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Chamber and committees

Health and Community Care Committee, 19 Sep 2001

Meeting date: Wednesday, September 19, 2001


Contents


Petitions

The Convener:

Agenda item 4 is our regular update on petitions. Members should all have a copy of the petitions report. PE370 is from Lydia Reid, on behalf of Scottish Parents for a Public Enquiry into Organ Retention, and calls for the Scottish Parliament to take the necessary steps to ensure that a full public inquiry is carried out into organ retention. No comments have been received from members. The Public Petitions Committee referred the petition to us, with the recommendation that it be considered in conjunction with PE283. Our attention is drawn to the request for an examination of the role of the procurator fiscal in relation to organ removal and retention following post mortems. The petition has been copied to the Justice 2 Committee for information only. We have previously considered PE283 and taken the view that we would await the outcome of the second part of Sheila McLean's investigation into the matter.

I hope that members have had a chance to read the relevant extract from the Official Report of the meeting of the Public Petitions Committee on 19 June. I suggest that we appoint a reporter to pull together the strands of what is happening in the background to both petitions. That would put us in a position to respond to the second report of the McLean commission when it is published. For the time being, we should treat the new petition, PE370, in the same way as PE283 and wait until we have received the second report from the McLean commission before taking further action. That is one possibility.

Mary Scanlon:

I suggest another possibility. Sheila McLean's report is likely to be published in the autumn. I do not see the sense in appointing a reporter who may duplicate some of the work that is being done for that report. Can you give us an indication of when the McLean commission report will appear?

The Convener:

I will explain why I think it would be useful for us to appoint a reporter. If members have read the Official Report of the meeting of the Public Petitions Committee at which PE370 was considered, they will know that claims and counter-claims are being made. Appointing a reporter would enable us to acquaint a member of the committee with some of the background issues, rather than with the work of the McLean commission. We have agreed that we will await the publication of the commission's report. We also need to consider the role of procurators fiscal in the removal and retention of organs. We could appoint a reporter to ask questions about their role, we could ask written questions, or we could decide to do nothing for the time being, as we did in the case of PE283.

Janis Hughes (Glasgow Rutherglen) (Lab):

I support Mary Scanlon's comments. Given the fact that the publication of Sheila McLean's report is imminent—it would be helpful if we could obtain information on when the report is likely to appear—it would be foolish for us to appoint a reporter, especially when PE370 relates specifically to the role of procurators fiscal. Any action that we take should be taken in the context of Sheila McLean's report, once we know what it says. If we started to consider steps that are not in line with what she recommends, we could get into difficulties.

Margaret Jamieson (Kilmarnock and Loudoun) (Lab):

I support the points that Janis Hughes and Mary Scanlon have made. Sheila McLean's report will provide a way forward for everyone. From the comments that have been made to the Public Petitions Committee, it is clear that there has been a parting of the ways on this issue. It is not this committee's function to establish which side is right and which is wrong, even if that were possible.

The Justice 2 Committee is carrying out an inquiry into the procurator fiscal service. If we believe that there is a problem relating to the role of procurators fiscal in the removal and retention of organs, we can ask the Justice 2 Committee to deal with that in its report. However, it would not be in anyone's interest for the Health and Community Care Committee to appoint a reporter at this stage.

Mr John McAllion (Dundee East) (Lab):

I disagree. The submission of PE370 and the evidence that was given by Lydia Reid to the Public Petitions Committee led to correspondence with the previous petitioners that was quite controversial. It would be in this committee's interests for someone to investigate the matter, so that when Sheila McLean's report is published we are able to take an informed view on the petitions. We are expected to deal with the petitions, irrespective of what Sheila McLean says in her report. I would prefer us to appoint a member of the committee to examine the dispute between the two groups involved and to report back to us on that. Their task would be not to resolve the dispute, but to inform the committee of the substantial differences between the two groups and of what is at issue.

I see a clear separation between Sheila McLean's inquiry and what we are being asked to do. As usual, our problem is shortage of numbers.

Dr Simpson:

I join Mary Scanlon, Janis Hughes and Margaret Jamieson on the matter. We should not become involved, because a third group exists that is not vocal—the group that has not wanted any investigation at any time. Is that group right? It is a question not of right and wrong, but of strongly held opinions about how we should proceed. It is clear that that has led to a split in the Scottish Organisation Relating to the Retention of Organs, or SORRO.

It would be wrong for the committee to become involved in a debate between organisations about who is right and who is wrong. We should wait for the McLean group's report. We should then hear all the parent groups' comments on that report. If problems arise from the report, the committee should then take up the concerns of all groups.

Nicola Sturgeon (Glasgow) (SNP):

I am not unsympathetic to that view. I agree whole-heartedly with Richard Simpson that it would be wrong for the committee to become involved in any disputes that arose in SORRO. However, John McAllion is right—we have two petitions that we must deal with, however we deal with them. We will want to take a keen interest in the McLean report, so I would be a bit worried if we prematurely drew the line under the issue today. We may want to keep the matter on our agenda until the McLean report is issued, when we can return to it. The committee cannot simply sweep some of the issues under the carpet. I want the committee to keep the matter open.

The Convener:

I will clarify my reasons for saying what I said. I do not want the committee to arbitrate between the groups. We have two distinct petitions on the issues. PE370 asks us to develop further lines of inquiry regarding the procurator fiscal and other matters. Given the time constraints on the committee, we cannot investigate those matters as a committee, so it might be useful for at least one committee member to be identified as the person who is keeping an open book on further developments. Meanwhile, we can wait for the response from Sheila McLean's group. When the McLean report is issued, we will take any further action.

I want to keep a sense of openness on the petition in a way that does not require the involvement of the full committee. On balance, the committee's view is that we should take the line that Nicola Sturgeon proposed: keeping the matter open and on the books. Most members who spoke said that we should take further action on the basis of the McLean group's report. Is that an acceptable position for the committee?

Dr Simpson:

Will we write to the McLean group and find out when its report will be published? We should also advise the group of PE370. I may be wrong, but I assume that the McLean group is considering the matters that that petition raises. Nevertheless, we must advise it that the petition has been lodged. If that group is not dealing with those issues, we will have to deal with them.

Is the proposal agreed?

Members indicated agreement.

The Convener:

PE374 is from Dr Steve Gilbert. The petition calls for the Scottish Parliament to act urgently to redress the underfunding of chronic pain management services, to debate the matter in Parliament and to urge the Minister for Health and Community Care and health boards to move chronic pain up the health agenda.

The petition was forwarded to us by the Public Petitions Committee for information only. That committee considered the petition on 11 September and agreed to refer it to us for our consideration, drawing attention to the lack of pain services provision in the Highlands. The Public Petitions Committee agreed to seek the Executive's views. Members should have the Executive's response attached to the petition.

Dorothy-Grace Elder:

The Public Petitions Committee agreed unanimously last week that, unfortunately, the Executive had not responded to the nub of the issue. We all thought that the Executive had made a mistake and responded about palliative care and cancer care, which are quite well served, whereas PE374 almost entirely concerns patients in the community who suffer from chronic pain, such as arthritis patients and back injury patients.

The Executive had gone off skew-whiff, so the Public Petitions Committee agreed to write to it again to point out that it had taken up the doctor's points wrongly and to ask for a fuller reply about what could be done to alleviate the pain of the huge number—270,000 to 500,000—in the community who do not receive much or any help. It was pointed out that Highland region has no specialist pain clinic. That is the stage we are at.

So, as things stand, the Public Petitions Committee has asked for clarification and further information from the Executive.

Yes.

The best thing for the committee to do is probably to await the Executive's further response to the Public Petitions Committee. Is that acceptable to members?

Dorothy-Grace Elder:

I am sure that John McAllion will agree that the Executive took a long time to reply the first time, which showed that it had missed the point. I am concerned that more months will drag on and that we will then receive a reply that is not very strong and that there will be no proper investigation of the issue. I move that we have a reporter on this.

Dr Simpson:

I disagree that we should have a reporter on this. However, in addition to the questions that the Public Petitions Committee is asking the Executive, we should ask the Executive what investigations it proposes to undertake to assess the needs of patients and the current chronic pain management programmes in Scotland. Those investigations should be carried out by SNAP—the Scottish needs assessment programme—or CRAG, which is the clinical research and audit group. There are serious problems about prolonged delays in people getting to chronic pain clinics. I hope that this is an area in which the Executive, as part of its new programme of waiting times, will indicate that it will set some targets. To do so, however, it needs to undertake the initial investigations.

The Convener:

Is it acceptable to members that I write to the Executive, making the points that Richard Simpson has just made and stressing the need for a quick response from the Executive to the Public Petitions Committee's second letter? We can come back to the petition at a further meeting, when we have received a response.

A few months ago, the minister refused to conduct an audit of services.

The Convener:

We will ask her whether she will undertake an audit and assessment of what is going on at a local level throughout the country. We are all aware that services are patchy in certain areas and that some people have access to better services than others. Generally speaking, we have all been impressed by different organisations that deal with a number of different conditions. This appears to be an area in which the Executive should undertake further audit and assessment work. We can take up Richard Simpson's points, which were echoed by Dorothy-Grace Elder, and ask the Executive to respond as quickly as possible to the Public Petitions Committee's request for further information. We will return to the issue again. Is that acceptable to members?

Members indicated agreement.

The Convener:

The next petition is PE381, from Thomas Campbell, on behalf of the Transport and General Workers Union and Unison, calling for the Scottish Parliament to examine the Scottish Ambulance Service's proposals to close five of its eight Scottish operations rooms. The petition was forwarded to us by the Public Petitions Committee, with the recommendation that it be for information only. On 11 September, the Public Petitions Committee considered responses to the petition from the Scottish Ambulance Service and the Minister for Health and Community Care. That committee agreed formally to refer the petition to the Health and Community Care Committee for further consideration. The responses are attached.

All members should have received a copy of a letter that was sent to me by Susan Deacon, relating to the Ambulance Service and making it clear that what is being asked for at this point is further development of proposals, leading to an outline business case on how response times and the effectiveness of the service can be improved. Do members have any comments?

Margaret Jamieson:

I declare an interest as a member of Unison.

The Audit Committee considered the difficulties that were experienced throughout Scotland because of varying response times, and undertook an investigation into the matter. It is in response to that investigation that the Ambulance Service has examined the way in which it is organised and whether triage is undertaken. A business case is currently being prepared. The petitioners are focusing specifically on one area of Scotland and are not considering on an equal basis the delivery of the service that will be provided to everybody in Scotland. I suggest that we simply note the comments and await the discussions between the Scottish Executive and the Scottish Ambulance Service, as the Audit Committee is also keeping an eye on the matter.

Has the Audit Committee agreed that it will consider the matter again at a specific time, or when the business case is proved?

When the business case is before the minister, the Audit Committee will take a further look at the matter.

Mr McAllion:

The Public Petitions Committee tried to do as much work on the petition as possible before referring it another committee. The responses from the Scottish Ambulance Service and the minister clearly said that the petitioners have no real concerns. However, that is not the petitioners' view, so it is not for the Public Petitions Committee to make a decision about whether the petitioners are right or the Executive and the Scottish Ambulance Service are right. It is therefore for the Health and Community Care Committee to decide whether to note the petition and take no further action or whether there is a case for some kind of investigation.

Nicola Sturgeon:

I understand that there are two issues before the minister at the moment. The first is the number of operations centres and the second is the prioritisation of 999 calls. The petition is concerned with only one of those issues. I am not sure what the Audit Committee is considering.

It is considering priority dispatch.

That is not what the petition is about. It is about the reduction from eight to three of the number of operations centres.

That is the same thing.

Nicola Sturgeon:

No it is not. The two issues do not necessarily go hand in hand. I am concerned that what the Audit Committee is doing and what the petition is asking us to do are perhaps not exactly the same thing. However, I am not sure, because I am not a member of the Audit Committee.

Margaret Jamieson:

Let me explain. The Audit Committee visited several of the operations rooms. There was a difficulty in the way in which they were managed locally without the bigger picture being looked at. There was also a problem with experience. The Scottish Ambulance Service is now considering a reduction in the number of control rooms, which would have a link to NHS 24. That is virtually a total reorganisation, and there will be local facilities for patient transport, so it does incorporate what the petitioners are concerned with. However, the petitioners are highlighting a difficulty—the subject of a number of petitions—that relates to human resources issues not being tackled by some elements in the NHS and, in this case, in the Scottish Ambulance Service in relation to effective communication with the work force.

Nicola Sturgeon:

I do not disagree. I do not really want to get into the substance of the petition; I want merely to clarify whether the Audit Committee's investigation of the issue covers the points that are raised in the petition. Discussions that I have had with the Scottish Ambulance Service suggest that it sees the reduction in the number of operations centres and the prioritisation of calls as a package. One could happen without the other, so I do not want us to be at cross purposes with the Audit Committee. If somebody who knows what the Audit Committee is doing is able to assure us that that is not the case, I am quite happy to leave the petition as it is just now.

Mary Scanlon:

I read Elaine Thomson and Richard Lochhead's comments. As a member for the Highlands and Islands, I understand the comments that the petitioners are making, because Inverness is recommended as the location for one of the new centres. However, I think that we should wait until the full business case and the final decisions that will be based on the proposals are made. We should be concerned about the priority dispatch system.

I understand that training is to be improved and that equipment is to be upgraded. If better response times are achieved—regardless of where the call centres are located—we should endorse the proposed change. A glaring point emerges from the Public Petitions Committee's consideration of PE381, which is that consultation has been poor. I hope that consultation will be included in the business case and in the proposals that are to be introduced.

Mr McAllion:

As I said, the Public Petitions Committee's view is that we did not want to go further down the road with PE381. That is because we were beginning to become involved in the substance of the petition. The Health and Community Care Committee might wish to note the petition and write to the petitioners asking for their response to the views that were expressed by the Scottish Ambulance Service and the Executive. That would move things on.

The Convener:

We can seek clarification as to what the Audit Committee will do when PE381 returns to that committee. I understand that the proposal is for a package that includes the operation centres and priority dispatch. We will look at PE381 again when we have sight of the full business case.

I do not know about other members, but I have so many bits of paper this morning that I do not know where I am going next. Annexe B shows the status of ongoing petitions. I understand that John McAllion will report on PE320 at our meeting next week. Is that the case?

Yes.

In that case, are we agreed that we consider PE320 next week?

Members indicated agreement.

The Convener:

We move on to PE283, which we have discussed previously. However, one issue has to be brought to the committee's attention. As some members are aware, Richard Simpson has been doing background work on issues around organ donation. A question has arisen as to whether, at various times, the Health and Community Care Committee asked Richard to undertake some of the work. That would make a difference to, for example, whether certain expenses can be claimed. Is the committee happy to agree that Richard's work and his meetings to look into the wider issue of organ donation were done on behalf of the committee?

I thought that that was the case. More than a year ago, I remember a discussion between Kay Ullrich and Richard Simpson on the subject.

The Convener:

Yes. That is the basis on which we have all have gone forward with the matter. However, looking back, there seems to be some doubt about whether a formal committee decision was made. I ask the committee to agree retrospectively that the decision was a committee decision. That would cover instances when Richard travelled to meet somebody, because he would have travelled on behalf of the committee, rather than on his own behalf.

Nicola Sturgeon:

I have no concerns about that. As I was not a committee member when Richard's work begun, I do not know the basis on which he was sent to do that work. I have no concerns about giving my retrospective agreement. My one concern, however, is that the issue is highly sensitive. When the committee begins to discuss organ donation more openly, it will attract a lot of attention.

I saw a good "Newsnight Scotland" piece in which Richard Simpson took part. He was described as a committee reporter, but it is fair to say that he was putting forward a firm outline of his views on the subject. If Richard is a committee reporter, he should be open-minded on the subject. With the greatest of respect to Richard, I am not sure that that is the case. That gives me cause for serious concern.

The Convener:

That is a fair point. If we accept that Richard is a committee reporter, anything that he works on has the same status as any other draft report in which any committee member is involved. That means that the report is private until it is presented to the committee. As Nicola Sturgeon said, reporters should keep an open mind so that they can pull together different strands of opinion. We then come together as a committee to make a decision on a draft report.

Nicola Sturgeon:

I mean no disrespect to Richard Simpson, but I think that he is perceived as not being an objective reporter on the issue. For the record, I do not disagree with Richard's view. Would it be feasible to appoint another committee member—whose views are not as fixed as Richard's—to join him on the investigation and try to provide some objectivity? The issue is incredibly sensitive and can polarise opinion. If any report that the committee produces is considered to have been driven by somebody who has a fixed view, that might detract from the committee's comments. Can we balance the investigation?

It would be fair to allow Richard Simpson to respond.

Dr Simpson:

I understand that the committee discussed in private whether Kay Ullrich or I would act as reporter. I remember clearly that I was appointed reporter.

The report is nearly complete. Contrary to the impression that has been given, I do not have a fixed view. My only fixed view is that we cannot continue with the way in which organ donation is dealt with. On the central issue of consent—about which it is assumed that I have a fixed view—I have suggested that the advice and evidence that we have received point to a fairly consensual view, which is different from my having a fixed view. If the impression that I have a fixed view has been created, I want to remove it.

My report will present the options and their implications to the committee. Presumed consent is not the only issue; the report makes 60-odd recommendations about organ donation, so it is wide-ranging, although I accept that the central issue is sensitive. It will be up to the committee to decide whether to make a recommendation on the central issue of consent.

Margaret Jamieson:

I have a point about people who act as reporters for the committee. We saw what happened when Mary Scanlon was involved in the measles, mumps and rubella report. Recently, I have written to Jennifer Smart about the single general practitioner issue on which I was reporter and on which I produced a report that became a report of the committee.

The reporter system identifies individuals as targets and places pressure on reporters. We must support reporters. It is wrong that members are identified as targets. It is okay that we do a piece of work, which then becomes the committee's property, so we need to get a message out. I will not offer to be a reporter again. I think that Mary Scanlon has said that too. The way in which members are treated is outrageous. We should be cautious and we should consider appointing two members as reporters. Much time and effort is put into preparing a report. The public do not realise that.

The Convener:

It might be worth while for me to pick up on the general point and take it to the conveners liaison group for discussion, to find out what feedback other conveners have had from reporters. Standing orders allow only one reporter per subject to be appointed, so I will take the matter as an agenda item to the conveners liaison group for open discussion with other conveners about what is happening with reporters in other committees.

If a problem exists that amounts to nothing less than intimidation, there might be a case for changing the standing orders or doing something else. The Presiding Officer or somebody else could say that the media must be aware of the difficulties that a reporter experiences and that, in the end, the report will be the committee's property.

Mr McAllion:

I agree. A reporter can produce a draft report only, which remains private until the committee considers it. The report then becomes the committee's property and goes into the public domain.

It is one thing for the committee to want reporters to have support and assistance, but I would never want one of the committee's members not to be trusted as a reporter because of his or her views. There must be balance in the reporting mechanism. If we cannot trust each other to come forward with objective draft reports it is a sad day for every member of the committee.

Dorothy-Grace Elder:

From the start, committee reporters have shown tremendous integrity. When they have had a fixed view of their own when they started out, they have often striven all the more to present the opposite view. I am sure that Richard Simpson will, as usual, produce a well balanced report. However, I do not see how we can protect the names of individual reporters—that is just impractical. All we need to do, as individual reporters, is say absolutely nothing when people get on to us.

You should see the letters, Dorothy.

I know, but we must just keep stumm.

Shona Robison:

It is not an issue about trust and integrity—it is rather unfortunate that that was said. I had no idea that Richard Simpson had been appointed by the committee, because it happened before my time. This is the first time that I have heard that Richard Simpson is a reporter to the committee. When I heard him talking about the issue, I assumed that it was something that Richard was running with as an individual. That is how it came across to me. If that was my perception, it could be the perception of anybody else who is listening. Human nature being what it is, people will have their own views, and those views will come across. The suggestion about the conveners liaison group is the right way to go. We can have a review not only of how the role of reporters is to be carried out, but about protection for reporters. I would be happy to progress in that way.

The Convener:

We will progress in that way on the general point. On the specific point, are members happy retrospectively to agree that Richard Simpson is the reporter? Those of us who have been here longer assumed that that was what we had done, only to find that we had not done so on the record. How close is the report to completion?

Subject to some legal discussions, it will be available just before or just after the October recess.

The Convener:

In view of the fact that the report is close to completion, I will liaise closely with Richard Simpson over the next few weeks on the matter, prior to the draft report coming before the committee. We are on another learning curve. In future, we will be a little more aware of the role of reporters when it comes to commenting on what are in effect draft reports. We are almost at the end of Richard Simpson's reporting phase and the report is about to come back to the committee, which will have ownership of it. I will work closely with Richard Simpson until the report gets to that point, and I will take members' general points to the CLG on their behalf. Is that acceptable to members?

Members indicated agreement.

The petition from the west of Scotland group of the Haemophilia Society and Thomas McKissock is an agenda item for later this morning. The next petition is from Bill Welsh on measles, mumps and rubella vaccinations. The Executive's response—

Can I have a quick word on that?

On which petition?

Bill Welsh's.

I am giving you an update—haud yer horses.

The Executive's response of 29 June 2001 is attached. Do members wish to comment?

Mary Scanlon:

I have read the Executive's response. The Health and Community Care Committee agreed on and set out eight questions as a remit for the expert group. Can we be assured that those eight questions are addressed in paragraphs (a), (b), (c) and (d) on page 5 of the Executive's response? It is not entirely clear. I presume that the headings are being addressed.

The clerks will clarify the matter for us.

I want to be sure that the eight headings that were set out by the committee as a remit for the expert group are dealt with, whether by the expert group, the Medical Research Council or the Joint Committee on Vaccination and Immunisation.

The Convener:

The clerks will clarify those points. Generally speaking, the committee's recommendations—based on a not inconsiderable amount of work by Mary Scanlon, who has been under great pressure as reporter on the matter—have been accepted by the Executive. That is good news for the committee.

More important, it is good news because of the work that will be done by the expert group in the coming six months. That group will try to get to the bottom of some issues and adopt a fresh approach to some single vaccination issues and to the work that might be required. To some extent, that came out of the report that Mary Scanlon and the committee put together. We shall receive clarification on those points.

I wish to make a final point. Can the committee examine the matter again after the expert group has dealt with it?

We shall return to the matter to see whether the expert group has covered all the issues that we identified. Are we agreed that we should proceed in that manner?

Members indicated agreement.

The Convener:

We move on to PE123 on the warm homes campaign. The draft report by Dorothy-Grace Elder and Malcolm Chisholm will be discussed later in our proceedings.

PE247 is in respect of the Epilepsy Association of Scotland. The committee agreed on 12 December to await the acute services review. In the light of the Executive's performance assessment framework, after its meeting on 27 June the committee wrote to the Executive to ask what minimum standards it intends to set for the provision of services to epilepsy sufferers. A letter from the Epilepsy Association of Scotland has been circulated to members of the committee by e-mail. Does anybody have any comments?

Margaret Jamieson:

The letter from the Epilepsy Association of Scotland does not change my view that we should wait to see what happens to the acute services. When we discussed the matter previously, people in the public gallery said that they were frustrated. Epilepsy might be subject to an acute services review. Everything in the acute sector is currently under review. We hope that the health plans for each health board area include epilepsy, as they do diabetes and so on. Until we have such information, I do not think that we can proceed.

We are waiting for further information from the Executive. I shall note the letter that we have received. Is that agreed?

Members indicated agreement.

As for PE223 from Mr and Mrs Mrs McQuire, we agreed to await the report from the National Institute for Clinical Excellence. We also agreed to seek information from the Executive.

Dr Simpson:

I warn members that the NICE report is now out for consultation. I presume that the Health Technology Board for Scotland is now examining the draft report. It has set itself a target of six or eight weeks in which to make observations on the report. We are close to receiving an answer about the timetable for the publication.

The report will be returned to us in a matter of weeks.

Can you ask for a copy of the NICE consultation document to be sent to us? I know that it is on the web, but it would be helpful if it could also be sent to us.

Yes. We will seek confirmation about the timetable and the clerks can timetable it into the forward work plan.

Members indicated agreement.

The Convener:

I come now to PE354 in respect of Stobhill general hospital. We agreed on 27 June to ask the Public Petitions Committee to keep the Health and Community Care Committee informed of progress. At its meeting on 11 September, the Public Petitions Committee noted the attached letter from Greater Glasgow Health Board. Will the committee note that letter?

Members indicated agreement.

The Convener:

Petition PE367, from Eric Drummond, calls on the Scottish Parliament to ensure that there are adequate and equal services for the diagnosis and treatment of people who suffer from sleep apnoea. It was agreed on 27 June that we should note the petition and pass Mr Drummond's concerns about the present system for the funding of small disease groups to the Public Petitions Committee. The Public Petitions Committee has gathered further information, and papers are attached to the members' briefing. At its meeting on 11 September, that committee considered responses from the Scottish Executive, Lothian Health and Greater Glasgow Health Board in relation to the petition. It agreed to request the results of Lothian Health's review of its sleep service, when they are available, and to reconsider the petition on receipt of that information.

I suggest that we simply note the petition. Is that agreed?

What is happening on the central question of how small illness groups are being managed?

Do you have any further information on the responses to the petition?

Off the top of my head, no, but I shall check that with the clerk to the Public Petitions Committee.

Dr Simpson:

Under the internal market system, any individual health board or fund-holding general practitioner could purchase those treatments from any service that was being offered anywhere. It was left to the market to sort things out. However, the situation was further complicated in the mid 1990s, prior to 1997, by the national health service in Scotland's decision to split up the purchasing arrangements between all the boards. Previously, there was often top-slicing of those services, and then they were funded directly.

After that, we found ourselves in a new situation in which, for example, North Glasgow University Hospitals NHS Trust had to negotiate with seven or eight different health boards to maintain a service, and had to do so annually. That strikes me as grossly inefficient.

I am concerned that, for many conditions that I have experience of, including severe allergies, Rett syndrome and cystic fibrosis, there is not yet a clear steer from the Executive as to the method that it proposes to use to deal with those issues. Some are dealt with under the national services division; a list of conditions is dealt with in that way.

However, if such treatments are funded by individual health boards, which have the right to buy into or not buy into those services, that leads to postcode treatments and prescribing. If members need any evidence of that, they can see it in the fact that almost all referrals to Lothian Health's sleep apnoea centre are from the Lothian area. This is an area of major concern, and we should press the Executive for a clear view of how ministers propose to deal with the matter.

Is that point included in the request for further information that the Public Petitions Committee has made to the Executive?

I am sure that it is, but I will check with the clerk.

If that point has not been included, will you ensure that it is added?

Yes.

Do members agree simply to note the petition at this stage?

Members indicated agreement.

Meeting adjourned until 10:52 and continued in private until 12:20.