Plenary, 09 Nov 2006

Meeting date: Thursday, November 9, 2006

Official Report 746KB pdf

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Question Time

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SCOTTISH EXECUTIVE

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General Questions

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Noise Pollution

Question 1 has been withdrawn due to illness.

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Shirley McKie (Inquiry)

To ask the Scottish Executive whether it will reconsider its decision not to hold an inquiry into the Shirley McKie fingerprint case. (S2O-11038)

I made a full statement to Parliament on 22 February and there was a debate on 2 March. Subsequently, Parliament concluded that a public inquiry was not appropriate. There is no reason to alter that view. Of course, the Justice 1 Committee has undertaken an inquiry and the Executive will reflect on its forthcoming report.

During the Justice 1 Committee's inquiry, it became evident that, due to time and other constraints, that parliamentary inquiry could not call a number of key players, such as Harry Bell, who presided over the Scottish Criminal Record Office fiasco—

That is not true.

I did not know that someone else was answering questions on behalf of the minister.

Further, the committee could not talk to Sir John Orr. In the light of the committee's inability to talk to all the witnesses and investigate the matter in the required depth, will the minister now reconsider the matter and have a public inquiry?

I do not think that anyone else was attempting to answer that question. A member of the Justice 1 Committee made a point, as she obviously feels strongly that the committee is the appropriate place for these discussions and that it is for the committee convener to decide what to do in relation to taking the report forward.

As I said, I have made a full statement to Parliament on this matter and Parliament has had an opportunity to debate it. The Executive has co-operated fully with the Justice 1 Committee's inquiry. I am well aware of the amount of work the committee has put into its inquiry and I have assured the convener that, when the report is published, I will read it carefully and consider any recommendations it makes about the way we deal with the fingerprint service. The committee was specifically invited to recommend ways in which the service can be improved, to ensure that it is a world-class service. I see no reason to do anything further until I receive the committee's report.

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Eye Appointments (NHS Lothian)

To ask the Scottish Executive what progress is being made in reducing the waiting times in NHS Lothian for a first eye appointment after referral. (S2O-10983)

NHS Lothian is making excellent progress reducing waiting times for a first outpatient appointment in all acute specialties, including ophthalmology. The board is consistently meeting the national maximum waiting time target of six months and, in the past year, it has reduced the number of patients waiting more than 18 weeks by almost 65 per cent.

Does the minister agree that the five-month wait that was suffered by the 91-year-old mother of one of my constituents is simply not acceptable? This is an important quality-of-life issue for many older people. Will the minister ensure that the need to improve the system, especially at the eye pavilion in Edinburgh, is accorded more urgency?

I agree that eye treatment is life enhancing and allows people to live their lives in a much better way. That is why "Delivering for Health" includes a target that states that people should wait no longer than 18 weeks for the procedure that we are discussing. We are resourcing the health service to deliver that.

NHS Lothian's improvement and support team is working with local teams to deliver a better service. That will be done through the progress that they are making around the managed clinical care network in Lothian. I reassure the member and his constituent that we are working hard to reduce bottlenecks and improve the performance of the service. That is evidenced by the fact that 65 per cent of patients are waiting no more than 18 weeks. Nevertheless, more needs to be done and more will be done.

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Electronic Health Records

To ask the Scottish Executive what progress it is making in developing electronic health records for national health service patients in Scotland. (S2O-11018)

We are making significant progress towards the electronic health record that is envisaged in "Delivering for Health". Some elements of the record are in place or are being created, such as the key medication and allergy information that is already stored in 4.4 million patient emergency care summary records and the digital X-ray images that are stored in the picture archiving and communications system that is starting to roll out in Glasgow. Preparation for the procurement of the additional systems we need is under way. We remain on target to meet the commitments that are set out in "Delivering for Health".

I am sure that the minister is aware of the necessity of effective information technology in ensuring patient safety and improving patient care, especially when care is provided at various sites. Can he assure me that the appropriate technology to ensure that will be in place when the new ambulatory care facilities open at the Victoria infirmary and Stobhill hospital?

This is not just about appropriate technology; it is also about the way in which we work in our health service. It is about, for instance, the community health index number, which is a unique patient identifier that is now being used in in excess of 95 per cent of cases in Scotland; the emergency care summaries to which I have referred, which cover 4.4 million patients; and the PAC system that I have described. We are building the elements of an integrated system in line with our targets.

In relation to the point about the new Stobhill and Victoria hospitals, we have committed to roll out the whole process up to 2010. I will ensure that, as we do so, those hospitals are included in the early stages of the process. That is appropriate in relation to the building of those very welcome new facilities.

Will the minister tell us what steps are being taken to protect patient confidentiality? What rights do individual patients have to refuse shared access to their medical records through the new electronic systems that are available?

The system that we are using meets all the security standards that have been established in the United Kingdom and elsewhere. A full audit trail of access that is made to the store is included in that. The Medical and Dental Defence Union of Scotland, the General Medical Council, the British Medical Association and GMC Scotland were all consulted on the programme, on accessing the records and on how that will be managed. An access protocol document was approved by all those parties. Therefore, I would argue that the protocols and security measures around the system are what they should be—leading edge.

We recently issued to all households information about their records and how they are stored. Under data protection legislation, patients have the right to choose whether information about their care is disclosed to other clinical staff.

We are ensuring that the national health service is empowered to use technology for the benefit of patients at primary and acute level. That is appropriate, as we have that information and it is used powerfully on behalf of patients. Nonetheless, patients who are concerned about such matters have been provided with adequate information and, if they wish not to allow access to their records, they can do so.

The minister will be aware of the significant cost increases of some of the e-health aspects of the NHS in England and Wales. He previously gave me an assurance in a written answer that the costs in Scotland are on track. Can he tell me whether that remains the case and give an undertaking that, should the costs of electronic health records escalate beyond what has been projected, he will inform members as soon as possible?

I reassure the member that we remain on track both financially and in terms of our commitment to roll out the electronic health system that is an integral part of "Delivering for Health". We are learning from other parts of the country to ensure that any lessons that can be learned about cost escalation are taken on board in Scotland. Indeed, on our advisory board, which is part of our governance procedures, we have a key member of the team from down south, who was involved in the national IT system for the health service south of the border.

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Alzheimer's Disease

To ask the Scottish Executive whether drugs for the treatment of Alzheimer's disease will be available to people in the early and mild stages of the disease. (S2O-10981)

I understand that NHS Quality Improvement Scotland will recommend shortly that the majority of those drugs should be used only for the treatment of moderate Alzheimer's disease and that they will no longer be recommended for people in the early and mild stages of the disease.

The minister will be aware that the professional bodies are strongly in favour of the drugs being provided for people in the earlier and mild stages of the disease. They argue for the quality of life of the people concerned and the long-term value for money to the national health service of providing the drugs at an early stage. Will the minister reconsider and extend the use of the drugs further down the scale, as it were?

I am aware of the concerns that have been expressed in the areas to which Mr Gorrie refers. Clearly, the views of the professional bodies are among the things that the National Institute for Health and Clinical Excellence will have taken into account in coming to its view. Our approach has been to follow the scientific views and conclusions of NICE, subject to the views of NHS QIS, whose job is to see whether those conclusions are appropriate and applicable in Scotland. We will continue to take that approach. There are issues beyond the determination on the drugs that will need to be looked at, and I am happy to consider how those issues can best be addressed going forward.

Will the minister clarify the reasoning behind the Executive's decision? Is it budget driven or do the minister and the Executive disagree with the policy that the expert prescriber should be the person who decides the best medication for an individual? On the back of Donald Gorrie's comments about the quality of life of the individual patient, will the minister consider the quality of life of the carers who are involved and the support that they receive?

The approach that ministers take is not to second guess the judgments of those with a professional responsibility in the area. We look to NICE, with its accumulated expertise, to consider the issues carefully. This is not about side-stepping the views of the expert prescriber; it is about providing a framework within which decisions are made, which is informed by the best available science. That is and will continue to be the approach that we take. I believe that it is the right approach.

The quality of life of the patients and the quality of life of the carers are both of significance. It is the job of NICE to establish where the benefit that is derived from any particular treatment is greatest and whether the benefit is sufficient to justify the treatment. For example, some of the drugs produce side-effects in many patients and produce benefits in only relatively few patients. These are difficult judgments, and they are judgments for the scientists rather than for ministers. It is for that reason that we follow the advice as we do.

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Medication (Care Homes)

To ask the Scottish Executive what importance it places on ensuring that medication is appropriately administered in care homes. (S2O-11035)

All care homes are expected to meet the national care standards and the requirements that are set out in the Regulation of Care (Scotland) Act 2001 and its associated regulations, which include requirements with regard to medication. The care commission inspects care homes at least twice a year to ensure that they do. Should a care home fail to meet those standards, the commission has the power to make recommendations or to impose requirements to ensure that the standards are met.

Is the minister aware that recent publicity surrounding the potentially harmful effects of pill crushing some medicines has left some patients and their relatives concerned about the safety of pill crushing? Can he give an assurance today that clear guidance on the safety and management of medication—both in nursing homes and in the community—will be made available to residents, patients and relatives? Will he also encourage pharmaceutical companies to develop other options, including patches, which would be of huge benefit, particularly to elderly people and those who have difficulty swallowing?

The existing standards are clear and I hope that all those who are involved will follow them. I take seriously the points that Irene Oldfather makes and I will be happy to draw them to the attention of the care commission, which has a responsibility both for enforcing standards and for ensuring the best possible standards of care in care homes.

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Physiotherapists (Employment Opportunities)

To ask the Scottish Executive what action can be taken to improve employment opportunities for recently graduated physiotherapists, in light of concerns raised by the Chartered Society of Physiotherapy. (S2O-11023)

We are working in partnership with the Chartered Society of Physiotherapy, NHS Education for Scotland and a national solutions group to address the current and potential challenges that are faced by the allied health professionals workforce in NHS Scotland, with an initial focus on physiotherapists. That work will include exploring and developing potential educational solutions, including a development programme to enable newly qualified staff to work in primary care and community settings. The national solutions group will be charged with providing short, medium and long-term solutions. We are also engaging directly with higher education institutions to discuss the management of AHP undergraduate programmes.

Will the minister join me in commending the Chartered Society of Physiotherapy for its highly informative and constructive lobbying of Parliament a few weeks ago? In view of the investment that has been made in those young professionals and the value of their skills to NHS services in the future, is there not a case for offering them the same employment opportunity assistance of one year's funding for an initial position that is already offered in the public sector to newly qualified nurses, social workers and teachers?

I share the member's view that the lobbying that was organised by the Chartered Society of Physiotherapy, which gave me the chance to meet many physiotherapists who have concerns about their future work prospects in our health service and beyond, was extremely effective.

Although we guarantee to offer one year's support to newly qualified nurses and midwives who have been unable to find employment through their own efforts, the vast majority of newly qualified nurses and midwives find employment through their own efforts. I am not ruling out adopting the member's suggestion in the future, but the Scottish Executive Health Department has no control over the number of students who undertake physiotherapy courses. Before I offered such a guarantee, I would seek to hold more discussions with further and higher education institutions about that issue, because it would not make sense to guarantee funding to anyone who came out of our universities and colleges with a physiotherapy qualification unless we had some control and influence over the number of trainees who are needed in the service. A balance needs to be struck. I do not rule out the member's proposal, but it requires careful consideration.

Does the minister agree that as the 187 physiotherapy graduates who are not employed in a physiotherapy post are looking to other countries for such posts, we need to get the problem fixed quickly, before Scotland loses that wealth of talent? Given that 28,000 patients in Scotland are on a waiting list to see a physiotherapist, will he agree to take firm action to ensure that we keep those Scottish graduates in Scotland?

I always want to keep Scottish graduates in Scotland to work in our health service and that is what the solutions group will seek to do. It is not the case that we have been inactive. In 2005-06, we provided one-off funding of more than £500,000 to three NHS boards to fund 20 basic grade physiotherapy posts. We have taken a number of measures that I could outline, but time will not allow me to.

We are targeting patients who are waiting. We have been extremely successful in dealing with waiting lists. The member failed to highlight that 94 per cent of patients who are waiting can be offered an appointment within 18 weeks, that 75 per cent can be offered an appointment within 10 weeks and that anyone who requires urgent treatment will receive NHS care in a short space of time.

I always want to retain the skills of Scottish graduates. I refer the member to my answer to Paul Martin, in which I mentioned that we have no control over how many students take physiotherapy courses or what training they undertake. I will seek to work with higher education institutions to ensure that we can and do keep our talent here in Scotland.

Is there any evidence that reduced levels of promotion from junior to senior grades are creating a logjam that is reducing the number of opportunities for trainees in the junior grades?

There is anecdotal evidence on that. Part of the work of the solutions group will be to examine the skill mix in existing services so that we can maximise opportunities in the system for new graduates. In addition, we have asked NHS Education for Scotland to develop a whole-system approach to dealing with the relevant part of the allied health professional workforce. Our workforce planning work is allowing us to make effective projections of how many people we require in each skill sector of Scotland's health service.

I reassure the member that we know there is an imbalance in the system in relation to the availability of promoted posts. We are on to the problem and are trying to deal with it. Much more effective workforce planning in the future should ensure that we train the necessary number of graduates and that they are able to find appropriate roles in our health service so that they can provide much-needed services to our communities.

Does the workforce planning work to which the minister has referred include a recommendation to health boards from the Scottish Executive on what level of coverage per capita would be sufficient?

I refer the minister to the fact that, in the Lothian region, there is only one specialist physiotherapist for people who suffer from Parkinson's disease. He will agree that, if one person in 500 in the population has Parkinson's disease, that is not sufficient coverage. How can we address that?

Margo MacDonald answers her own question: the workforce planning process will address those issues. It builds up a picture from the front line of the health service and balances it with projected demand of future need, which allows us to recruit the appropriate workforce. I remind members that the workforce in the NHS has grown dramatically—by more than 14 per cent—in the past few years. We continue to grow that workforce appropriately to meet our commitments under "Delivering for Health".

Before we move to First Minister's question time, members will wish to join me in welcoming the hon Joyce Banda, the Minister of Foreign Affairs and International Co-operation, and the hon Anna Kachikho, the Minister of Education and Vocational Training, and a large delegation from Malawi. [Applause.]