Health and Community Care Committee, 27 Jun 2001

Meeting date: Wednesday, June 27, 2001

Official Report 128KB pdf

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Contacts

From time to time, people contact us with proposals to brief or give evidence to the committee on their work. We have a number of requests and we can approach them in a number of different ways.

The Scottish Executive physical activity task force and John Beattie, who heads up the task force, would like to brief the committee on the task force's work. I am sure that members think that the amount of physical activity in which children are engaged—certainly at school level—is important.

Would it be of benefit if we invite the Education, Culture and Sport Committee to a briefing if we agree to one? Could we have a joint briefing, given that it would cover both areas?

If we are considering public health, could we include the briefing? We have a busy agenda for the forthcoming year, but I hope that we do not lose sight of public health. Perhaps we could include the briefing in a day with Phil Hanlon or others to get an update on public health.

I echo comments from colleagues, and from Mary Scanlon in particular. There might be some mileage for the committee in considering the wider public health agenda and having a briefing that would include the briefing that is proposed. Margaret Jamieson made a point about opening up the briefing. Do committee members wish to do that in open session of the committee or to have an informal, round-table discussion?

We should have an informal discussion. Perhaps we could have an advance briefing sheet. It is always good to have something in writing.

If the committee is thinking of an informal briefing on a range of public health issues, such a briefing might also include issues relating to public health nurses and school nurses. An update on such issues might be good. The clerks could prepare something for after the summer recess.

Clydeside Action on Asbestos is asking for the issue of clinical trials for those with mesothelioma to be included and noted within the cancer plan. At this stage, that is within the Executive's remit rather than that of the committee. I would be happy to write to the Executive on behalf of the committee to point the matter out and ask that the Executive make reference to the matter in the cancer plan. Is that acceptable?

Members indicated agreement.

Greater Glasgow Health Board has offered to brief the committee on the plans to modernise Glasgow's acute hospitals.

I would have concerns if we were to accept the offer. We would find that every health board area would want to discuss such plans. That could compromise the committee at a future date.

I agree with Margaret Jamieson on the general issue of the acute services review in relation to Glasgow, but there is another issue on which we might want to brief ourselves. Hospitals in Glasgow, Edinburgh and Dundee provide services to a much broader group of individuals than do hospitals in other areas. Constructing services within an acute services review is a major problem when, for example, Greater Glasgow Health Board provides services to Lanarkshire Health Board, Ayrshire and Arran Health Board, Argyll and Clyde Health Board and Forth Valley Health Board. I would appreciate an opportunity to hear from Professor Hamblen, or from somebody else, on how it is proposed—within an acute services review that is based on an individual board—to undertake the strategic review that will be necessary for providing those services.

I agree with Richard Simpson. My main interest is in the acute services review in Tayside Health Board. That is of much more interest to me than the Glasgow review. However, there is a national problem. Clinical standards are being raised all the time and more expensive equipment is required. We are seeing big, mega, superhospitals—teaching hospitals. Those are currently based in health board areas that simply cannot sustain them. That is the case in Tayside and, indeed, in Glasgow, which is leading to the pressure to close Stobhill general hospital and other places. Something is happening that almost demands a shake-up in the way that we run the national health service. The problems in Glasgow and Tayside are symptomatic of that. This committee should be addressing the problem.

Professor Hamblen has offered assistance and that is good. We may not be inundated with requests from other areas. We must bear in mind that Chris Spry, the chief executive in GGHB, is leaving, and that Professor Hamblen is chair of the board. It is good that he has taken the initiative to reach out to us. I do not think that we should turn him down. We have an opportunity.

Richard Simpson and John McAllion's points covered issues that go wider than the acute services review. They were about how services are provided across Scotland. Because of other work, we did not take the opportunity when the national plan was published to ask the minister about it. After the summer break, when things will have settled down a bit, we should perhaps invite the minister so that we can hear a progress report on the national plan. We would be able to ask specifically about acute services, and we would also be able to decide on other people that we might want to take evidence from. We could cover members' concerns in that way. It was unfortunate that, because of the time that was required for the legislation that we were working on, we did not have the time to focus on the national plan.

I have a certain amount of sympathy for Dorothy-Grace Elder's point, simply because we have been quite critical of the consultation carried out by Greater Glasgow Health Board, and rightly so. Other colleagues may know more than I do about the situation in Glasgow, but it seems that the health board has changed the way in which it consults and has become more open. The health board has made us aware that it has done a lot of extra work in the intervening months.

If it would be an acceptable compromise, I would be happy to meet Professor Hamblen on behalf of the committee. In that way, we could get updated information and GGHB would have an opportunity to brief the committee.

Members indicated agreement.

Convener, could a Glasgow member of the committee be present? We have to bear it in mind that Glasgow contains one national hospital—the royal hospital for sick children at Yorkhill. Glasgow is the biggie in all acute services reviews.

I do not know whether other members wish to comment. My suggestion is that, although when we walk through the door we bring our own experiences and views, we work as a committee. I could meet Professor Hamblen over the summer recess so that he did not have to hang around for months until we returned. The committee recognises that Greater Glasgow Health Board is continuing with work that follows from work that we did.

I suggest that if you set a date, you could e-mail members about it. Members who were available could then accompany you to meet Professor Hamblen. It would also be a good idea to question the Minister for Health and Community Care about aspects of the national plan.

I am happy with both Shona Robison's suggestions. Is everyone else happy?

I want to clarify a point that Dorothy-Grace Elder made. The sick kids hospital in Glasgow is not the only sick kids hospital in Scotland. There are another two. I say that so that we do not get mixed up.

I am well aware of that, but the hospital in Glasgow is a national hospital.

That is the point. It is not a national hospital.

It takes people from everywhere and especially severe cases that are passed on.

It is like many hospitals—it has specialisms and accepts patients from throughout the country, just as the Edinburgh sick kids hospital takes patients from outside Edinburgh. We should not get into a discussion about which hospital is the most national. All the hospitals do great work. A visit next week to Yorkhill sick kids hospital was organised for me yesterday. I will do a night shift with a paediatric nurse, so I will see for myself what people get up to there.

Do members agree to the proposals?

Members indicated agreement.

An update on hospital-acquired infection has been prepared by the Scottish Parliament information centre.

I am sorry; I have missed out a contact. The Health Technology Board for Scotland has offered us an informal question-and-answer session. I am open to suggestions about that—are there any views? We have had an informal briefing from HTBS, the clinical resource and audit group and all the other bodies such as the Clinical Standards Board for Scotland. I have some concerns about the way in which the HTBS is developing, which picks up on comments that a range of organisations has made to me.

It would probably be useful for us to have an update on developments. We are in a different situation from that which some of us had expected to deal with, as the HTBS will not end postcode prescribing and it is suggested that the HTBS will rubber stamp something that NICE produced. I would like to ask the HTBS for the facts on whether the suggestions that are being made are correct and I am happy to meet the HTBS. If other members are available at the same time, we can all meet its representatives, or we can have an informal briefing that is more akin to those that we have had before.

The organisations are all new, but when I saw that the HTBS was this year examining positron emission tomography scanners, alcohol intervention and digital eye cameras for diabetic retinopathy, I thought that those were issues for the Clinical Standards Board. I am confused about why the HTBS is not considering drugs or therapies. There is some overlap. Should not the Clinical Standards Board examine PET scanners, a protocol for alcohol intervention and which digital eye camera is best?

No. The HTBS examines the technology and finds out what it is appropriate to use PET scanners for. The Clinical Standards Board will then say that a PET scanner should be used as part of the protocol for that clinical condition. The two things are separate.

For example, there are different ways in which fundal examination of diabetics can be done; there are different types of cameras. Mobile laboratories are used in Tayside. Are they of an adequate standard? Do they meet the requirements of modern technology? That is the HTBS's role. The requirement for fundal examination of diabetics would be a matter for the Clinical Standards Board and would be part of a Scottish intercollegiate guidelines network guideline. The two roles should be complementary; they should not overlap. The point that is perhaps being hinted at is that now that the new organisations are in place, which is excellent, we must ensure that they are being co-ordinated and that the centre is overseeing them effectively. I am not convinced that that is happening yet, but it may be too soon for it to happen.

There are two options, the first of which is that the committee has an informal meeting with the HTBS. The other option is that I arrange to have a meeting with the HTBS and, as with the Greater Glasgow Health Board meeting that we have just discussed, if other members of the committee are available, they can come along.

In the letter, the HTBS suggests next spring for the meeting.

The letter referred to this spring.

Yes. The letter is dated December 2000.

We have sprung over them.

I favour the informal question-and-answer session. It is some time since we met the HTBS, and it would be useful to have an informal meeting in that format.

We will opt for the informal briefing. We will inform the HTBS of that decision.

The next matter for us to consider is an update on hospital-acquired infection. Andrew Welsh suggested that there should be an investigation of that issue and there may also have been a petition about it. Hospital-acquired infection is an important issue for all of us. There has been some debate about the numbers involved, but any of the numbers that have been bandied about—on the number of people infected, on potential fatalities and on the financial cost to the health service—are cause for great concern.

The committee has three options. Do we want to appoint a reporter to develop the work that has been done so far, which has been done by the researchers? Do we want to take evidence on the issue, or do we want to leave the issue in abeyance and perhaps come back to it at some point?

Going back to first principles, I recall that in one of the committee's discussions soon after the Parliament was formed, it was suggested that we should consider the timetable of Audit Scotland reports and ask that body when it would be appropriate for us to inquire whether it was reviewing the matter in question. We would also ask whether the Executive had carried out those reports' recommendations, and we could choose to carry out an investigation.

The Auditor General's report, "A clean bill of health? A review of domestic services in Scottish hospitals" is now more than a year old. We should contact Audit Scotland and ask what it is doing about the report. We should also ask the Executive what steps it has taken to implement the report's recommendations. We should do that for all the reports at the same time. The operating theatre report is important in relation to waiting times and waiting lists, and I am not convinced that it is receiving the attention that it should receive at local level.

I had forgotten that we had written to Audit Scotland when we discussed the issue previously and asked for that information. We are still waiting for a response. We can pick up on Dr Simpson's point about the operating theatre report.

Apparently we wrote to Audit Scotland in April. We will chase up that information.

My understanding is that every hospital trust must provide a report on "A clean bill of health?" by this August.

Okay. We can check that. Did that requirement follow an instruction from the Executive to all trusts?

Yes. As a result, when we write to the Auditor General, it might well be of benefit to ask the Executive for an update. That would give us further information to consider before we make a decision.

I welcome that suggestion. After writing recently to all health trusts, I discovered that there is no agreed definition of hospital-acquired infection. We need an update on the working group's three recommendations.

A working group that was set up to examine surveillance was meant to report in March, but as yet there has been no indication of when we will hear from it. Perhaps we could also ask the Executive about that.

There are clear figures for hospital-acquired infections in England, whereas we seem to be having difficulty in gaining those figures for Scotland. I would certainly welcome an update on that point.

We will ask Audit Scotland and the Executive for updates on all those issues.

Mary Scanlon is quite right. Hospital-acquired infections fall outside the current net of notifiable diseases, because a person with such an infection dies of some other disease or contracts some other severe problem. There is also a problem with death certificates. The policy must be tightened up, and any mention of suspected hospital-acquired infection must be added to death certificates. That issue would have to be dealt with by individual health boards deciding on some kind of national policy.

Are we agreed to ask for the information that we have discussed and then, on receipt of that information, to decide how we will proceed with the matter? The various points that committee members have raised will be covered in any further work that we might undertake. For the moment, are we agreed to elicit information?

Members indicated agreement.

That brings us to the end of the public part of the meeting.

Meeting continued in private until 12:28.