Official Report 1039KB pdf
National Health Service Boards (Winter Pressures)
To ask the Scottish Government, in light of NHS Ayrshire and Arran suspending routine hospital visits due to a sharp increase in flu cases, whether it will provide an update on the action that it is taking to support NHS boards in relation to increasing winter pressures. (S6T-02794)
I am aware of the significant pressures that the national health service and its staff, who I am incredibly grateful to, are under over the winter period. I was clear in my statement to Parliament last month about the steps that we have been taking since last winter to improve our resilience this year. That includes providing additional support to NHS 24 and the Scottish Ambulance Service, as well as up to £20 million of investment to support social care and address front-door pressures to improve flow. Furthermore, the Scottish Ambulance Service is taking forward initiatives, such as a hospital ambulance liaison officer at the front door of our hospitals, that are designed to relieve pressure on acute services.
Experts in Public Health Scotland and in the Scottish Government are closely monitoring the flu situation, and vaccination remains our best protection against the virus. That approach, alongside enhanced infection prevention and control measures, aims to support boards to manage the increase in respiratory infections over this winter.
As the cabinet secretary outlined in his answer, vaccinations are the best way of protecting oneself from flu. Last year, the uptake of vaccinations was poorer, so why has uptake been so low this year? There are more than 300,000 fewer adults vaccinated now in comparison with the figure two years ago. Children’s vaccination rates are down, and some areas have had delays in administering vaccinations. Public Health Scotland has reported that all age groups are now affected at levels not previously seen at this time of year, and it has confirmed that cases of flu in Scotland have
“more than doubled in the past week”.
As the cabinet secretary said, prevention is key, so why were there delays in administering vaccinations, and why are vaccination rates significantly lower than they were two years ago?
I reiterate Carol Mochan’s point about the importance of vaccination. Anybody who is eligible, whether they are staff or a patient, should be picking up their vaccination; it is the best way of protecting themselves, their family, their colleagues and services this winter.
The Joint Committee on Vaccination and Immunisation recommended that the groups for flu vaccinations should change this year, so when we compare like for like, in particular among adults, we are actually ahead of where we were last year on vaccine uptake. There is much more to be done, however, and I encourage people to continue to take up the vaccine.
We have delivered more than 1.5 million vaccinations so far this year. The vaccine programme started on delivery of the vaccine supply in September, and we continue to push the important message—I hope that it will leave the chamber resoundingly today—of, “Please, take up the vaccine.”
Health boards across the country are facing a sharp increase in cases, with hospital admissions as a result of flu increasing by 70 per cent. NHS Ayrshire and Arran has been forced to suspend routine visits across all hospitals; some hospital wards in NHS Dumfries and Galloway have closed to new admissions; and NHS Greater Glasgow and Clyde has told patients with flu symptoms to stay at home and treat themselves. The situation is worsening. What support has the cabinet secretary put in place to support staff who are dealing with that early, and very sharp, rise in cases?
I offer my absolute gratitude—as, I am sure, do all members in the chamber—for the work that is being delivered under significant pressure by our health and social care staff. They deliver remarkable care and service to the people we seek to serve all year round, but I am certainly grateful for the sacrifice that they make at this time of year in particular, and I know that colleagues will be, too.
The uptick in flu rates this winter is following a similar trajectory, albeit slightly earlier in the year, to what we saw last year, when there was significant disruption. I have already set out some of the measures that we are taking to improve performance and flow through the system, but the Government has also made wider investments to support the wellbeing of our staff at particular times of pressure such as this, so that they can continue to deliver remarkable care and treatment for the people of Scotland.
As the cabinet secretary is aware, NHS Ayrshire and Arran is under extreme financial pressure, which is in no small part due to high levels of expensive agency staff. Given that the higher prevalence of flu cases will inevitably put greater pressure on staff numbers through sickness absence, has the cabinet secretary considered the possibility of emergency financial support to the board to prevent high levels of staff absence from making a bad situation worse?
We continue to support the resilience of all boards, all year round. I note—as Brian Whittle will—the substantial reduction in the utilisation of agency staff across the national health service over the past couple of years. That is better for our staffing establishment, and it provides better continuity of care.
However, there are times of peak demand when the use of agency and locum staff is clearly important. We continue to have conversations with all boards around their pressures this winter. This week, I am standing up the winter resilience meetings—they were held last year through Christmas and new year—and I expect conversations on that subject and on boards’ ability and resilience to respond to come through in those discussions.
Scotland is experiencing what is said to be the worst flu death season in more than four decades, and changes to vaccination eligibility, to which the cabinet secretary referred, have meant that an additional half a million people were not offered the flu vaccine. Is the Scottish Government reconsidering eligibility and whether it should be extended to those aged 50 to 64?
It is difficult to say for certain what this flu season will end up looking like, but the trajectories at the moment are following the very same path as last year, when there was an unprecedented level of flu in the system, which caused clear disruption to patients and the system.
We take our vaccination advice on a United Kingdom-wide basis from the Joint Committee on Vaccination and Immunisation. Its members are the experts and, as we have done this year, we follow their advice on the most effective use of the vaccine.
I reiterate that anyone who is eligible should make sure that they take up the vaccine, because there are still more in the eligible groups who could take up the vaccine to help themselves, their families, loved ones and colleagues, and our health systems. I know that health boards are doing all that they can to make that as available as possible, including for staff of health and social care services, with drop-in clinics and peer-to-peer vaccination happening, too.
Three quarters of NHS staff in Ayrshire and Arran report that they are working in conditions where they are so short staffed that they believe that patient safety has been put at risk. That is a major concern, because, if staff now go off sick due to flu or other viruses, the pressure on accident and emergency, for example, will be immense. If staff do not believe that they can deliver adequate levels of care to their patients—and that was before the current flu pandemic—what will the situation look like in January and February next year? What is the Scottish Government doing to ensure that all our NHS boards are appropriately staffed during the winter season? This situation has been a long time coming.
The staffing establishment and safe staffing levels are covered by legislation, and we support boards to ensure that they have the requisite staffing establishment, although I absolutely take Mr Greene’s point about the pressures on staff, particularly at this time of year.
In my response to the initial question from Carol Mochan, I set out some of the areas in which we are investing in order to reduce and suppress demand, particularly in relation to accident and emergency and our acute system, which is particularly pressured at this time. That includes the investment that we have made in general practice; the increased investment that is going through social care; and the upskilling and upstaffing of NHS 24 and the Scottish Ambulance Service, to ensure that we provide the best possible resilience to the whole system, so that the pressures that Jamie Greene is narrating and which are felt in our hospital settings are suppressed as much as possible.
It is alarming that our hospitals are so stretched that, because they are petrified of a routine winter flu taking them beyond breaking point, they are having to deprive people of family visits at their time of need. What assessments have been made of whether flu vaccination uptake by NHS staff is sufficient? What additional steps will be taken to strengthen resilience across all NHS boards this winter?
The decisions to restrict visiting that Sharon Dowey mentioned are not taken lightly and are not unprecedented, either. Local teams need to carry out a difficult balancing act around risk and the potential impact that restrictions can have on families and loved ones, which everybody will be well aware of.
On the vaccination programme, as I have already set out, there is more work to do, particularly among our staff groups. Our boards are doing what they can to provide drop-in clinics and peer-to-peer vaccinations. Vaccination is the best way for people to protect themselves, their colleagues and their loved ones at this time of year. I encourage anyone—regardless of whether they are staff in health and social care or members of the public—who is eligible for a vaccine to take the opportunity to have it as soon as possible.
Salmon Farming (Mortality Figures)
I refer members to my entry in the register of members’ interests, in which I declare that I am a proprietor of salmon fishings on the River Spey, and that I am a member of the Spey Fishery Board and of Fisheries Management Scotland.
To ask the Scottish Government what action it is taking in response to the newly published October mortality figures for the salmon farming industry. (S6T-02793)
Edward Mountain refers to data that was published by Salmon Scotland, not by the Scottish Government. Salmon Scotland stated that
“These figures represent isolated events, with overall survival rates remaining high at around 98.5 per cent per month.”
Fish farming is highly regulated, and reasons for fish mortalities are complex and vary significantly between sites and incidents. Nonetheless, we expect producers to manage mortalities to the lowest possible levels. We support the sector in that regard through our support for the Sustainable Aquaculture Innovation Centre, which enables research into the challenges that are faced by the sector and the development of innovative solutions to those challenges.
It does not help that, this year, the industry has changed the way that it reports fish mortality. We know that more farmed salmon will die in Scotland this year than last year. Does the cabinet secretary share my deep concern about that, especially when one fish farm had a monthly mortality rate of 45.2 per cent, with more than 600,000 fish dying since the end of September?
Edward Mountain raises an important point. I hope that I made clear in my initial response that we expect producers to drive mortalities down to the lowest possible levels. This was an area of interest when the Rural Affairs and Islands Committee undertook an inquiry into salmon farming. Several recommendations stemmed from its report, and the Scottish Government made several commitments in response.
It is important to highlight that, although Edward Mountain chose in his question to reflect one set of data that is published on mortality figures, there are several different sources of data, and we collect many different pieces of information on many different reporting matters. When we compare figures, it is important that we look at the overall analysis, such as the rate of survival to harvest, which is part of the Scottish fish farm production survey that the Scottish Government publishes each year.
I think that even the cabinet secretary will agree with me when I say that the optics do not look good. The industry is under the spotlight for increasing mortality. While I am threatened with legal action by the chief executive of the body that represents the farmed salmon sector for highlighting the industry’s failures, the cabinet secretary has twice been entertained by that body at international rugby matches. Will she confirm that she shares my concern that more than 10 million salmon have died in the first 10 months of this year? Will she therefore implement all the recommendations from the Rural Affairs and Islands Committee’s 2018 report—specifically, recommendation 9?
There were many points in Edward Mountain’s question. First, he will be aware that the committee undertook a follow-up inquiry on the back of the work that was done in 2018. We published our response to that in full, in terms of the recommendations, all the work that we are taking forward as a result and the commitments that I have made. To follow up on that work, I published a response to the committee in September outlining the steps that have been undertaken, and I am due to provide another follow-up for the committee in March to update it on our progress.
However, it is important to highlight that we expect mortalities to be driven to the lowest possible levels. It is in no one’s interest for there to be high mortalities or for such mortality events to take place. We also have to recognise that, sometimes, these incidents and events are completely outwith the hands of the fish farmers—they could be due to changing climatic conditions, micro jellyfish or algal blooms, which cannot always be predicted. Our investment in innovation is critical in ensuring that we get ahead of those challenges and drive down mortalities to the lowest possible levels.
There is much interest in this question. Concise questions and responses will be appreciated.
As we rightly consider these figures, does the cabinet secretary agree that we also have a responsibility to ensure that we recognise the economic importance of salmon farming to the Highlands and Islands, not least in my own constituency?
Alasdair Allan raises a hugely important point. Salmon farming businesses are in the most rural parts of Scotland and in many of our island communities, where they support employment and provide well-paid jobs. I can give an indicator of that and of some of the value that they provide. In Alasdair Allan’s constituency, more than 40,000 tonnes of salmon were produced for export in a year, which was worth around £276 million, while nearly 200 people are employed in the industry. In the wider supply chain, there are about 11,000 jobs, with exports worth about £1.3 billion. Salmon farming is a hugely important industry to Scotland and our wider economy.
What is the Scottish Government doing to support the industry and ensure that research and development is carried out? With climate change, more threats are emerging. We need to anticipate events and, where possible, support the industry before they occur.
I could not agree more. As I tried to outline earlier, it is important to recognise that, with the changing climate, we face new threats and challenges all the time, so investment in innovation is hugely important.
Some work is being funded through the marine fund Scotland, and we also provide funding for the Scottish Aquaculture Innovation Centre. We are trying to get ahead of the challenges, and predicting what is coming further down the line and addressing that will be so important in the future.
Does the cabinet secretary recognise the investment by the salmon farming industry and the improving trend in survival rates, as well as the hard work that the men and women on the farms do every day to produce the United Kingdom’s top food, with exports expected to reach £1 billion this year?
I absolutely recognise that. One thing that stuck out to me, when the committee was taking evidence and undertaking its inquiry, was hearing from the fish farmers who are working really hard to produce that high-quality source of protein, which, as I have outlined, is so important for our wider economy.
As much as I have outlined in previous responses the investment that we are putting into that innovation and ensuring that we are ahead of some of the emerging challenges, it is also important to recognise the huge sums of investment that the industry is putting in to tackle and address some of the challenges that it knows that it faces.
In mass mortality events at Gob Na Hoe and Portree, which are both in Skye, the Government did not know the real numbers of fish deaths as they happened because Scotland’s mortality figures exclude early deaths and losses from culls and transport; they also exclude cleaner fish. That has allowed Bakkafrost, for example, to report zero early deaths at Portree to regulators, while telling investors that 19 per cent of its fish died in the first weeks at sea.
With nearly four in every 10 farmed salmon placed in cages dying, will the cabinet secretary accept that regulation is not credible, and will she commit to closing those reporting loopholes so that every farmed fish death is counted in real time?
First, I emphasise that we have a really robust regulatory regime when it comes to finfish aquaculture.
On the data that is produced, I outlined in a previous response the number of different reporting mechanisms that we have. We collect that information for a variety of purposes. One of the key recommendations from the committee was on how we transmit that data and how we can make it more accessible and transparent for people. A number of pieces of work have been undertaken in that regard.
I can only reiterate what I have said about mortalities in previous responses: we want to ensure that they are driven down to the lowest possible levels. We undertook—we have made a commitment—to do pieces of work on that in response to the committee’s recommendations, and I am determined to continue that work.
Surely the Scottish Government must be concerned about the increasing levels of disease in the salmon industry, especially given the finding in the committee’s report from earlier this year that slow progress was being made on regulation. Does the cabinet secretary recognise the damage that that continues to do to the national and international reputation of Scottish salmon?
I can only reiterate what I have said in previous responses in that regard. We want to ensure that mortalities are driven down to the lowest possible levels. It is in all our interests—those of the Government and those of the industry—that that happens, which is why the investment in innovation is critical.
On mortality levels and the events that we are talking about, a lot of that can be completely outwith the control of the fish farm, because of the changing climatic conditions.
It is important that we bear all that in mind when we look at some of the figures. We can pick out figures from month to month, but it is important to note that mortality can be variable and, as I outlined in my initial response to Edward Mountain, there have been increasing survival rates, too. We need to look across the whole cycle.
A lot of work is going on in relation to the issue. We have responded to the Rural Affairs and Islands Committee recommendations with a number of commitments, and I have followed up with the committee to outline our progress against what we said that we would do. That work very much continues.
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