Meeting of the Parliament

Meeting date: Wednesday, February 6, 2013

Official Report 714KB pdf

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Portfolio Question Time

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Health and Wellbeing

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NHS Lanarkshire (Future Plans)

1. Presiding Officer, it is very nice to see you back.

To ask the Scottish Government what discussions it has had with NHS Lanarkshire regarding the board’s future plans. (S4O-01769)

Can I just stop everyone saying how nice it is to see me back? I am delighted to be here, but everyone said yesterday that it was nice to see me back, so let us just take that as read. [Applause.]

I am moving straight to my answer: ministers and Scottish Government officials regularly discuss a wide range of matters of local importance, including future plans, with all national health service boards.

Does the minister share my concern that the Labour Party in Lanarkshire appears to be campaigning to close the mental health unit in Monklands hospital, which serves people from places across the region, including Cumbernauld, Kilsyth, Airdrie, Bellshill and district, Kirkintilloch and beyond? Does the minister agree that the campaign should be opposed and the unit should stay open?

I appreciate the strong local feeling in support of the in-patient mental health unit at Monklands hospital. At this stage, we have not received a proposal from NHS Lanarkshire for a major service change in mental health services. Should such a proposal be submitted to ministers, it will of course be given careful consideration.

In the context of work with NHS Lanarkshire on future plans, will the minister encourage the Cabinet Secretary for Health and Wellbeing to fulfil the promise that he made a few weeks ago to write to me with an explanation for the astonishing reduction in social unavailability—from 27 to 7 per cent between summer 2011 and 2012—that NHS Lanarkshire achieved? The cabinet secretary made that promise in the Parliament, but as yet he has been unable to fulfil it.

I have no doubt that the cabinet secretary will want to ensure that the member gets his reply within the next week.

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Individual Patient Treatment Request System

2. To ask the Scottish Government what its position is on the fairness and transparency of the individual patient treatment request system. (S4O-01770)

National health service boards are expected to take full account of Scottish Government guidance when dealing with individual patient treatment requests for medicines that have not been accepted for routine use in the NHS in Scotland.

The guidance provides NHS boards with a framework to support consideration of IPTRs, to achieve a consistent approach. It makes clear that, as a matter of good practice, NHS boards should ensure that IPTR decisions are communicated to the patient or their representative by the clinician who is responsible for the patient’s care. The guidance clarifies that the decision should be accompanied by a letter from the chair of the IPTR panel, to provide a summary of the rationale for the decision and to set out the circumstances under which an appeal can be considered.

If a patient has concerns about fairness or transparency in relation to their IPTR, their concerns should be discussed with the requesting clinician. The Scottish Government guidance includes a section that describes the circumstances under which an IPTR appeal can be considered.

The recently announced new medicines review includes a strand of work to examine the current IPTR arrangements and advise on whether changes are needed to them.

The guidance to which the cabinet secretary referred is dated 17 May 2010, and its key features make its direction of travel quite clear. The cabinet secretary will not be surprised that, at a recent meeting of the Health and Sport Committee, concern was expressed about the application of the guidance. My experience of being involved in cases in the system suggests that the guidance is not adhered to. Will the cabinet secretary take steps to ensure that the guidance is adhered to?

If the member sends me details of where the guidance has not been adhered to, I will have the matter investigated and a timeous response sent to him.

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Prescribed Drugs (Waste)

3. To ask the Scottish Government how national health service boards ensure that general practitioners reduce the unnecessary waste of prescribed drugs. (S4O-01771)

The prescribing workstream of NHS Scotland’s efficiency and productivity programme is addressing medicines waste in a number of key areas.

Scottish Government guidance, “Appropriate Prescribing for Patients and Polypharmacy Guidance for Review of Quality, Safe and Effective Use of Long-Term Medication”, which was issued in November 2012, provides guidance and recommendations on how to manage patients who are taking multiple drugs. It promotes the idea that, by further optimising the therapeutic benefit of complex treatment, there will be a resultant reduction in medicines waste. The process includes stopping drugs that are of reducing benefit and increasing risk, particularly with the frail elderly.

Repeat medicines are also being addressed by a project that promotes a more in-depth review of repeat medicine lists. Careful management of repeat medicine lists will reduce the potential for the overordering of medicines that are not required by the patient.

All other areas of the prescribing workstream, including the 12 national therapeutic indicators, promote quality and cost-effective prescribing, a key aim of which is to reduce medicines waste.

The Scottish Government is promoting compliance with NHS boards’ local joint formularies as a key means of reducing the use of drugs that are considered less suitable for prescribing as identified in the Audit Scotland report “Prescribing in general practice in Scotland”, which was published last month.

I was encouraged to read in the Audit Scotland report about NHS Greater Glasgow and Clyde’s invest-to-save initiative. What can the cabinet secretary do to ensure that the initiative is rolled out to other NHS boards in Scotland?

We are taking forward the issues in the report. The Auditor General made a number of recommendations that are designed to increase the quality and cost effectiveness of prescribing. We intend to implement those proposals throughout the entire country.

Nanette Milne.

I think that the total estimated savings are £26 million a year.

The moral is: do not pause for breath. Nanette Milne.

Given the demographic changes that are facing communities throughout Scotland and the projected increase in the number of people with multiple health pathologies, which will presumably result in a corresponding increase in the volume of prescribed drugs, what assessment has the Scottish Government made of the cost of that to the NHS, should current levels of wastage continue?

As I said in my first answer, under the efficiency framework we are constantly reviewing prescription practices and analysing where there is waste in the system. Steps have already been taken to reduce waste and save a substantial amount of money every year. We will now take forward the recommendations in the Auditor General’s latest report, which, if fully implemented, it is estimated can save another £26 million a year through the prevention of wastage resulting from overprescribing. We will do that.

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NHS Greater Glasgow and Clyde (Meetings)

4. To ask the Scottish Government when it last met NHS Greater Glasgow and Clyde and what issues were discussed. (S4O-01772)

Both ministers and Government officials regularly meet national health service boards, including NHS Greater Glasgow and Clyde, to discuss a range of matters of importance to local people.

Is the cabinet secretary aware of the alleged practice in Glasgow City Council of implementing quotas for placements in care homes, resulting in a delay in discharging patients from hospitals? Will he raise that matter at his next meeting with NHS Greater Glasgow and Clyde?

I am advised that Glasgow City Council does not operate a quota for care home placements although, like most local authorities, it allocates and operates a budget for all forms of care. That said, there are no patients delayed in hospital awaiting funding. In addition, the delayed discharge situation has improved considerably in Glasgow in the past year. I am happy to raise the issue, but I want to ensure that that progress continues.

At his last meeting with NHS Greater Glasgow and Clyde, did the cabinet secretary ask for a full report on the problems that are affecting the assisted conception unit at Glasgow royal infirmary? I am still being contacted by distressed women and couples who have simply and categorically been told that they were unaffected, but information about what has happened at the GRI is not yet in the public domain.

As the cabinet secretary will be aware, I have asked his department many parliamentary questions on the issue of access to in vitro fertilisation treatment. Now that, as I understand it, the Scottish ministers have before them the report of the working group that is considering issues around standardisation, can the cabinet secretary give the chamber an update on the Government’s direction of travel?

We received the report within the past few days and we will be publishing it in full fairly soon. We will then consult on the recommendations in the report with a view to implementing those that enjoy a consensus in the chamber as well as in the medical community, I hope.

Does the cabinet secretary share the concerns of my constituents who have contacted me regarding the operational practice at the New Victoria hospital? I understand that last Friday, two receptionists were on duty to cover multiple clinics involving several hundred people before 9 o’clock and they were clearly overwhelmed.

Much more disturbingly—and of concern—two patients who were referred to the hospital for diagnosis of potential cancer treatment, having waited two and a half months, were told by their consultant that, if they had lived on the north side of the river, they would have been seen expeditiously in a fraction of the time. Will the cabinet secretary investigate with Greater Glasgow and Clyde NHS Board whether there is an issue there and whether that situation needs to be addressed urgently?

I am happy to take that up. If Jackson Carlaw can provide me with more details, ideally this afternoon, I will ensure that that situation is urgently investigated and dealt with accordingly.

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Resource Allocation (NHS Lothian)

5. To ask the Scottish Government when it expects NHS Lothian to achieve NHS Scotland resource allocation parity. (S4O-01773)

The NHS Scotland national resource allocation committee formula has been phased in from 2009-10. The NRAC formula was introduced to ensure that NHS board funding was better aligned to local characteristics such as deprivation, population, age profile and rurality. It is right that it was phased in gradually to minimise disruption to board finances.

It has been made clear that any adjustments to the 14 territorial health boards’ funding will be phased in over a number of years, as has been the practice under both the previous Scottish health authorities revenue equalisation and Arbuthnott formulae—under previous Administrations—and that no board would receive a cut in funding. As a result of that phased process, we have ensured that no board has lost out financially and we have levelled up funding to support that. As NHS Lothian is below its target share of resources, the board receives additional NRAC funding each year to support movement towards the target.

The formula has not kept pace with Lothian’s expanding population and services have been stretched. Any additional NRAC funding that is received this year will immediately be eroded as the board pays back the Scottish Government’s waiting times loan. This year, the board remains £50 million below the target allocation. That fundamental underresourcing is at the heart of NHS Lothian’s problems. Can the cabinet secretary provide assurance that he will look to address the funding gap sooner rather than later in order to take into account the key issues that are arising due to a rising population in the Lothians?

We are addressing the issue; in fact, the board is getting an additional £12.3 million uplift annually as a result of NRAC. On top of that, every territorial board will get a rise in excess of inflation this coming year and next year. The combination of those factors and proper management of its resources should allow NHS Lothian to deliver as required.

I thank the cabinet secretary for what he has said already, but I will just re-emphasise that the population of the NHS Lothian area is increasing faster than the population in any other part of Scotland. Does the cabinet secretary accept that that is creating particular pressures on the NHS in Lothian, in addition to the inherited problems that the new chief executive is making a very good attempt at trying to sort out?

I thank Malcolm Chisholm for that final comment about the new chief executive—I will pass on his congratulations to Tim Davison. I remind Malcolm Chisholm that the NRAC formula is not just about population growth; it is also about the other factors that I mentioned in my reply to the initial question on resource allocation.

One of the major problems in the NHS Lothian area has been that there is undercapacity in the Royal infirmary of Edinburgh because when the hospital was planned—many years ago, before this Government came to office—there was a 20 per cent underestimation of population growth in the Edinburgh area. We are tackling that issue with the additional resources and the additional capacity that we have put in place. I am aware of the challenges that NHS Lothian faces, but substantial progress—very substantial—has been made in the past few months, under Tim Davison’s leadership, in tackling the backlog of problems that he inherited.

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Prescribing (Best Practice)

6. I apologise for my late arrival in the chamber, Presiding Officer.

To ask the Scottish Government how best practice in prescribing is shared between national health service boards. (S4O-01774)

Since 2011, the prescribing workstream of NHS Scotland’s efficiency and productivity programme has worked with all NHS boards to promote best practice and improve the quality and cost-effectiveness of prescribing through national guidance, support tools and compliance with 12 national therapeutic indicators.

In addition, the national prescribing workstream is supporting NHS boards in making better use of their prescribing advisers network, which meets regularly to share information and good practice and to inform the Scottish Government about local prescribing issues that might require national action.

I suspect that mention has been made of the 11 per cent real-terms fall in the cost of prescription drugs in the NHS since 2004, despite there having been an increase of one third in the quantity of drugs that are prescribed. The best practice that the cabinet secretary speaks of comes from NHS Greater Glasgow and Clyde. Will he give a commitment that its best practice on prescribing advisers and use of generic drugs—statins, for example—will be shared across Scotland?

When I became the Cabinet Secretary for Health and Wellbeing, I was told that the national health service is very good at testing but not as good at spreading. I am absolutely determined that, as a priority, we become as good at spreading good practice as we are at testing and piloting it. Improved and more cost-effective prescribing is one of the aspects on which we intend to roll out good practice across the country, on the basis of Glasgow’s tremendous performance.

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Cumbrae (Health Services)

7. To ask the Scottish Government what progress is being made with the Cumbrae public reference group on reviewing and improving health services on the island. (S4O-01775)

Throughout the review to improve health services on Cumbrae, there has been comprehensive engagement with people on Cumbrae, including the Cumbrae public reference group. The Scottish Government continues to take a keen interest in the progress of those discussions.

Ayrshire and Arran NHS Board assumed responsibility for providing out-of-hours cover on Cumbrae from February 2012. From April 2013, new interim arrangements will be in place to maintain in-hours and out-of-hours general practitioner cover until the new model of working, which fully meets the requirements of the people of Cumbrae, can be fully introduced.

Cumbrae is a particularly vulnerable community; more than 30 per cent of its 1,350 or so residents are 75 or over. Will the cabinet secretary confirm that Ayrshire and Arran NHS Board’s position is to improve and enhance Cumbrae’s health services, not least by securing a new GP practice on the island, if possible?

I confirm that the Cumbrae GP practice vacancy has been advertised—the closing date for applications is 8 March 2013. Following that date, the board will apply its normal process to appoint a new GP contractor. In the meantime, from 5 April—when the current GPs will retire—the board will run the practice directly with locum GPs who have already been secured. The board will continue to do that until a new contractor is appointed.

I stress that NHS Ayrshire and Arran sees the review as an opportunity to ensure that safe, sustainable, high-quality and cost-effective services are provided for Cumbrae. It continues to progress the review openly and inclusively with all stakeholders, and particularly with the public reference group, which represents the people of Cumbrae.

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Healthy Eating (Cumbernauld and Kilsyth)

8. To ask the Scottish Government what steps it is taking to encourage healthy eating in Cumbernauld and Kilsyth. (S4O-01776)

Last month, our Scottish cooking bus visited St Patrick’s primary school in Kilsyth, where local children and parents enjoyed healthy cooking sessions. Last week, I saw the cooking bus in action at Merkland school in nearby Kirkintilloch. The bus is just one part of a suite of actions to improve diet. We are also spending £7.5 million over three years to encourage healthy eating. We are also discussing actively with the food industry what more it can do to promote healthy eating.

I welcome the activity that took place at St Patrick’s primary school, which recognises that one way to encourage healthy eating is to engage with young people early. Will the minister join me in congratulating the staff and pupils of Abronhill primary school—who need some cheer today, because North Lanarkshire Council has decided to close their local high school—on their success in earning the healthy eating initiative award 2012?

Jamie Hepburn has made an important point. It is important that we support young people to make healthy choices because we know that, if we help to educate their palates at an early stage by encouraging them to eat healthy foods, that is likely to continue with them as they develop. Abronhill primary school is clearly on the front foot in that respect, so I join the constituency member in congratulating the pupils and teachers on winning the healthy eating initiative award 2012. I wish them well with their on-going work in the area.

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NHS Lanarkshire

9. To ask the Scottish Government when the Cabinet Secretary for Health and Wellbeing last spoke to the chief executive of NHS Lanarkshire. (S4O-01777)

Ministers, including me, and Scottish Government officials regularly meet senior management from national health service boards, including NHS Lanarkshire.

Has the cabinet secretary discussed with NHS Lanarkshire the letters from Lanarkshire Links that ask about the seven-month delay in implementation of the mental health plan for North Lanarkshire that was endorsed by Nicola Sturgeon? If the cabinet secretary is not the cause of that delay, why are we still waiting for the plan to go to the board?

As I have made clear in the chamber many times, responsibility for any ministerial discussions and decisions on the matter rest with my colleague Michael Matheson, because I have taken myself out of the discussion to ensure that there is no potential or actual conflict of interests between my role as the member of the Scottish Parliament for Airdrie and Shotts and the surrounding villages and my role as the Cabinet Secretary for Health and Wellbeing.

When the cabinet secretary last spoke to the chief executive of NHS Lanarkshire, did they discuss progress towards single-room provision in hospitals in Lanarkshire?

When I met the chief executive of NHS Lanarkshire, a range of issues were discussed. My officials are working with colleagues in NHS boards to support them in the implementation of Scottish Government policies, including increasing the provision of single-room in-patient accommodation.

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Healthcare Improvement Scotland (Inspections)

10. To ask the Scottish Government what recent progress Healthcare Improvement Scotland has made in inspections of care for older people. (S4O-01778)

Sorry—I have my notes in the wrong order. My apologies.

Healthcare Improvement Scotland has inspected care of older people in 12 of the 23 acute general hospitals in the inspection programme, across seven NHS boards. The inspections have highlighted areas of good practice and areas where improvements must be made.

Following inspections, boards have developed action plans to address all areas for improvement, and Healthcare Improvement Scotland is closely monitoring boards’ progress in implementing agreed improvement measures. That is exactly why we asked for the inspections to be carried out, and it reassures me that they are driving up the standards of care for older people in hospitals across Scotland.

Does the cabinet secretary agree that an important part of care for the elderly is ensuring that people have dignity? Will he consider how that is measured during inspections? Should hospitals be encouraged to implement robust procedures for encouraging and paying heed to feedback from users and their families and friends?

Absolutely. There should be feedback to carers, families and friends as well as to patients themselves. Healthcare Improvement Scotland has made that absolutely clear. Indeed, if there are any urgent issues during inspections, they are reported immediately to the appropriate member of the senior management team in the hospital for immediate action.

A whole list of actions are taking place to improve the dignity of people in hospital. Yesterday, for example, I had the pleasure of opening the new Royal Victoria building as part of the Western general hospital in Edinburgh. Each of the five wards has 26 single-room units, with patients having their own toilet and en-suite facilities. When I spoke to the patients, even those who had been sceptical about the benefits of single rooms before they went into them told me that they are of huge benefit. Those people are real converts. One of the main advantages of a single room is that the person is not wakened during the night by other people snoring.

I would not know.

Can the cabinet secretary tell me why Healthcare Improvement Scotland decided not to publish the report on the September inspection of Ninewells hospital elderly assessment unit after it had received the factual inaccuracies from NHS Tayside, which would have been the appropriate mechanism, and why two inspectors have resigned over the failure to publish?

On the latter point, my understanding is that this particular inspection is not the reason why the inspectors resigned.

Secondly, as Healthcare Improvement Scotland has explained publicly, it decided not to publish the report at the time because it did not believe that the process had met its very robust quality assurance standards. That is why it made a second unannounced inspection, the results of which were published last week. Having read an interview that she gave last week, Ms Marra seems to have changed her mind from accusing the health board of a whitewash to admitting that no whitewash took place.

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General Practitioner Services (Access)

11. To ask the Scottish Government what measures are being taken to improve access to GP services. (S4O-01779)

During 2012, the Scottish Government invested approximately £12 million in encouraging general practices to improve access for patients, and we have introduced an enhanced service arrangement that extends opening hours beyond core hours and offers patients early morning and evening appointments. The Scottish Government has also successfully reached a negotiated settlement with GPs for next year. As a result of those measures, more patients in Scotland will benefit from evidence-based care, including control of blood pressure and cholesterol and influenza immunisation, which will help to reduce the risk of complications and admissions to hospital. As part of the agreement, we have the Scottish general practitioners committee’s commitment to work with the Scottish Government on reviewing access arrangements.

I am grateful for that response, but I am sure that the cabinet secretary is aware that the number of general practices has continued to decrease since 2007 and in Scotland has fallen below 1,000 for the first time. Many GP surgeries do not even have a website, and I am sure that the cabinet secretary is aware of moves in other parts of the United Kingdom to ensure that patients can arrange repeat prescriptions, book appointments and obtain test results online by 2015. What steps is the Scottish Government taking to encourage Scottish general practices to expand that type of activity particularly in rural areas, where I think it would be very helpful?

The member raises a very valid point. Our view is that an online repeat prescriptions facility should be available from every general practice within a reasonable time period. In fact, it should be a basic requirement in 2013 and we are working with GPs and health boards across the country to ensure that such a service is available. We are also working with GPs and the British Medical Association’s GP committee to look beyond this year at how we can reduce some of what they would describe as the red-tape requirements in the contract and free them up to spend more time on providing direct services to their patients.

Of course, the member will be glad to hear that unlike south of the border, where the Government, led by his colleagues in the Conservative Party, imposed an agreement on GPs against their will, we in Scotland negotiated an agreement with GPs.

The cabinet secretary will be aware that far too few GPs operate in deprived areas and that as a consequence access for some of the most needy patients is constrained. Given that the last data set is apparently 10 years old, would it be useful for the Government to collect current data on GP numbers and their distribution? What action will the cabinet secretary take to ensure that extra GPs and additional capacity are available in deprived areas?

I am very keen to look at how in particular we can extend the role of deep-end practices, which service deprived and poorer areas. Scotland now has more than 100 such practices, many of which are concentrated in the greater Glasgow area. They have clearly been very successful and I am proactively looking at how we can increase the number and improve the range of services provided by those practices in Scotland’s poor and deprived parts.

The cabinet secretary will be aware that, in England, many local GP services are being contracted out to private providers such as Virgin Care or Circle and that there are accusations that that has led to poorer access to services. Will the cabinet secretary confirm that national health service services will remain in public hands in Scotland?

I remember some time ago, when Andy Kerr—that long-forgotten name—was the health minister, he tried to privatise GP services in Harthill, which is now part of my constituency. We put an end to Labour’s privatisation agenda in Harthill, and we will certainly not follow the Tory-Liberal Democrat privatisation agenda north of the border.

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Air Ambulance Provision

12. To ask the Scottish Government what air ambulance provision there is across Scotland. (S4O-01780)

The Scottish Ambulance Service currently operates the only integrated and publicly funded air ambulance service in the United Kingdom. In 2011-12, it flew 3,382 missions. Under the current arrangements, cover is provided by two purpose-built fixed-wing King Air aircraft, which are based in Aberdeen and Glasgow, and two EC135 helicopters, which were also built as dedicated air ambulances and which are based in Inverness and Glasgow. Those aircraft are backed up by Ministry of Defence and coastguard aircraft in the case of time-critical emergency evacuations when weather conditions prevent the deployment of the contracted aircraft.

In June 2012, following an extensive reprocurement process, the Scottish Ambulance Service announced that the current service providers, Gama Aviation and Bond Air Services, had been awarded a new seven-year £120 million contract, which will commence from 1 April this year. In addition to sustaining the current levels of provision across Scotland in the coming years, the new contract includes the new generation of EC helicopter—the EC145—which will be introduced during 2014. The greater capacity, speed and range of those helicopters will enhance the current service.

I am impressed by the cabinet secretary’s technical knowledge. I am sure that he will want to welcome the new air ambulance that is provided by Scotland’s Charity Air Ambulance, which is based at Perth airport and which has boosted the service by 50 per cent during daylight hours. Is it the Government’s intention to measure just how much additional service we require to ensure that all rural areas are fully covered?

Absolutely. We are keeping the situation closely under review. For example, I have had discussions with some of our parliamentary colleagues who cover the northern isles to ensure that the coverage is improved, particularly during periods of bad weather.

The additional capacity that is provided by the new service that the member mentions is very welcome indeed. Before I came to the chamber today, I had a meeting with one of the major funders of the new service, during which I congratulated him and his colleagues and thanked them for the tremendous generosity that they have shown. That service will make a significant improvement in air ambulance cover for many parts of mainland Scotland and particularly for the islands of Scotland.

I want to make progress through the remaining questions, so I would be grateful for short questions and answers.

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Equally Well (Glasgow)

13. To ask the Scottish Government what lessons have been learned from Glasgow’s equally well testing programme. (S4O-01781)

The equally well test site programme set out to support new ways of working in community planning partnerships—to do things differently and to do different things. Several key factors have been associated with local success across all the test sites, including those in Glasgow. Those are the need for a skilled co-ordinator; clear shared outcomes; empowerment of staff; space for reflection and learning; and senior-level commitment and leadership. The evaluation has suggested that the more those building blocks are taken forward as part of partnership redesign and enthusiastically and consistently pursued, the more success there will be for projects.

The reconvened ministerial task force on health inequalities, which I chair, is already scheduled to examine, at its next meeting, the lessons learned and the outcomes derived from the test sites.

What plans does the Scottish Government have to implement Scotland-wide the lessons on the integration of health issues into city planning?

The Scottish Government is reviewing the national planning framework and Scottish planning policy. We are considering how best to reflect in those policy documents the lessons from equally well and from the good places, better health initiative. We aim to publish both those documents for consultation around the end of March this year.

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NHS Greater Glasgow and Clyde (Meetings)

14. To ask the Scottish Government when the Cabinet Secretary for Health and Wellbeing last met the chief executive of NHS Greater Glasgow and Clyde and what was discussed. (S4O-01782)

Both ministers and Government officials regularly meet national health service boards, including NHS Greater Glasgow and Clyde, to discuss a range of matters of importance to local people.

The sudden death of a loved one can be a traumatic experience for any family, and in most cases it will result in a post mortem. In the west of Scotland, that procedure would likely be carried out at the Southern general hospital in Glasgow. The current wait for a post mortem there is 10 days, but in some local circumstances that can stretch to more than two weeks. Such a wait increases the trauma for the family, disrupts religious and cultural practice, and makes the bereavement process even more difficult. Will the minister instruct his officials to bring together Greater Glasgow and Clyde NHS Board and the Scottish fatalities investigation unit to ensure that there is an investigation into that unacceptable situation for bereaved families?

First, I thank Duncan McNeil for the way in which he has raised what is a very sensitive issue. It is important that post mortems should be carried out as quickly as possible to minimise any upset and distress to bereaved families. I have been assured by NHS Greater Glasgow and Clyde that there are no delays to the service provided by the national health service. Fiscal post mortems are the responsibility of the Crown Office. Therefore, I will refer this question and answer to the Lord Advocate to bring the matter to his attention.

I understand that, within the health board area, fewer than 100 hospital post mortems are carried out annually. Pathology services for that activity are scheduled on a Tuesday and Thursday each week at the Southern general site. At a family’s request and to meet personal arrangements, such as a set day for a funeral, a post mortem will be rescheduled to meet a need.

As I have already stated, I am not aware of any delays in the hospital-based post mortems in the NHS Greater Glasgow and Clyde area. I recognise the point that Duncan McNeil makes, and I will refer the matter to the Lord Advocate.

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Radiotherapy

15. To ask the Scottish Government what action it is taking to ensure that patients requiring radiotherapy after surgery receive it as soon as possible. (S4O-01783)

Cancer treatments that are subsequent to the initial cancer control treatment are in general covered by good practice clinical guidelines rather than management targets. That allows clinicians to prioritise and make decisions based on clinical need and best practice. Those guidelines and recommendations are based on clinical evidence on delivering the best outcomes for patients rather than on arbitrary timelines.

Over the past three years, the Scottish cancer task force has made more than £3 million available to facilitate the introduction of new technologies and to drive forward improvement to meet the ambitions of the quality strategy, including access to radiotherapy.

As the cabinet secretary will be aware, a report in today’s edition of The Press and Journal says that half of the medical physicist posts in NHS Highland are currently vacant. What steps is he taking to attract, train and retain medical physicists to ensure that treatment can be delivered at the optimum time? What thought has he given to including such treatment in the treatment waiting time guarantee?

We are doing everything that we possibly can to recruit people in rural areas. There is a particular problem with the recruitment and retention of doctors, consultants and general practitioners in remote rural and island areas not just in Scotland but across the entire United Kingdom. We are concentrating on that issue to look at how we might do more to incentivise such professionals to come and work in rural areas.

When I visited the Ardnamurchan peninsula last week, I witnessed proposals to establish a completely new way of delivering GP services on the peninsula, whereby the existing three small GP practices will be incorporated into one larger practice. We believe that that is one way in which we can recruit and retain GPs in rural areas.

We also have a problem in filling consultancy posts. We recently filled a consultancy post in the Western Isles that had been vacant for almost a year. The upside is that the post was filled; the downside is that it was filled by somebody from another remote rural area hospital. The net contribution to solving the shortage in rural areas was therefore fairly neutral.

Rhoda Grant raises a valid issue: there is a genuine problem in recruiting consultants and GPs in rural areas. We are very conscious of that and we are taking a lot of proactive action to deal with it.

I apologise for the length of my reply.

I should hope so, cabinet secretary.

I apologise—not on behalf of the cabinet secretary—to members for the external noise from the building work. The contractors are well aware that there should be no work when members are in the chamber. A message is going out to them to cease and desist.