SCOTTISH EXECUTIVE
Health and Wellbeing
Good afternoon. The first item of business is questions on health and wellbeing. I remind members that the Presiding Officer stated last week that they should keep their questions brief and in the form of a question, rather than a statement, and that multiple questions should not be asked. If members fail to adhere to that advice, we may have to stop them.
British Dental Association (Meetings)
To ask the Scottish Executive when it next plans to meet the British Dental Association. (S3O-4729)
My officials have meetings with the British Dental Association planned for 10 November and 19 November. The Minister for Public Health last met the BDA on 9 September at its offices in Stirling.
I note that we have in recent times seen an improvement in the number of people who have registered with dentists. However, given that there are wide discrepancies among areas—only 38 per cent of people in my patch are registered, whereas 71 per cent of people in Glasgow are registered—what steps does the cabinet secretary plan to take to encourage the BDA and its members to return to delivering NHS dentistry across Scotland and not just in some areas?
Brian Adam is right to point out that the latest statistics show that, across Scotland, we have the highest number of registrations with dentists for both adults and children since registrations were introduced in October 1990. That is extremely good news and I know that everyone in the chamber will welcome it.
In evidence to the Health and Sport Committee during the budget process, the British Dental Association said that it would need £600 million to provide greater access to NHS dentistry—in other words, £245 million more than it receives at present. What is the cabinet secretary's response to that request?
I saw the evidence that the BDA submitted to the Health and Sport Committee. No doubt some of it will form the basis of future discussions that we will have with the BDA. I am not entirely clear what the basis of the BDA's calculation is. I think it might have been making some comparisons between independent dental practitioners and salaried dentists, which are not always valid comparisons.
Question 2 was not lodged.
National Health Service Dentists
To ask the Scottish Government what factors explain the recently announced increase in the percentage of the population registered with an NHS dentist. (S3O-4684)
Several factors are at play. First, the number of national health service dentists increased by 4.1 per cent in the year to March 2008. Secondly, through the Scottish dental access initiative, we are funding the establishment and expansion of additional dental surgeries. Thirdly, the extension of the registration period to 36 months has strengthened the relationship between patients and dentists. Fourthly, payments that are linked to the level of NHS commitment mean that dentists are incentivised to maintain their patient registrations.
Is the third factor not the overwhelming one? The previous Government extended the period in which a patient could go without visiting an NHS dentist from 18 months to 36 months before being deregistered. That means no deregistrations between July last year and April next year. Before that change, 650,000 patients were deregistered for non-attendance each year. The increase in registrations in the past year was only 445,000. Does not that indicate an underlying trend that is still negative? If the change in the registration period had not happened, would the minister be announcing a fall rather than an increase in the number of registered patients?
It is not like Derek Brownlee to take the glass-half-empty approach to life. He is usually much more optimistic than that, and than some of his colleagues sometimes are. In my first response, I openly acknowledged that lengthening the registration period to 36 months was undoubtedly a factor in the increased number of registrations. However, nobody who studies dental health in any depth could conclude anything other than that other factors are at play, too. Surely Derek Brownlee is not suggesting that a 4 per cent increase in the number of dentists has had no impact on registrations. I also presume that he does not suggest that funding new dental surgeries and the payments that we make to dentists to encourage them to register more NHS patients have no impact on the number of registrations. All those factors play a positive part in reversing the long-term decline that I spoke about. Yes—the 36-month period is one of the factors, but the bottom line is that more people are registered with a dentist than are being deregistered. That must be a good thing.
Is the cabinet secretary aware that, despite the initiatives in the Grampian NHS Board area that she mentioned, adult constituents of mine still cannot register with an NHS dentist? The number on the waiting list has risen by 2,000. Surely the solution is to enter negotiations with the BDA and to make it attractive for dentists who have gone private to return to the national health service to tackle the backlog of adults who are waiting to register.
I absolutely recognise the picture of Grampian that Mike Rumbles paints. I openly acknowledged that in response to Brian Adam's question. That trend is historic. If Mike Rumbles has magic solutions to the problem, I am keen to hear them—believe me. However, the reality is that no shortcut exists. The solutions are those that we are pursuing. They are bearing fruit, as I said in my other answers, but there is much work still to do. Some of NHS Grampian's plans, such as opening new dental premises and encouraging independent dentists to take on more NHS patients, will have a positive impact.
Social Rented Housing
To ask the Scottish Executive what investment it is making in the development of social rented housing. (S3O-4727)
The Scottish Government is investing in social rented housing in a number of ways. Our main investment will be through the affordable housing investment programme, under which we plan to invest a total of £493 million in 2008-09 in the development of affordable housing. In addition, we recently announced the acceleration of £100 million AHIP moneys. That will see an extra £30 million being spent in 2008-09, most of which will be invested in social rented housing.
Having spoken to a number of housing associations, I understand that the Government is keen for additional housing investment to be spent on shared equity properties. In the current situation, in which many people are reluctant to take out additional loans, does the minister feel that that priority is appropriate? Would it not be better to direct all the money at homes for rent?
This is not an either/or situation. Investment is required in both social rented homes and low-cost home ownership. The vast majority of this Government expenditure is on social rented homes. The extra investment is being spent on securing new land for housing, buying off-the-shelf units from private builders, and accelerating projects that would have taken place further down the track. Clearly, the bulk of the money that is being invested is going into social rented homes.
The building of affordable houses is vital for social rented housing. Will the minister revert to the previous rules for housing association grants, under which far higher levels of grant were given to associations than is the case under the new rules? Does he accept that the new rules are seriously inhibiting the building sector, housing associations and, above all, families that need homes?
I am sorry, but I do not accept the premise of Jamie McGrigor's question. The fact is that if we had carried on in the same vein, we would have spent more money on building fewer houses, which would have been neither a reasonable option nor a sensible option.
National Health Service Boards (Meetings)
To ask the Scottish Executive when it next plans to meet with the chief executives of national health service boards. (S3O-4694)
The chief executive of NHS Scotland meets the chief executives of NHS boards on a monthly basis to discuss a wide range of issues. The next meeting is scheduled for 19 November. I meet with chief executives on an individual basis regularly, for example, at their annual review meetings. Of course, I have regular meetings with NHS chairs.
The cabinet secretary will be aware of the National Deaf Children's Society's campaign to gather data on the number of deaf children in Scotland. When she next meets the chief executives of NHS boards, will she discuss the progress of the NHS-delivered universal newborn hearing screening programme that was introduced in Scotland in 2005? Specifically, will she consider collecting information from NHS boards on the number of children who have to date, through that programme, been diagnosed with a hearing loss, so that such a data collection mechanism could form the basis of a national register of children who have hearing loss, which would inform future service developments and allow the impact of the hearing screening programme to be monitored? Does she accept that such a register would help colleagues in the education and social care sectors to plan and deliver effective interventions in the early years of a deaf child's life?
I thank Bill Butler for raising a serious issue and will do him the justice of giving his proposal serious consideration. I pay tribute to the National Deaf Children's Society and the work that it does on a range of issues, especially its collection of data on the number and circumstances of deaf children in Scotland, which Bill Butler mentioned.
In its meetings with the chief executives of NHS boards, will the Scottish Executive question in detail their plans for tailoring health service resources to the differing clinical needs of the people who live in their areas?
Indeed. I might be wrong, but I assume that Ian McKee refers to the need to ensure that we can target resources appropriately on areas of deprivation and inequality which—as members will be aware from "Equally Well", the report of the ministerial task force on inequalities—is a Government priority. I am sure that that is a priority that is shared by members of all parties.
At her next meeting with NHS chief executives, will the cabinet secretary mention provision of cross-boundary services? My concerns relate particularly to the stance to obesity services that seems to be taken in Glasgow. In the past, people from the Lanarkshire area were able to receive such services in Glasgow, but it appears that people from Lanarkshire are now being treated differently from people who reside within the Glasgow boundary.
I know that that is an issue that Cathie Craigie raised on the margins of this morning's debate on patients' rights. I will be more than happy to look into the circumstances to which she has drawn attention, on which I think she might already have corresponded with me. Although there is a general issue, which I will be happy to look into, I understand that, particularly with obesity services, there are issues of clinical decisions and recommendations at stake. I will be more than happy to have further discussion with Cathie Craigie on the specifics of her constituency cases and to come back to her in due course.
When the cabinet secretary meets the chief executive of Highland NHS Board, I presume that they will discuss the recent publicity surrounding the scary cuts in funding for that organisation. Will she take the opportunity of that meeting to look extremely favourably on NHS Highland's bid for finance for a four-surgery dental unit in Thurso?
I have already mentioned the resources that are being made available to NHS Grampian from the primary and community care modernisation fund for next year and the year after. Dental premises will be that fund's priority in those two years. I do not have with me the figure for NHS Highland's allocation, but it has been given such an allocation, so I certainly expect it to use it to upgrade and modernise its dental premises.
National Health Service Board Elections (Ayrshire and Arran)
To ask the Scottish Government how patients in Ayrshire and Arran will benefit from having a directly elected NHS board. (S3O-4738)
Having a directly elected element on an NHS board will introduce greater awareness of local issues and opinions at the very heart of a board's decision-making process, which I believe will benefit all patients.
Does the cabinet secretary agree that democratically accountable health boards are fundamental to an effective health service and to delivering for patients? Will she confirm that had elected health boards been in place a couple of years ago, some unfortunate proposals, such as the suggested closure of vital accident and emergency units, would not have required her direct intervention?
I am a great believer in democracy, and I know that it is being exercised in at least one part of Scotland today, which is why there are not more members in the chamber. I agree with Kenny Gibson that introducing democratic accountability into health boards is an important step forward. It is right in principle, and will lead to better decision making.
I am glad to hear the cabinet secretary place her faith in the democratic process. Of course, that does not come cheap. Ayrshire and Arran NHS Board's estimate of the cost to it of around £800,000 every four years is causing it some concern. In the context of its being required to achieve £11 million per annum of cash-releasing efficiency savings, it has described that as "a significant amount", which it believes could better be spent on services for patients. Does the cabinet secretary believe that NHS Ayrshire and Arran has accurately estimated the cost of the elections to health boards? If so, will she ensure that that money comes as an additional sum rather than being taken from front-line services?
I encourage Cathy Jamieson and, indeed, representatives of NHS Ayrshire and Arran—or any other health board—to read the terms of the Health Boards (Membership and Elections) (Scotland) Bill. If it is passed, the bill will commit only to piloting elections to health boards. The cost of pilot elections to health boards is estimated at £2.86 million. I have made it clear that that money will be funded centrally from the health directorate's budget.
NHS Greater Glasgow and Clyde (Meetings)
To ask the Scottish Government when the Cabinet Secretary for Health and Wellbeing last met officials of the board of NHS Greater Glasgow and Clyde. (S3O-4730)
I regularly meet all NHS chairs to discuss matters of importance to health and the NHS in Scotland. The most recent meeting was on 27 October. I also met the senior team of NHS Greater Glasgow and Clyde on 18 August this year when I chaired the board's annual review. The board's performance on key national health targets including health improvement, efficiency, waiting times and service changes was discussed.
Last week, NHS Greater Glasgow and Clyde decided against removing health visitors from local general practitioner practices. Does the cabinet secretary welcome the health board's announcement, and does she agree that the original proposal was ill-advised? How will the future role of health visitors be promoted and protected throughout the country?
I thank Bashir Ahmad for his question and for his interest in an important issue that has raised a number of concerns across NHS Greater Glasgow and Clyde. I am very pleased indeed that NHS Greater Glasgow and Clyde has agreed a way forward on this issue with the local medical committee. At its meeting towards the end of October, the committee formally agreed with the health board on proposals that will guide the local planning and implementation groups. The board intends to write to all health visitors to share the outcomes. The discussion will continue with the trade unions.
National Health Service Dentists<br />(Highlands and Islands)
To ask the Scottish Government what action it is taking to ensure that all adults and children in Caithness and other parts of the Highlands and Islands are able to register with an NHS dentist. (S3O-4739)
Responsibility for the overall provision of NHS general dental services rests with NHS boards.
I thank the cabinet secretary for that detailed answer. At present, there is a shortfall of graduates who are able to take up posts. For example, in Orkney, around 2.4 full-time posts are required. The figure in Caithness would probably be double that. Will the cabinet secretary give us an idea of the flow of graduates who will be able to fill the posts in the new dental premises that we are about to build?
Rob Gibson raises an important point. As we expand the opportunities and the incentives for dentists to do NHS dentistry, we must ensure that the flow of dentists through education and into those posts is as smooth as possible. That is one of the key reasons why the Government took the decision to open the Aberdeen dental school. It opened on 6 October, and I am pleased to say that it has now accepted its first intake of students. That will increase the number of students training in Scotland, so in time it will increase the number of graduates.
I do not know whether the front page or the editorial of last week's Orkney Today featured among the cabinet secretary's press cuttings. If so, she will have seen that NHS Orkney's chief dental officer, Moya Nelson, described the situation in my constituency as a "crisis". Rob Gibson spoke about the statistics on access, which bear little relation to what is happening in Orkney. They ignore the loss since June of three dentists, which has resulted in 4,000 people being added to the existing 1,500 who are already on the waiting list to register with a dentist. The total population is 20,000.
It is clear that the member was not present when I talked about long preambles and multiple questions. Nevertheless, I call the cabinet secretary to answer.
I fear that I am at risk of repeating myself. As I said previously, I do not for a moment deny the scale of the challenge that we still face with regard to dentistry in Scotland, notwithstanding the progress that has been made in some parts of the country.
Wheelchair and Seating Services Modernisation Draft Action Plan
To ask the Scottish Executive what progress is being made towards implementing the wheelchair and seating services modernisation draft action plan. (S3O-4714)
A final costed action plan, taking account of comments from the public, and recommended by the project board, will be available for my consideration and approval in December 2008. Once the plan is approved, implementation will commence early in 2009.
Does the cabinet secretary share the concerns of disability groups that several recommendations in the 2006 report, "Moving Forward: Review of NHS Wheelchair and Seating Services in Scotland", which are critical to the success of the modernisation plan, have been omitted from the action plan? Those include the establishment of a single national structure, which would enable uniform development throughout Scotland; the monitoring and evaluation of standards; and the removal of the eligibility criteria, which are used to restrict access to resources.
Yes, I hope that the expectations can be met. That was the objective behind the original plans, which—as the member is aware—commenced under the previous Administration. It is also why the Government has set aside substantial additional funding—some £16 million over the next three years—for the project. There will, of course, be other aspects of service redesign that do not require extra funding, but require different measures.
A key omission in the action plan is the development of agreed response times for care and maintenance of wheelchairs. Are the times for repair and maintenance part of the patients' rights proposal that was debated this morning? If not, will the cabinet secretary seriously consider including that in the action plan? It is a problem of mobility, so it should be part of patients' rights in relation to response times. It is the same as having a hip replacement: if someone is immobile, they are immobile.
I agree that the issue of waiting times is important. The member makes the powerful point that someone who relies on a wheelchair and does not have proper or adequate access to that wheelchair has their mobility affected. That is similar to other conditions, and wheelchair users should therefore be treated as other such patients are.
Secure Forensic Mental Health Services<br />(Young People)
To ask the Scottish Executive whether it intends to develop a secure forensic mental health service for young people. (S3O-4701)
Improving the mental health and wellbeing of children and young people is a priority for the Scottish Government. We are working with NHS boards and other partners to deliver the specific objectives and commitments that we have set for children's and young people's mental health.
I have a constituent whose adolescent son has been placed in secure accommodation in Newcastle in the north of England as there is no such provision in Scotland. Does the cabinet secretary acknowledge that, small though the numbers are, such Scottish patients and their families feel that they deserve better in the form of a service in Scotland?
I entirely understand the motivation of the question and the frustrations that Charlie Gordon's constituent will feel. The situation that he describes and which I described in my substantive answer is not new—it has always been the case in Scotland. The issues are difficult, as are the judgments, and I repeat what I said earlier: we must strike a balance between the understandable desire to provide services close to home and the need to ensure that any service is safe and effective. The small number of patients means that it is difficult to provide such services on a more local basis. We are talking about one or two patients a year over the past few years, and I do not need to spell out to members the difficulties in service provision that that raises.
The cabinet secretary will recall that, this morning, I raised the case of a young woman with mental health issues who was self-harming and the insensitive and frankly counterproductive attitude of the accident and emergency departments that have dealt with her. In her discussions with NHS boards, will the cabinet secretary raise the issue of training, of A and E staff in particular, in dealing with young people and others who have mental health issues and need medical treatment, for instance when they self-harm? The situation is not satisfactory.
Christine Grahame did indeed raise that important issue in our debate on the patients' rights bill. All staff who work in the NHS need an awareness of, and an appropriate level of training and education in, dealing with people with mental health problems, which in some cases are extremely challenging. Mary Scanlon, Christine Grahame and others have raised that issue consistently, and I know that members generally agree that we have made progress in mental health services in recent years. However, we have a considerable way still to go, not least—returning to Charlie Gordon's question—in child and adolescent mental health services. We are encouraging all NHS boards to prioritise that issue in both their policies and investment decisions.
Question 11 was not lodged.
Media and Communication Services (Hospitals)
To ask the Scottish Government what steps it is taking to provide value-for-money media and communication services for hospital in-patients. (S3O-4734)
Arrangements for and decisions regarding media and communication services, and patient services in general, are in the first instance matters for NHS boards, taking into account the needs of their local communities.
The cabinet secretary might be aware that customers of the Patientline service were paying up to 49p per minute to receive a phone call, and at the rate of £98 per month to watch television while in hospital. Will she take steps to ensure that hospital in-patients will, in the future, be able to speak to relatives and access TV and media services at reasonable cost and with reliability of service?
I understand the concerns that patients and their families have about such services. As I said, whether such services are provided in hospitals is a matter for NHS boards. Any Patientline services are an addition to the telephone or television services that an NHS board would routinely make available, so they are a matter of choice for patients; patients are not compelled to use them. Nevertheless, I understand the concerns.