Meeting of the Parliament

Meeting date: Tuesday, May 6, 2014

Official Report 788KB pdf

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Topical Question Time

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National Review of Asthma Deaths

1. To ask the Scottish Government what its position is on the national review of asthma deaths, which suggests that some deaths from the condition arise because of complacency among both medical staff and patients. (S4T-00686)

I call the health secretary, Michael Matheson. I beg your pardon, Mr Matheson. I meant to say the Minister for Public Health.

I am grateful for the promotion, Presiding Officer.

The Scottish Government is committed to providing the best-quality care and treatment for people living with asthma in Scotland. We welcome the publication of the national review of asthma deaths, which is the first major investigation of its kind. We will look closely at the key findings of the report to ensure that actions and learning are taken forward at board level where appropriate. That will be part of a wider programme of work to develop and deliver local improvements, including asking boards to review asthma deaths as part of their mortality review process.

The Scottish Government continues to work closely with and support a number of initiatives in partnership with our third sector partners, including work in primary care, to drive forward the national improvements in asthma services.

Even though I have had a direct interest in asthma all my life, I was shocked by the report. For so many people to die for avoidable reasons will, I am sure, worry the minister. I want the Government today to make a clear commitment to step up its work on asthma in light of the report. The Government produced a good set of standards in “Asthma priorities: influencing the agenda”, which was published well over a year ago, in February 2013, but the implementation of its recommendations is patchy. In light of the report that has been published today, will the minister ask every health board to publish a report locally on the progress that it is making on the implementation of the standards that were set out in “Asthma priorities”?

I recognise the member’s long interest in the issue. I will address the points that he made. First, we will consider what we can learn from the national review. One of the areas of work that we will now take forward is to ask our national advisory group on respiratory managed clinical networks to consider each of the report’s recommendations and consider what action has to be taken forward at a local level. Part of that will be about what local plans need to be developed by individual health boards to respond to the recommendations locally. The member is right that the report highlights a number of areas where patients and individuals with asthma are clearly not receiving the services that they deserve and require. There is clear learning there for both patients and clinicians to take forward.

I assure the member that we will continue to drive forward the implementation of the national priorities. Alongside that, we will ensure that the learning that comes from the national review is applied at a local level and that there is national oversight of that through our national advisory group on respiratory conditions.

I do not doubt the minister’s absolute commitment to the issue. As I said, some of the work that the Government has done in the area has been good, but implementation is patchy. I have received reports from health professionals, including those who are closely involved in the managed clinical networks, who say that they are frustrated that health boards are not treating the issue with sufficient priority. All that I am asking for is a bit of transparency. I recognise that the minister will drive the local health boards to make improvements, but will he publish the results so that local campaigners can press for improvements in delivery?

As I said, the principal delivery body is our national advisory group on respiratory managed clinical networks. The MCNs have a key role to play in making sure that our boards are undertaking the work at a local level that is necessary for the services that have to be delivered at both primary and secondary care level. We are considering reviewing the managed clinical network establishment, to look at whether we have to change how it is operating and to ensure that the guidance is implemented much more effectively at a local level. Part of that will be to look at how we can ensure that boards are much more transparent in their actions. I am open to that coming in the form of a formal published report so that patients and individuals can see the progress that individual boards are making.

However, we need to consider the detail in the report that was published today to see how it can feed into the way in which the managed clinical networks are operating at present. We also need to consider whether we should review the whole process to ensure that the system is robust and transparent in the way that the member has suggested. We want to ensure that, ultimately, it delivers the services on the ground that patients with asthma deserve.

The Government’s circulation of a benchmark reporting template last year was welcome. I hope that, as Willie Rennie said, the results of that will now be published so that we can see what is happening. However, will the minister immediately ensure that every patient who is prescribed more than 12 reliever inhalers in a year is reviewed? That is something that can be done immediately, but it should also be done as a matter of course, because the report shows very clearly that that group is one of those that are most at risk.

The member raises an important issue for the quality of the clinical care that is provided to patients with asthma. Interestingly, the report highlights that there is evidence of excessive prescribing of reliever medication as well as of underprescribing of preventative medication. There are issues there in terms of clinical practice. That is why it is important for the national advisory group to look at the report’s recommendations and consider what is necessary at a local level to address the issues.

I am sure that the member will recognise that for me to do something immediately while a clinical decision is being made on it would not be appropriate. However, the point that the member is driving at is one that we need to address to ensure that clinicians prescribe the right medication at the right time, whether that is preventative or reliever medication, and that they review that on a regular basis, because the report also highlights the lack of such review.

We have an opportunity to use the review as a way of helping to drive forward clinical standards and standards of service delivery.

The report is very worrying. Specifically in relation to childhood asthma, what implications does it have for how the national health service and schools work together to help pupils to manage their condition?

The report focused on how care is delivered in primary and secondary care in the NHS. I am aware that the ability of children with asthma to receive their inhaler while they are in school has been an on-going issue. There is an inconsistency in how local authorities are applying the relevant policy, which they are responsible for implementing.

That is an issue of concern. We are carrying out a review of the guidance to local authorities on the matter. What should happen is that, if a child requires medication, a healthcare plan should be put in place for that child in their school and arrangements should be made for their medication to be provided for them. There are some legal complications to do with the ability of teachers and support staff to do that. Because of the inconsistency of approach among local authorities, we are reviewing the guidance, which goes back to 2001, to look at what we can do to ensure that local authorities adopt a much more consistent approach in this area.