Health and Community Care Committee, 25 Feb 2003

Meeting date: Tuesday, February 25, 2003

Official Report 210KB pdf

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Petitions

We resume the meeting with consideration of agenda item 4, which is on petitions. If we require to consider any of the petitions further, we must do so by our meeting of 11 March. We must report back to the Public Petitions Committee by 17 March at the latest on any further required action. We should bear it in mind that we are coming to the last few weeks of the current Health and Community Care Committee's life.

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Aphasia (PE475)

We will begin with new petitions. The first is petition PE475 from Ms Cecilia Yardley on behalf of Speakability. The petition calls for the Scottish Parliament to take the necessary steps to acknowledge aphasia as a life-disabling condition. The Public Petitions Committee considered the petition and agreed to ask the Health and Community Care Committee to say whether we consider that the petition would merit further investigation by our successor committee in the next parliamentary session.

We cannot direct our successor committee, so I recommend that we let the petition lie. When the new committee comes in, it can decide what it wants to do about the petition. We can do no reasonable work on the petition, given that there are only four or five weeks left in which we could get information back from the Executive and deal with it. It is better to let the petition lie. Is that agreed?

Members indicated agreement.

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Heavy Metal Poisoning (PE474)

We move on to on-going petitions. Petition PE474, from Mr James Mackie, calls for the Scottish Parliament to acknowledge the seriousness of the threat to children that is posed by heavy metal poisoning. We have a copy of the Executive's response to the petition. The committee's view is sought on how we should proceed with the petition.

Nicola Sturgeon's members' business debate on thimerosal raised awareness of the issue of mercury in child vaccines. I understand that the petition refers to that issue, but the letter to the Health and Community Care Committee from Trevor Lodge does not. He considered exposure to cadmium, on which his letter says:

"‘the risk estimates that can be made at present are imprecise' and therefore recommend further research particularly on the relationship between exposure to cadmium and renal tubular dysfunction."

On exposure to lead, his letter says that exposure to lead has

"‘negligible effects on intellectual developments.'"

I am not sure how negligible "negligible" is. I feel uncomfortable about those two points from the letter.

I am also concerned about another comment in Trevor Lodge's letter. He states:

"A report of lead in drinking water in new houses … by the Scottish Centre for Infection and Environmental Health attributed higher than expected concentrations of lead in tap water to the illegal practice of using solders containing lead on copper fittings for potable water."

I understood that lead was a problem in old houses, but this is the first time that I have heard that there is a serious problem of lead being in drinking water in new houses. I am not sure what to recommend, but I do not want to leave the petition because—

You are assuming, Mary, that if you keep talking for long enough, I will come in and give you a recommendation.

Yes, I hope that you will do so. I am concerned about several points in Trevor Lodge's letter: first, the letter does not deal with mercury; secondly, I am concerned about what the letter says about cadmium and lead; and thirdly, I am concerned about what the letter says about lead in drinking water in new houses.

Petitions are spread throughout parliamentary committees and they are in a similar position to petition PE474 because there is perhaps not enough time for individual committees to explore any petition's potential. The Public Petitions Committee recommends that, when a committee does not have time to deal with a petition, it should refer the petition back to the Public Petitions Committee and let it keep the petition open. It will be up to the successor committees to decide whether they want to take up any such petitions. If the Health and Community Care Committee closes down petition PE474, it will disappear. However, we can do as we did for the previous petition and refer petition PE474 back to the Public Petitions Committee and tell it to keep the petition open for the successor Health and Community Care Committee, which can decide whether to deal with the petition.

I support John McAllion's suggestion. We should keep the petition open.

I agree, but should we also write to the Executive and pick up on the points that Mary Scanlon has made? The Executive could deal with that letter in the interim. We can also refer the petition back to the Public Petitions Committee so that it can be held open.

On a point of information, convener. There has been a problem in one or two parts of Glasgow with lead in new houses, although old Victorian piping has been our overarching and much-publicised problem. I believe that that problem in new houses is mainly the result of carelessness among builders.

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MMR Vaccination (PE515)

Petition PE515 concerns measles, mumps and rubella injections. The committee forwarded questions on MMR to the chief medical officer after the evidence session on 29 January. A response is expected by the beginning of March. The committee is invited to conclude consideration of the petition once a response from the CMO is available. Given that we have done a fair amount of work on the petition, I would rather wait until we receive that response from the CMO before we sign the petition off. Do members agree?

Members indicated agreement.

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Epilepsy Services Provision (PE247)

Petition PE247 concerns epilepsy services provision. The committee sought a response from the petitioners to the letter from the Minister for Health and Community Care. We now have a response from Epilepsy Scotland. What are colleagues' views on how to proceed with the petition?

I read the documents last night and, at times, I thought that we had achieved what we had set out to achieve, but I also felt a bit uncomfortable. Page 2 of Epilepsy Scotland's letter mentions the setting up of a managed clinical network for epilepsy and Epilepsy Scotland's

"working in partnership with 7 Health Boards on devising two pilot projects",

which sounds good, but I understood that the idea behind a managed clinical network is that it should cover the whole of Scotland.

Epilepsy Scotland has raised many issues. It says that only four national health service trusts have fully implemented the findings of the clinical resource and audit group. There are still serious concerns that people with epilepsy are not being diagnosed within four weeks and that the Scottish intercollegiate guidelines network recommendations are not being adhered to.

Epilepsy Scotland says that it would like to check information from the national waiting times unit, but I am not sure whether that would give it much more information. It would be a start if the SIGN guidelines were implemented. However, when the committee took evidence in Inverness, the chairman of the local health care co-operative said that there was not a hope of diagnosis within four weeks. Despite all the work that we have done, and although some progress has been made, I still think that a lot more still has to be done to give people with epilepsy the services that they need.

I can see where Mary Scanlon is coming from, but significant moves are being made in my health board area. Perhaps the matter should be picked up in the performance assessment framework when ministers ask for specific action to be taken to manage disease. If there are SIGN guidelines, it is incumbent on clinicians to comply with them. There is also a quality issue, because they will not be rated very highly when they are visited.

The matter is difficult; Epilepsy Scotland says that it will champion the new managed clinical networks and is enthusiastic about them, but highlights the impotence of the SIGN guidelines. It says that although the guidelines are some of the best guidelines that can be found anywhere in the world for the treatment of epilepsy, they are not applied and are simply ignored. That is an issue for a future health committee. How can we make SIGN guidelines mandatory? They are widely ignored throughout Scotland.

I agree with the point that has been made. To read that 77 per cent of the trusts that responded said that they had fully or partially implemented the guidelines might be reassuring, but when I read on, I found that only four trusts claimed to have implemented the guidelines in full. Four out of 39 is disappointing. The committee could write back to the Executive to say that we want trusts to make more progress.

We must acknowledge that the response is a mixed bag. Some movement is taking place; pilot studies are being undertaken and some trusts are taking the matter on board seriously. John McAllion touched on the wider issue about SIGN guidelines. We have always been told that SIGN guidelines are considered throughout the world to be groundbreaking, but they are no good if they sit on someone's shelf and are not put into practice.

We could continue our consideration of petition PE247 and write back to the Executive to pick up on those points. We are unlikely to put the petition to bed before the end of the parliamentary session, so do members want to refer the petition to the Public Petitions Committee with a note that we will take that final action?

Members indicated agreement.

Page 3 of Epilepsy Scotland's letter says:

"we would remind Committee members that the NHS Board Clinical Governance committees have not yet picked up the issue of SIGN implementation."

Clinical governance was the great white hope for consistent health care throughout Scotland. Perhaps we could pick up on that.

Do we agree to pick up on that?

Members indicated agreement.

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Digital Hearing Aids (PE502)

I skipped a few petitions, so I ask members to return to page 3 of the petitions report, which deals with petition PE502, from Fiona Stewart. The petition calls on the Scottish Parliament to urge the Scottish Executive to show a firm commitment to digital hearing aids and to modernising audiology services.

We have a response from the Executive about the audiology services review. We asked the petitioners to comment on the work of that review, but we have not received their views yet, so I suggest that we return the petition to the Public Petitions Committee with the recommendation that it be reallocated to a subject committee in the next session. However, many of the petitioners' concerns might have been covered by the audiology services review. Is that proposal okay?

Members indicated agreement.

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Fife NHS Board (Right for Fife Business Plan) (PE498 and PE499)

We are now on page 5 of the paper—I am keeping members on their toes. Page 5 deals with petitions from Letitia Murphy, on behalf of Fife Health Service Action Group, and from Mr Tom Davison, on behalf of the Dunfermline Press and West of Fife Advertiser. The petitions are linked to petition PE453 from Father Stephen Dunn on the siting of the proposed secure unit in Greater Glasgow NHS Board's area. Members will remember that we took evidence on that. We have not yet received an Executive response, so we should make the petitions an agenda item at another meeting and refer them to the Public Petitions Committee after we have received the Executive's response. Do members agree to that?

Members indicated agreement.

What is the time scale for that?

The Executive's response is imminent. We will put pressure on the Executive to produce the response before dissolution.

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Organ Retention (PE283, PE370 and PE406)

Page 8 of our paper refers to petition PE283, which is from the Scottish Organisation Relating to the Retention of Organs. How do members want to proceed with that and with petition PE370, which is from Lydia Reid, on behalf of Scottish Parents for a Public Inquiry into Organ Retention? Petition PE406, which is from Miss Margaret Doig, takes a slightly different view and concerns post mortems.

I have received a letter from Margaret Doig, which has been circulated to other members of the committee. She complains that her petition, PE406, has been confused with PE283 and PE370 when, in fact, it deals with an issue other than organ retention. She is concerned that any new legislation should include an assurance that

"persons who have instructed executors while they were competent to do so may know that hospitals shall be obliged by law to ascertain from executors the wishes of those who die in hospital before proceeding to a post-mortem examination, and to respect these wishes."

PE406 does not quite deal with the same subject as the other petitions. In a sense, it is arguing for some sort of advance statement. It asks for the wishes of someone who has stated in their will and instructed executors that they do not want a post-mortem to be carried out to be respected when they die in hospital and for their executors to be consulted. I suspect that such a statement would bring about conflict with the procurator fiscal's office, if it felt that there had to be a post-mortem for some reason.

We have referred the petition to one of the justice committees because, in cases such as one involving a suspicious death and the possibility of a criminal prosecution, the need for a post-mortem would have to be considered on the merits of the case.

Have we referred the petition formally to another committee or have we simply raised the matter?

The clerks inform me that we have asked for the input of a justice committee. We will find out what the situation is in relation to the petition and deal with it as a separate agenda item before the end of the Parliament.

In relation to the other two petitions, we have received a letter from the Executive. It speaks about

"the development by the Clinical Standards Board for Scotland (now part of NHS Quality Improvement Scotland), with the strong involvement of family support groups, of clinical standards relating to the post-mortem process. These standards, which will be published shortly, will be mandatory on any NHS Trust carrying out a hospital post-mortem examination".

The letter also says:

"The Review Group on the Retention of Organs at Post-Mortem has been continued in existence for a further year, until October 2003, to undertake a third phase of work".

It seems that the intention is to legislate on the matter early in the next Parliament.

Petitions PE283 and PE370 are works in progress in that many of their concerns will be dealt with. I suggest that we refer them back to the Public Petitions Committee. Any concerns that remain will probably be taken up during the run-up to the introduction of any legislation. Family support groups are at the heart of work that is going on.

Guidance has been issued to members of the Crown Office and Procurator Fiscal Service that the family must be advised. That seems to answer many of the points that Margaret Doig has raised. Would it be possible to send the petitioners a copy of the guidance to see whether they are satisfied with it?

Do you want to send them a copy of the Executive's response?

Yes, and a copy of the guidance that has been issued to members of the Crown Office and Procurator Fiscal Service. If they saw the guidance, they might be satisfied with the new regime.

I will send a copy of the Executive's response to all three of the petitioners and refer all three of the petitions back to the Public Petitions Committee. We will write to the petitioners to point out that it is likely that there will be legislation on this subject sometime soon and ask them whether they wish their petitions still to stand or whether they simply want to make their comments known to the Executive as part of the legislative process.

I expect that we might get a different response from Miss Doig, whose concern is different to some extent—it is not only about post-mortems that are done after an offence has been committed, but about post-mortems that doctors carry out in general. The Public Petitions Committee might seek further clarification from the petitioner about what she wants. Meanwhile, because the petition covers areas of responsibility of the Procurator Fiscal Service, we will seek a response to it from one of the justice committees. The on-going work might allay the fears of some of the petitioners, but not of others.

Is it the case that individuals are not allowed to access the guidance that is given to Crown Office and Procurator Fiscal staff on the retention of organs at post-mortem?

I cannot answer that, but we will find out.

Given that the issue is sensitive and requires a certain amount of background reading, I confess that it was not acceptable for committee members to receive the letter from Miss Doig at the meeting. I am inclined to suggest that we should pass her letter to the Executive to seek clarification, check what the relevant justice committee suggests and pass the matter back to the Public Petitions Committee to proceed with the matter.

We should also ask all three petitioners whether they want their petitions to be continued in the new Parliament, given that the independent review group on retention of organs at post-mortem is carrying out a third phase of work, and that legislation on the matter is likely. At that point, I would expect all three petitioners to have their views expressed and acted on in the normal manner. Do members agree to my suggestions?

Members indicated agreement.

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Chronic Pain Management (PE374)

We come to the petition on chronic pain management services, which is on page 10 of the paper. The Executive's response of January is attached; it indicates that the Executive intends to commission a review of the current provision of chronic pain services and notes the work that the committee and the Scottish Parliament information centre have done in pulling together information on pain services throughout the country.

The letter states:

"It is plain from the Committee's questionnaire that chronic pain services are not provided evenly across Scotland. I will take this opportunity to thank the Committee and SPICe for carrying out this useful survey, which will help to expedite the review I referred to in the response".

That work will obviously be on-going.

The letter also states:

"The Executive does not produce good practice clinical guidelines directly. Among the options which might be considered is that of asking the Scottish Intercollegiate Guidelines Network or NHS Quality Improvement Scotland to undertake such work",

which would be to produce a set of guidelines or protocols to encourage health boards to adopt a consistent approach in chronic pain management and to roll out good practice. The letter continues:

"Much would depend on the quality of the research evidence base for chronic pain management."

There is a question as to whether the committee wants such work to be done by the SIGN network or by NHS Quality Improvement Scotland.

I see that Dorothy-Grace Elder wants to comment—that is a surprise.

I welcome the Executive's intention to carry out a review. I was aware that Mary Mulligan had taken on the task of considering possible options for the future—she did so about a year ago. By now, I expected to have something more positive than a review, although that is reasonably positive.

Unfortunately, as the convener may recall, when the minister replied last time vis-à-vis the budget, neither he nor the civil servants had read the returns of the questionnaire that we sent to all health boards last summer. The minister was appearing before us several months after the questionnaire returns had been received, but he had not read the returns. Although the Executive might prefer a wider review, those returns amounted to some kind of review and provided quite a lot of information. However, the minister could reply only from an obscure angle because he had not read the facts.

The minister has now obviously read the returns, but he does not home in on two areas that we mentioned to him both verbally and in writing: the Highlands, which still has no provision for chronic pain; and Lanarkshire, which has particular needs. There are some particularly innovative people in Lanarkshire, where the provision is nurse-led.

Members will note the minister's reference to patients who travel long distances. The minister admits that the health boards do not provide returns on how much it costs to send patients not only all over Scotland but down to Bath, Manchester and London for the treatment of pain. He mentions only that

"NHS Boards also have discretion to reimburse the travelling expenses of patients not eligible under the travel schemes".

However, we already knew that patients get travel expenses because there is no service available in the Highlands.

The minister also goes on to say:

"The Executive is keen to encourage the development of jointly planned and commissioned services which may operate in one NHS Board area and also benefit patients from further afield".

We do not want that. We have said repeatedly that we want NHS services for chronic pain in each area. The whole point is that people should not need to travel. Patients who suffer from many conditions might be able to travel, but if patients who are in pain are made to travel, their pain worsens. When they get to London, London might do a very good job, but the Scottish patient's journey back to Aberdeen or the Highlands can be enough to harm some of the good work that was done. We have an army of people who are in pain moving around this country. Sometimes, the smallest distance that they need to travel is from Dumfries up to Aberdeen or Dundee.

Our centres of excellence are overstrained. The Executive needs to speed up on the issue. Perhaps we should send the minister another letter.

The committee has done a fair amount of work on the petition. All members have taken the issue seriously; certain members take it very seriously indeed, but we are getting to the point at which we have not much more time.

We can send a letter to the minister to note that we would like to take up his response to question 14, where he states that guidelines might be developed by SIGN. Our letter can also re-emphasise Dorothy-Grace Elder's points about the patchiness of the service. However, we probably need now to refer the petition back to the Public Petitions Committee. We can ask the PPC to keep the issue open until we see what proposals arise from the review of the provision of services. Our letter to the Executive can also ask for a likely timetable for when the review will be complete. Is that agreed?

Members indicated agreement.

As you—

Sorry, we have already agreed a course of action and must move on.

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Scottish Parliament Health Policy (PE320)

The next petition, which is detailed on page 11 of the paper, is the petition from Mr Watson on behalf of the World Development Movement. John McAllion was dealing with the petition.

As it says in the paper, Pascal Lamy, who is the European trade commissioner, announced at the beginning of February that the European Commission would not further commit Europe's health and education sectors to the free-market rules of the general agreement on trade in services. The announcement has been hailed as a partial victory by those who campaign against GATS. When I spoke to John Watson of the World Development Movement, he welcomed the announcement, although he stressed the need for vigilance over future rounds of GATS negotiations. He conceded that he did not think that the petition should go any further at this point and that he was quite happy with the outcome.

Good. It might be worth our while to pass on to our successor committee Mr Watson's comment about the need to keep a watching brief on the matter. The issue highlights the fact that, although health is a devolved matter, a number of other layers of Government and bureaucracy can have a major impact. It will be worth keeping an eye on that issue for the future.

As on the issue of chronic pain.

We have already had a discussion about, and made a decision on, chronic pain. Is the suggested action on the petition from the World Development Movement agreed?

Members indicated agreement.

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Myalgic Encephalomyelitis (PE398)

The final petition is on ME. In December, the committee was informed that the short-life working group's report was in the final stages of drafting and would be sent to the minister before Christmas. The report has now been published and is attached to members' papers. The recommendation is that the petition should be returned to the PPC with the recommendation that it be reallocated to the appropriate subject committee in the next parliamentary session. Is that agreed?

Members indicated agreement.