Plenary, 06 Dec 2007

Meeting date: Thursday, December 6, 2007

Official Report 701KB pdf

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Question Time

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SCOTTISH EXECUTIVE

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Health and Well-being

This afternoon, for the first time, the sole subject of themed question time is health and well-being.

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National Health Service (Scottish Budget)

To ask the Scottish Executive what impact the decisions in the Scottish budget will have on the NHS. (S3O-1488)

As a result of decisions made in the Scottish budget, spending on health will increase by an annual average of 4.1 per cent over the next three years. That increased funding will support the people of Scotland to lead longer and healthier lives, with a particular focus on the areas and communities with the worst health records.

The total health budget in 2008-09 will be £10.65 billion, rising to £11.52 billion in three years' time. The majority of that funding will be passed to NHS boards to take forward our key health priorities, with a specific emphasis on measures to improve health and prevent illness. Additional funding will be targeted to deliver further improvements in quality and the speed of access to health-care services.

Dentistry is a major issue in rural Scotland as well as in the rest of the country. What impact will the budget have on the provision of national health service dentistry? Will the proportion of adults and children who are registered with an NHS dentist increase over the period of the spending review? If so, to what percentage will it increase?

I thank Derek Brownlee for that important question. I am sure that he is aware that there will be specific questions on NHS dentistry later in this question session. I assure him of the importance that we attach to increasing access to NHS dentists, which has been a particular problem in recent years. The action plan that we will publish shortly will make specific suggestions and set specific targets for the proportion of children whom we want to be registered with an NHS dentist. The Minister for Public Health will expand on those issues later.

The Government has announced a significant increase in expenditure on the prevention and treatment of alcohol abuse. What will that increased expenditure achieve? How will progress be measured?

As the member is aware, in its budget—this is obviously subject to parliamentary approval—the Government has dedicated an additional £85 million over the next three years to assist us in tackling alcohol misuse, which I hope everyone in the chamber recognises is a key priority. Those resources will be allocated through health boards to alcohol and drug action teams. The exact details of the allocation of that money have not yet been set out, but the type of initiatives that it is intended to support are initiatives to improve prevention and treatment and initiatives to support brief interventions in primary care in line with Scottish Intercollegiate Guidelines Network guideline 74, which is recognised as extremely important.

I would like to press the minister a bit more on the announcement that she made yesterday on free prescriptions and the implications that that will have for the budget. She seemed quite sure yesterday that her calculations were right. I ask her to think again about the evidence that might come from general practitioners about the prescribing budgets. If there is pressure on those budgets, particularly if there seems to be a shift in spend on minor ailments, will she meet GPs to discuss how they address such pressures? Will she give us some indication of how she is monitoring her calculated spend and how she will act on that appropriately?

As the member is aware, those issues were addressed in detail yesterday. I reassure Margaret Curran that I will continue to meet GPs regularly to discuss a range of issues. If she cares to check, I think that she will see that the British Medical Association is positive about the abolition of prescription charges. The issues that she raises will be carefully monitored by the Government. However, I am more than happy to repeat that I believe that it is right to abolish prescription charges so that people with serious long-term conditions are no longer penalised and, in some circumstances, unable to take their prescribed medication because they cannot afford it. That is not a set of circumstances over which this Government is prepared to preside.

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Antidepressants

To ask the Scottish Executive what steps it intends to take to achieve the aim of reducing the use of antidepressants by 10 per cent by 2009. (S3O-1573)

We will ensure that those who need antidepressants will continue to receive them while we invest in alternatives that increase choice for clinicians and service users through improved access to evidence-based interventions, including psychological therapies.

We continue our aim to reduce the annual rate of increase to zero by 2009-10, and will put in place the required support framework to achieve a 10 per cent reduction in an appropriate timeframe.

The 10 per cent reduction was, of course, an SNP manifesto pledge and it was accompanied by the statement that it would be backed by ring-fenced funding to health boards and local authorities. Can the minister give us a bit more guidance on whether that is to be the structure? Does she agree that the reduction in the use of antidepressants and the prevalence of mental health problems that underlie it represents a key challenge that stands a good chance of being dumped if there is no agreement on tackling it on the part of councils and health boards? As the issue is not dealt with specifically in the concordat, and in the absence of stringent procedures to ensure that it remains a top priority, does the minister agree that there is a good chance that mental health services will fall off the edge?

I do not agree that mental health will fall off the edge because we will ensure that it is a top priority for health boards and their partners in local government.

The member might be interested to know that our forward direction for mental health improvement, moving towards a mentally flourishing Scotland, is currently out for consultation. I look forward to receiving responses to the proposals that have been made, including, I hope, suggestions from the member. We will consider the most appropriate timeframe for the 10 per cent reduction in the context of that consultation.

I can assure Robert Brown that with record levels of investment in the health service, mental health will continue to receive the high priority that it has had to date. I am sure that that will reassure the member.

As many younger children are now being diagnosed as depressed, will the minister confirm that the Government intends to honour its manifesto commitment to double the number of school nurses, which would help?

We are working up a model that will deal with the increase in the health care resource in schools. It will include other professionals because, although we recognise that school nurses are some of the key professionals, there are other professionals—particularly those involved in mental health—whom we want to bring into the health care resource base in our schools. We will be able to provide further details in the new year as that model is worked up.

I would like to clarify a point of information. You said that mental health will not fall off the edge because you will ensure that that will not happen. For the benefit of those of us who are not clear about this, could you explain how you will ensure that?

I am sorry, Ms Lamont, but I cannot explain that. Could you please refer to the minister in the third person?

My apologies. Could the minister explain the process by which she will back up her claim that she will ensure that that funding will be provided?

We have confidence that our local authority partners see mental health as a priority, as we do. They have demonstrated that. Why would they not invest the additional resources that are required, in addition to the work that they have done so far, when they also see mental health as a priority? They will work alongside their health partners to deliver these important services. I obviously have more confidence in our local authority colleagues than the member has.

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Affordable Housing

To ask the Scottish Executive how many affordable houses it expects will be built during the current spending review period. (S3O-1528)

We expect that, during the current spending review period—2005 to 2008—funding approvals for around 21,500 new affordable homes will be issued.

It is interesting that that answer is slightly different from the information Mr Maxwell gave during a meeting of the Local Government and Communities Committee, when he was reluctant to give any figure. I have to say that if we have to wait for the next spending review period for those houses, the problems that will arise during this spending review period will mean that we will have difficulty reaching the 2012 target. Can the minister define what he understands by the term "affordable housing"?

For the sake of clarity, I should point out that the member's question is about the current spending review period, which is why my answer deals with the current spending review period. At the committee meeting, the questions were about the next spending review period. If Patricia Ferguson wanted to ask about that, she should have worded her question slightly differently.

Spending on affordable housing in 2008 to 2011 will be more than £1.5 billion, which is up 19 per cent on the planned budget for 2005 to 2008—a big increase in a tight settlement. It will deliver more new affordable homes, including homes for affordable rent and low-cost home ownership, than are planned for 2005 to 2008.

My definition of affordable homes is homes across all tenures that people can afford.

The minister will be aware that, over the next three years, 19 per cent more will be spent on affordable housing—despite average growth in the Scottish budget from London Labour of only 3.8 per cent. That was confirmed by Professor David Bell, the adviser to the Finance Committee. Does the minister consider that a fair deal for affordable housing under such a tight financial settlement? Will he provide more detail on how housing associations might use their housing association grants better, to provide more new social rented properties at a better price to the public purse?

I agree in no uncertain terms that it was an incredibly tight settlement, and the worst since devolution—that is in no doubt, despite the noises. It is clear that we have invested considerable resources in affordable housing over the next three years. As the member said, there is a 19 per cent increase for planned expenditure, like for like, over the amount the previous Administration planned for affordable housing. That shows our priority in terms of affordable housing.

Will the minister confirm today that the Government's budget for housing and regeneration will not rise by 19 per cent over the comprehensive spending review period—as the First Minister stated last week in response to my question, and as the minister has stated today—but by only 10 per cent? Does he agree that using cash values rather than real-terms values when discussing the budget is unhelpful to Parliament and the public? Will the minister confirm whether the Government even has a target for the social housing that is to be built by 2011, in addition to its target for house building across the entire sector, which cannot be measured until 2015?

I will not agree with the member because he is wrong about the increases, but even if he was right, such an increase would show the priority that we put on housing as it is a much bigger rise than was planned for the previous review period. The like-for-like comparison is 13 per cent for the 2004 spending review and 19 per cent for SR 2007. That is a clear indication of this Government's priority in providing housing for Scotland.

Question 4 has been withdrawn.

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National Health Service Dental Care

To ask the Scottish Executive what action it will take to increase access to NHS dental care across Scotland. (S3O-1565)

A revised Scottish dental access initiative was introduced earlier this year to encourage the establishment of new NHS dental practices and the expansion of existing ones. It builds on a range of existing measures to recruit and retain dentists in the NHS.

I launched a school-based preventive service in Fife on 3 December 2007, and good progress is being made towards the establishment of a third dental school, in Aberdeen.

We will work to continue to increase the dental workforce and to improve dental facilities.

I welcome the plan to build a dental school in Aberdeen—it is something the Liberal Democrats have campaigned for vigorously.

But they never built it.

Order.

Will the minister look into the problem of practices deregistering NHS patients, which has resulted in 31,000 patients being deregistered in 2006 and 2007?

There is a difference between the Scottish National Party Government and the Liberal Democrats—the Liberal Democrats might have campaigned for a third dental school, but we are delivering a third dental school. That is a sizeable difference.

We are very concerned about the level of registrations and deregistrations. The member will be aware that a major expansion in facilities is coming on stream, particularly during the next year. He will be aware of the new Dumfries dental centre that is scheduled to open in his constituency in late January. That centre will provide an outreach training facility for dental undergraduates and dental therapists. In addition, the salaried service wing of the new centre will operate with extended hours, and four dental officers will be employed there—initially to provide general dental services. The community dental service will also relocate to the new centre. I am sure the member will appreciate that that will be a major step forward in his constituency.

Can the minister please outline any plans that there may be to develop a school-based dental service and tell us which communities will benefit first?

As I said earlier, the school-based dental service was launched successfully in Fife this week. It will focus on the most deprived communities. We will roll the service out to Tayside in the new year, and then to the Borders and to Ayrshire and Arran. We will focus on the communities with the highest levels of deprivation to ensure that we give our children the best oral health start in life.

The minister will be aware that there is a specific problem with registration in rural areas. The level of registration in Dumfries and Galloway is 8 per cent below the Scottish average of 46 per cent, and most other predominantly rural health boards are even further behind. Will the minister consider what special measures she could put in place to encourage registration by adults in rural areas, and to make it easier?

Alasdair Morgan will be aware that we already offer substantial allowances to attract dentists to deprived communities and rural areas. We recognise the problems and will lay out in the action plan that will be published shortly some additional measures that we believe will help to address the issue he raises.

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Cabinet Secretary for Health and Wellbeing (Meetings)

To ask the Scottish Executive when the Cabinet Secretary for Health and Wellbeing last met NHS board chairs. (S3O-1526)

I last met NHS chairs as a group at my regular monthly meeting with them on Monday 26 November.

I am sure that, through her many discussions with health boards, the minister will be aware of the evidence from NHS Greater Glasgow and Clyde on the profound impact of inequality on health outcomes and health services. Particularly given the fact that she is a Glasgow MSP, does she believe that the NHS in Glasgow should get extra resource to recognise the disproportionate burden that it carries in meeting the challenge? Further, does she believe that the health board should be required to target its resources on deprived areas?

I assure Margaret Curran that as I am the Cabinet Secretary for Health and Wellbeing, and particularly as I am the MSP for a Glasgow constituency, I am well aware of the continuing problems of poverty and deprivation and the consequent inequalities in health that exist in that city. It is extremely important that health boards' funding recognises deprivation. The Arbuthnott formula recognises deprivation. The member will also be aware that I am currently considering the findings of the NHS Scotland resource allocation committee—NRAC—which has made recommendations to refine the Arbuthnott formula as well as other recommendations beyond that. I will make a decision on the implementation of that in due course.

It is important that boards target resources to tackle health inequalities. When I chaired the annual review of NHS Greater Glasgow and Clyde in the summer, I was reassured to hear of the work that the health board is carrying out to tackle health inequalities. I encourage it to continue and to intensify that work. Increasingly, community health partnerships—or, in Glasgow, community health and care partnerships—have a vital role to play in ensuring that resources get into the community and into primary care, where they can have the biggest impact in tackling inequalities.

I am not sure whether we have a new health board chair in Glasgow yet. It would be good if the minister could let us know when that will happen.

It is Andrew Robertson.

Oh. Good. When the minister meets the new chair, will she discuss the situation that is faced by the St Margaret of Scotland hospice? The hospice has been placed in a difficult position because of the plans that are being put forward by NHS Greater Glasgow and Clyde. Will she meet me and representatives of the hospice to discuss a way forward?

It is good to see that Des McNulty's finger is on the pulse, as usual. The new chair of NHS Greater Glasgow and Clyde was announced on Monday. It is Andrew Robertson, who was, until now, the vice-chair of the health board. I am sure that he will do a fantastic job. I put on record my thanks to John Arbuthnott, who has been the chair of NHS Greater Glasgow and Clyde over the past few years. I am sure that everyone agrees that he has done a splendid job.

Des McNulty's finger is slightly off the pulse on the issue of the St Margaret of Scotland hospice. The particular issues around the hospice are for the health board to address, and I expect it to do so, but I have agreed to meet representatives of the hospice early in the new year, and I look forward to that meeting.

When the cabinet secretary last met the NHS board chairs, what discussions did she have about the health needs of veterans of our armed forces, who experience a much higher than average liability to physical and mental illness?

I confirm that the needs of veterans in the health service were discussed at my most recent meeting with the health board chairs as well as at the one before it. That is a sign of how important the Government considers the issue to be.

As members are aware, I announced—I think it was two weeks ago now—that all veterans with a medical condition associated with their service in the armed forces are to have priority treatment in the NHS. Prior to that announcement, only veterans who were in receipt of a war pension got priority treatment. The Government's announcement, which was mirrored by a similar one south of the border, is a good step forward and, as members would expect, it has been welcomed by veterans' organisations around the country.

The cabinet secretary will be aware of the welcome conclusions of the Clyde scrutiny panel report, which states quite clearly that NHS Greater Glasgow and Clyde should think again about the proposals for the maternity unit, the medical assessment unit and mental health services at the Vale of Leven hospital. Will the cabinet secretary comment on NHS Greater Glasgow and Clyde's press release, which is either an interesting piece of spin or an indication that the board has not read the scrutiny panel's report? When the cabinet secretary next meets Andrew Robertson, will she insist that NHS Greater Glasgow and Clyde, which is an agency of the Government, fully implements the recommendations of the panel's report?

I am sure that Jackie Baillie did not mean to forget to congratulate the SNP Government on putting in place the independent scrutiny process, which led to, in her words, a welcome report. That process is designed to build the public's confidence in the process of major service change in our NHS. It is a welcome development.

As Jackie Baillie indicated, the independent scrutiny panel that was asked to review NHS Greater Glasgow and Clyde's proposals published its report earlier this week. I put on record my thanks to Professor Angus Mackay and his entire panel for the hard work they have done in producing a comprehensive report. I expect the board of NHS Greater Glasgow and Clyde to take full account of that report before deciding on the proposals that it puts out to public consultation. The final decision on any proposed change will come to me, so it would not be appropriate for me to say any more at this stage.

Question 7 has been withdrawn.

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Central Heating Programme (Additional Funding)

To ask the Scottish Executive how the recently announced extra £7 million for the central heating programme will benefit pensioners concerned that they may have to wait until after Christmas to have their heating installed. (S3O-1505)

The funding will be used to accelerate installations for pensioners who are eligible for a central heating system and in the meantime are without heating and hot water. This is in addition to funding made available in August to install around 1,500 extra systems.

I have a number of constituents who have real concerns about their heating this winter, including one pensioner couple in Baillieston, both of whom are receiving treatment for cancer and other serious illnesses, who will be without heating and hot water as their central heating was condemned. Can I offer them hope that the situation will be readily resolved? May I meet the minister to discuss the situation?

I am more than happy to meet the member to discuss the issue that he has raised, and I would appreciate it if he would write to me about that particular case and I will take it up with the managing agent.

The central heating programme is extremely popular. It has had waiting times of approximately six months associated with it since it began in 2001. The priorities and extra money for the programme have been welcomed around the country during the past month, and will lead to many more people getting central heating systems before Christmas. Our intention is to maximise that.

The managing agent is working as hard as possible so that the maximum number of people get their heating before Christmas. That effort will carry on into the new year, but we have put a priority on those who are living without heating and hot water, who are over 80, who have a medical condition and whose ability to live independently could be significantly impaired if they did not have a central heating system. Those extra criteria will help more people to get their central heating system earlier without disadvantaging those who are currently on the list.

One of my constituents has not been so fortunate, as he has been told that the replacement of his central heating system is unlikely to take place until June 2008. Scottish Gas tells me that it cannot find subcontractors to address the workload and reduce waiting times. What is the Scottish Government doing to encourage properly registered local contractors to come forward and do the work, so that my constituent does not have to wait eight months?

I cannot comment on the individual case that the member raises, but the fact remains—the member may not like to have this pointed out—that this has been the situation since Labour put the programme in place in 2001.

I will go over the situation yet again. In 2001, the first year of the programme, the average waiting time was eight months. In the second year of the programme, the average waiting time was eight months. In the third year, it was about six months, and it has been about six months ever since. Those are the facts, although Labour members want to create the impression that something has changed since the election in May.

We are reviewing the system. An internal review is currently under way to try to improve the system and minimise the length of time people have to wait. We have put in additional resources twice this year, to take the figure up from 12,000 installations to a planned 15,000 or more. This Government is tackling the problem; the previous Government left us with an inheritance of enormous waiting lists and a difficult situation to deal with.

The change from Eaga to Scottish Gas was meant to bring improvements. Why do the concerns about the delivery process still exist? Aside from the financial aspect, what will the minister do to ensure that pensioners and people who really need the heating get it in a shorter time than is currently the case for some of them? They have to wait for months and even years.

I am not aware of a case in which a person has had to wait for years, but I understand people's concern about the system. As a result of such concerns we are carrying out an internal review to ensure that we minimise the length of time people have to wait.

The member will be aware that two announcements have been made this year—one in August and one on 21 November—of additional money for the programme, which will raise the number of installations from 12,000 to 15,000 this year. That will bring forward a large number of installations so that people get their systems much earlier. We have introduced additional criteria to bring forward the most urgent cases.

Over and above that, I have had meetings with Scottish Gas to discuss particular problems in the process. It is working on the matter, and it assures me that it can drive down the length of time it takes for individual cases to go through the system, but clearly the process must ensure that we have proper checks in place, that proper surveys take place and that the systems installed are of a suitable standard for the kind of people for whom we are putting them in. We must ensure that they get a good high-standard central heating system that is installed within a reasonable timescale. We are doing everything we can to try to ensure that that happens.

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Health (Consultation)

To ask the Scottish Executive how it will plan to ensure effective consultation on health matters. (S3O-1559)

Revised informing, engaging and consulting guidance has recently been produced for national health service boards. It is currently out for consultation.

NHS boards must routinely communicate and involve the people and communities they serve, to inform them about their plans and performance. That is part of boards' patient focus and public involvement responsibilities.

I hope that people will respond to the consultation.

The minister will be aware of my concerns about the handling of the process to provide general practitioner services to the 1,800 patients who belong to the South Nimmo practice in Airdrie. I am concerned that NHS Lanarkshire failed to consult and involve patients effectively.

In my constituency, NHS Lanarkshire has had to manage the process of selecting GPs to take over two separate GP practices. On neither occasion has the process been handled properly or effectively to engage patients fully in the decision-making process. Therefore—

A question please, Ms Whitefield.

—does the minister agree that, in future, health boards around the country will have to intervene in similar circumstances—

A question, please.

—and that agreed national guidance on patient involvement will therefore be of benefit to the process to ensure that patients are not needlessly worried at a very anxious time?

I am not sure whether a question has been asked, but if the minister would like to answer, she may.

There was a question.

I will be charitable—[Interruption.] If Labour members give me a chance, I will give them the answer for which they bellow from sedentary positions.

As Karen Whitefield knows, the matters that she raises are for NHS Lanarkshire. People who have concerns about those matters can and should take them up with NHS Lanarkshire. When I chaired the annual review of NHS Lanarkshire just a couple of weeks ago, at which I do not recall seeing Karen Whitefield, people turned up—I do not know whether they were from her constituency or other parts of Lanarkshire—to put their concerns direct to Lanarkshire NHS Board, and they were given answers.

I take public involvement and engagement seriously. That is why the Government has established the independent scrutiny process that Jackie Baillie has praised highly and why we will consult shortly on a local health care bill to embed public involvement further and on proposals for elections to health boards. I hope that all members will participate in those consultations.

As Karen Whitefield knows, even under current procedures, every board has a statutory obligation to show year on year how it consults and engages the public. I expect all boards to take that responsibility seriously.

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Modernising Medical Careers

To ask the Scottish Executive what progress is being made on modernising medical careers. (S3O-1546)

Planning is under way for selection and recruitment to medical specialty training posts under modernising medical careers in 2008. NHS Education for Scotland is developing a Scottish system for the application process, which opens on 4 January next year.

We have developed our own mechanisms to ensure that MMC is fit for Scotland's purposes. Work continues with all key stakeholders, particularly the British Medical Association, the royal colleges and junior doctors' representatives. I am grateful for the commitment and support that they have shown.

In common with other parties, the Scottish National Party endorsed the direction of travel that was outlined in the Kerr report on modernising the national health service in Scotland. That report focused on the development of specialisms in the NHS and said that primary care needed to be given greater priority. Will the cabinet secretary reaffirm her support for the Kerr report's conclusions? Will the development and improvement of expertise among palliative care specialists be ensured through appropriate support for and resource allocation to palliative medicine?

I do not know whether Michael McMahon's complete ignorance of health matters is why his supplementary question bore no relationship to the question in the Business Bulletin, which was about modernising medical careers, but I am more than happy to answer his question. I will say what I have said many times in the chamber: the SNP Government endorses the direction of travel that was set out in the Kerr report, but that does not mean that we will endorse everything that is done in the Kerr report's name if we think that something is wrong for the communities and people of Scotland.

Soon, I will publish the new Government's action plan for health, which will build on the Kerr report's work. When Michael McMahon has the chance to read that, I am sure that he will be encouraged by the range of proposals that are designed to support the shifting of the balance of care into community and primary care, about which I hope there is consensus. I also hope that, when he reads that plan, he will be reassured about the importance that the Government attaches to improving the standards of palliative care for everybody who needs it, regardless of their diagnosis.

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Ambulances (Infection Control)

To ask the Scottish Executive what efforts are being made to control the spread of infection in ambulances, given reports in England that ambulance crews are complaining about a shortage of cleaning products to sterilise their vehicles properly. (S3O-1503)

The Scottish Ambulance Service operates a national infection control policy that has clear processes for cleaning vehicles. Those processes allow for appropriate cleaning of ambulances after each response and a regular full deep clean. Specialist cleaning materials are issued to all stations and crews and new cleaning arrangements, such as the use of specialist cleaning teams, are being trialled at busier stations.

The cabinet secretary's answer will reassure not only passengers and patients in ambulances, but ambulance crews themselves. Through appropriate agencies, will her department continue to monitor the cleanliness of our ambulance fleet to ensure that an all-encompassing approach is taken to avoiding what we hope is avoidable—the spread of MRSA?

I thank Christine Grahame for that extremely important question and assure her that I will continue to monitor closely the Scottish Ambulance Service's compliance with infection control procedures, just as we will continue to monitor the performance of the national health service generally in complying with infection control procedures.

As Christine Grahame will be aware, I announced last week that £54 million will be available over the next three years to equip us to tackle infection in hospitals better. Those resources will fund a pilot programme and then the roll-out of a national MRSA screening programme. They will help us to boost hand hygiene procedures in our hospitals. I also said last week that we are reviewing the cleaning standards that apply in hospitals and, by extension, in ambulances and other health care settings, to ensure that they are as robust as they can be.

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Osteoporosis (Ayrshire and Arran)

To ask the Scottish Executive what steps it is taking to improve the detection and treatment of osteoporosis in Ayrshire and Arran. (S3O-1536)

We encourage all boards to support early diagnosis of osteoporosis by ensuring that there is ready access to dual energy X-ray absorptiometry—DEXA—scanning. That is in line with Scottish intercollegiate guidelines network—SIGN—guidelines and the audit that NHS Quality Improvement Scotland published in 2005. In addition, NHS Ayrshire and Arran intends to take up the option of choosing falls and bone health under the Scottish enhanced services programme for primary care, which will mean that falls co-ordinators will be appointed in each community health partnership area to improve awareness of the incidence of falls and address bone health as a health improvement issue.

I hope that the minister will join me in congratulating Janette Leitch and the other members of the Cumnock osteoporosis support group, who celebrated that group's 10th anniversary this week. Is she aware that that group is concerned that patients in Ayrshire, unlike those in many other parts of Scotland, have been unable to benefit from a full fracture liaison service? When will all patients who have been diagnosed as having osteoporosis and low-impact fractures enjoy a complete service, including a DEXA scan, full results, support and the follow-up services that are available in other parts of Scotland?

I join Cathy Jamieson in congratulating the Cumnock osteoporosis support group on its hard work. I suggest that she write to me giving me the full details of the issues in Ayrshire and Arran. I will certainly make it my business to get back to her with full and detailed answers to her questions.

Is the minister aware that Forth Valley is the only area in Scotland that does not have a DEXA scanner? Patients from my constituency have to travel to the Golden Jubilee national hospital for testing. Is she prepared to join me in an approach to Forth Valley NHS Board to invite it to use some of the new money that will be available to ensure that it will not be the only health board in Scotland that does not have such a service?

Richard Simpson is correct. However, boards have been encouraged to improve access to DEXA scanning, especially in the light of the results from the audit that NHS QIS published in 2005, which I mentioned, and good progress has been made. Only one mainland board—Forth Valley NHS Board—does not provide a DEXA scanning service, as Richard Simpson said. I will certainly follow up that matter with that board and find out what plans it has to make improvements to that service. I will keep the member informed about what happens.

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Central Heating Programme (Scottish Gas Contract)

To ask the Scottish Executive whether it is satisfied with the way that Scottish Gas is handling the central heating programme. (S3O-1507)

The managing agent has said that it will meet the target for installation this year, which includes a total of 3,000 installations announced in August and on 21 November. However, we recognise that more can always be done to improve performance, and regular meetings are held between the managing agent and officials that are aimed at improving programme delivery.

I appreciate that the minister inherited the central heating contract from the previous Executive, but is he aware of the serious concerns about how Scottish Gas is administering the contract? In particular, I draw his attention to its withholding payments from contractors who have carried out installations on its behalf. It has not paid contractors until the very last moment, which I understand has already caused several companies to go under. I understand that an increasing number of contractors are looking to withdraw from such work as a result of that policy.

In addition, I draw the minister's attention to the fact that Scottish Gas is failing to pass on work to contractors who are prepared to work for it. I know of one contractor who has a contract with Scottish Gas to install 40 systems per week, but who in the past two weeks has received only 14 requests for installations. Will the minister ensure that, as part of his review, contractors are consulted on what can be done to improve the system?

The member raises a serious issue. As the managing agent, Scottish Gas is subject to a contractual requirement to ensure that contractors are paid within 30 days of satisfactory completion of work and on submission of a valid invoice. Communities Scotland has made it clear that it should comply with that requirement. If the member has evidence that that requirement is not being complied with, I would be interested to see it and will take the issue up with Scottish Gas personally and through official channels.

Will the minister confirm that he recently extended the contract with Scottish Gas, despite the fact that waiting times are at an all-time high? Did he seek or receive advice that would have allowed him to place conditions on Scottish Gas in the contract? How will his internal review of the central heating programme address the concerns of contractors who want to support the programme—concerns that Michael Matheson, a back bencher from his own party, has raised?

I am keen that as many contractors as possible should subcontract to the managing agent, to ensure that we install as many systems as possible as quickly as possible. We have extended the contract for one year while we carry out the review; that is the sensible approach to take.

If Johann Lamont and other members have evidence that Scottish Gas is in breach of contractual arrangements, they should make us aware of such breaches. Thus far, I have seen no factual evidence of that. I have made it clear that it is unacceptable if contractors have not been paid, if companies have gone under for that reason or if the managing agent has failed to supply the work that it is contracted to supply to subcontractors. If contractors have evidence that that is happening, I will take the matter up immediately with the managing agent.

Before we move to the next item of business, I acknowledge the fact that Karen Whitefield's supplementary included a question. I am afraid that I lost it while I was exhorting her to ask a question. I say to members from all parties that I expect supplementaries to be short, sharp and to the point. There is a growing tendency for members from all parties to turn them into brief speeches, which is not particularly welcome.