Plenary, 04 Dec 2008

Meeting date: Thursday, December 4, 2008

Official Report 709KB pdf

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Question Time

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SCOTTISH EXECUTIVE

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Health and Wellbeing

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NHS Fife (Whyteman's Brae Centre)

To ask the Scottish Executive what plans it has to upgrade and improve the health centre facilities at Whyteman's Brae, Kirkcaldy. (S3O-5084)

NHS Fife is planning to transfer the podiatry service from Kirkcaldy health centre to Whyteman's Brae. That will free up accommodation in Kirkcaldy health centre to allow for expansion of the general practitioner practices based there.

I will meet NHS Fife and staff at Whyteman's Brae later this month. The centre at Whyteman's Brae provides GP and community health services to some of the most disadvantaged communities. Does the Scottish Government have any plans to make additional resources available to support health practices such as Whyteman's Brae, to give them the additional support that is needed to provide a wide range of health services in disadvantaged communities?

I am reviewing the proposals from all boards on the use of primary and community care premises modernisation programme funds. I expect to be able to advise boards of the results shortly. In addition to those funds, Fife has access to its normal capital allocation. My officials will be working with the board to help it to deliver its identified projects as quickly as possible. NHS Fife has received an increase of £0.768 million over its 2007-08 formula capital allocation. It has also been notified of its indicative formula capital allocations for the next two financial years. I am happy to remain in communication with the member over the issue.

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Telehealth

To ask the Scottish Executive whether it is satisfied that as much as possible is being done to introduce telehealth links ensuring easier, faster and more local access to health care. (S3O-5060)

The Scottish Government established the Scottish Centre for Telehealth in 2005 to facilitate the national introduction of telehealth services. There are many good examples of how the centre is helping to bring patients closer to health services, including testing access to hospital specialists from the homes of patients with chronic illnesses, such as motor neurone disease and epilepsy, and extending the use of telemedicine in areas such as unscheduled care and paediatrics. Looking to the future, the centre intends to mainstream such uses throughout Scotland where appropriate.

The Scottish Centre for Telehealth is nearing the end of its third year of existence and a review of its work is under way. That review will be complete by the end of January next year.

I understand that the Cabinet Secretary for Health and Wellbeing will visit the telehealth centre in the near future. I hope that she is as impressed with what she sees there as Mary Scanlon and I were during our recent visit to the centre.

What practical steps are being taken to accelerate the extension of small-scale pilot schemes through to comprehensive national adoption of telehealth services, which I am in no doubt would be cost effective for the NHS?

The cabinet secretary will visit the telehealth centre on Monday, where she will see for herself the excellent work that is going on there. We have supported that work with resources over the past three years. The review that I mentioned will report early in the new year. Funding will be considered in relation to the outcome of that review.

The member asked about the work that the telehealth centre has been involved in. It has developed a number of interesting services. In Orkney, there is a service for patients with suspected minor stroke. In the Western Isles and Shetland, there are ear, nose and throat tele-endoscopy clinics for patients. We want to consider how the services that have been developed in those areas can be used elsewhere. It is about providing the evidence base for how we would do that. Of course, we would expect to share that learning with other boards and that they would use that information. Such work is especially relevant in areas such as the Highlands and Islands. Not only can it produce a better health care system for patients, but it is very cost effective.

We have talked about the benefits of telemedicine for patients in their own homes, especially in remote or rural areas, but is the minister aware of the potential use of telemedicine to prioritise the patients who would benefit from early intervention and treatment in specialist centres? If given priority, those patients could be given the treatment that they need as quickly as possible.

Yes, I am aware of that potential. The development of telehealth—and, of course, telecare, which is separate but linked—has potential in many areas. We must use the technology to our best advantage.

I have said before and I will say again that we are only scratching the surface of the potential of both telehealth and telecare. I want us to step up their use in future—not only because of the demographic challenges that will face us, but because such systems will be better for patients in many respects. For example, patients may not have to travel to specialist clinics or other services.

I agree with the point that the member makes, and I will be happy to keep him informed of progress.

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National Health Service (Winter Pressures)

To ask the Scottish Government how it is preparing for winter pressures on the national health service. (S3O-5091)

The NHS is once again building on the good practice and planning of previous years to prepare for the challenges of this winter. The huge planning efforts that are being made are underpinned by record funding levels, with a health budget that is now in excess of £10.6 billion.

I note the comments that were made earlier this week about planning for the festive season. The pressures have already begun. On an icy day in my constituency this week, accident and emergency admissions to Inverclyde royal hospital shot up by 70 per cent. I am therefore concerned that plans should not cover only the festive season.

Will the cabinet secretary explain why, despite the Scottish Government's undertaking in March to achieve and maintain a level of zero blocked beds, we now have almost 100 blocked beds? That is creating substantial delays in our most vulnerable patients being discharged.

Our plans for the winter apply not only to the festive season but to the entire winter season. That is appropriate.

The Government has made clear its intention to keep delayed discharges at zero. We achieved that in April and, although there has been a slight rise since then, the level of delayed discharges is now much lower than it was in previous years under the previous Administration. However, that gives me no cause for complacency. We will continue to focus sharply on this important area.

Duncan McNeil raises a general point about winter pressures. Members know that, because of adverse weather conditions, many accident and emergency departments had their busiest ever day on Tuesday of this week. In the Greater Glasgow and Clyde NHS Board area, attendances were up by as much as 20 per cent on previous highs. Despite that, more than 96 per cent of patients were still seen within the four-hour target. That was a massive achievement, and I place on record my thanks to all staff—clinical staff, management and support staff.

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Perth and Kinross Council<br />(Multiple Disability Support)

To ask the Scottish Executive whether it is satisfied with the level of support services available to people with multiple disabilities in the Perth and Kinross Council area. (S3O-5059)

The Scottish Government is satisfied that Perth and Kinross Council is taking forward a number of actions to deliver better services for people with learning disabilities—including people with profound and multiple disabilities—following the best-value review that it undertook in 2006-07.

Over the past few weeks, I have been contacted by three sets of parents and carers, from across the Perth and Kinross Council area, who have expressed concerns that the provision of some support services—principally in the Bridge of Earn and Gleneagles areas—has been unsatisfactory. Will the minister agree to meet me to discuss my constituents' concerns so that they can be addressed as soon as possible?

I am aware of the important concerns that are being expressed by a small number of local parents. I am also aware that the Social Work Inspection Agency conducted an inspection of services in Perth and Kinross in 2006, which coincided with the best-value review that was being undertaken by the council at that time. A follow-up report from the SWIA is due to be published within the next week, which will help in taking the process forward.

In addition, there are plans for the refurbishment and redesign of services in the area. Those plans are at an early stage and will involve full consultation with everybody who is affected. However, I am more than happy to meet Elizabeth Smith to discuss any concerns that her constituents may have.

Is the minister aware of the considerable additional investment that is being made in disability services in Perth and Kinross, such as the £533,000 in capital moneys that is being allocated for day service improvements and the additional £35,000 that is being used to improve respite for carers? Those sums are considerable. Will the minister join me in congratulating Perth and Kinross Council on its success in finding those resources to invest in these financially constrained times?

I am happy to congratulate any council that invests successfully in local services that support people, especially those who are struggling in these difficult times. I am more than happy to congratulate the council on its investment in that area. I hope that local services meet the needs of all local people, not just at this difficult time, but across all periods of time, to ensure that people who have multiple disabilities are provided with services that support their needs and that their families are not overburdened by the difficulties that they may otherwise face.

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Violence Against Women<br />(No Recourse Scheme)

To ask the Scottish Executive when it will publish the report from the short-life working group examining options for assisting women who have no recourse to public funds, referred to by the Minister for Communities and Sport on 29 May 2008 (Official Report, col 9252). (S3O-5092)

Since the last meeting of the short-life working group, on 27 May 2008, officials have been working with the Home Office on the no recourse scheme. Officials consulted the short-life working group on the draft proposal and comments from the group were fed into the Home Office at the end of October.

The Home Office will make an announcement about the scheme in the near future, and I have asked that the short-life working group provide a report on progress on the Home Office scheme in Scotland once it has begun operating.

I am sure that the minister will agree that we are keen to see the detail of that. The facts on the ground suggest that there is hugely inadequate provision for families. In Glasgow, five families were provided for but another 42 families were not, and Glasgow Women's Aid suffered a loss as a result of that.

Will the minister assure me that there will be a speedy conclusion to putting forward options to rectify the situation? Will he further assure me that, given that only five local authorities refer to domestic abuse as a priority in their single outcome agreements, he will ensure that all local authorities make it a priority?

I share the member's concern on the issue of women who find themselves in that difficult situation. It is disappointing that the Home Office has taken so long to implement the scheme. We originally hoped that the scheme would be in operation by the autumn of 2008, but I am assured that an announcement is due very soon and that the scheme will begin in the new year. I hope that that is the case. We will do all that we can to ensure that the scheme is in operation and helps some of the folk who are in difficulties because of the no recourse problem.

The member is aware that we have doubled the funding for work on violence against women to £44 million over the next three years. That has been widely welcomed and shows the Government's commitment to ensuring that women who have to leave their homes as a result of violence, or who find themselves in difficulty because of other problems with their children with regard to domestic abuse, get the protection and services that they require.

I am sure that that is a priority for all councils throughout Scotland. All the single outcome agreements are being renegotiated for the next year, and councils throughout Scotland are signed up to ensuring that we achieve the national outcomes, which include the outcome that people should be able to live free from violence and in safer and more secure homes.

Question 6 has been withdrawn.

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National Health Service (Bullying)

To ask the Scottish Government whether it has estimated or will estimate how bullying impacts on the NHS and in other areas, in light of an increasing body of evidence linking bullying to mental and physical health problems. (S3O-5128)

In response to the results of the 2006 NHS Scotland staff survey, the health directorates commissioned a project to examine dignity at work in NHS Scotland. That project commenced in August. In particular, it seeks to measure the impact of bullying and harassment in NHS Scotland and to develop tools and cultural improvements that will reduce the impact of such behaviour on all staff in the NHS.

Respectme's comments about Renfrewshire Council's anti-bullying strategy are:

"the guidance is head and shoulders above other local authority guidance that has been reviewed to date".

Given that, will the Scottish Government assure me that it is doing what it can to ensure that anti-bullying best practice is shared?

I note Bill Wilson's comments about Renfrewshire Council's policy, which I welcome. I assure him that the NHS in Scotland will always seek to learn from best practice, whether through NHS boards learning from each other or through learning from other agencies. I am sure that, as we develop the work in the NHS on dignity at work, with the emphasis on tackling bullying and harassment, we will bear in mind such examples.

Members might be interested to know that the study to which I referred in my first answer will take between 12 and 18 months to complete. Members know that the NHS Scotland staff survey is conducted every two years. The previous survey was undertaken in 2006 and the results of the 2008 survey should be available in January.

I acknowledge the cabinet secretary's comments, but I remind her that while we await the welcome project that she described, many highly trained and experienced NHS employees will be suspended or on gardening leave, which has an almost immeasurable effect on an individual's health. Many such people are unlikely to return to work. After the survey's results are produced, I ask not only for those people to be treated with dignity, but for human resources departments in the NHS to be more professional and to conduct their business with more dignity than at present.

I expect all HR departments in NHS boards to behave with dignity. If Mary Scanlon has cases that she wants to bring to my attention, I am more than happy to discuss them with her.

I agree absolutely with Mary Scanlon and Bill Wilson about the importance of the issue. I mentioned the 2006 staff survey, which showed that 18 per cent of staff considered that they had been the subject of bullying behaviour and that 19 per cent said that they had suffered harassment. That gives us some idea of the scale of the issue. It is essential to do work properly to identify the tools and the culture changes that we need to deliver to tackle bullying more effectively.

I value every member of staff in the NHS. It is important that their work is valued and that they are provided with a working environment in which they can give of their best.

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Hospital-acquired Infection Rates (Reporting)

To ask the Scottish Executive whether it will introduce regular reporting on hospital-acquired infection rates and, if so, whether the reports will be broken down by hospital. (S3O-5063)

Yes, we will, and yes, they will be. We will introduce a common reporting template for all national health service boards to use from January 2009. Boards will be required to report on local performance, hospital by hospital, on key indicators such as MRSA, Clostridium difficile, hand hygiene, cleaning and the causes of adverse incidents to their bimonthly open board meetings. That information will be transparent and public and it is a vital part of our plans for local reporting systems.

I have no doubt that reports to bimonthly health board meetings will be welcome. Will the public be able to monitor online the performance of hospitals? The public can look at information online in their own time and at their leisure.

Information that is made public is normally able to be monitored by the public. I assure Wendy Alexander that, as with other information from NHS board meetings, the reports will be available online. I am glad that she welcomes the reform and I hope that she welcomes the other substantial reforms that we are making to the monitoring, control and prevention of infection in our hospitals. I like to think that every member will come together to agree that that is a top priority.

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NHS Orkney (Computed Tomography Scanner)

To ask the Scottish Executive what discussions it has had with NHS Orkney regarding the benefits of locating a CT scanner in Orkney. (S3O-5135)

Within the framework of national priorities, national health service boards are responsible for assessing the need for local services. It is therefore for NHS Orkney to consider the case for a CT scanner, and I am aware that it has been doing so.

Dr Bob Hazlehurst, who is NHS Orkney's stroke lead and a key player in its award-winning stroke telelink service with Aberdeen, firmly believes that having a scanner on Orkney is now essential to the delivery of high-quality care to patients in my constituency. As I am sure the cabinet secretary is aware, Dr Hazlehurst is preparing a cost benefit analysis of such provision for the NHS Orkney board.

Does the cabinet secretary accept that many of the savings from having a locally based scanner would arise from a reduced need for patient transfers to and from Aberdeen and stays at Aberdeen royal infirmary? While such savings would be welcome, does she recognise that they would accrue to NHS Scotland and Scottish Ambulance Service budgets, which would make it impossible for NHS Orkney to factor them into its calculations? Can she reassure my constituents that, before any final decision is taken, a comprehensive cost benefit analysis will be carried out?

That was almost a speech.

I will try to avoid making a speech in response, Presiding Officer.

I recognise the strength of clinical feeling on Orkney about the benefits that could arise from having a CT scanner on the islands. As the member is aware, in visiting NHS Orkney over the summer to conduct its annual review, I detected directly the strength of feeling. It is for NHS Orkney—as for any other board—to assess the demand for and benefits of any such capital development. That is what NHS Orkney is doing.

As the member is aware, NHS boards receive revenue and capital funding allocations. For additional capital funding allocations to cover projects that cost more than £5 million, island boards are required to prepare a business case and submit it to the Scottish Government for consideration and approval. It is likely that a CT scanner for Orkney would come into that category. The Scottish Government is happy to consider a business case should one be submitted. If a CT scanner were to be introduced into the islands, savings would arise, not least, of course, for NHS Orkney.

What is the cabinet secretary's response to the Auditor General for Scotland's deficit funding report, which shows NHS Orkney's recurring deficit to be 2.7 per cent this year and predicts that it will be 6.7 per cent next year? Other island boards and NHS Highland also show a deficit. How will she ensure that boards are adequately supported and that they can afford equipment such as CT scanners?

You just made it, Dr Simpson.

I have three points to make. You will be glad to hear that I will make them briefly, Presiding Officer.

First, I am sure that Richard Simpson meant to but simply forgot to congratulate the NHS on the findings of the Audit Scotland report, which was published today and shows that the NHS is in good financial health and is making good efficiency savings that are being reinvested in front-line patient care.

Secondly, when mentioning the financial position of NHS Orkney, I am sure that Richard Simpson also forgot to point out that, only a few weeks ago, I allocated an additional £500,000 to NHS Orkney to bring it up to parity under the funding formula. That is another important fact that it would have been appropriate for Richard Simpson to mention in his question.

Thirdly, I ask Richard Simpson to reflect on the damage that will be done to NHS Orkney and the whole NHS if Labour's cuts to the health service—indeed, to the entire Scottish budget—go ahead.

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St Margaret of Scotland Hospice (Funding)

To ask the Scottish Executive what action it is taking to prevent NHS Greater Glasgow and Clyde from withdrawing funding from St Margaret of Scotland hospice in Clydebank in light of public and political support for its continued existence. (S3O-5133)

The continued existence of St Margaret of Scotland hospice is not in doubt. As the member is aware, NHS Greater Glasgow and Clyde is responsible for planning, providing and securing the provision of national health service services for its population. St Margaret's receives NHS funding for particular services that it provides, and the nature of those services determines the type of funding that is provided. NHS Greater Glasgow and Clyde continues to work with the board of St Margaret's on the services that could be provided in line with the NHS board's overall approach to the care and health needs of the population.

With all due respect to the cabinet secretary, I am afraid that I find unhelpful the comment:

"The continued existence of St Margaret of Scotland hospice is not in doubt."

The cabinet secretary is well aware that NHS Greater Glasgow and Clyde appears to be willing to keep the building open but has no intention of allowing it to continue as a hospice. That is the nub of the question. In its latest letter to the management of the hospice, dated 13 November, NHS Greater Glasgow and Clyde sets out alternative means by which St Margaret's might remain open, but they do not include services that would use the skills of the nursing staff at St Margaret's or its skills as a hospice. I repeat my question: what steps will the cabinet secretary take to ensure that St Margaret's continues as a hospice?

With the greatest respect to Ross Finnie, it is incumbent on him when dealing with an issue as serious as this to familiarise himself fully with the facts and not to scaremonger needlessly in the chamber. He should be aware that NHS Greater Glasgow and Clyde's proposals affect not palliative care provision at St Margaret of Scotland hospice but continuing care bed provision. I support the work of the hospice, which I have visited, but, when funding services that are provided by voluntary organisations, NHS Greater Glasgow and Clyde and all other NHS boards must consider the needs of the populations that they serve.

Discussions between the board of NHS Greater Glasgow and Clyde and the board of the hospice are on-going. I understand that NHS Greater Glasgow and Clyde has proposed two options that would secure the hospice's future and that, because no response has yet been forthcoming from the hospice, no formal proposal has been put to the board of NHS Greater Glasgow and Clyde. I encourage both organisations to continue positive dialogue, in the interests of the people and patients whom they both serve.

The minister is being disingenuous. She knows very well that the removal of two thirds of the funding that goes to St Margaret of Scotland hospice will make it very difficult for it to survive as a palliative care centre. At present, relatives of patients are being told by consultants that, because no new continuing care patients will be admitted to the hospice, there is no point in patients being placed on a waiting list for admission. It is not right that people are being diverted from the excellent facilities at St Margaret's to the dilapidated facilities at Blawarthill hospital, just along the road. Does the minister accept that St Margaret's delivers outstanding care to both continuing and palliative care patients and that the co-location of continuing and palliative care benefits patients and their relatives?

I have already said what I think about St Margaret of Scotland hospice. I hope that all members accept that any NHS board or other statutory agency that commissions services from another agency must ensure that it commissions services that reflect the needs of its population. I would like the issue to be resolved without delay, because that is in the interests of everyone concerned.

I understand that the board of NHS Greater Glasgow and Clyde has put two options to the hospice's board, which I encourage to respond to those options. I also encourage both organisations to have a constructive dialogue that will lead to a resolution. I hope that all members, whatever their party, who have the concerns of the people involved genuinely at heart will do likewise.

Does the cabinet secretary consider that sufficient progress has been made towards addressing the issue of future service provision?

It probably goes without saying that I would have liked progress towards resolving the situation to have been made faster. Those who can resolve the situation are the board of NHS Greater Glasgow and Clyde and the board of the hospice. I encourage both sides to discuss the proposals that have been made, so that a resolution can be found that is right for the populations that NHS Greater Glasgow and Clyde serves and that allows St Margaret of Scotland hospice to continue doing its work.

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NHS Greater Glasgow and Clyde (Meetings)

To ask the Scottish Executive when ministers last met with the chief executive of NHS Greater Glasgow and Clyde. (S3O-5089)

I last formally met the chief executive of NHS Greater Glasgow and Clyde on 18 August, when I chaired the board's annual review. Most recently, I saw him yesterday at the opening of Springburn health centre, when he updated me on the record attendances at accident and emergency units throughout the board's area on Tuesday. We agreed that the staff had done a sterling job.

I am sure that, from her discussions with the chief executive, the minister is aware of the widespread concern about the recent review of the health visitor service in greater Glasgow. Does she agree in principle that health visitors should continue to be attached to general practitioner surgeries? If so, will she give me or GPs that assurance in writing?

Not only do I agree with that in principle, but if Ken Macintosh cares to read the principles that have now been agreed between Greater Glasgow and Clyde NHS Board and the local medical committee, he will see that they state that every GP practice will continue to have an attached health visitor within the primary health care team. That principle is now recognised by everyone involved. I am pleased that the principles have been agreed and I encourage GPs, staff, stakeholders and, indeed, the health board to continue discussing the issues and taking them forward in a spirit of consensus.

Is the cabinet secretary aware of suggestions that Greater Glasgow and Clyde NHS Board is introducing a number plate recognition scheme as an alternative to the hated hospital car parking tax, with fines applying after four hours? Does she agree that while the scheme, if confirmed, will certainly address casual commuter parking, it is debatable whether the period will be long enough for patients, it is doubtful whether it will be appropriate for volunteers, and it will leave nursing and auxiliary staff even worse off than they are now? Will the cabinet secretary undertake to discuss the matter with the chief executive of Greater Glasgow and Clyde NHS Board, with a view to safeguarding the interests of all hospital car park users?

I know that Jackson Carlaw supported the Administration's decision to abolish car parking charges at hospitals, which was a positive development that will benefit patients, staff and visitors. As a result of the decision, all the affected boards were asked to submit alternative car park management strategies to the Scottish Government. They have either done so or are in the process of doing so, and we will scrutinise and consider the plans carefully to ensure that they are fair to patients, visitors and staff.

It is no secret—and nobody in the chamber should ignore the fact—that there is enormous demand for car parking at some of our hospitals and that demand is often bigger than the supply of car parking spaces. Hospitals and boards have to manage that, but they should do so in a way that is fair. That will be the guiding principle as we scrutinise the policies.

Question 12 has been withdrawn.

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Scottish Ambulance Service (Savings)

To ask the Scottish Executive what savings it expects the Scottish Ambulance Service to achieve in the current financial year. (S3O-5098)

The 2 per cent efficient government savings target for the Scottish Ambulance Service in 2008-09 amounts to £3.668 million, and the service is forecast to achieve that sum in recurring cash revenue savings. In addition, non-recurring capital and productivity savings of £1.67 million are forecast. Those savings will be retained by the Scottish Ambulance Service for reinvestment.

Is the minister aware that the Scottish Ambulance Service predicts a saving of £160,000 from reducing the number of paramedics that it uses during night-time helicopter flights? According to the service's budget papers, the change will result in a reduced potential to treat some patients. Does the minister believe that the relatively small financial saving is worth the increased risk, albeit that the money will be reinvested in other parts of the service?

It is up to the Scottish Ambulance Service to make decisions about the provision of the service as long as it provides a safe, good-quality service to the public and the patients that it serves.

Peter Peacock glosses over the central point in the debate, which is that every single penny of the efficiency savings that the Scottish Ambulance Service or any other national health service board achieves is reinvested in front-line care. So far this year, the Scottish Ambulance Service has invested in 30 additional front-line accident and emergency ambulance crews, including the vehicles and their running costs, and 10 additional posts in the emergency medical dispatch centres that deal directly with the public. It has also made other significant developments.

In all seriousness, I think that there is a real issue about members of the Labour group getting up in the chamber and complaining about efficiency savings that are being reinvested in front-line services when the party that they represent intends to impose £500 million-worth of cuts in the Scottish Government budget, which will result in real problems for NHS services across the country. Of course, that is without taking into account the £130 million that the United Kingdom Government intends to remove from the Scottish health capital budget, which will create serious problems for the Scottish Ambulance Service. I suggest that Peter Peacock turn his attention to that issue.

The cabinet secretary will be aware that, following the transfer of an ambulance station to Ballater, the local community in Braemar has become involved in developing an ambulance service for the area. Will the cabinet secretary urge the Scottish Ambulance Service to take the same approach in other parts of the country? Does she agree that it is important for the service to evaluate what it is doing in Braemar?

The Scottish Ambulance Service should—and, indeed, will want to—evaluate the approach and learn and apply any lessons that emerge. It is incumbent on the service to find innovative ways of delivering services to patients, particularly in our rural communities. As I have said before and will no doubt say many times in the future, people who live in areas where delivering public services is more difficult are still entitled to the same quality of service. How that service is delivered will vary from area to area, and the Scottish Ambulance Service is leading by example in putting in place innovative and imaginative solutions.

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NHS Grampian (Cancer Referrals)

To ask the Scottish Executive what percentage of referrals for cancer treatment in NHS Grampian are seen within 62 days. (S3O-5061)

In December 2000, it was announced in "Our National Health: A plan for action, a plan for change" that, by 2005, the maximum wait from urgent referral to treatment for all cancers would be two months. Quarterly performance statistics showing progress against the 62-day target, broken down by national health service board and cancer type, have been published from October 2004 and are available on the Scottish Government website. NHS Grampian's latest performance for patients diagnosed from April to June 2008 is 89.9 per cent.

Is the cabinet secretary satisfied with the progress that has been made, particularly on colorectal cancer? Has she had any more discussions on how waiting times might be reduced further?

No, I am not satisfied with progress, and I will not be satisfied until boards are delivering sustainably on the 95 per cent target. According to the latest figures, performance stands at 93 per cent, although there has been significant improvement across Scotland, with a 6.2 percentage point increase over the past year. Significant progress has been made on a target that has been in place for some time, but I want further action to ensure that the target is met not only across Scotland but in every NHS board.

As the member rightly points out, colorectal cancer is a particular issue in NHS Grampian. Melanoma is another concern, and such issues are being actively pursued by the Scottish Government cancer performance support team, which is establishing a programme of visits to boards and targeting, in particular, colorectal pathway improvements. NHS Grampian will be included in that round of support.

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Epilepsy Specialist Nurses

To ask the Scottish Executive how many specialist epilepsy nurses are employed in the national health service and what action it has taken to increase this number. (S3O-5099)

We understand from Epilepsy Scotland that in Scotland there are 24 epilepsy specialist nurses: 11 for adults, seven for children and six for people with learning disabilities. We very much recognise the value that people with epilepsy attach to having access to an epilepsy specialist nurse and welcome the fact that the draft clinical standards on epilepsy, which were published on 24 November by NHS Quality Improvement Scotland, highlight the important role that epilepsy specialist nurses play in the provision of services.

I agree with the minister's comments on the role played by epilepsy specialist nurses in providing services. However, is she aware of and will she look into the real shortage of epilepsy specialist nurses for children?

As I said, NHS QIS's draft clinical standards on epilepsy will play an important role in ensuring that health boards consider the role of specialist nurses in their areas. For example, the managed clinical network approach is a good way of involving specialist nurses in the delivery of services. The draft epilepsy standards recommendation that services be organised through an MCN approach will, I am sure, be of great relevance to children's services as well as adult services.