsman. We shall ask for clarification of what recourse people have if they have a complaint against a high-street optician.
Cathy Jamieson's letter also raises the question of how some supermarket opticians are operating and how they are governed. The individual in question raises the valid point that they were given the cheaper option, but that might not always be the option that is required.
We shall include that issue in our on-going work on the ombudsman and get some clarification on the matter.
I think that we have missed the boat. Audit Scotland produced a report on domestic services in the health service and their effect on hospital-acquired infections. That was published well in advance of the report from Westminster. The Audit Committee could deal with the issue, because Audit Scotland undertook that report.
I read Audit Scotland's report. There are several failings in how we prevent and treat new infections. Audit Scotland spotted the problem and said that something has to be done about it. One of its key recommendations is that it is down to local health boards to produce a plan to combat infection. I am sure that inconsistency in treating infections will not lead to their extinction; indeed, it will probably encourage them. Treating a patient one way in Perth and then moving them to Falkirk and treating them differently there will do no good.
Hospital-acquired infection seriously damages not only the patient, but the health services. I have heard of people whose stay in hospital has been prolonged by three months because of hospital-acquired infections. The issue is serious—many people are more worried about methicillin-resistant staphylococcus aureus than about surgery.
I agree with Mary Scanlon. This is a big issue. The briefest of conversations with any hospital risk manager will give a horrifying insight into some of the decisions that are taken daily in hospitals and that are impacting on the incidence of hospital-acquired illness. We could examine the issue.
We know that there is concern in some areas, particularly about operating theatres. However, it is not just a question of name and shame—it is not necessarily that people are doing something wrong. The lack of a consultant microbacteriologist—there are not enough of them in Scotland—the distance that samples have to be sent for testing or the frequency of lab tests, might be the problem. I go back to the point about who is at the top of the tree. Many consultant places have been cut, including in microbacteriology, which is essential to the health of patients.
The onus is on the Executive. It is unfair to name and shame a hospital. That would cause panic, particularly if people have only one hospital that they can go to. I would not like to be the GP who is told that a certain hospital is the death hospital and that the patient wants to go somewhere else. The Executive must address the problem nationally, rather than leave it up to health boards that might be strapped for cash and do not have the consultants.
I do not think that it is as sophisticated as Dorothy-Grace Elder is making out. It is not as if MRSA would disappear if we had plenty of microbacteriologists. The Audit Scotland report mentions domestics on wards, their training and so on. We need to start at that level. If we have clean hospitals, the incidence of hospital-acquired infection will reduce dramatically. That is an area where health boards and trusts must actively recruit people. That would give us the opportunity to eradicate hospital-acquired infections and only in certain areas—particular types of surgery, for example—would MRSA be prevalent. We can take a broad brush approach.
I suggest that that is the appropriate course of action. We should find out what the Executive has been doing. We can revisit the issue when we consider our work plan in January. The committee recognises that this is an important issue. In the future, we might want to consider it further. We can impress on the Executive the need for a swift response.
The Accounts Commission has produced several reports over the past few years, one of which was on the matter in hand. We should write to the Accounts Commission and ask at what point it thought it reasonable to reconsider the extent to which a report had been implemented. What role does the Accounts Commission take in following up its reports? The Executive has a role, as does the Accounts Commission. I am thinking of operating theatre time, which is crucial to waiting times and lists.
There have been other reports. We considered an excellent report on prescribing and an Accounts Commission report into bank and agency nursing. If both those reports were followed through, the health service would make considerable savings and possibly provide a better service.
Members indicated agreement.
The next two contacts are from the General Dental Council and the Scottish Dermatolological Society—I seem to have my teeth in the wrong way. The SDS asks us simply to note its role. I think that we should note both of those contacts.
We discussed, once, whether we should ask someone from the British Dental Association to meet us. I suggest that we tie that in with the dental action plan and the work force planning review, both of which are excellent documents. As dentistry is so important to Scotland, could we come back to this issue in the spring, in order to tie in—
That is a specific request. For clarification, the clerks are still trying to organise an informal briefing, to which we agreed, from the BDA. The best solution would be for the committee to get that briefing from the BDA, which we envisage will be an umbrella briefing on dentistry. Dentistry and the dental action plan have been raised in Parliament on a couple of occasions in the past few weeks and I suggest that we simply note these contacts. Are members agreed?
Members indicated agreement.
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