Health and Wellbeing
Question 1 was not lodged.
Podiatry Services
The planning and provision of national health service podiatry services are a matter for NHS boards. Podiatry is provided on the basis of clinical need, as judged by a registered podiatrist. As part of NHS service provision, there is no charge to patients for NHS podiatry services.
In Lanarkshire, revised criteria for podiatry have stopped general practitioners referring their elderly patients for nail cutting, which is having a negative impact on those patients’ health and wellbeing. Does the cabinet secretary recognise that the majority of elderly people are unable to carry out essential nail cutting for themselves and have a clinical need for the service? Does she accept that the refusal to offer that vital service on the NHS has a disproportionate impact on the poorest and most vulnerable elderly patients, who cannot afford to pay privately? Given that she has indicated to me in a letter that the service could be provided by nursing staff or foot care assistants, will she ensure that it is provided free on the NHS?
I am sure that Elaine Smith appreciates that assessment of clinical need in this or any other regard is a matter for clinicians—in this case, for registered podiatrists. When a registered podiatrist considers that foot care is required for clinical reasons, that is provided on the NHS. It is worth pointing out that free personal and nursing care also has a role to play. Personal care services are provided by local authorities at home, without charge, to people aged 65 or over; payments for such care are made for self-funded residents of nursing or care homes. Personal care can include foot care, including nail care.
Many elderly people in Highland have been taken off the list for regular podiatry assessment. Will the cabinet secretary ensure that podiatry services are provided on the NHS to all elderly people who are assessed as being in need of such services? That is a wonderful investment that helps to ensure mobility and independence.
As I said to Elaine Smith, clinical assessment is paramount in such cases. Podiatry, like all NHS services, is provided on the basis of assessed clinical need. That assessment should always be made by the appropriate health care professional—in this case, the podiatrist. Where it has been determined that clinical need exists, services should be provided on the NHS.
Glasgow Western Infirmary (Patient Care)
NHS Greater Glasgow and Clyde will continue to provide high-quality services and to maintain high standards of care for patients at the Western infirmary, which will remain an important acute hospital within the Glasgow network of hospitals until the new south Glasgow hospital is opened and services are transferred there. The board is implementing a significant programme of capital investment to refurbish areas of the Western infirmary and is following up infection control environmental audits to improve the basic fabric of ward areas.
Will the cabinet secretary give me a cast-iron assurance that patients at the Western infirmary will not receive an inferior service while the new Southern is in its planning stages? The closure of Stobhill hospital is expected to put added pressure on the Western and its sister hospital, Gartnaval, with regard to acute and emergency beds. What will the cabinet secretary do to ensure that there is not undue pressure on beds at the Western infirmary and how will she satisfy herself that, during the on-going changes, there will be no detriment to the services that are used by patients who attend the Western infirmary?
I thank Pauline McNeill for her question and her interest. I can say unequivocally that patients who use the Western infirmary during the period up to the transfer of services to the new Southern general have the right to expect the same standard of care that they would get in any other circumstances. Through the normal methods and means of managing the performance of all NHS boards, I will ensure that that is the case.
Football Clubs (Supporters Trusts)
Football clubs and the relevant football authorities are responsible for managing how they run their clubs and the sport. We expect the footballing authorities and clubs to ensure that appropriate mechanisms are in place to allow their supporters’ views to be represented.
The minister is no doubt aware of the plight of Dundee Football Club, which has slipped into administration for the second time in seven years. The situation has resulted in the club receiving a record 25-point penalty from the Scottish Football League. Dundee FC is one of Scotland’s oldest clubs, with a proud history. Has the minister been in touch with the club’s administrator and HM Revenue and Customs to discuss what assistance the Government can offer to the club’s supporters at this time?
I am more than aware of the issues surrounding Dundee Football Club, some of which are complex financial issues. Bill Butler should be aware that Dee 4 Life has representation on the club’s board. Given the complex financial issues, I am not sure that a greater role by supporters on the board would necessarily have made a big difference in this case. Nevertheless, a greater role for supporters on boards is something that we would wish to encourage.
I am tempted to say, that is if they are not attending Stranraer’s game on Saturday—but I will not.
I am pleased to hear that the minister will attend Dens Park. As has been said, the thoughts of football fans in general and, in particular, Dundonians, are with Dundee FC and the 25-point penalty meted out to it. Will the minister meet the Scottish Football League to discuss the situation and the impact on Dundee and the local economy?
The process from here on in is that the first appeal will be made to the SFL. Beyond that, the appeal will be to the Scottish Football Association. Yesterday, I met the SFA to discuss a number of matters. During the meeting, I raised the issue of Dundee FC to ensure that the SFA is aware of the issues that have been brought to my attention by fans and the club. As would be expected, given that the SFA is involved in the appeal process, it would not necessarily have been appropriate for the SFA to pass comment, but I can assure the member that it is well aware of the issues involved. As a local member, I will continue to do all that I can to support Dundee FC, which is, of course, a great institution for the city and one of Scotland’s very important football clubs.
Hospitals (Patient Care)
Patient safety and quality of care are key priorities for both the Scottish Government and the national health service. Through the quality strategy, we continue to support the NHS to ensure that it delivers the quality health care that patients want and deserve. Programmes such as leading better care, releasing time to care and the patient safety and health care associated infection programmes are key drivers for improvement, and the proposed care governance approach that is being taken forward by the chief nursing officer will further support care delivery.
I am sure that the cabinet secretary will agree that the recent survey by the Royal College of Nursing, which concluded that 54 per cent of nurses feel prevented from providing care with dignity to a standard that they are happy with, is very worrying, especially as three quarters of those who felt that they could not provide such care cited a lack of staff as the main problem.
I thank Margaret Smith for an important question. Input from the RCN and professional bodies such as the RCN is always extremely welcome and helpful. It is essential that we use the leadership, the professionalism and the skills of nurses, and of midwives and allied health professionals, to take forward the quality strategy and the other programmes of work that I have mentioned.
Chlamydia (Testing)
As part of our national sexual health strategy “Respect and Responsibility” and national outcomes 2008-11, national health service boards are required to ensure that young people have access to sexual health information, advice and services, including chlamydia testing and treatment, when that is appropriate. NHS boards are also required to comply with service standards set by NHS Quality Improvement Scotland, which support testing for chlamydia in the under 25s.
The sexual health statistics, which were published last week, highlighted the work that needs to be done to ensure that chlamydia testing is targeted at the 16 to 25 age group. NHS Dumfries and Galloway has a commendable rate of testing but also has the highest proportion of positive tests among young men, at 18 per cent. Are further initiatives planned to make young men in particular aware of the need for prevention and testing?
I congratulate NHS Dumfries and Galloway on the work that it has undertaken to encourage young people who might be at risk to come forward for testing and treatment. It is clear that the board sees the benefits of testing and treatment for improved sexual health outcomes for that group of young people. I am sure that it will be keen to continue the service and, perhaps, to customise and develop it to meet local circumstances. I will be happy to furnish the member with information about developments in the area.
The minister will be aware of concerns about the rise in sexually transmitted infections among older members of the population. It might be comparatively simple to target messages at under-25s, who might be at college or university. What is the Government doing to try to target sexual health messages at more middle-aged members of society?
The issue was identified in the sexual health strategy. Society has changed, and people quite often develop new relationships in their middle years. It is important that we realise that STIs are not the domain just of young people. Therefore, the strategy to do with the information that is given to the older age group is important, as are treatment and testing. The matter is being taken forward as part of our sexual health strategy, in recognition of the changing society in which we live.
Question 7 has been withdrawn.
Malignant Melanoma
The Scottish Government recognises the importance of tackling skin cancer. Through improvements in cancer services, education and legislation, we are seeking to reduce incidence rates and improve outcomes for patients.
Given figures that show a 71 per cent rise in malignant melanoma diagnoses during the past decade, will the minister agree to look at the age incidence and consider whether the age of presentation of malignant melanoma is changing? Will she also agree to consider the potential need to improve awareness education for different age groups, targeting schoolchildren and their parents, as has been done in other countries?
I am always happy to consider ideas that are raised. I will take forward Nanette Milne’s point.
Community Empowerment Action Plan
The Scottish Government launched the community empowerment action plan jointly with the Convention of Scottish Local Authorities in March 2009. I am pleased with the progress that has been made during the past year and a half.
Most members put increased community participation and empowerment at the core of Scottish politics. In the context of invigorating democracy, I am sure that the minister is aware of the upcoming national event in Govan, which aims to highlight the success of community-based projects. What further plans does the Scottish Government have to build on the current successes of community asset ownership?
I am delighted that an event celebrating creative approaches to regeneration will be held in Govan, and I am pleased to say that a senior Scottish Government official will be a key speaker at that event.
Armed Forces Personnel (Health Statistics)
The Scottish Government holds no specific records relating to the incidence of cancer, stillbirth and birth deformities in respect of armed forces personnel and their families who are based in Scotland. We understand that the Ministry of Defence, similarly, does not break down military statistics by geographical area of birth, upbringing or recruitment.
In view of the considerable circumstantial evidence linking cancers, stillbirths and birth deformities to exposure to the depleted uranium that is used in armour-piercing shells in Iraq and Afghanistan, for example, would the Scottish Government consider collecting information on the incidence of such problems and investigating whether they might be linked to depleted uranium exposure? Or will it ask the United Kingdom Government to do so, if it is ruled to be a reserved matter?
I am not sure that the Scottish Government would be best placed to do that, but we are certainly open to discussing the matter with the MOD. It might be best if I write to the member with more detail on that.
NHS Lanarkshire (Meetings)
I and my officials meet all health boards regularly. The most recent meeting with NHS Lanarkshire representatives was on 25 October 2010.
A number of constituents have approached me because they have been unable to obtain admittance to accident and emergency services at Hairmyres hospital. It has, in effect, been closed to those local people. I have taken the matter up with NHS Lanarkshire, as it is a great concern to them. Is the cabinet secretary aware of the situation? What discussions have she or her officials had with NHS Lanarkshire, the royal colleges or any other relevant bodies on the matter? What plans are in place to ensure that the situation does not occur again?
I understand from NHS Lanarkshire that, for a short period in October, Hairmyres hospital experienced high levels of activity. However, I can tell the member and the chamber that Hairmyres hospital was never closed to new emergency admissions. The member will be aware that when there are peaks of activity in any of the three Lanarkshire hospitals they operate as an emergency clinical network, which means that patients can be redirected between the three hospitals to ensure that they receive the treatment that they require without delay. That situation occurs in all health boards in Scotland—it is not unique to Lanarkshire.
According to figures that were released in August, the number of patients aged 65 and over with a recorded diagnosis of malnutrition and treated in acute hospitals in NHS Lanarkshire rose from 66 in 2007-08 to 70 in 2008-09. There were also increases in NHS Ayrshire and Arran and in NHS Forth Valley, in contrast to a fall in the overall Scottish figure. What measures is the minister taking to address this vexing issue, which affects some of Scotland’s most vulnerable people?
Margaret Mitchell raises an extremely important issue. We all recognise the problem of malnutrition among all older people, not just those in hospital. She will recognise that, although we should not be complacent about what happens to patients in hospital, many older patients are admitted to hospital already suffering from malnutrition.
Insulin Pump Therapy
Between February 2007 and the end of 2009, the number of people with type 1 diabetes using an insulin pump increased from around 200 to about 553.
Does the minister accept that the uptake and availability of insulin pumps across NHS board areas is a serious issue? What further steps is the Government taking to avoid a postcode lottery for patients who have insulin-dependent diabetes, particularly in terms of paediatric provision?
The member has raised the issue previously and I acknowledge his long-standing interest in the matter. As he is aware, we have been very proactive with boards, including asking for their plans, to ensure that we increase the number of people who can access an insulin pump. He is also aware of our work on the national procurement insulin pump framework, which has been designed in such a way as to release savings that can be reinvested in diabetes services. Thus far, 156 pumps have been purchased through that mechanism with maximum potential savings of around £100,000. More needs to be done and I am very keen to see more action in that direction. It is a good way of ensuring that we maximise the money that goes directly to diabetes services.
I absolutely share David Stewart’s concerns about a postcode lottery. For instance, the figures for NHS Grampian show that only 2 per cent of those who have insulin-dependent diabetes and who qualify for a pump have access to insulin pump therapy. The Scottish diabetes action plan does not project an increase in the number of those who will gain access to such therapy. In view of the apparent postcode lottery, will the minister consider reviewing the guidance to NHS health boards on the provision of insulin pumps?
As I am sure the member is aware, the Scottish diabetes action plan, to which she referred and which was published in August, sets out a series of actions that are designed to support boards in making significant and sustained progress in improving pump provision. Progress should include the development of waiting time criteria for pumps and a national insulin pump study day, the aim of which is to ensure that staff are aware of requirements. There is a mixed picture, as we have discussed previously in the chamber. The member cited the figure for NHS Grampian. If we look at the figure for NHS Fife, which is 4.4 per cent, and that for NHS Tayside, which is 4.6 per cent, we see that other boards are further along the path that we would like all boards to follow. The issue is important. Through the procurement framework, we have set incentives for boards to use the mechanism and, in turn, release savings from which they can benefit by making investment in their services. We are encouraging boards on a number of fronts down that road. I hope that that will bear fruit over time.
XMRV (Blood Testing)
Based on up-to-date medical and scientific advice from a range of expert advisory bodies and committees, the Scottish National Blood Transfusion Service in Scotland does not currently screen blood for xenotropic murine leukaemia virus-related virus as the virus has no known association with any blood-borne infection.
I understand that patients who suffer from long-term conditions such as myalgic encephalomyelitis are no longer allowed to donate blood. One such patient—a constituent of mine—has been refused a referral for a blood test by her general practitioner on ethical grounds, a view that her local health board backs. Does the cabinet secretary recognise the increased concern among such patients? If so, how will she address it?
I thank Charlie Gordon for raising the issue. I understand the concern of such patients. Indeed, a member of the public asked me a question on the topic at the public question and answer session at the Greater Glasgow and Clyde NHS Board annual review on Monday this week.
Dentistry (Far North)
Responsibility for the overall provision of national health service dental services in the area rests with NHS Highland. The board is undertaking a range of measures to improve access to NHS dental services in the Highlands.
The same NHS Highland has warned that, if gaps cannot be filled in the current overstretched service, people could face having to travel to Inverness for out-of-hours and emergency appointments. Indeed, although the new publicly funded dental unit at Thurso’s Dunbar hospital, which we all welcome, will open in the spring, there is already concern about whether we can staff the unit. By the end of this month, as many as three out of four posts may not be filled.
I am always in favour of constructive discussions, so I would be happy to do that. However, we should acknowledge the efforts that NHS Highland is making, such as its international recruitment initiative. Although it has had some setbacks with people leaving, which happens, it is trying again to recruit through that initiative.
Will the minister tell us about the first destinations of dentists who are trained in the University of Aberdeen dental school and other Scottish dental schools? How many of them have been attracted to the far north?
I will be happy to provide Rob Gibson with the detail of that. The University of Aberdeen dental school has clearly identified encouraging students to go out on vocational placements in the north of Scotland as important because it gives those students the opportunity to consider basing themselves in areas in the north of Scotland once they are qualified. I am confident that that will produce real benefits for those areas, but I am happy to write to him with more detail on that.
The minister is aware of discussions about the provision of salaried dentists in areas that have shortages of dental practices, but progress on that seems to be delayed. Will she ensure that any barriers to employing salaried dentists are dealt with quickly?
I can say with certainty that the employment of salaried dentists has been a tremendous success in the NHS. Through the recruitment of salaried dentists, we have tackled long waits the length and breadth of Scotland, so I am not sure whether the picture that Jackie Baillie seeks to paint has any basis in fact whatever.
National Health Service (Training)
Yes—training is a priority. Our priority is to deliver the highest-quality health care to people in Scotland by providing person-centred, safe and effective care. Appropriate training is an essential part of that and is required of all NHS boards as part of the staff governance standard.
Will the cabinet secretary note that, in NHS Fife’s area, e-mails have been sent to tell clinicians to stop all training immediately? Were they sent with the Scottish Government’s knowledge, consent and blessing? If not, why is that happening in Fife?
I am not aware of the e-mails to which Helen Eadie refers. If she cares to copy them to me, I will be happy to investigate and come back to her with my view on them. I have learned from experience to ask to see the full context before giving a full answer.
Out-of-hours Medical Services
We are committed to ensuring that all patients have the necessary information to guide them in accessing safe, timely and appropriate out-of-hours health care that is provided by a range of health professionals.
The cabinet secretary might be aware of the perceived threat to the Grampian medical emergency department—GMED—coverage in the Stonehaven and Mearns area. Will she guarantee that that service does not face an immediate threat and that any review that NHS Grampian undertakes will ensure that a proper service is maintained in that area?
I am aware that the GMED out-of-hours service has considered how to maintain a safe and quality service while trying to better match clinical capacity to patient demand. Service managers are meeting clinical and non-clinical staff across the Grampian board area to examine potential options for that. However, I assure Alex Johnstone that that is work in progress. To date, no proposals or option appraisals have been tabled. I am sure that he will also be reassured to know that any issues and concerns that are raised during the exercise will be taken into account fully before any changes are recommended, let alone approved.
One aspect of out-of-hours care is the availability for people with possible epileptic seizures of access to electroencephalogram technicians, who operate—broadly speaking—from 9 to 5, Monday to Friday. Will the minister reassure me about the number of such technicians who are in post? Do health boards have effective protocols for dealing with out-of-hours services in that situation?
Several measures are in place. Robert Brown might be referring to the report that was recently published on the issue. I do not have at my fingertips the number of technicians and the detail for which he asks, but I am happy to write to give him that information as soon as possible.
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