Health and Wellbeing
Detect Cancer Early Programme
Since February 2012, there have been three phases of public awareness campaigns: a priming campaign that was aimed at tackling fears and negative attitudes about cancer; a bold breast cancer awareness campaign in September; and, more recently, a campaign to encourage uptake of bowel screening. The initial evaluation of the social marketing campaigns has been encouraging. Published data indicates that more women are reporting breast symptoms and more people are enquiring about participating in the bowel screening programme. It is too early yet to assess what impact that is having on early diagnosis.
I thank the cabinet secretary for that comprehensive answer.
I do indeed applaud the Teenage Cancer Trust’s work in raising awareness of the importance of early detection of cancer. It has been shown that, as a result of the trust’s presentations in schools, awareness raising extends beyond the young people who attend the talks and benefits the wider circle of friends and family. That contributes positively to the overall aim of improving early diagnosis.
I welcome the measures that the cabinet secretary has outlined, but can he offer an assurance about what is happening for those patients who are awaiting secondary treatment? Although all the Government’s efforts on early detection and initial treatment are extremely important and welcome, they will not be enough if people then face further waiting periods for follow-up treatment such as radiotherapy.
We have not set specific targets for the number of days within which follow-up treatment should begin because that is very much determined by the clinical situation for each patient. However, clinical guidelines on follow-up govern the situation and, as far as we can tell—we monitor these matters fairly closely—those guidelines are being adhered to throughout Scotland.
At the older end of the age spectrum, what progress is the detect cancer early programme making with those in the over-70 age group? As the cabinet secretary will be aware, frequently they have a higher incidence of cancer but often they do not present with symptoms or get a diagnosis until it is too late.
The evidence that we have is that the programme is having an impact on older age groups as well as on younger age groups. I am happy to send the member more detailed information on uptake among older age groups.
I congratulate the Government on the detect cancer early programme, which is an excellent initiative. However, people are approaching me—I suppose that they are approaching the cabinet secretary, too—about whether other cancers will be brought into the programme and, if so, when. In particular, people have recently asked me about cervical cancer and prostate cancer. Will those be brought into the programme in due course?
We will give further consideration to the future of the programme once we have done a proper evaluation of its impact, particularly on breast and bowel cancer. As I said, the early indications are that the programme is very effective indeed, but we must wait for the evaluation before we decide to spend additional resources to cover other types of cancer.
Adults With Learning Difficulties (Service Redesign)
The decision to redesign services is entirely a matter for local authorities. However, the Scottish Government expects local authorities to listen to people with learning disabilities and their carers and to take into consideration what will work well for them.
The minister will be aware that Glasgow City Council has decided to close three day centres for adults with learning difficulties, which will have a massive detrimental impact on the health and wellbeing of service users and carers across the city. If those centres were schools, ministers would have the power to call in any decisions on them. Given the health impact on my constituents, what powers does the health minister have to intervene, particularly given the flawed and pre-determined consultation process? I believe that further powers, including the possibility of call-in, are required to protect the vulnerable constituents I represent.
One benefit of the integration of health and social care is that it will allow our health and social care services to be much more effectively planned and delivered locally in a way that reflects the needs of the local population. The member will recognise that, ultimately, it is up to the local authority to use its resources and to provide services in a way that it feels fits its local communities’ needs. In considering what can at times be a challenging issue, it is important that the council has a process that allows for genuine consultation with those who have a learning disability and their carers, and that those who participate in the process have trust in the way that the local authority is taking it forward. In the process in Glasgow, it is important that Glasgow City Council continues to consider what it can do to address the concerns that carers and those who use the centres have expressed, and how it can achieve an outcome that meets the needs of those who use the services.
NHS Shetland (Dementia Services)
Dementia services in NHS Shetland, including any staffing issues, are assessed by Scottish Government officials as part of their twice-yearly visits to all national health service boards to review mental health services, and as part of the annual review of boards. A local dementia action plan for Shetland was produced for 2012-13 and the board and local authority are working together to redesign services to better meet the needs of people with dementia.
A constituent of mine who has dementia has been regularly transferred to the Royal Cornhill hospital in Aberdeen. Does the cabinet secretary understand the difficult circumstances that that creates for his family? Will he undertake to work with NHS Shetland to consider how best services can be delivered through investment in the necessary staff and, potentially, capital investment in an appropriate facility, with the aim of finding a way to minimise the amount of travel? Inevitably, such travel means that patients are further away from their families in what are extremely difficult times.
I am aware of the circumstances that the member describes and I am extremely sympathetic to the point that he raises. We recognise that there are particular challenges in island communities because of the number of people involved. Specialist services are sometimes required that are available only on the mainland.
Further to Tavish Scott’s question, I understand that the new dementia strategy that is due next month will recommend four test sites to support people in the mid to later stages of dementia. Could one of those sites be in a remote and rural area such as the Highlands or, indeed, one of the island groups such as the Shetlands?
We are in the process of finalising the dementia strategy. I will certainly take into consideration the very substantive point made by Mary Scanlon.
Healthcare Improvement Scotland (Meetings)
The Scottish Government is in regular contact with Healthcare Improvement Scotland. Monthly meetings are arranged between the Scottish Government and the HIS chief executive; the last took place on 11 April 2013. At times there is almost daily contact, during which operational issues are discussed, such as the Scottish patient safety programme, hospital standardised mortality ratios and other HIS organisational issues.
What discussion has the cabinet secretary had with the HIS on progress in risk management associated with death certification, in particular on the Blake Stevenson Ltd report on death certification evaluation? Although the random samples of medical certificates of the cause of death highlighted that only 3 per cent were not in order, any delay in funeral arrangements being made can and does lead to greater distress to relatives during their time of grief. What further work will be done on that?
I am very aware of that issue. We are talking to the HIS and many other people about how to address those concerns. The system is being developed in a way that will minimise delays; processes are being put in place that will ensure that medical reviewers can assess the information that they need quickly, in order to enable reviews to be carried out within a day or so of registration. We anticipate that once the system is up and running, in the vast majority of cases there will be little detectable delay as a result of the new system.
In relation to the recent scandal of doctored inspection reports—which resulted in a lack of confidence in Healthcare Improvement Scotland—and the forthcoming integration of health and social care, does the cabinet secretary agree with Labour’s proposals for a new independent scrutiny body?
First, I totally disagree with Jackie Baillie’s depiction of “doctored ... reports”. No reports have been “doctored”, as she called it.
Stroke Patients (Care)
The “Better Heart Disease and Stroke Care Action Plan”, which is backed by over £1 million of funding each year, contains actions aimed at ensuring that people with stroke get access to effective, safe and person-centred care as quickly as possible. Full implementation will help to ensure that we maintain momentum and continue to improve the quality of care and support that is available to people with stroke.
I thank the minister for that response. He is probably aware of a survey that was conducted by the Stroke Association that states that over 42 per cent of patients lacked emotional support after their physical needs had been met. Can the minister reassure me that the figures are, in terms of emotional support for our patients, better in Scotland? What more can be done to reassure patients who are awaiting emotional support after their physical needs have been met?
I am aware of the Stroke Association’s survey, which rated hospital care in Scotland as being high. However, the report also recognises the need for further improvements, particularly around emotional and psychological support. Any healthcare condition can, of course, have a wider impact than the physical element, in terms of its impact on the emotional and psychological wellbeing of individuals and their families. That is why we recognise in our new mental health strategy the importance of providing a better response to conditions such as stroke, in order to provide the right type of emotional and psychological support.
Community Pharmacies (Applications)
In my reply to Mr Kelly in the chamber on 6 December last year, I indicated that the Scottish Government has no role in monitoring applications or appeals relating to the opening of a community pharmacy. Those are entirely matters for national health service boards and the national appeal panel, respectively.
I thank the cabinet secretary for his reply, although I point out that it was the Minister for Public Health who answered on 6 December, not him.
I am aware of the application to which Mr Kelly refers. My understanding is that the issue is that there is sufficient local provision, which is why the application has to date been unsuccessful. However, I am absolutely sure that my colleague, the Minister for Public Health, would be more than happy to meet Mr Kelly to discuss his concerns about the process.
Would the cabinet secretary or the Government consider further amendment to the 2009 regulations or, alternatively, to the guidance notes in respect of providing a time limit for appeals?
Appeals can be complex and the complexities can vary from case to case, depending on the merits of individual cases. That is especially so where there is more than one interested party lodging an appeal, or there is new evidence to be considered.
Shingles Vaccination Programme
Shingles can be a particularly severe illness. Many people are affected by the chronic pain that can develop after having it. The vaccine that we are introducing has been shown to reduce the incidence of shingles in older adults, as well as the persistent pain that often develops following the illness.
Further to my question on the matter last year, I am pleased that the vaccine has been introduced. Does the minister agree with Professor Adam Finn of the University of Bristol that we are
Vaccine uptake rates in Scotland are consistently high. That is in no small part thanks to the concerted effort that has been made over a number of years to raise awareness of the importance of being vaccinated against a number of different conditions. Our vaccination uptake rates are rightly attracting attention from other countries, but we cannot afford to take them for granted.
The minister will be aware of my support for extension of the vaccination programme. Is he also aware of comments by Alan McDevitt, who is chair of the British Medical Association’s Scottish general practitioners committee, who has expressed concern about the ability of GPs to deliver vaccination programmes without significant support from other health staff, including school nurses, health visitors and district nurses? What specific action is being taken to release nurses to participate in the shingles vaccination programme and in other extremely important vaccination programmes?
I am aware of Dr Alan McDevitt’s recent comments—I believe in The Scotsman newspaper—in relation to the extended vaccination programme. The majority of the work that will follow from the extended vaccination programme will fall to NHS Scotland; a smaller proportion of it will fall to general practices. We are working with NHS boards and the Scottish GPs committee to consider what further additional measures are necessary to ensure the required support for delivery of what is at present a very successful vaccination programme. I have no doubt that it will be in our interests to build on it and to ensure that the extended programme is successful.
Question 8, in the name of David Stewart, has not been lodged. The member has provided an explanation, and I think that we are all well satisfied with it.
Health Visitors (Universal Entitlement)
We believe that legislation already adequately provides for entitlements to health services. Universal services are delivered by a range of practitioners, not solely by public health nurses. They can be delivered by health visitors, general practitioners, midwives and family nurses, based on the needs of individual children and families.
The Royal College of Nursing, the Royal College of General Practitioners and Children in Scotland are among the notable bodies that are calling for statutory entitlement to universal services. There is a concern that, if that does not occur, some vulnerable children might not be identified and could miss out on interventions in the early years. The cabinet secretary will agree that prevention is central to improvements that we can make to Scotland’s health. How will the cabinet secretary prevent an increase in direct public costs over the long term if that right does not become statutory?
We have to distinguish between two issues. The first is entitlement to care, which already exists. The second is identification of people who, for some reason or other, have been bypassed by the system. We have a range of mechanisms in place to ensure that as few people as possible are bypassed. For children, the mechanisms include nursery education, family nurse partnerships and a range of other networks and mechanisms. One of the key objectives of integration of health and social care is to ensure that all those who need and are entitled to universal services—health and social care services, in this case—receive them.
Royal Infirmary of Edinburgh (Maintenance Contract)
Officials are in regular contact with colleagues in NHS Lothian on a range of issues, including the contract that was signed by NHS Lothian with Consort Healthcare for the Royal infirmary of Edinburgh.
Does the cabinet secretary share the alarm that I and people across Edinburgh felt when we learned from this edition of the Edinburgh Evening News that Consort Healthcare could be fined a maximum of only £28.24 per day—
You can put that advert for the newspaper down.
—for serious failures, such as the closure of operating theatres for more than six hours? What further steps will the Scottish Government take to ensure that the growing mood of public outrage at the management of this private finance initiative contract is properly and finally addressed?
Before you start your answer, cabinet secretary, I should say that the Presiding Officers do not approve of stunts that have been telegraphed in advance.
My concerns about the PFI contracts for hospitals such as the Royal infirmary, Hairmyres, Wishaw and many others is well and truly on the record. Many aspects of the contracts are costing the public purse very dearly, so much so that the Government down south has abandoned PFI as a method of funding future capital projects. I share many people’s frustration about the cost of the contracts to the public sector. We review them constantly to see if there is any way in which we can reduce the costs to the taxpayer.
I welcome the fact that there are regular discussions between the health secretary’s officials and NHS Lothian. However, to return to the question that Jim Eadie asked, are there any possibilities of changing this particular contract, especially given the huge costs to patient care and to the operation of the Royal infirmary and the problem with cancelled operations and the consequent delays?
One of the unacceptable aspects of these contracts, which were signed by the previous Administration when Sarah Boyack was a minister, is that one of the provisions in the contract is that only the contractor can reopen the contract. That is an absurd provision. Frankly, the ministers who signed these contracts have a lot to answer for.
Type 2 Diabetes (Treatment)
Our diabetes action plan, which was published in 2010, sets out our vision for a world-class diabetes service and offers a comprehensive and ambitious programme of work that we are committed to implementing. The Scottish diabetes group has reported that good progress is being made on the implementation of the plan. For example, we have appointed national diabetes education and paediatric co-ordinators, enabled patients to access their own health data online, established a diabetes in-patient programme and consolidated our diabetes foot-screening programme. We will invest a further £900,000 in the programme this year.
What steps are being taken to ensure that there is a consistent approach to the treatment of type 2 diabetes across Scotland’s 14 health boards?
Of course, it is for clinicians to determine the type of treatment that is most appropriate to an individual patient, having regard to local and national clinical guidelines. The member will be aware that the managed clinical network on diabetes has been established and is looking at implementing a prescribing strategy to address areas of variation in the way in which patients are prescribed with various forms of medication in the treatment of their condition. We will continue with that work and continue to support the work of the managed clinical network to reduce variation in how patients who have diabetes are treated in different parts of the country.
What progress is the minister making with the roll-out of insulin pumps in Scotland, particularly in the NHS Ayrshire and Arran area?
We are making significant progress in increasing the number of pumps that are available to under-18s and to those who are over 18. Some health boards have made greater progress than others, but the Government recognises the real difference that pumps can make to the lives of individuals should they be clinically appropriate. Of course, it will not always be clinically appropriate for patients to move on to an insulin pump. We are working with individual boards to make sure that they have plans in place to be able to deliver the increase in the use of insulin pumps that we want to see, particularly among our under-18s as well as in the wider patient group.
NHS Grampian (Dentistry)
The responsibility for the overall provision of national health service general dental services in the area rests with NHS Grampian.
I welcome the fact that increased numbers of patients in Grampian are registered with a dentist. What reassurance can the minister give me that there is proper monitoring of the practices that have received NHS grants to establish new surgeries to ensure that they fulfil the requirement that 80 per cent of their work is NHS treatment, and to ensure that patients who are registered with the practices are receiving check-ups and treatment at appropriate intervals? I know that those issues have already been raised with the Scottish Government.
The member referred to the Scottish dental access initiative that was developed to increase the number of dental practices that will register NHS patients, particularly in areas in which there is a lack of service. He rightly recognises that there has been a significant increase in the level of NHS dentistry that is being made available within the NHS Grampian area. It is part of the condition of that grant that a significant number of the dental practice patients are registered as NHS patients and individual boards are responsible for monitoring that.
Is the minister aware that, 10 years ago, there were areas of Grampian in which it was impossible to register even for private dental treatment and that some of my constituents used to travel twice a year to Budapest, Amsterdam and other European cities for their treatment? Can he assure us that we will continue to see improvements in the provision of NHS dental care in the NHS Grampian area?
The member makes a good point because there were significant difficulties for patients in the NHS Grampian area who wanted to access NHS dentistry. For example, in 2007 only 59.2 per cent of children in NHS Grampian were registered with a dentist under NHS arrangements; as at 30 September 2012, that figure had reached 77.1 per cent. In 2007 only 28.9 per cent of adults in NHS Grampian were registered with a dentist under NHS arrangements; as at 30 September, 2012, that figure had reached 56 per cent.
Individual Patient Treatment Requests
The review report on the role and remit of national health service board area drug and therapeutic committees and individual patient treatment request arrangements was published on Friday 3 May 2013.
The cabinet secretary will be aware of the struggle that my constituent Janice Glasswell and her family endured recently and of the fact that, sadly, Mrs Glasswell passed away last month. At no time did the family feel as though they were an integral part of the IPTR process—they felt excluded from it.
I met Mr and Mrs Glasswell some time ago and I fully appreciate the difficulties that the family are now facing. Clearly, one of the reasons why we set up the reviews in the first place was the degree of public dissatisfaction with the current process in a number of cases.
British Sign Language (National Health Service)
The equality team in NHS Health Scotland is working to strengthen equality of access for all in NHS Scotland through its health inequalities impact assessment, which will include those who use British Sign Language. In addition, we are supporting NHS 24 to provide an in-house centralised resource of BSL interpreters for NHS Scotland by funding four places on the Heriot-Watt University BSL undergraduate degree for four years.
Although the interpreter service that NHS Fife uses for the deaf community is excellent, does the minister agree that improving the co-ordination of services is crucial for BSL users who need additional assistance to communicate, so that their medical needs are fully understood and addressed by medical staff and themselves?
I fully agree with David Torrance that good co-ordination of BSL services is crucial if we are to ensure that patients receive the person-centred care that they require. I am aware of the changes that were made in the NHS Fife area, where the BSL service was brought in-house, which allowed NHS Fife to enhance the quality of provision.
Poor Air Quality in Cities
The Scottish Government supports a number of measures, both local and national, to tackle air pollution successfully. They include the establishment of a statutory framework and clear strategic aims for air quality and transport; supporting the development of renewable energy; providing grant funding for local authority actions; and providing advice and information through the Scottish air quality website and Scotland’s environment web.
The minister describes a framework of measures that is clearly failing to provide air that is fit to breathe in some of our cities. Glaswegians and our many visitors—who will of course arrive in great numbers next year—are subjected to the worst air quality in the whole United Kingdom. In fact, Glasgow is the fifth worst city for air pollution in the whole of Europe.
I am sure that everyone would agree that improving air quality is important. A range of measures has been progressed nationally and locally, and improvements have been made in some areas. However, I recognise that, in some areas, that improvement has not been as fast or at as great a level as some members would like. I have no doubt that my ministerial colleagues with the environment and transport portfolios will continue to progress measures to drive up standards of air quality in Scotland in the years to come.
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