Meeting of the Parliament [Draft]

Meeting date: Thursday, December 7, 2023

Official Report 996KB pdf

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General Question Time

Good morning. The first item of business is general question time. Members seeking to ask a supplementary question should press their request-to-speak button during the relevant question. As ever, I make the usual appeal for brevity in questions and answers.

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Long Covid (Support)

To ask the Scottish Government whether it will provide an update on what support is in place for people with long Covid. (S6O-02854)

National health service boards are providing support for people with long Covid across local primary care teams and community-based rehabilitation centres and through referral for investigation in secondary care settings, where clinically appropriate. We are making £3 million available from our £10 million long Covid support fund in the course of this financial year.

Within the member’s constituency, that funding stream is supporting the operation of NHS Lanarkshire’s long Covid rehabilitation pathway. People can access the pathway following referral by their health or care professional, and it is supported by a specialist team of professionals including dieticians, occupational therapists, physiotherapists, speech and language therapists and psychological practitioners.

I have raised the plight of my constituent Jonathan McMullen in the chamber on a couple of occasions. Jonathan has been suffering from long Covid since he contracted the virus at the age of 14 in March 2020. His mother Tracy has worked tirelessly for her son, but the family has recently resorted to seeking private healthcare for his chronic fatigue and postural tachycardia syndrome, which he was diagnosed with post infection. It feels as though we need to do more to help patients who have long Covid. What more can the Scottish Government do to understand long Covid and ensure that people who develop conditions such as Jonathan’s are effectively diagnosed and treated in the NHS?

I pass on my sympathies to the member’s constituent for the difficulties that her family are experiencing. I understand that my officials wrote to Ms McMullen earlier this week about Jonathan’s case.

The national long Covid strategic network has developed a recommended pathway for the assessment and management of PoTS for use by NHS boards, as well as an educational webinar for healthcare staff across Scotland who are supporting people living with long Covid. We are working hard to implement our neurological care and support framework for 2020-25, with its vision of ensuring that everyone with a neurological condition, including people with ME, or chronic fatigue syndrome, can access the care and support that they need.

As we have heard, the Scottish Government has promised £10 million over the course of three years for the treatment of long Covid. In contrast, however, NHS England has dedicated £224 million to support the assessment, treatment and rehabilitation of people with the condition, £90 million of which was allocated last year. That would have produced £21.7 million in Barnett consequentials for Scotland. Will the minister tell us where the missing money that her Government has received has gone? Will she allocate any additional funding to long Covid services in the upcoming budget?

There is no missing money. The Scottish Government allocates NHS funding as appropriate to the needs of Scotland. Given that no single service model would fit all areas of Scotland, we are giving NHS boards the flexibility to design and deliver the best models of care tailored to the specific needs of their local populations.

Increasingly, there is evidence of links between long Covid and ME, a disease that a number of my constituents and others feel has been neglected for decades. On behalf of my constituents with ME and long Covid-related ME, I ask the minister to provide an update on specific actions that the Government plans to take to implement the 2021 National Institute for Health and Care Excellence—or NICE—guidelines on ME in Scotland, including specialist services. When will that happen?

I recognise the importance of supporting people with ME/CFS. We inserted the key recommendations from the 2021 NICE guidelines on the condition into the Scottish good practice statement on ME/CFS, which was published on the Scottish Government’s website in February.

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National Health Service (Missed Appointments)

To ask the Scottish Government what it is doing to reduce the number of missed appointments in the NHS. (S6O-02855)

A range of initiatives is being undertaken to minimise missed appointments. For example, the centre for sustainable delivery is supporting boards to implement high-impact programmes in planned care, including active clinical referral triage and patient-initiated reviews, which help to reduce unnecessary appointments and eliminate waste. Patients with a preference for digital communication receive a reminder text or email about their vaccine appointment. NHS National Services Scotland analyses patients’ booking behaviours and habits to request non-attending patient groups to book directly, as opposed to being given timed appointments.

Last week, Caroline Hiscox, the chief executive officer of NHS Grampian, told me that a digital appointment system would be a solution in preference to the letters that the board sends. However, the Government’s failure to properly resource the board makes it impossible for it to implement such a system. What steps is the Government taking to allow NHS Grampian to implement proper modern systems, and when can patients expect to see progress?

We are providing record funding to our NHS boards to make sure that they can deliver the best possible services to patients as close to home as possible. As for communication with patients, Liam Kerr might be aware that we have just published new NHS Scotland waiting times guidance; it sets out a range of actions that boards have to take, and it provides for a standard package of communications that all boards should use. He will be aware that there are boards that use digital services; we encourage other boards to do likewise, and I certainly encourage NHS Grampian to do so, too.

The cabinet secretary mentioned having appointments close to home. Given the countless stories of patients being asked to travel long distances for appointments—particularly in rural health board areas, where the necessary transport infrastructure is often not there—what is the Scottish Government doing to ensure that appointments are offered in communities, close to home, to reduce the number of missed appointments?

Boards try to provide appointments as close to home as possible. However, as Carol Mochan might be aware, there are difficulties in doing that for some clinical specialties, so patients have to travel to centres to access services.

We want boards to continue to do what they can to deliver services as close to home as possible, when that is clinically safe. Where travel is involved, there are schemes to reimburse patients for the costs associated with that travel.

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Woodland Creation

To ask the Scottish Government how it plans to accelerate new woodland creation in order to meet its targets. (S6O-02856)

Over the past five years, Scotland has delivered 76 per cent of the tree planting across the United Kingdom, and we are committed to doing more. In June, I announced an action plan aimed at ramping up tree planting levels, and I am actively taking forward a comprehensive package of measures that will help to boost woodland creation rates. Earlier this week, I introduced the most significant enhancements to the forestry grant scheme since it was established in 2015.

Since the 1940s, Galloway has been subjected to indiscriminate and damaging planting of huge areas of monoculture conifers, which has been to the detriment of our communities, our rivers and our natural environment. In what seems to be another mad rush to plant more trees, tens of thousands of hectares will be planted in the south of Scotland next year. Only this week, despite assurances that issues would be addressed before approval, Scottish Forestry approved the Mackilston scheme without any satisfactory arrangement having been reached with the residents at Kendoon and Blackwater. How will the Government address cumulative impacts on local jobs, biodiversity and culture? Will the cabinet secretary meet me and my constituents to hear their concerns?

I am glad that Finlay Carson has raised that point. We have always been clear that, as with most things and most areas, this is about getting the balance right. We are listening to communities; indeed, that is part of the package of improvements that I have announced in relation to the guidance on community engagement.

We have always been clear that this is ultimately about having the right tree in the right place. It is important to remember how vital our forestry sector is; it supports 25,000 jobs and is worth £1 billion to our economy. Our agriculture is important, too.

It all comes back to balance. If Finlay Carson wants to raise particular points, I will be more than happy to follow them up with him and discuss them further.

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Autumn Statement (National Health Service Funding)

To ask the Scottish Government what analysis it has undertaken of the impact of the United Kingdom Government’s autumn statement on NHS funding in Scotland. (S6O-02857)

The autumn statement provided a real-terms cut to NHS England and no funding whatsoever in 2024-25 to cover the costs of this year’s pay deals or the 2024-25 increases. That equates to a less than 0.06 per cent increase against the current Scottish health budget and means that there is at least £260 million of pay pressures on NHS Scotland for 2024-25.

The UK Government must face up to the pressures across health and care and provide adequate funding to address the cost crisis that is hampering service recovery from Covid, and also make sure that we can support fair pay for our health and social care staff.

Given the recent calls from Labour’s shadow health secretary for further privatisation and the continuing Tory zeal for more austerity, does the minister agree that the only party that can guarantee that our national health service will remain in public hands is the Scottish National Party, and that only the full powers of independence will get rid—for good—of Westminster Governments and the threat that they pose to our public services?

Health spending per head in Scotland is already higher than it is in Wales and England. My view is that, rather than channelling precious public sector money out of our NHS and into the hands of private healthcare companies for profit, we should invest in our health service to ensure that we provide first-class public services through NHS Scotland.

I assure Bill Kidd and other members in the chamber that, under an SNP Government, Scotland’s NHS will always remain in the hands of the public and will be free at the point of use.

The Rural GP Association of Scotland has highlighted the impact of changes that were made in 2018 to the Scottish workload allocation formula, which it says

“fails to reflect the workload and services provided by rural GPs and their teams”

and has meant that general practitioners in rural areas, many of whom are in my region, are losing money.

Will the Scottish Government use its forthcoming budget to do anything to reverse those SNP cuts to rural GP funding?

Jamie Halcro Johnston might be aware that the health consequentials from the autumn statement for Scotland were £10.9 million, which is equivalent to five hours of NHS funding. I assure him that we have provided the commitment that was set out in the Doctors and Dentists Review Body report for the uplift for general practice, both for GPs and their staff groups.

We will continue to do what we can to help to support rural GPs through programmes such as the Scottish graduate entry medicine programme, for example. I assure the member that we will continue to do what we can to make sure that we invest in our NHS at both primary and secondary care levels.

The blame for NHS deficits cannot be attributed solely to the UK Government autumn statement. The Scottish Government has mismanaged the situation for years now. Scottish NHS health boards are facing a forecast deficit of £395 million. Will the Scottish Government take responsibility and address the situation before patients and staff pay the price?

We have already provided an extra £200 million to support our NHS boards in meeting their financial challenges. Beatrice Wishart will be aware that our boards are having to manage significant increases in costs because of capital pressures and energy costs, for example, which are putting pressure on budgets. The additional £200 million that we have provided is to help to manage some of those things. That is why we are also engaging with boards to provide them with tailored support to help to address financial challenges.

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Medical Records (Access)

To ask the Scottish Government what progress it has made on enabling patients to access all of their primary and secondary care medical records, from one source. (S6O-02858)

I recognise that some people can currently access certain parts of their medical records and, although everyone has the legal right to access information that is held about them, that is not consistently available on a national level. We are determined to resolve that, and the cabinet secretary and First Minister have committed to addressing that in the policy prospectus.

We have now commissioned NHS Education for Scotland to develop a digital front door that will begin to provide access over time. I expect the first version of that to be available by 2026.

We are moving painfully slowly. Since early last year, I have been trying to find a simple process for giving patients access to their primary and secondary healthcare records. Currently, as I have found out to my cost, in order to get their records, patients are required to submit a subject access request—individually—to GPs and all secondary care doctors who are involved in their treatment.

Does the minister agree that there should be a one-stop shop to allow patients to access their medical records? What action will the Government take to ensure that patients, who already face the trauma of treatment, do not have the additional stress of hurdles in the way of accessing their medical records?

I know the hard work that Edward Mountain has been doing in this specific field of health, especially the work that he has done on the “Let’s talk health” summit in Highland. I am very happy to meet Edward Mountain to further discuss the matter and to see how we can move it on.

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Post-mastectomy Breast Reconstructive Surgery (Waiting Times)

To ask the Scottish Government what action it has taken to reduce waiting times for post-mastectomy breast reconstructive surgery. (S6O-02859)

I am aware there are some extensively long waits for post-mastectomy breast reconstructive surgery, and I recognise the impact that that has on women’s health and wellbeing. Boards are currently prioritising patients with trauma and/or active cancer, and delays have, of course, been exacerbated by the pandemic.

We remain committed to reducing long waits and seeing a year-on-year reduction in waiting times. We are taking the issue seriously and are working with stakeholders to take the next steps to address it.

After almost four years, my constituent has finally been given a date for her post-cancer breast reconstruction surgery. That is good news, but raising individual cases in Parliament should not be the only route open to women to receive a date for that crucial surgery. Part of the problem stems from Scottish Government directives on priority cases and the decision to cut surgery theatres at the Canniesburn unit from six to two. There are many more women on the waiting list, and there still will be unless the Scottish Government tackles the problems with plastic surgery. Will the cabinet secretary commit to producing a concrete plan to reduce waiting times so that women are not forced to endure that trauma for years?

I recognise the concern that the member raises on behalf of her constituent, and I apologise for the extended delay that she has had in accessing the treatment that she requires. I can assure her that we are working to reduce long waits. The member might be aware that we have committed to investing an extra £100 million in each of the next three years to drive down our waiting lists. That will help us to increase our capacity to tackle waiting lists and to reduce numbers by 100,000 during that three-year period, on top of the action that we are taking at the moment.

Alongside that, the member might be aware that NHS Greater Glasgow and Clyde is working closely with the Golden Jubilee university national hospital to look at additional capacity provision, which will allow it to make provision for additional plastic surgery capacity to address some of the extended waiting times that its patients are experiencing.

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Cumbrae Ferry (Ticketing)

To ask the Scottish Government how it is addressing the ticketing issues raised by the Cumbrae ferry committee and Cumbrae community council. (S6O-02860)

I recently met the member to discuss this issue, and I have also written directly to the Cumbrae ferry committee.

Transport Scotland has previously noted the issue of season tickets, which is being reviewed, as well as wider issues on ferry fares. Options for an interim product are being considered, including multijourney tickets; however, the Ar Turas booking platform needs to be stabilised prior to further product introduction being considered. It is anticipated that CalMac Ferries’ stabilisation work on the booking platform will be completed later this month at the earliest.

I thank the minister for her engagement with me and with residents on Cumbrae. I wish that I could say that there had been the same quality of engagement from CalMac.

The removal of the season ticket has resulted in a significant increase in cost for Cumbrae island residents, most of whom travel to the mainland every day of the working week, and for whom this is a lifeline service. Island residents want to know more about the options that are being considered for interim ticketing in particular, but CalMac has been unable or unwilling to provide any additional information on that or on any of the other issues that island residents have raised, which they were led to expect from CalMac. Will the minister instruct CalMac to engage with the community directly on the issue of interim ticketing and to provide further information on the options being considered?

As I said in my first answer, I have already engaged directly with the Cumbrae ferry committee on a number of the issues that it has raised. Clearly, the community has previously been given assurances that the issue will be addressed, and I am keen that that happens. Transport Scotland officials will continue to consider the options for doing so with CalMac.

That concludes general question time.