Meeting of the Parliament

Meeting date: Thursday, December 2, 2010

Official Report 1023KB pdf

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Scottish Executive Question Time

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Health and Wellbeing

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National Health Service Boards

1. To ask the Scottish Government whether it plans to reduce the number of territorial NHS boards. (S3O-12166)

The Scottish Government currently has no plans to reduce the number of territorial national health service boards.

On the subject of NHS boards, I take this opportunity to thank all staff in all NHS boards for their exceptional efforts during the severe weather that we are experiencing.

I thank the cabinet secretary and, on behalf of my constituents in the Borders, I thank NHS Borders for the sterling work that its staff are doing in that area.

I note that the cabinet secretary said that there are currently no plans for the Scottish Government to reduce the number of NHS boards. We also know that another party in the chamber has plans to create a national quango for care, and that the Government has set up a commission so that it can pass on the responsibility for decisions about some health service areas and structures. The cabinet secretary will know that NHS Borders is one of the most efficient and best health boards providing services in Scotland. Its board is made up of individuals who come from the Borders and who are dedicated to services for the Borders. Can she give the categorical assurance that that board will continue in its current form?

I value the independence and local accountability of NHS boards, including NHS Borders. When I visit the islands, I am often asked about the continued independence of NHS boards there, and the answer that I give then is the same as the answer that I have just given. I hope that Jeremy Purvis and those whom he represents will take some comfort from that.

That said, in the current circumstances, we need to make sure that structures are in place—not just for the health service but for the public sector in general—that ensure the efficient use of taxpayers’ money. That is why we set up the Christie commission, and we will reflect on its recommendations in due course.

I take this opportunity to thank NHS Borders for the work that it does and I look forward to its continuing to do it.

For the record, I say to Jeremy Purvis that he is incorrect. None of our proposals is about creating a new quango.

The eight special boards employ 12,500 staff at a cost of £2.5 billion. Does the cabinet secretary believe that any savings could be made if functions were merged? When money is tight, I am sure that she will agree that we want resources to be directed to the front line.

Strange as it may sound, I agree with much of the sentiment behind Jackie Baillie’s question. We should always be looking at the special health boards to see whether better working together and integration can release efficiency savings and redirect money to the front line, and work is being done in that direction at the moment. Let me give just one example: the Scottish Ambulance Service and NHS 24 are progressively working closer together, and they have a joint medical director.

Jackie Baillie will have perused the draft budget, which was published a couple of weeks ago, so she will know that we are asking special boards that do not deliver front-line or point-of-care services to meet more stretching efficiency targets. The money that will be released from that effort will be redirected to the front line. There is a great deal of work to be done, but we will continue to do it. Again, the Christie commission might want to make further observations on the issue in due course.

I hope that NHS Highland will be retained or expanded in any review because it does a good job—witness the fact that it has decided to retain the Highland rheumatology centre in Dingwall. I thank the cabinet secretary for her support of that centre. Does she agree that NHS Highland deserves our plaudits?

First, I reflect on the great praise that has been heaped on territorial health boards so far during this question time. That does not always happen, but I am sure that they will be delighted. They deserve that praise because they do a good job of delivering good services for patients across Scotland. I certainly echo Dave Thompson’s comments about NHS Highland.

I welcome what Dave Thompson said about the rheumatology service. At his instigation, I had the pleasure of meeting some of the patients who use that service. They made their case strongly and powerfully, and I am glad that the NHS board listened to them.

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Nurses (NHS Grampian)

2. To ask the Scottish Executive how many newly qualified nurse graduates have been employed by NHS Grampian in each of the last six intakes. (S3O-12170)

Between 2008 and 2009, NHS Grampian employed a total of 402 newly qualified nurses. We are working closely with national health service boards, including NHS Grampian, to secure job opportunities for newly qualified nurses and midwives who have graduated in 2010. In the current financial context, that is clearly very challenging, but our commitments to the one-year job guarantee and to support the transition to employment remain as solid as ever.

The minister has carefully not answered the question. The figures that I have been given for the previous five intakes, going back to 2008, are: 89, 132, 73, 108 and, in March of this year, five. I would be very interested to know what the figure is for October of this year. It should now be available to the minister.

The figures show an alarming reduction in the number of newly qualified nurses getting jobs. A probationary year of work is guaranteed for newly qualified teachers but not nurses. A constituent has raised the issue with me and said in a letter:

“The health ministers say they cannot guarantee newly qualified nurses jobs in their own locality. I am well aware of that, but having to go to England for a job I find is a bit much. Is this how they are trying to promote independence for Scotland? I have never known the morale amongst staff within the NHS to be so low”—

Mr Stephen, you have asked your question. I call the minister.

Nicol Stephen raises an important issue, and it is important that it is treated appropriately.

Notwithstanding the welcome protection that the Government has afforded the national health service, the financial context that it faces is challenging, and it is reflected in the issue that Nicol Stephen raises. In the circumstances, it is absolutely right that we work with health boards—not just Grampian but all of them—to secure employment opportunities for newly qualified nurses and midwives. It is vital that we give them the skills and experience that allow them to take advantage of their training—training that is a result of the public investment that the taxpayer makes.

Nicol Stephen pointed out that the one-year job guarantee scheme does not secure employment in a nurse or midwife’s own locality. I remind him that that is not a change; it has always been the case under the scheme. We will continue to work hard to secure employment opportunities for people who will become a massive asset to the health service in Scotland.

The financial challenges faced by the health service and the rest of the public service are a direct result of the public spending cuts imposed on Scotland by the current coalition Government of which Nicol Stephen’s party is a member and which no doubt he will enthusiastically support from his new place in the House of Lords.

On the lack of employment opportunities for newly qualified nurses, can the minister give me any update on the number of agency staff who are employed by NHS Grampian? Does that have any bearing on the lack of jobs for new nurses?

I will provide Nanette Milne with the detail in writing. She will be aware that in NHS Grampian, as in health boards across the country, the use of agency staff has dramatically declined in recent years. That is a thoroughly good thing and something that we should all welcome. I am more than happy to provide the specific numbers for NHS Grampian in writing.

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Private Rented Housing (Scotland) Bill

3. To ask the Scottish Executive what impact the Private Rented Housing (Scotland) Bill is expected to have on the level of supply of rented housing. (S3O-12157)

The bill is part of my strategic approach to enabling the private rented sector to play its full part in building mixed, sustainable communities and offering flexibility and choice in housing options. By strengthening the enforcement of regulation, the bill will assist local authorities to identify and target landlords who cannot meet acceptable standards. Improving the standards and reputation of the sector will enhance its standing as a housing option and increase the confidence of landlords and potential investors, thus creating the conditions that will encourage future growth and the supply of quality homes to rent.

I very much hope that many of those objectives are realised through the bill.

There are a substantial number of empty homes in Scotland. A more assertive approach from the Government could make those available for the social rented sector and, through incentives and penalties, bring them back into supply in the private rented sector. Does the bill offer the opportunity to take that kind of approach? Would the minister be open to amendments that would lead an approach that would bring some of those homes back into use so that we can meet the aspiration that we all share of eradicating homelessness?

I hope that Mr Harvie noted our announcement with Shelter last week. We have funded a secondment to Shelter to deal specifically with the issue of empty homes and to engage in the activity that he validly points out is needed.

The rate of vacancies and empty homes in the private sector is about seven times that in the social sector. Mobilising the use of empty homes in the private sector is much more difficult than doing so in the social sector, but we are determined to try every possible way of making greater use of empty homes in Scotland.

Question 4 has been withdrawn.

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Parkinson’s UK

5. To ask the Scottish Executive what recent discussions it has had with Parkinson’s UK. (S3O-12152)

We met the Scottish branch of Parkinson’s UK on 1 September 2008 and on 15 May 2009. We discussed preparations for the world Parkinson’s congress, which was held in Glasgow this September, at which the chief medical officer delivered the opening address. We also discussed the organisation’s get it on time campaign and specialist services for people living with Parkinson’s.

The Scottish Government is committed to helping people to live well with long-term conditions such as Parkinson’s. Parkinson’s UK in Scotland was fully involved in developing the clinical standards for the condition and the Scottish intercollegiate guidelines network guideline 113 on Parkinson’s.

I thank the minister for that comprehensive answer. She is obviously aware of the Parkinson’s UK get it on time campaign in Scotland. Can she confirm that she recognises the benefits of ensuring that hospitalised Parkinson’s sufferers receive their medicine on time, both on medical and compassionate grounds and in terms of the economic benefits of ensuring that the strict timing of medicine is adhered to, thereby preventing more serious medical problems from developing? More important, if so, what steps has she taken to ensure that national health service boards in central Scotland and elsewhere are complying with their equality duties and are equality impact assessing the spending decisions that are associated with the issue?

I acknowledge what Margaret Mitchell says about the get it on time campaign. The issue has been discussed on a number of occasions in the chamber. It is an important issue, and we have made sure that NHS boards are aware of their responsibility to ensure that the right practice is happening on the wards.

As Margaret Mitchell outlined, it is very important that those who work on the front line understand that and that patients get their medication on time, as they should do. We will continue to make sure that boards continue to deliver that service, and I am happy to keep Margaret Mitchell abreast of any developments on that front.

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Homoeopathy

6. To ask the Scottish Executive whether it considers that homoeopathy has a role to play in health care. (S3O-12177)

The Scottish Government recognises that complementary or alternative therapies, including homeopathy, may offer relief to some people suffering from a wide variety of conditions. It is, however, a matter for national health service boards in Scotland to make such services available on the basis of an assessment of needs within their respective areas. The treatment of individual patients is always a matter of professional judgment.

The cabinet secretary will know that NHS Lothian is planning to close the general practitioner-run homeopathy clinic in Dalkeith, in the face of huge opposition. Can she confirm that her department is developing an integrative care strategy that is being headed up by Dr David Reilly, one of Scotland’s leading homeopathic practitioners? Does she agree that it would be inappropriate for NHS Lothian to cut homeopathic services, which are so important for many patients, especially those with long-term conditions, at the same time as the Scottish Government is developing a national integrative care strategy?

I am sure that Rhona Brankin would want the Parliament to have the full information about the case, so it is important to stress that NHS Lothian has taken no decision about the Midlothian community health partnership’s proposal concerning the Dalkeith health centre.

The proposal is still subject to consultation, and the outcome of the on-going discussions will be reported to the community health partnership subcommittee at its next meeting in January. I encourage Rhona Brankin, as the local member who has, rightly, raised this issue, to engage with that consultation, as I am sure that she is doing, to ensure that her views and those of her constituents are heard.

On the wider issue, I repeat what I said in my initial answer. We recognise that, in some circumstances and in relation to some conditions, complementary or alternative medicines and therapies can have a role to play. However, decisions about the provision or otherwise of those services in particular areas are, rightly, for local health boards. That is why I have stressed that Rhona Brankin should continue to discuss the matter with NHS Lothian.

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Mental Health Problems

7. To ask the Scottish Executive what progress has been made since 2007 in the early diagnosis and treatment of people with mental health problems. (S3O-12154)

The Scottish Government recognises that prevention of mental ill health and timely diagnosis followed by appropriate intervention are key to improving treatment and outcomes for patients.

Although we believe that there has been no change in the number of people who are ill, the number of people registered with their general practitioner with a diagnosis of depression has increased from 6.2 per cent in 2006-07 to 8.6 per cent in 2009-10. The number of people registered with a diagnosis of dementia increased from 29,761 in 2006-07 to 35,816 in 2009-10, and we expect to meet the health improvement, efficiency, access and treatment—HEAT—target in advance of March 2011.

Given that 54 per cent of new courses of antidepressant treatment last for more than 90 days, and that 36 per cent of the new patients are on antidepressants for more than 180 days, is it not time to ensure that patients with mild and moderate depression are given access to appropriate talking therapies as soon as possible, to reduce the likelihood of their condition becoming severe, chronic and enduring?

I acknowledge the member’s long-standing interest in these matters—she has raised the issue in the chamber on a number of occasions.

The Public Audit Committee was right to recommend that we review the antidepressant target, given that the research showed that, in 98 per cent of cases, people on a prescription are receiving medication appropriately. We are committed to ensuring that their needs are met in an appropriate way, as per the clinical diagnosis.

However, the member is right to talk about the need to look at the issue from the other end of the telescope, as it were, and to ensure that people can get access to psychological therapies. That is why we committed ourselves to developing a target for access to psychological therapies for inclusion in the HEAT targets in 2011-12. This is the first time that such a target has been established, and I think that it will be important in ensuring that people, particularly those with more mild depression, anxiety and low mood, get access to those talking therapies and a range of other therapies that can help to reduce the likelihood that a more serious mental health problem will develop.

I thank the minister for the further information that she has given. Of course, the antidepressant prescribing target, which we hoped would lead to prescribing stabilising and then falling, has been summarily dropped by the Government without being immediately replaced by the alternative, although I acknowledge that the minister has just confirmed that the alternative is being considered.

In England, 3,000 new therapists have been trained. How many new therapists have been trained in Scotland? In light of the earlier discussion about nurse graduates, would it be sensible to train further therapists who can apply these therapies, and then replace or backfill them with new graduates?

I am sure that Richard Simpson will be aware of the amount of new work that is going on with the boards and NHS Education for Scotland. I hope that he will recognise that, despite the rather unfortunate comments that his party made about disbanding NES, it is doing a really important job in ensuring that the education is in place that will enable us to reach the target to improve access to psychological therapies, as well as other important work.

NES is funding psychological therapies training co-ordinator posts in boards to provide the educational infrastructure that is necessary to ensure that the training and supervision are well organised and sustainable, and that the therapies have maximum service impact.

NES is also funding a psychological interventions team to co-ordinate work, particularly in relation to improving patient pathways and referral criteria to help to improve access to services. My concern is that Richard Simpson, in making his proposal, criticises NES and undermines the good and important work that it does. Perhaps he will reflect on his party’s comments in light of that work.

Question 8 has been withdrawn.

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Tenants (Security of Tenure)

9. To ask the Scottish Executive what its position is on the announcement by the United Kingdom Minister of State for Housing and Local Government on removing security of tenure from tenants of social landlords and whether it is considering a similar proposal. (S3O-12156)

Unlike the plans that were set out by the United Kingdom Government, we are committed to the future of social housing in Scotland, which includes building new social homes with affordable rents. We will continue to have a social rented sector with security of tenure for tenants at its core.

This summer we launched a discussion on the future of housing policy. As part of the debate, some stakeholders have pointed out that additional flexibilities would be beneficial—for example, removing the restrictions on social landlords that prevent them from providing properties for mid-market rent. We will publish a paper on the future of housing policy early in the new year.

I thank the minister for his answer. However, if he is opposed—as he is—to the direction that has been set by his equivalent in the Westminster Government, will he explain why the “Housing: Fresh Thinking, New Ideas” paper that he published in the summer raised the possibility of ending security of tenure for social tenants in Scotland? Can he now say, unequivocally and with complete clarity, that he will guarantee security of tenure for Scottish tenants, which the majority of respondents to the paper argued for?

I can guarantee that we will continue with security of tenure. The two main aspects of the new English housing policy are to increase rents to 80 per cent of the market value and to restrict tenancies to a minimum of two years. I believe that both measures will be very unfair, will hit the most vulnerable members of the community most and will lead to the destabilisation of the housing system and communities south of the border. We have no intention of going down that Conservative-Liberal Democrat route.

Will the minister confirm that it is not just a Conservative-Liberal Democrat route that he has articulated? The first proposals for removing security of tenure actually came from Caroline Flint when she was Labour’s UK housing minister. I am sure that we all welcome the assurances that the Scottish National Party Government has given today.

I have in my file a copy of the statement that was made by Caroline Flint when she was housing minister in which she first mooted the idea that the Tories and the Liberal Democrats are now implementing. It is interesting that we have had no input or ideas from the Labour Party in response to the discussion paper that we published six months ago. Perhaps we should ask it whether it will still adhere to Caroline Flint’s Tory policy.

Questions 10 and 11 have been withdrawn.

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Violence Against Women and Children (Funding for Services)

12. To ask the Scottish Executive whether the violence against women fund, the Rape Crisis specific fund and the children’s services Women’s Aid fund will be maintained in 2011-12 and, if so, at what level. (S3O-12179)

Funding for work to tackle violence against women remains a top priority for the Scottish Government. The equality budget for 2011-12, from which violence against women funding is allocated, has been retained at its 2010-11 level. We have done that because we believe that in the current economic climate, it is crucial to continue to promote equality, protect front-line services and support our families and communities. We will continue to support work to tackle violence against women, but we have not yet made decisions about the precise allocation of the equality budget. We will do so as soon as possible.

I thank the minister for that answer, although it is regrettable that he could not say anything more definite today. Will he assure us and, more important, those who work in the field that, given that the budget line has not been cut in cash terms, the funding levels for violence against women work will also not be cut in cash terms? Will he remember that important violence against women work is also done by local authorities? Will he try to raise with his colleagues the issue of ensuring that violence against women work and funding are built into the concordat with local government? Unfortunately, at present, that is not the case.

As I said, we are still to take decisions on the precise allocation, but we will be maintaining the overall budget in respect of violence against women, which of course incorporates a number of programmes. As I said, there is no cash cut in the budget for equalities and we intend to maintain our commitment to tackling violence against women and to the programmes, funding for which has been doubled in the past three years or so.

We are in constant touch with local authorities and, through the national violence against women group, which I chair, we are discussing how to ensure that throughout Scotland the right levels of support and funding are made available for services.

I thank the minister for that reply. I am overjoyed that we can go back to our constituencies and tell the people who have been asking us about the issue that their funding is protected. As the letter from the minister states, the area is an important priority. Does the Scottish Government intend to sponsor a debate on violence against women as it and previous Governments have done in the past? If so, does he have a date for that?

We do not have a precise date at the moment, but there is usually a Government-sponsored debate on violence against women at about this time of year. If we are not able to hold such a debate before Christmas, we will suggest to the Parliamentary Bureau, which schedules these matters, that we should do so early in the new year. It would be helpful if the debate was held once we know what the precise budgets are for each of the programmes under the banner of violence against women.

I welcome the minister’s comments on the funding. Will he clarify that he is continuing the dedicated funding for the services that Malcolm Chisholm mentioned in his question? A degree of anxiety has been generated that the funding might be rolled up in the local government settlement, which would put the services at risk. I would welcome clarification of that.

I also raise the critical issue of the provision of services at the local level through single outcome agreements. The minister will be aware that analysis of single outcome agreements suggests that there is not a commitment at the local level to specific funding on the issue of violence against women. Will he clarify the Cabinet Secretary for Finance and Sustainable Growth’s intention to provide an analysis of the implementation of single outcome agreements for 2009-10? Thus far, he has simply said that he has not yet decided. I understand that the decision remains with him. If we had that analysis, it would give confidence to those who seek to deliver services locally.

First, I was hoping to get congratulations for the Cabinet Secretary for Finance and Sustainable Growth, because he published an equality statement simultaneously with the budget for the first time ever—that was never achieved in the first 11 years of the Parliament. I am sure that everybody will want to join me in welcoming that.

Secondly, I absolutely confirm that we will continue with our dedicated funding and that it will not be incorporated into the local government settlement. It remains within the direct control of the Scottish Government.

Thirdly, there is no specific reference to the area of work in some of the single outcome agreements, but the agreements do not cover every area of work that is done by local authorities, so that in no way suggests that local authorities are not committed to what we are trying to achieve. Through the national group, we are looking at the picture across Scotland to ensure that the requisite levels of services and support are being provided.

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Air Ambulance (Orkney)

13. To ask the Scottish Executive what discussions ministers have had with the Scottish Ambulance Service regarding the future provision of air ambulance services in Orkney. (S3O-12161)

At the annual review of the Scottish Ambulance Service in September, I was given an update on the extensive consultation process that will inform decisions about the future provision of air ambulance services across Scotland. The consultation is in its concluding stages; final comments were sought from stakeholders by the beginning of this week. Scottish Government officials will remain in close dialogue with the Ambulance Service as the reprocurement exercise continues.

As the cabinet secretary knows, I have been raising the issue for three or so years. The Ambulance Service’s final report on the consultation on the air ambulance reprocurement project says:

“There was ... a strong voice from Orkney favouring a locally-based Islander aircraft, as it is felt that local knowledge of weather conditions and landing sites would allow the service to make better use of short windows of opportunity and respond more quickly.”

Will the cabinet secretary assure me and my constituents that she will use all her good offices to persuade the Scottish Ambulance Service to continue to work with NHS Orkney and the Orkney Islands Council to ensure that a locally based aircraft solution is put in place as quickly as possible?

I thank Liam McArthur for again raising an issue in which he has shown a consistent interest. I assure him on behalf of the Scottish Ambulance Service that the service will reflect on and take seriously all the feedback from the public consultation. I understand that the views of more than 450 people throughout Scotland were fed into the review.

I am encouraged that the specific proposal that Liam McArthur talked about is being considered in detail by the three organisations. We support and encourage on-going partnership working in that respect, to ensure that the communities of Orkney get the best service, which is best tailored to their needs. I hope that that assurance satisfies Liam McArthur.

Questions 14 and 15 have been withdrawn.

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Older People Care Services (Mansionhouse Unit)

16. To ask the Scottish Executive what the timescale is for the replacement of the care services for older people currently delivered by the Mansionhouse unit. (S3O-12186)

NHS Greater Glasgow and Clyde has confirmed that inpatient services will transfer from the Mansionhouse unit to the new south Glasgow hospital in 2015, in line with the board’s acute services review plans.

The unit is located in my constituency. NHS Greater Glasgow and Clyde’s original plan was for the services that are delivered by the Mansionhouse unit to be replaced by 2009-10. Can the minister explain the reasons for the delay and the change to the strategy?

I understand that the plan has been part of the acute services review plans for some time and that a timeframe of 2015 was laid out around the plans and is on-going. As the member knows, the south Glasgow hospital project is an important, flagship project, which will allow first-class beds to replace some of the very old provision at the Mansionhouse unit. I would have thought that the member would welcome progress on that.

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Bedblocking (Dementia Patients)

17. To ask the Scottish Executive what action it is taking to reduce bedblocking for dementia patients in Glasgow hospitals caused by the need to obtain orders under the Adults with Incapacity (Scotland) Act 2000. (S3O-12158)

Section 13ZA of the Social Work (Scotland) Act 1968 was commenced in March 2007, to clarify to local authorities when they can provide community care services for someone who lacks capacity, when a guardianship order is not in place. To assist further, guidance was issued on when the powers may be used, to ensure that there are no unnecessary legal barriers to adults with incapacity receiving the services that they need.

The Scottish Government also published a good practice guide in June 2010. Glasgow City Council, in partnership with NHS Greater Glasgow and Clyde, has developed the guide for use locally and will implement a performance framework to ensure best practice.

Further work is under way, as part of the national dementia strategy, including development of a skills and knowledge framework for staff and common standards of care for dementia, both of which tools are designed to help to improve service response in those and other care settings.

The central point of the question relates to the time that is taken to process applications and to obtain orders under the 2000 act. Am I right in saying that such delay, which keeps dementia patients in hospital—perhaps in the Mansionhouse unit to which Charlie Gordon referred—does not figure in Scottish Government statistics on bedblocking? Will the minister give an indication of the problem’s extent? I am told that the issue is significant and costly and that unnecessary delays in processing and obtaining guardianship orders sometimes approach a year. Will she confirm that? Is that exacerbated by any rationing that Glasgow City Council has imposed on the availability of free personal and nursing care?

Robert Brown needs to understand that the process can be complex. The courts and local authorities, including Glasgow City Council, do their best to expedite the process when guardianship orders are applied for. Detailed decisions about individuals are involved, which sometimes take time. Safeguards are built into the process, which can also take time to work through. I am sure that Robert Brown recognises the importance of ensuring that the correct procedures are followed.

As for the relationship to delayed discharge and the delayed discharge census, dealing with cases of adults without capacity takes time and the local authority and the national health service board can do nothing while the cases go through the legal process. It would be unfair to include such cases in the delayed discharge figures, because local authorities and NHS boards can do nothing about cases that are in the court process. Of course, it is important to keep delays to a minimum. We expect that to be the position.

I hope that I have explained to Robert Brown why some cases take time. Once the court process is complete, I am sure that local partners do everything in their power to put people into appropriate care settings.

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Preventive Treatment (Glasgow City Council)

18. To ask the Scottish Government how the money for preventive treatment announced for national health service boards in the draft budget will help support Glasgow City Council in looking after vulnerable citizens. (S3O-12218)

The Scottish Government will allocate £70 million in 2011-12 in the NHS budget to a change fund for NHS boards and partner local authorities, together with the third and independent sectors, to redesign services to support the delivery of improved care outcomes for the growing older population. The change fund will be used as bridging finance to lever improvement throughout older people’s spend in health and social care and will provide an opportunity to make better use of the total resources that are available in health and social care, in recognition of pressures on older people’s services across Scotland.

Does the minister agree that it will be vital in Glasgow for the NHS and the local authority to work closely together? That has not always been easy, given the problems that have existed with the community health and care partnerships. Will she encourage those bodies to work as closely together as possible and to ensure that the voluntary sector has a role in the delivery of services in the community, to promote preventive health spend?

Absolutely. I recognise the previous difficulties to which Bob Doris refers. We have made it clear that the partners must work closely together. Only with the partners’ agreement will any resources be released. If the resources are to go to the local partnership, it is vital that the partnership works as one to receive the resources.

As for the voluntary sector’s role, I have made it clear that the voluntary sector must be around the table at the start of the process to decide on the priorities for which the resource should be used. It is clear that the voluntary sector will be key in delivering some of the more innovative services in the community. We have made it clear to local partners that the voluntary sector has a key role in that.

Will the minister explain why funding for social care has dropped from £3.2 billion in 2007-08 to £2.8 billion in 2009-10? That is a reduction of £400 million, which has been taken from our most vulnerable citizens.

Despite the fact that Jackie Baillie is trying to scaremonger, she will appreciate the difficulties in which the Scottish Government budget is operating. [Interruption.]

Shh.

Two thirds of the cuts to that budget were planned by Alistair Darling. Rather than scaring the most vulnerable people in our society, we are taking direct action to deal with the difficult situation that faces us and ensuring that the resources tied up in the acute sector are released to support people in the community.

Come on!

Instead of sniping loudly from the sidelines, as Richard Simpson does so well, we are getting on with the job in hand and ensuring that services for vulnerable people are protected.