First Minister’s Question Time
Engagements
1. To ask the First Minister what engagements he has planned for the rest of the day. (S4F-01050)
Later today I will speak with Steve Frisch, regional president of the global electronics manufacturer Plexus, which I am delighted to announce is creating 130 jobs as part of a £9 million investment in Bathgate, West Lothian. After the disappointment of Vion deciding to close its operations, today’s announcement will be very welcome news for the people of West Lothian and is an early result for the West Lothian recovery strategy.
It is appropriate to pay tribute to John Park, who I understand is shortly to stand down as a member of the Scottish Parliament. He has made a considerable contribution to our proceedings over the years.
In light of everything, we should also congratulate Celtic on qualifying for the European championship. I think that Neil Lennon is on his way to becoming a legend.
The only word that I would dispute there is “becoming”—maybe we can discuss that later.
I welcome the First Minister’s comments about jobs and about John Park’s decision to stand down. I am sure that we all wish John Park well. Labour members will miss him very much, but we know that in his new job he will continue to engage with the struggle, the battles and the values in which he believes as well as he has done in the past.
This week, doctors called for honesty from politicians on cancer treatment. Alex Neil has announced a review of access to new medicines, which I welcome. Of course, under Nicola Sturgeon, Scotland went from being the top nation in the United Kingdom for using innovative drugs to being the worst. Will the First Minister explain why Scots do not get access to the latest cancer drugs on the national health service?
The process by which the Scottish Medicines Consortium looks at such matters is robust and has been supported by all parties, and it would be very unwise to change it.
The recent controversy concerns the introduction in the English health service of a special cancer drugs fund. That introduction has been opposed in Scotland, by not just the Scottish National Party but the Labour Party and the Liberal Democrats, and it has been opposed by the Welsh Assembly Government, basically because the fund does not fulfil many of the things that are claimed for it. In particular, it introduces in England a postcode lottery. There is criticism from the range of charities that submitted evidence to the Parliament, which cannot see the reason for having a specific cancer drugs fund when other, equally serious, conditions do not have such a fund.
We should be confident that the SMC process in Scotland is a robust one and we should continue our all-party support for the integrity of the process.
I did not ask the First Minister for a critique of what is happening elsewhere; I asked him about his responsibility. He said that a cancer drugs fund might create a postcode lottery. Is he not aware that there is currently a postcode lottery in Scotland?
There is no test of cost-benefit for my free hay fever tablets, but such a test is applied to cancer drugs. Let us look at the reality. This morning, we spoke to Iain Morrison. He is 56 and suffers from bowel cancer. He has to pay £1,700 a fortnight for the drugs that he hopes will prolong his life. What is astonishing is that part of that cost is an administration charge from the NHS, so that he can get the drugs that the NHS will not give him for free.
As patients suffer, doctors despair. Dr Tim Crook told the Parliament this week:
“As an Englishman looking after patients in Scotland, I think that there is an inequality that, to my mind as a simple doctor, is unacceptable, in that I cannot offer my Scottish patients the same medication with which I could treat my English patients. As a human being and a doctor, I do not see how that can be right.”—[Official Report, Health and Sport Committee, 4 December 2012; c 2988.]
Does the First Minister think that that is right?
That refers specifically—I saw the quote and, indeed, the evidence to the committee—to the introduction in England of the special cancer drugs fund. The committee also heard from the Scottish cancer research network lead, Dr David Dunlop, who referred to
“the cancer drugs fund, which clinicians south of the border say is far from perfect. In fact, that fund brings more postcode prescribing than existed previously, because each of the different strategic health authorities has a different shopping list that is influenced by its clinicians.”—[Official Report, Health and Sport Committee, 4 December 2012; c 2986.]
Incidentally, that position has previously been supported by the Labour Party in this chamber.
We should always look for ways to improve the position and we should always look for ways in which the Scottish Medicines Consortium can be even better in progressing its work, but I point out that that is exactly why the health secretary Alex Neil has set up the investigation by Professor Routledge, who is looking specifically at how we can improve the situation in Scotland.
In this extraordinarily difficult area, I do not think that it is particularly helpful to give quotations that refer to the existence of a special cancer drugs fund, which we have thus far decided is not appropriate in Scotland for the reasons that I have given. We should also hear the evidence from the cancer charities and others who support the work of the SMC and who point out the advantages of the SMC process.
This is a matter that we must consider, as a Government and as a Parliament, with the utmost care and sensitivity, because it obviously touches on life-limiting conditions and people in conditions of great extremity. I think that Johann Lamont should accept that, thus far at least, the SMC process has enjoyed cross-party, robust support in Scotland, and I think that we should be very careful about departing from that established process of integrity.
The First Minister ought to stop accusing me of doing things that I am not doing, and he ought to stop arguing about something that I am not arguing for. I do not need anyone to tell me how serious an issue this is—nobody in here does. What I am saying to him is that there is a postcode lottery in Scotland, and I have described a particular case. This is a very serious issue, but the First Minister’s response seems to be that what we have is very good. I am not promoting a particular model to solve this; I am asking the First Minister to confront the fact that there is a major problem.
The issue affects not just those people whom I have already described. The inequality is not just between Scotland and England; there is an even greater inequality within Scotland. Dr Noelle O’Rourke of the Beatson cancer centre told the Parliament’s Health and Sport Committee this week that middle-class, articulate patients are more likely to get the cancer drugs that they need than vulnerable patients from deprived backgrounds. She said that patients in less need receive treatments that are denied others in greater clinical need because they are more articulate. Dr O’Rourke described that as “inequitable”. Does the First Minister agree?
The reason that I made those points to Johann Lamont is that the quote that she gave was an illustration of the impact of the introduction of the special cancer drugs fund in England. I am looking at the evidence and the argument is that there are drugs available in England because of the special cancer drugs fund, but those are not available in every part of England. The committee has heard evidence—and I suspect will hear more evidence—of the drawbacks of that particular system.
The reason that I point to the robustness of the SMC process is not to argue that the position that we have in Scotland is perfect. If we thought that the position was perfect, we would not have set up the Routledge review in order to see how we can improve the situation. However, in Scotland the time that the SMC takes to produce guidance, following authorisation for drugs, is just over seven months; the equivalent time in England is 21 months. There is much evidence from the charities and people affected on why they appreciate the speed with which the SMC goes about its work.
There are important improvements that we have made to the process of individual patient treatment requests. The purpose, among other things, of Professor Routledge’s review is to see how we can improve that further.
Johann Lamont says that she is not proposing a particular solution. It would be helpful as we contribute to the debate—I hope that this is what the Health and Sport Committee will do—if people would contribute positive suggestions as to how we can improve the situation. However, that should be done with a recognition that what we are dealing with, whether it is in Scotland, England, Wales or wherever, is an extremely serious issue; that we are doing our best to deal with it; that the SMC’s process is robust; and that the Routledge review is there to make further improvements on behalf of the people of Scotland.
Of course, the doctor referred to was talking not about the SMC but about the individual patient treatment request, into which a review was conducted.
My point is that the review needs to be broader than the remit that has been given to it because of the huge challenges.
The First Minister says that we should have an open and honest debate about this. When I questioned his priorities in health spending, I was accused of wanting to tax the sick and that debate was quickly closed down. This is all part of the same serious process because it is not just about patients getting the latest drugs. The NHS in Scotland spends only just over half the European average on cancer drugs. Cancer specialists do not want to work here. Dr Richard Casasola told this Parliament—[Interruption.]
Order.
Dr Richard Casasola told this Parliament this week that every Scottish cancer centre is at least one specialist short and that the most gifted doctors do not want to work here because they cannot prescribe the latest drugs.
We are not able to be at the cutting edge because of the choices that the First Minister has made about the way in which drugs are accessed. Will the First Minister please be honest with cancer patients and specialists and confront the reality that this is the result of choices that he has made and it is about his priorities for spending in the NHS? [Interruption.]
Order.
Johann Lamont should accept the substantial efforts and spending on cancer research in Scotland and cancer centres, the substantial increase in the successful outcomes for cancer that we are seeing, and the abidance—for the first time, I think—of the target to have 95 per cent of cancer patients seen in a specified period. The figure when Labour was in office was 85 per cent. Those are all substantial improvements in the service that we are able to offer.
When I argue that the SMC has a robust process that we should reflect on, be proud of and be careful about overturning, I am not just saying that as the First Minister. Myeloma UK, for example, says:
“The modifiers that the SMC use in their decision-making are applied more pragmatically than the comparable but not identical ... criteria used by the National Institute for Health and Clinical Excellence (NICE).”
It says that it prefers the SMC approach to the approach south of the border. That the SMC process is robust has substantial support from many people.
There is much evidence that the individual patient treatment request process, which applies to drugs that have not been authorised by the SMC, has factors in it that could be improved, and the health secretary set up Professor Routledge’s review to see whether we could improve the situation further.
Johann Lamont should be careful about suggesting that cancer treatment in Scotland is not improving, because it is. She should not say that there is not a commitment to cancer research, because there most certainly is. [Interruption.]
Order.
Well, £6 million is being spent on 24 cancer research projects by the chief scientist’s office.
Johann Lamont should also accept that we are dealing with hugely difficult circumstances around how to successfully approve and make available to the people of Scotland new, experimental drugs that become available; how to find a safe process for authorising them; and how to find the best possible way of making them available to the community of Scotland.
Every single person in the chamber is committed to better outcomes for cancer patients in Scotland. Let us go forward to find that better solution, supporting the Routledge review, in an atmosphere that accepts that in essence this cannot be seen as a party-political matter but as a matter of trying to improve the health and welfare of the people of Scotland.
Prime Minister (Meetings)
2. To ask the First Minister when he will next meet the Prime Minister. (S4F-01032)
There are no plans in the near future.
One party in the chamber has consistently argued for a Scottish cancer drugs fund. The First Minister is right: that argument, which the Scottish Conservatives have put forward, has consistently been opposed by the Scottish National Party and the Labour Party. Today, he says that that is because it is an imperfect solution.
A cancer drugs fund may not be perfect, but it is a solution to enable Scottish cancer patients to get better treatment and access to the same drugs as people elsewhere, and to address the difficulties in recruiting cancer specialists north of the border. I have raised that point with the First Minister, as has my predecessor. The postcode issues that the First Minister cites today have been being addressed down south since the fund’s inception.
Does the First Minister even know which drugs are routinely denied to Scottish patients, but are now available in England?
I have seen a number of drugs cited that are available via the cancer drugs fund in England, but are not available—except through individual patient treatment requests, if those are successful—in Scotland. Equally, the Scottish Medicines Consortium’s authorisation process for medicines means that a range of drugs, for a range of conditions, are available in Scotland that are not available in England. I can list some of those if Ruth Davidson would like me to.
We should properly conduct a debate on trying to get the best possible system for the people of Scotland. To argue—as Ruth Davidson seems to be saying—that the cancer drugs fund that has been introduced in England is the best solution tends to ignore the substantial evidence of the difficulties, drawbacks and inequities of the situation in England, and the evidence that a range of charities have submitted to the Parliament to say that they do not want to go down that road.
The suggestion that a cancer drugs fund is the solution is not met by the evidence. This Government’s willingness to look for a better position than we have in Scotland is symbolised by the Cabinet Secretary for Health and Wellbeing setting up the Routledge review. If we were not interested in finding better outcomes for Scottish patients, we would not have set up Professor Routledge’s review.
I have information here—which I am happy to lodge in the Scottish Parliament information centre—to show that, between October 2010 and 27 November of this year, more than 23,000 cancer patients in England have had their lives extended by the cancer drugs fund. That is 23,000 families who have been able to spend more time with their loved one and who thought that that road was worth going down.
Because of the fund, patients in England have had access to everolimus to tackle kidney cancer, which is a drug that is not routinely available in Scotland; Avastin for kidney cancer; lapatinib and eribulin, which are available for those with breast cancer and are not routinely available in Scotland; and bendamustine for those who are suffering from non-Hodgkin’s lymphoma and chronic leukaemia—that drug is not routinely available in Scotland.
This Government has failed the Scottish patients who died of those conditions and who, with access to those drugs, could have had more time. It does not have to fail thousands more. Rich people do not need free prescriptions: cancer patients need better treatment. Will the First Minister, in his review, at least reconsider his opposition to a cancer drugs fund?
The review exists, as has previously been discussed, to look at all areas that could improve the situation in Scotland. Ruth Davidson should at least acknowledge not only that there is substantial criticism of the cancer drugs fund—not least from cancer charities themselves and from Conservative members of Parliament—but that the fund is a temporary fund before value-based pricing is due to be introduced.
In acknowledging that different systems produce different outcomes, I could cite to Ruth Davidson the range of drugs, for a range of conditions, that are available in Scotland through the SMC process and are not available through the National Institute for Health and Clinical Excellence. We try to find the best possible system for Scottish patients, and, generally speaking, the SMC process is well regarded by members on all sides of the chamber and by the medical profession and patients in Scotland. It is a system that we can have confidence in. The Routledge review is designed to look at whether particular improvements can be made, whether in the SMC process or the individual patient treatment request process.
There is huge willingness on the part of this Government to look for better outcomes for the people of Scotland, but there is also a track record that indicates that cancer patients in Scotland are receiving better and earlier treatment than they have ever had before. In terms of the move in prevention and early detection of cancer, there have been very substantial advances.
So, let us proceed on this subject with the understanding that every single member of this Parliament in every single party is trying to get better outcomes for the patients of Scotland and that our national health service in Scotland has certain advantages over models that might be pursued elsewhere.
I have a number of back benchers who wish to ask questions and I am determined that they will do so. Can the questions and answers be brief?
The First Minister will be aware of the outcome of the ballot of RMT members serving on the Orkney and Shetland ferry service and that the islands now face the threat of industrial action over the Christmas holiday period. When my colleague Tavish Scott raised the issue with the First Minister last month, he rightly highlighted the potentially devastating impact on the islands of any strike action affecting those lifeline services. In light of that, can I urge the First Minister to take whatever steps he can to ensure that the strike does not happen, so that people in Orkney and Shetland can look forward to Christmas without the threat of disruption to those genuine lifelines?
The Scottish Government is aware of and concerned about the situation. We hope that all involved will recognise the importance of talks and coming to a satisfactory conclusion to minimise the likelihood and impact of disruption on a lifeline service.
Does the First Minister share my deep concern about the announcement this morning by Remploy in a company statement that three Remploy businesses are not commercially viable and have no realistic prospect of being sold as going concerns? The businesses are those in Stirling, Dundee and Clydebank and they are now to be closed. Does the First Minister agree that the workers in those factories have been badly let down by the United Kingdom Government in the way in which they have been treated in this matter?
I think that UK Government’s attitude to Remploy speaks very poorly of its attitude to workers in that position. I feel particularly for the workers in those factories, who were given the indication that there could be a successful outcome to the change of process, which has not as yet come to pass. As I have said before in the chamber, Fergus Ewing, the Minister for Energy, Enterprise and Tourism, is working very closely with individual constituency members to try to find a satisfactory outcome. I think that that work, again, should be supported across the parties in the chamber.
I was contacted by a couple this morning who are concerned that they may have been affected by the problems at the Glasgow assisted conception unit, but they have not yet been contacted by the health board. Does the First Minister agree that no women or couples should have their chance of a family reduced by that situation and that, if necessary, some should begin their treatment again? Will he ask the Cabinet Secretary for Health and Wellbeing to look at the resources available to the board to ensure that the result is not even longer waits for women and couples who are still at the back of the queue for treatment?
I will look into why the member’s constituents have not been contacted by the health board to say what the way forward will be. I shall make arrangements for the cabinet secretary to contact the member directly.
Autumn Budget Statement
3. To ask the First Minister what impact the autumn budget statement will have on Scotland. (S4F-01048)
There are two aspects in particular to consider. Once again it is quite clear—I suspect from the statement yesterday and certainly from analysis of the figures—that the poorest in society are to bear the brunt of the prolonged austerity that the Chancellor of the Exchequer is now indicating. The Treasury’s own analysis indicates that the poorest households will be £200 worse off next year as a combined result of the tax and benefit measures that were outlined in the autumn statement.
I should also say that the autumn statement contained an increase in capital spending, which is a measure for which the Scottish Government has campaigned over the past two years. There will be about £330 million net in consequentials. However, it should be remembered across the chamber that that will just undo some of the position of the previous cuts, because the net capital budget will still be going down by 26 per cent. I think that that perhaps indicates that the chancellor’s change of heart on capital spending is in itself an admission that the previous strategy was clearly not working and that the economy was flatlining. However, his tendency to punish those least able to protect themselves is in itself an indictment of the chancellor’s approach.
The failure of the UK Government’s programme of economic bloodletting is clear for all to see, but instead of changing tack, the chancellor takes billions more from the pockets of the poorest, forcing them to fund yet another massive tax cut for big business. In that context, is it not time for the Scottish Government to give up on the dream of even deeper corporate tax cuts and accept that corporation tax is a necessary tool for raising the investment that we need for a fairer society and a healthier economy?
I think that we should plan our tax policies to increase the wealth in the community and the economy, and having a competitive economy is part of that. We should also plan our tax and distribution policies to bring out an equitable distribution of that wealth.
I do not accept, and I am not sure that Patrick Harvie would put forward the argument, that an increase of wealth necessarily means unfairness in distribution. I think that the most successful economies in the world are those that have an equitable distribution of wealth as well as the ability to create that wealth. One reason why an independent Scotland will be so successful is that we shall be a just nation.
Transport Network (Winter Preparations)
4. To ask the First Minister what steps the Scottish Government is taking—
Can we have Mr Eadie’s microphone on, please?
—to ensure that the transport network is prepared for winter. (S4F-01049)
All that I heard at first was:
“To ask the First Minister what steps the Scottish Government is taking”.
I thought that this was, in that case, going to be an extremely long answer.
We cannot control the weather and transport disruption can never be ruled out, but there has been a great deal of proactive planning. For trunk roads, additional gritters will patrol the busiest roads and there are increased stocks of salt and alternative de-icers. There are also two new ice-breaking vehicles and increased technology to get real-time information to people on the move. We have seen the completion of a £2.2 million programme of investment to improve the resilience of the railway network to adverse weather, the investment of £1 million in an ice-buster train that can quickly thaw out junctions and other key equipment, and the completion of a programme of points-heater upgrades by Network Rail. There is significant investment by Scotland’s airports, including new equipment such as walkway sweepers, a new snow blower and de-icing equipment, and increased snow team numbers at Edinburgh airport.
All of that means that, although the weather cannot be controlled, the member can be reassured that the resilience and preparation of the Scottish Government and our partners are very good indeed.
I accept that the First Minister does not control the weather, but will he endeavour to ensure that all relevant departments and agencies work together so that the vital work is both prioritised and funded, for the safety of all people who travel on foot or by bike this winter? Many of my constituents use the Edinburgh Innertube map and travel to work or school by bicycle or on foot. As well as keeping our vital roads and motorways open and safe, we must do all that we can for all our people who travel on foot or by bike.
As Jim Eadie knows, Transport Scotland treats a number of key footways on the trunk road network. It is working with communities that are keen to play their part in helping to keep their footpaths free of snow and ice. It is also providing footway self-help kits to communities that are adjacent to trunk roads, not to replace the service that is provided by the operating companies or, in the case of local authority roads, by the local authorities, but to allow people to play a fuller part in contributing, if they are able to do so. [Interruption.]
I will now take question 6, from Mary Scanlon.
Mental Health (Supreme Court Ruling)
6. To ask the First Minister what action the Scottish Government will take following the recent Supreme Court ruling relating to the Mental Health (Care and Treatment) (Scotland) Act 2003. (S4F-01034)
As Mary Scanlon is well aware, the case arises from the provisions of the 2003 act and arrangements that have existed since that act came into force. The member also knows that arrangements that were in place in respect of security arrangements and forensic care facilities outwith the state hospital at Carstairs were found by the Mental Welfare Commission to be appropriate in the visits in 2009 and 2010. The Scottish courts, interpreting Scottish legislation, agreed with the Government’s position and found that there was no requirement to make regulations. It was on that basis that the appeal was contested in the Supreme Court.
It should be noted that the case turned on a technical issue of statutory interpretation. We are currently considering the terms and implications of the judgment in order to decide on the most appropriate course of action in responding to the ruling.
Notwithstanding further interpretations, I note that the Supreme Court judgment relates to two amendments in my name, which were passed unanimously by Parliament in March 2003.
Given that the Supreme Court has now found that ministers acted unlawfully by failing to implement regulations to ensure that mental health patients receive security appropriate to their needs, will the First Minister give Parliament an indication of how many potential compensation claims for victims are expected as a result of the Government’s failure to comply with its own laws?
It is not possible to do that at the moment.
I will say two things to Mary Scanlon. I know the background: I know that an amendment was lodged on 20 March 2003, I know that she lodged it and I know that Shona Robison seconded it. We have the full background. Mary Scanlon should accept that it is important to note, when considering what is in the interests of the welfare and natural justice for the people involved, that the Mental Welfare Commission considered in 2009 and 2010 that the arrangements were appropriate. That is a very important point, which perhaps was not the case when Mary Scanlon was extremely concerned about the issue back in 2003.
It is not possible to consider the full implications of the court judgment. The Government is currently considering the terms of the implications of the judgment and deciding on the most appropriate course of action.
Waiting Times (Cancer Patients)
5. To ask the First Minister what the maximum time is that a patient has waited beyond the cancer waiting times targets in 2012. (S4F-01039)
As Richard Simpson is aware, we have two targets for cancer treatment: the 62-day target, which is measured from the point at which the patient is referred to a specialist, and a 31-day target for treatment to begin once a course of action has been agreed by the patient and the specialist.
In the second quarter of 2012, 2,975 patients were seen within the 62-day limit, which represents 95.3 per cent of those who were referred for treatment. That is good performance; it is the first time those targets have been met over the past couple of years. However, there are individuals for whom that target was not met. The maximum wait for one patient was 399 days, which is totally unacceptable. However, I am sure that Richard Simpson will reflect on the fact that the vast majority of patients in Scotland are now treated within the target time.
Please be brief, Dr Simpson.
Yesterday, the whole Parliament joined together in acknowledging the achievements of national health service staff in reducing waiting times. Is the First Minister aware that annually 600 Scots are not being treated for cancer within the 62-day target? The Government’s early detection of cancer programme is very welcome, but one third of those who breach the target for treatment are colorectal cancer patients. Will the First Minister undertake to get the health department to investigate, track and research those patients, to see where the problems lie? Those problems could be resolved by making more of the hard choices that Johann Lamont referred to today.
I will certainly take a look and the Cabinet Secretary for Health and Wellbeing will reply specifically to Richard Simpson’s information on that aspect and on his advice—given his specialism—in the subject.
We aspire for the 95.3 per cent figure to be 100 per cent. Richard Simpson should reflect on the fact that the reason why we have the 95.3 per cent figure, as opposed to the 85 per cent figure that we inherited when we took office—which means that a huge number of patients are being seen within the timescale—is a result of the hard choices that this Government took in order to protect the revenue budget of the NHS. My clear memory—which will no doubt be confirmed by the leader of the Labour Party, who is sitting alongside Richard Simpson—is that that was not the position of the Labour Party in the election campaign, or was not confirmed by the Labour Party leader.
The hard choice that we took to protect the revenue budget of the NHS has been a substantial addition, in terms of providing a successful outcome for many people. I accept totally that we should aspire to 100 per cent, but we should reflect on the fact that our NHS has achieved that 95 per cent target. We all should aspire to do more.
That ends First Minister’s question time. Members may be aware that there has been an incident in the gallery; I thank Richard Simpson for attending at that incident. I ask people in the gallery to sit where you are, and to follow the instructions of the security guard. I understand that an ambulance has been called. Please do not rush for the exits; follow what the security guards say, to allow us to deal with the person involved as quickly as possible. To allow that to take place, I suspend the meeting for 15 minutes.
12:35
Meeting suspended.
12:50
On resuming—