Meeting of the Parliament

Meeting date: Tuesday, January 8, 2013

Official Report 690KB pdf

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Topical Question Time

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Accident and Emergency Units (Increased Demand)

1. To ask the Scottish Government what steps it is taking to ensure that national health service accident and emergency units are able to cope with increased demand on their services during the winter. (S4T-00192)

Presiding Officer, I wish you, the chief executive and all your staff a happy new year for 2013. I also wish every other member of the Parliament a happy new year.

NHS Scotland “Preparing for Winter” guidance was circulated to NHS board chief executives and partner organisations on 16 October 2012. The guidance was developed in consultation with NHS Scotland and focuses on helping NHS boards to make efficient use of capacity and to optimise patient flow from point of admission through to point of discharge.

As part of their winter planning arrangements, NHS boards have also been asked to ensure that they have effective preparations and outbreak control measures in place for norovirus and seasonal flu, and to consider resilience and business continuity factors such as mutual aid arrangements relating to staff, vehicles, service support and other resources. NHS boards have been given an extra £3 million to help to manage winter pressures and to ensure that patients are not delayed in hospital, and they will use the extra money to make sure that people can be discharged from hospital as soon as they are ready. Those measures are over and above what NHS boards have already put in place.

I thank the cabinet secretary for that response and wish him and all others a happy new year.

Little more than a month since that £3 million in winter surge capacity funding was promised in order to, in the cabinet secretary’s words,

“make sure the winter runs smoothly”,

we are reading in the media alarming reports from consultants that accident and emergency units are so overstretched that some patients are waiting up to 12 hours to be assessed. The additional funding has clearly failed. With the national four-hour target likely to be under threat for January, does the cabinet secretary agree that more must be done to ensure the timely treatment of patients with the dignity and respect that they deserve?

As Dr Jason Long, who was quoted in that article, said, the Scottish Government is working and has been working with the College of Emergency Medicine to make sure that any problems are quickly addressed. There is no doubt that an upturn in seasonal flu and norovirus incidence has had various knock-on impacts in certain hospitals. For example, as it stands today, 14 wards are closed in eight hospitals across Scotland because of norovirus. Inevitably, that has some knock-on impact, but we are managing that effectively. In a number of health board areas additional bed capacity has been brought in to deal with the situation.

Dr Long also said:

“The capacity isn’t there at the moment.”

Before the Christmas recess, the publication of their waiting times audits revealed that in certain health boards a culture exists of pressure on staff who are battling to achieve national targets. Despite the additional funding, the constraints on staff are so severe that as few as 62 per cent of patients at some hospitals were treated within four hours over the festive period, with some patients being forced to wait almost half a day in their hospital ward before treatment. I think that we would all agree that that is unacceptable.

The cabinet secretary must get a tighter grip on the situation, and quickly. Why did the additional funding not have an impact on A and E waiting times? Will the cabinet secretary confirm this afternoon that he will host an urgent meeting with his officials and health board chief executives to ascertain what solutions are available to him and what additional emergency funding may be available to tackle this crisis?

We should make a distinction between two issues: number 1 is the NHS’s on-going business; and second are the particular pressures that arise over the holiday period. Indeed, unusually, instances of the norovirus bug started in October this year, which is much earlier than normal.

There is no doubt that in recent weeks the NHS has been dealing with a very challenging situation because of the combination of a huge incidence of norovirus and an increased incidence of seasonal flu. For example, the seasonal flu figure last year was something like nine people per 100,000. This year it is something like 37 people per 100,000, which is a quadrupling of the incidence of flu that the NHS is dealing with.

We should not paint the kind of picture that Mr Hume is trying to paint. I certainly do not recognise the 62 per cent figure in relation to any health board or hospital in Scotland.

Will the cabinet secretary tell me how the Government works with NHS boards in monitoring and co-ordinating responses to mitigate the impact of the sort of event that we saw with the earlier-than-anticipated spike in the incidence of norovirus and seasonal flu?

We are dealing very effectively with the 14 territorial health boards, and Health Protection Scotland and the directors of public health are, of course, heavily involved in looking at what we can do to prevent incidents from happening and ensuring that we are prepared in each area. We are also working with general practitioners throughout Scotland. Indeed, in recent days, we have been in touch with nearly 1,000 GPs throughout Scotland so that we have a clear handle on the incidence of norovirus in the community as well as the likely impact on the acute, secondary sector. As I have said, we are working very closely with the College of Emergency Medicine on the short-term and medium-term challenges that the national health service faces.

I should point out that there are measures that people themselves can take. For example, a very high percentage of accident and emergency admissions are alcohol related. If people took more responsibility for their own behaviour, that would certainly reduce the pressure on A and E departments throughout the country.

I draw the cabinet secretary’s attention to the fact that, in September 2012—that is, before the winter season really got under way—only two out of 11 mainland health boards met the 98 per cent A and E target, and to the fact that, since September 2010, the 98 per cent target has been met only once on the Scottish average.

My colleague Jim Hume raised the issue of capacity. This is not just about the winter situation or the norovirus; it is about the capacity in the system. Will the cabinet secretary join me in paying tribute to accident and emergency staff for their extremely hard work in endeavouring to meet the targets? Will he also respond to Mr Hume’s question and say whether he will urgently hold a further meeting with the College of Emergency Medicine to try to determine what capacity is necessary so that the target can be met on a regular basis?

I am absolutely delighted to join Dr Richard Simpson in paying tribute not only to the tremendous work that is done in accident and emergency departments, but to the work that is done by many other services throughout the national health service, particularly during the challenging period over the festive season. On 2 January, I visited NHS 24 in Glasgow and saw the tremendous work that it is doing and the huge increase in contacts that it has had, particularly as a result of the norovirus and the increase in the incidence of seasonal flu.

On the capacity issues, I am working with the College of Emergency Medicine on an on-going basis. Indeed, we work jointly and have joint meetings on a regular basis precisely to deal with the point about ensuring that we meet the 98 per cent target in relation to people waiting for less than four hours for accident and emergency treatment throughout Scotland. We believe that we are putting in place the necessary measures to ensure that that is achievable. That is in addition to all the other work that is going on—for example, with the Royal College of Physicians on developing a strategy to eliminate boarding in the national health service, which was announced just before Christmas. A great deal of work is therefore going on with the medical profession and others, including allied health workers, nurses and midwives, to ensure that we achieve the targets in 2013.

For many years, the intention of policy has been to reduce the number of emergency admissions by developing services in the community. Has the Government carried out any assessment of why that has not happened? Are there are any plans to ensure that it will happen in the future?

Until the recent surge, there was a sign of an overall reduction in A and E admissions, and particularly in board areas. However, Malcolm Chisholm raises a fair and valid point. My view is that tackling unscheduled admissions, which make up 70 per cent of all admissions into hospitals in Scotland, must be a high priority. Some of those admissions are preventable. As I have already mentioned, those that involve alcohol are certainly preventable if people behave responsibly.

Malcolm Chisholm is absolutely right. We need to do much more to prevent unnecessary admissions to accident and emergency departments or other forms of unscheduled care in the acute sector.

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Flooding (Assistance for Victims)

2. To ask the Scottish Government what assistance it is providing to the victims of recent flooding in Stonehaven and other areas. (S4T-00188)

First, I take this opportunity to express my and the Scottish Government’s sincere sympathies to all those affected by the recent storms and flooding. It was particularly traumatic for that to happen at such a key time of the year. I record my thanks to local authority staff and emergency responders, who did their best to mitigate the impacts and provide support to those affected.

On Christmas eve, I visited Stonehaven and Brechin and saw at first hand the devastation and distress caused by the flooding. I reiterate what I said on my visit, which is that the Scottish Government has given a strong commitment to work with the local authorities whose communities have been affected to support them in any way that we can. Specifically, the Cabinet Secretary for Finance, Employment and Sustainable Growth has committed to consider all eligible expenditure under the terms of the Bellwin scheme when formal claims are received from the council. I heard that, in the light of the circumstances of the most recent event, Aberdeenshire Council will revisit the specification for its proposed flood scheme on the Carron.

During my visit, I was hugely impressed to see the generosity and community spirit demonstrated by the people of Stonehaven. The flood victims also received valuable support from the Scottish flood forum, which of course receives funding from the Scottish Government.

I thank the minister for his reply and associate myself with his remarks in relation to those who have been heavily involved in the charitable effort by raising money and giving time. However, my concern is that raising money takes time but need is immediate. Has the minister any provision available to ensure that no one in need of direct assistance will have to wait for the money to be raised locally?

The member is right to indicate that the Bellwin scheme and other forms of funding, including the money that has been raised locally, will take some time to be distributed. Indeed, I am aware that some work is going on with the Scottish flood forum and the Stonehaven flood fund to develop legal advice so that those involved understand the parameters within which donations can be administered to local people. I think that the SFF has indicated that its immediate priority is to use the fund to dry the properties of those without flood insurance.

I encourage the member and other members with a constituency interest in this regard, such as Nigel Don, to encourage communities to apply for crisis loans through the Department for Work and Pensions, which is another means by which people can access funds to help with the cost of disasters.

I thank the minister for that answer. Moving on, while not forgetting the needs of those who were the victims of the high tide on Saturday 15 December, I want to look specifically at the incident of the morning of Sunday 23 December, which was almost a carbon copy of one that occurred just over three years before. Will the minister give an undertaking at this stage to work closely with the local authorities and other interested agencies to ensure that action can be taken in a shorter timescale than the one that appears to be in action at the moment and that, if there is a recurrence of the bad weather conditions, we can avoid the same flooding incident happening for a third time?

I certainly sympathise with the sentiment of what Alex Johnstone is saying. Clearly, there is an imperative under the Flood Risk Management (Scotland) Act 2009 for the local authority to identify a scheme for flood prevention in Stonehaven and to deliver the detail of that to the Scottish Government for a joint decision by the Convention of Scottish Local Authorities and me, as minister, on its administration.

As I understand it from my visit, the problem is that the recent flood is a quite different type of flood from the previous one, although that point may be subject to revised information that the member may be aware of. The recent flood’s severity was similar—in fact, it was slightly worse than what happened in 2009—but circumstances suggest that it was slightly different in its origin from the flood of 2009. I understand that, once the council has a fuller understanding of how the floods occurred on this occasion, it will revise its proposals to ensure that they take into account exactly what happened, so that any proposals that it submits to the Government for consideration do not miss the opportunity to prevent a similar flood from happening in the future.

I support what the member says about seeking to ensure that the community of Stonehaven avoids being affected by a similar flood again. I will do everything that I can to ensure that we do not prevent any fast consideration of the council’s proposals. However, unfortunately, we do require Aberdeenshire Council to come forward with its plans before we can consider them.

I want to pick up on a couple of issues. First, the minister is well aware of the flooding. He came to see it, for which I thank him. Quite a number of the houses that were flooded are, in effect, uninsured because they have become uninsurable. It is not a question of people not wanting to insure their houses; they cannot get the insurance. Can the Government do anything to help people in the future who simply cannot get commercial insurance in such circumstances?

Nigel Don is quite correct. I understand from the information that the Scottish flood forum has provided that approximately 10 per cent of those affected by the Stonehaven flood do not have flood cover. Early indications are that 3 to 4 per cent have no contents insurance, 6 per cent have no flood cover at all, and 2 to 3 per cent face flood excesses of between £2,000 and £10,000. Clearly, there are significant issues to address.

On how we can help those individuals, I stated earlier—as I have on previous occasions—that I will meet the Association of British Insurers shortly to discuss the information requirements to inform the identification of flood premiums and, indeed, the excesses that are charged to businesses. It is important that we ensure that all the available information on planned and available flood defences is taken into account when insurers determine their premiums. I hope that we can work with the ABI to ensure that individuals who are suffering as a result of situations such as the one that occurred in Stonehaven have affordable insurance in place.

I am grateful that the minister visited Brechin. Frankly, Brechin got away by the skin of its teeth. The minister is aware of the proposed scheme there, and I seek his assurances that that will be progressed through his officials as quickly as possible.

I assure Nigel Don that I will encourage my officials to deal with it as speedily as possible.

I want to pick up on the important issue of insurance that arises post-flooding following events such as the one in Comrie in my constituency. The insurance company, at the time of renewal, will say that it does not have clear information about what remedial action the specific local authority is taking. Will the minister undertake to discuss the matter with Perth and Kinross Council and, indeed, other affected council areas, to seek that they proactively communicate with the insurance sector what they are doing to reduce the risk that flood cover will be withdrawn?

The Scottish Environment Protection Agency has recently written to all local authorities seeking their permission to share the data that it provides to the Scottish flood defence asset database with wider professionals involved in flood risk management and allied services such as the insurance industry. It would do no harm whatsoever for councils to be open about their future plans with the ABI and, where necessary, individual insurers, to inform them of the progress that Annabelle Ewing has quite rightly identified and to improve the availability and cost of insurance to the community. Without that information, it is entirely reasonable that insurance companies would assess the area as having a continued level of high risk. Once the proposals are known and are being implemented, it is important that local authorities and all those involved share that information so that people do not face unreasonable premium levels when insuring their properties. As I say, I have a meeting planned with the ABI, which will happen in a matter of weeks, and I guarantee to Annabelle Ewing that I will raise the issue with it.