SCOTTISH EXECUTIVE
Health and Wellbeing
Energy Assistance Package
To ask the Scottish Executive what progress there has been with implementation of the energy assistance package. (S3O-8300)
In its first six months, the energy assistance package has helped more than 16,000 households in Scotland to reduce the proportion of their incomes that they spend on fuel. Yesterday, I announced that we would extend the package to many more homes in Scotland as soon as the regulations can be amended. We will widen the definition of an energy inefficient house to include those with a standard assessment procedure rating that would put them in band E on an energy performance certificate. I also announced that we will provide local authorities and registered social landlords with up to £2.5 million of additional funding for stage 3 work in the social sector.
I am delighted that my lodging a question led to that rushed announcement by the minister yesterday to try to rescue a policy that is clearly failing. By the end of September, only 429 energy assistance package systems had been installed throughout Scotland, which includes legacy projects from the central heating programme. That is a substantial tail-off in the rate of installations, given that as many as 16,000 systems per year were installed under the former central heating programme. Is the minister aware that only 19 systems were installed in the whole of my vast region of the Highlands and Islands? Part of the reason for that is the lack of availability of mains gas. In those circumstances, people are offered inefficient and costly-to-run electric storage heaters or oil systems. If they go for oil, the scheme rules mean that they have to find significant sums to proceed.
Do you have a question, Mr Peacock?
What will the minister do to ensure that my constituents do not continue to be disadvantaged by his policies?
As the member probably knows, the current package was based on the recommendations of the fuel poverty forum. The forum made representations to me about the need to make changes to the eligibility criteria. As I said, I have agreed to do that. I have asked the fuel poverty forum to consider the wider eligibility criteria for the groups that are entitled to benefit from the programme. The forum will report back to me in due course on whether a widening of the eligibility criteria is required. I am sure that the member will be delighted that, given the backlog of people who are in band E, the reforms that I announced yesterday should result in a tenfold increase at stage 4.
Homeless Services (Edinburgh)
To ask the Scottish Executive whether it agrees with the City of Edinburgh Council's decision to put its homeless services out to tender. (S3O-8279)
Local authorities are responsible for providing or procuring local services to tackle and prevent homelessness. The decision whether to put homeless services out to tender is therefore for the City of Edinburgh Council. It is the council's responsibility to ensure that local services are aligned with the Scottish Government's objectives on addressing homelessness and that resources are used in the most effective way to deliver its strategic outcomes.
Is the minister aware that, under the Scottish National Party-Liberal Democrat council in Edinburgh, there are no longer any council-run addiction services for homeless people and that the number of support hours for people with multiple needs has been cut? Those are people with recurring homelessness, combined with alcohol or drugs addiction, a history of abuse and, in some cases, learning disability. Also, just before Christmas, the council will close its night shelter. Surely the minister must agree that, when vulnerable people will end up in hospital wards, police stations or prison cells, the matter becomes the Scottish Government's responsibility. What representations will he make to the City of Edinburgh Council to ask it to rethink its decision?
I remind the member that the City of Edinburgh Council has an A listing from the regulator for its homelessness services. On the impact of the tendering procedure, we have been absolutely assured by the council that there will be no reduction in capacity of any of the services and that the council will ensure that the outcomes that the services are designed to deliver will be achieved.
I remind members that this item of business is questions to ministers, not stories to ministers.
Does the minister agree that the decision to tender homelessness services in Edinburgh might have been influenced by the amount of money that is raised in rent and which goes to paying off historical housing debt within the city, which stands at more than 40p in every pound? Does the minister agree that if Lord Foulkes and the Labour Party want to see an end to homelessness in Edinburgh, they should lobby the United Kingdom chancellor to end the historical housing debt in Edinburgh and the rest of Scotland?
I agree with every word that Shirley-Anne Somerville has just said.
Infertility Services
To ask the Scottish Executive what actions it has taken in the last six months to remove the perceived postcode lottery and improve the availability of infertility services and standards for patients across Scotland. (S3O-8277)
In the past six months, we have announced that we are funding Infertility Network Scotland to work with national health service boards during the next three years to ensure fairer access to treatment and offer patients a direct influence on the future direction of infertility care. I recently wrote to the chairs of NHS boards asking for their assistance with that work. We are also in the final stages of setting up a national group to look at many long-standing issues surrounding infertility services across Scotland.
Does the minister accept that although this is a historical problem not of her making, she is in the powerful position of being able to make change happen? Does she accept that the working group and review that she is talking about have not put a single penny at the sharp end where our constituents are crying out for access to NHS services? Does she accept that there is definitely a major case of rationing and point-blank refusal to fund patients by the Scottish Government? What will the minister do to address the problem of patients being compelled to go private because the NHS refuses them treatment? Will she, at the very least, pay the cost of the drugs that they require, which can amount to several hundred pounds if hormone stimulation is required? Finally, when couples have to move—
As I said, this is questions to ministers. There is an s at the end of "questions", but we need a singular question from you, Ms Eadie. Can you come to the end of your question, please?
Okay, Presiding Officer. Thank you.
Helen Eadie is correct to say that the problem is historical. Under the previous Administration, waiting times of five to six years for infertility services were not uncommon. This Government has tried to get to grips with the issue of infertility services by ensuring that there is a move towards equity of access.
Not a single penny at the sharp end.
Not from a sedentary position, Ms Eadie.
I ask the minister to recollect that the previous Executive took action in raising the age at which treatment could be provided, and I welcome any progress that can be made. Does the minister accept that couples should be able to be referred between health boards if there is indeed patient choice in the NHS?
We will be looking at a number of infertility services issues that require to be resolved. Some of those issues are quite complex and some are more straightforward, including those around guidance. Jackie Baillie called for national guidance, which has been around for quite some time; I am sure that she is now aware of that. We want to ensure that all boards are implementing that guidance; as I said, only a few boards have not done so. I have made that very clear. Indeed, I have issued another letter to chairs to ensure that they give priority to ensuring that the guidance is implemented. The focus of our work should be to ensure that every board makes the investment that is required in infertility services. We know that the boards that have invested in those services have addressed issues such as waiting times. I am sure that Jackie Baillie will welcome that.
I have challenged questioners. In terms of equality, I now ask ministers to please be careful about the length of their answers. I may stop them, too.
Regeneration (Glasgow)
To ask the Scottish Executive when it will bring forward proposals for the regeneration areas in Glasgow and details of how in particular the areas of Gallowgate and Laurieston in the Glasgow Shettleston constituency will be affected. (S3O-8288)
It is a matter primarily for Glasgow City Council and Glasgow Housing Association to bring forward proposals for regeneration, but the Scottish Government has been working closely with them to ensure progress.
Briefly, what measures will be taken through the special purpose vehicle to ensure that the voices of local residents are central to the regeneration of those areas?
I am glad to say that the local steering group in Laurieston has already been convened—indeed, it met last week. The council will reconvene the Gallowgate group before Christmas with the intention of holding a meeting before Christmas.
NHS Lothian (Elections)
To ask the Scottish Executive what has been—oops, I am reading the wrong question. I will start again.
Wrong question then short question—a short answer would be good.
I hope that the difference will be noticed in the answer.
I am sure that the cabinet secretary agrees that the non-statutory pilots provide an ideal opportunity for boards—in this case, NHS Lothian—to increase patient involvement and further democratise health boards. Does she accept that patient forums could, for example, be expanded and used as a constituency from which to elect board members? If so, is the suggestion worthy of fuller exploration and consideration?
I thank Angela Constance for her interest in the subject. I very much agree that the non-statutory pilots are an opportunity to improve public involvement and engagement—indeed, that is their very objective. They also provide a point of comparison with the elected health board pilots, which will allow the Parliament at a later date to evaluate and decide on the best way forward.
One suggestion around democratisation and participation that the Health and Sport Committee heard at the time of its consideration of the Health Boards (Membership and Elections) (Scotland) Bill was for increased representation of both councillors and patient groups at the level of the community health partnerships. Following that discussion at committee, has the cabinet secretary looked into the suggestion and will she issue guidance on the matter?
Richard Simpson is absolutely right. The suggestion was raised along with a host of other ideas at committee. As a result of those discussions, I brought forward—at stage 3 of the bill, I think—suggestions for alternative pilots to the statutory elected health board pilots. The bill was passed by the Parliament on the basis of the general form of the non-statutory pilots, but I am always open to considering and discussing other ways in which to increase public engagement in NHS boards. However, we are about to embark on two elected and two non-statutory pilots. It is right for the Parliament properly to assess and evaluate those before taking specific decisions about further steps.
Electronic Patient Records
To ask the Scottish Executive how many simultaneous users of the clinical portal the system is being designed to handle and how long it will take for a typical electronic patient record request to be completed and delivered when the system is used at maximum capacity. (S3O-8345)
The overall strategy for the portal programme will be agreed by the clinical portal programme board, which will meet for the first time later this month. The detailed design and capacity of systems, including the target number of users and the target speed of system response, will be determined by boards to meet the needs of their local clinicians. The member will be aware that there is no plan to create a single national database of patient records, so portal services to support clinicians will be developed more locally.
When will the electronic patient record be available for delivery through the portal, once the clinical portal technology has been implemented?
The clinical portal will, in and of itself, provide access to what we are referring to as the electronic patient record. In a sense, it is the electronic window on that information, which will be available in a much easier and more integrated fashion. We see the clinical portal concept as delivering information that is assembled virtually from existing information sources, rather than as creating a new database. It is an incremental, sensible and pragmatic way of building the electronic patient record.
What guarantees can the cabinet secretary offer that only those with the patient's informed consent will have access to the contents of electronic records?
Systems that provide access to information electronically are in place at the moment; I am thinking specifically of the emergency care summary. There are clear rules and regulations about who can access that information and in what circumstances. The same will apply to any information that is available electronically.
Dentists (Highlands and Islands)
To ask the Scottish Government what is being done to attract and provide incentives for national health service dentists to relocate to the Highlands and Islands. (S3O-8330)
Although the Scottish Government has introduced no incentives specifically for the Highlands and Islands, those areas are designated for the purposes of payment of golden hellos. The golden hello payable in a designated area is double that in other areas. A number of other grants and allowances, including a remote area allowance, have been introduced over the years to recruit and retain dentists in general dental services in Scotland.
One constituent told me recently that the waiting list at Dunvegan dental clinic on Skye is around 350. When I raised the issue with NHS Highland, it suggested that the constituent could travel to the practice in Acharacle—95 miles and a ferry trip away in Lochaber—which was taking on NHS patients. In light of that totally unacceptable situation, what is being done specifically to improve the situation in Skye and Lochalsh?
NHS Highland has found it challenging to recruit to dental posts in Skye and Lochalsh, but has taken a number of steps to resolve the situation. It has invested in a modern two-surgery dental clinic in the new health centre in Kyle of Lochalsh, which opened in 2008. Capital is in place to build a four-surgery dental facility in Portree; the anticipated opening date for the new facility is December 2010. In the meantime, the existing two surgeries in Portree have been relocated to temporary accommodation that provides an improved working environment. I hope that those developments give the member some reassurance that a lot of action is being taken.
I thank the minister and her team for today's announcement about a new Migdale hospital.
It is a serious problem. The issue of did not attends has been a challenge not only for dental services, but for the health service generally. Many initiatives have been undertaken to try to deal with the problem, such as texting and phoning to remind people about their appointments. We must do what works to reduce the number of did not attends, because Jamie Stone is right to identify that they represent hours lost and appointments lost to other people.
Rural Communities (Health and Wellbeing)
To ask the Scottish Government what steps it is taking to improve the health and wellbeing of communities in rural areas. (S3O-8309)
"Delivering for Remote and Rural Healthcare", published by the Scottish Government in November 2007, sets out a vision and provides a framework for a sustainable health system for remote and rural Scotland. That complements the implementation of "Equally Well: Report of the Ministerial Task Force on Health Inequalities", which will see the Scottish Government, NHS Scotland, local authorities and the third sector work together to tackle health inequalities across the country.
Will the minister join me in acknowledging the excellent work of Healthy Valleys, which works to improve the health and wellbeing of communities that are affected by rural deprivation in the Clyde valley, and Clydesdale Community Initiatives, which supports young people at risk and adults with learning difficulties in rural South Lanarkshire? Both organisations are finalists in prestigious award ceremonies next week. Will she join me in wishing them and all the finalists the best of luck?
I am delighted to wish both organisations the best of luck at the award ceremonies in which they are taking part next week. It is good that such ceremonies exist to recognise and celebrate very good community work.
Given previous concerns over ambulance provision in remote and rural areas, how will the Scottish Government encourage ambulance workers into the Highlands—for example, to north-west Sutherland—when the posts that are available are mainly part-time posts? Secondly, is it acceptable that ambulance workers in Highland do not get paid for standby shifts?
First, I acknowledge the importance of Mary Scanlon's question. Parliament has discussed ambulance issues in general, but has also done so particularly in relation to remote and rural communities, on many occasions.
Fuel Poverty
To ask the Scottish Government what steps it is taking to combat fuel poverty. (S3O-8329)
The energy assistance package replaced the central heating and warm deal programmes on 6 April. It is a more holistic approach that tackles all sides of the fuel poverty triangle: helping to maximise household incomes though benefits and tax credit checks; reducing fuel bills by providing advice on wise energy use and access to social tariffs; and improving the energy performance of the poorest performing Scottish homes by providing a package of measures for those most vulnerable to fuel poverty, including, for the first time, intensive support for low-income families with young or disabled children.
As I am sure the minister is aware, Macmillan Cancer Support in Scotland found that cancer patients in the Lothians are twice as likely as the United Kingdom average to face fuel poverty. One in five cancer patients is turning off their heating, despite the fact that they are cold, because they are worried about their rising fuel bills. What representations has the Scottish Government made to the UK Government regarding winter fuel payments, with a view to extending them to cancer patients who need them?
We have made representations not only on winter fuel payments, but on cold weather payments. In addition, we have been working with Macmillan Cancer Support to ensure that income maximisation advice and support are provided to cancer patients throughout Scotland. That has been a very successful service for a number of years.
The minister will be aware that many MSPs have heard concerns from constituents who are having to wait months for the energy assistance package measures to be carried out—in fact, Scottish Gas is quoting a wait of up to six months for central heating systems. What is the minister's response to the Scottish fuel poverty forum's recommendation to introduce a fast-track system for homes that are assessed as being eligible for EAP measures, in order to help the most vulnerable households?
One of the reforms to the energy assistance package that I announced yesterday is specifically to deal with the question of what happens between stage 3 and stage 4 of the programme. There had been an unnecessary delay for those who qualified for stage 4 but had to wait for stage 3 to be completed before they were referred to stage 4. With immediate effect, we will now ensure that those who qualify for stage 3 and stage 4 will have both stages taken together, instead of having to wait for stage 3 to be completed before they move to stage 4.
Healthy Living Centres (Glasgow)
To ask the Scottish Government what it is doing to promote the development and promotion of healthy living centres in Glasgow, given the long-term health inequalities that exist in the city. (S3O-8319)
The Scottish Government recognises the valuable contribution that healthy living centres make to reducing health inequalities, and has established a transition fund to help lottery-funded centres achieve sustainable futures. We have so far provided more than £900,000 to support healthy living centres in the NHS Greater Glasgow and Clyde area. The health board in Glasgow is also working with healthy living centres and other community health initiatives to help them to sustain their good work for the future.
I thank the minister for that encouraging reply. Does she agree that, given that many of those who access healthy living centres live in intergenerational poverty, education on low-cost healthy eating should be as widespread as possible?
I certainly agree with that. The healthy living centres' most valuable work is to serve communities with the highest levels of deprivation, where, of course, many of them are located. Having visited some of the centres and having heard about some of their work, I know that innovative work is going on in those areas, which I encourage members to support.
Given the need to tackle the long-term health inequalities that exist in the city, does the minister think that it is acceptable that the number of health visitors in the Glasgow Springburn medical centre has been reduced from three to one and that the Possilpark medical centre has been without a health visitor for the past four weeks? That story is repeated across the health board area, so will the minister intervene to tackle the chaos that is unfolding with regard to provision of health visiting?
I will certainly look into the circumstances that Jackson Carlaw describes, but I do not agree with his description—which I do not think is helpful—of the situation as "chaos". If he wants me to look into the specific issue about the Springburn health centre, I am happy to do so and I will get back to him about it.
Pre-diabetes (Identification and Support)
To ask the Scottish Executive what measures are being taken to identify and support the 600,000 people estimated to have pre-diabetes. (S3O-8304)
Tackling non-diabetic hyperglycaemia requires the detection of people at risk. They can be offered either lifestyle advice or treatment. Our keep well programme is an example of that approach in action.
The minister will be well aware of the figures that have been released by Diabetes UK, which estimate that some 15 per cent of the population has pre-diabetes or impaired glucose regulation. That includes 37,500 people in the Highland NHS Board area. Does the minister share my view that people with pre-diabetes have the chance to reverse the condition through losing weight, adopting a healthy, balanced diet and increasing their physical activity? Is the long-term solution early intervention through targeted high-risk screening for type 2 diabetes, particularly focused on those who are overweight, over 45 and have a family history of the condition?
I agree that healthy eating and physical activity are important steps that can be taken to prevent the onset of diabetes. David Stewart also asked about screening. He may already be aware that, at the request of the Scottish diabetes group, the Scottish public health network has conducted a type 2 diabetes needs assessment. The report on that is expected to include recommendations on screening for diabetes and non-diabetic hyperglycaemia, and will be published early next year, following a national stakeholder review in December.
Given the previous discussion about patients who are overweight and the prevalence of diabetes that being overweight generates, will the minister confirm whether she is happy that the national health service is doing enough to assess individuals' weights and give them the advice that they need?
We are doing a lot more than was previously done in recognition of what a big issue and challenge it will be for the health service if we do not get to grips with the matter and ensure that we have a series of interventions. Weight is, of course, included in the screening and health check in the keep well programme, and people are referred on appropriately. We have rolled out the counterweight programme within the NHS to ensure that people get the support that they require. However, more can always be done and I am happy to take forward any suggestions.
Stillbirth (Classification)
To ask the Scottish Executive whether it will consider changing the method of classifying causes of stillbirth. (S3O-8281)
Work is in the planning stages for a proposal to survey international coding systems and to seek agreement from the clinical community to change our coding and classification systems to take cognisance of improvements in placental pathology and improved coding systems in other countries.
Does the minister agree that an improved method of classification could lead to better understanding of patterns of causation of stillbirth?
I am certainly hopeful that the work that is under way will consider all such issues. I am happy to keep Charlie Gordon updated on progress.
Question 13 was not lodged.
Winter Deaths
To ask the Scottish Executive how it will respond to recent figures showing more than 3,500 additional winter deaths in 2008-09. (S3O-8291)
Reducing the number of additional winter deaths is a key priority for the Scottish Government. The causes of additional deaths in winter are complex and there is no simple solution to the problem. The long-term trend is clearly downward, although figures can fluctuate from year to year.
Will the minister confirm that only 10 central heating systems have been installed in the whole of East Renfrewshire under the new terms of the Scottish Government's central heating programme? Is that an appropriate response to the worrying rise in winter deaths?
As I indicated earlier, I announced yesterday a number of reforms to the energy assistance programme that should result in a significant increase in the number of stage 3 and 4 installations not only in Mr Macintosh's constituency, but throughout Scotland. I am sure that he will welcome those measures.
Psychogeriatric Hospital (Sutherland)
To ask the Scottish Executive what progress has been made in building and bringing into use the new psychogeriatric hospital at Migdale, Sutherland. (S3O-8317)
The full business case that supports a new-build facility at Bonar Bridge was discussed by the health directorates capital investment group at its meeting on 22 September. My officials have since liaised with NHS Highland on a range of outstanding issues. However, I am pleased to say that the project has now been approved, and the development is expected to proceed as planned.
I thank the cabinet secretary for her long-standing support for the Migdale project. I hope that she agrees that the kind of scaremongering by the Liberal Democrats that has upset many older people in the area has raised questions about whether their kind of opposition has helped at all, and that the consistency of the SNP Government in delivering it is, in fact, the real message to come out of today.
I am trying to get my head round the notion of Liberal Democrats being scary. I think of them as many things, but that is not one of them.
Health Inequalities
I will try not to be too scary.
The Scottish Government's commitment to tackling health inequalities was set out in "Equally Well: Report of the Ministerial Task Force on Health Inequalities". We expect action to tackle health inequalities to be prioritised in single outcome agreements, alongside action on the Scottish Government's other major social policy frameworks—the early years framework and the achieving our potential framework.
Cancer figures that were released last week show that mortality rates for all cancers combined are approximately 75 per cent higher in the most deprived areas than they are in the least deprived areas of Scotland. Does the minister agree that that is entirely unacceptable in 21st century Scotland? What actions is the Government taking to address those figures?
We accept, despite the fact that we are providing state-of-the-art cancer treatment—of course, the prognoses and survival rates for cancer patients are much better than they were many years ago—that there is still a gap between the mortality rates of people in the most deprived areas and those in the least deprived areas. There are many reasons for that. For example, there are issues around the underlying health of people and late presentation. Certainly, it was recognised very much in "Better Cancer Care, An Action Plan" that we need to ensure that we can encourage people and get to them early enough, because we know that the prognosis is so much better if we do. However, I am happy to write to Margaret Smith with more detail on the matter, if that would be helpful.
Before I call Bill Aitken, I remind members that, if they have a question, they should be in the chamber from the beginning of question time.
Minimum Pricing
To ask the Scottish Executive, in the light of the ruling by the European Court of Justice's advocate general that minimum pricing is "not necessary in order to protect public health" and represents a distortion of competition, whether it is satisfied that a policy of minimum pricing will not be ruled to contravene European Community law. (S3O-8341)
The directive that was considered in the opinion of the advocate general to the European Court of Justice in respect of tobacco pricing is specifically about the excise duty on tobacco. It is therefore inappropriate to translate the comments in that opinion about a specific directive to the imposition of a minimum price for alcohol for public health reasons.
The matter has been to some extent subsumed by this morning's debate, but does the cabinet secretary agree that the two issues are most certainly analogous? Is it not likely that the ruling that was applied to tobacco pricing will also apply to alcohol pricing?
As I said in this morning's debate, I accept that the introduction of minimum pricing involves challenges and hurdles that must be overcome, but I do not agree that the opinion on tobacco can be applied analogously to alcohol. If Bill Aitken has not read that opinion, I strongly suggest that he do so because it is based entirely on the specific wording of a specific directive that does not apply to alcohol. Yes—there are challenges, which Parliament will continue to discuss, but members should take care before making assertions about the legality of the proposals.
That concludes question time. We must move smartly on to the next piece of business.
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