Health and Wellbeing
Huntington’s Disease
We are encouraging implementation of NHS Quality Improvement Scotland’s clinical standards for neurological health services. That will help to improve access to services for those with neurological conditions such as Huntington’s disease, wherever in Scotland they live.
I am sure that the minister will be aware of how much patients rely on the support and care of specialist nurses. Is she aware that specialist nurses are available in the Greater Glasgow and Clyde NHS Board area, but only to residents of Glasgow City Council, so patients with Huntington’s disease in, for example, East Renfrewshire cannot access that specialist nurse provision?
I am aware that there are specialist nurses in eight NHS boards. Obviously, we would encourage more specialist nurses to be recruited, particularly given that we know that they are good value for money, and we encourage boards to do that. Also, it is fair to say that the progress that we believe will be made through the investment in the neurological managed clinical networks—which we have given money to each board to develop—will make a real difference to patient care.
Support for Carers (Remote Areas)
Scottish Government spending on support to carers has not reduced. With the approval of the budget, members will be pleased to note that the £1 million that we allocated for 2010-11 for short breaks will now be rolled forward to 2015, making £5 million in total over that period. Now that the budget has been approved, there is £5 million for the carer information strategies in 2011-12, and both of those programmes support carers in remote and rural areas.
I thank Shona Robison for her answer—indeed, I welcome it. One of the problems that we have in my constituency is that if a patient from north-west Sutherland has to go to Raigmore hospital in Inverness for an appointment, the carer who is accompanying the patient—and, of course, the patient himself or herself—has a round trip that may last the whole day. Trying to find the time for that puts the carer in a pretty impossible position, and the Scottish Ambulance Service is not able to offer a huge amount of help. We have money in the budget, so how can the minister help carers who are placed in that situation?
When they are considering how to spend their share of the £5 million for carer information strategies, we would expect health boards to consider local need. They should be discussing with local carers and carer organisations the priorities for spending the money. I suggest that Jamie Stone raise that point with the health board as a possible way forward.
I hear the minister’s answer, and I wonder whether she can help us with the detail of the joint community care plan that Highland Council and Highland NHS Board have set up, which includes carer centre and carer advocacy tenders. Will those help some of the remoter communities, as mentioned in the original question? Is that the way forward to find new money?
I believe that it certainly is, and I will be happy to write to the member with more detail of the plan and how I see it being taken forward.
Question 3 is from Dr Richard Simpson—[Interruption.]. He is not here, I am afraid to say.
National Health Service Dental Services (North-east)
The Scottish Government, through a series of measures, has taken significant steps to increase the number of people registered with an NHS dentist in the north-east. From June 2007 to June 2010, patient registrations have increased by 146,992 in NHS Grampian and NHS Tayside.
What steps is the Government taking to increase registrations and access to dentists in rural communities?
This is a very important issue, and we have been trying to focus in particular on areas where there are still access issues. Indeed, we have been very successful in that respect, although I know that the area that Nigel Don represents still faces some challenges. We have the remote areas allowance, which provides up to £9,000 for independent and salaried dentists who are classed as remote, and we are also encouraging dentists to locate in towns such as Montrose. Indeed, the health board has been very effective in encouraging dentists to set up in areas where people might still require access to an NHS dentist. The member should perhaps contact the health board to get a bit more detail on the future plans for that particular area.
Many NHS dentists left the service a few years back. Are there any records showing how many have come back into the service?
The number of dentists coming into the NHS has increased over the past two or three years and I find it very encouraging that so many dentists see the NHS as their future in their profession. Five years ago, there was a feeling that dentists were drifting out of the NHS, and the change in that situation is down to the significant investment that has been made in NHS dental services. The NHS can make dentists a good offer. Although I do not have specific figures on the number of dentists who left and then have come back into the NHS, the increase that I referred to is likely to be a mix of those dentists and, of course, new dentists coming out of our dental schools and wanting to work in the NHS in Scotland.
New dental surgeries have been planned in Portree for some time now. I believe that the land acquisition process is nearly complete, but what further progress is expected to be made this year?
We are expecting significant progress this year. Of course as the member will be aware, and as I have said in response to previous questions, despite our efforts, the recruitment of dentists and the increase in registrations across Scotland, we have still faced a challenge in Portree. That is why it was right and proper to identify the area for investment through the primary care fund, and we certainly expect major progress to be made this year. I am very happy to provide the member with more detail of that plan.
Adult Community Care
The Scottish Government has been discussing the need for better integration of health and social care with a range of stakeholders over the past four years. As part of that work, NHS Highland and Highland Council decided to implement a lead agency model based on strong evidence of benefits for service users. We have now made it clear that that is our preferred model for integrating health and social care and a lead agency group will be established to take that work forward.
Is the minister able to assure the chamber that service users and carers will be consulted prior to the proposal’s implementation and roll-out?
Yes, I can give that guarantee. Of course, the staff involved will also be fully consulted. When one speaks to service users and carers, it is clear that they want an integrated single system. After all, what matters to them are the outcomes of what is delivered and they, like me, feel that those outcomes can be significantly improved with a single system for the delivery of health and social care.
What lines of accountability will apply for care workers under the proposed new arrangements? Will accountability be through the NHS or through local government?
The governance structures will be those of the NHS. There are two key reasons for that. First, it makes more sense to me to deliver an integrated system through the wider geographical areas of the boards, given the economies of scale that are involved. Having said that, I think that it is important that local authorities continue to have an input to plans. Under the lead agency model, they will continue to do that. They will be the commissioners of services from the NHS, so they will not be excluded from the process. That is important. Secondly, under the new governance arrangements, it will be much easier to deliver a more consistent service throughout Scotland. The approach has a number of benefits; I have set out the key ones.
St Brendan’s Hospital
The Scottish Government is committed to delivering health care of the highest quality to people on Barra. At its meeting on 26 January, Western Isles NHS Board approved the undertaking of a formal feasibility study, to complete an options appraisal on the various potential solutions, so that both NHS Western Isles and Western Isles Council, whose care home facility is in the same building, can make an informed decision on the modernisation or replacement of St Brendan’s hospital.
In light of recent comments by the chief executive of NHS Western Isles that the current hospital building on Barra is “completely unacceptable” and “wholly inadequate” for modern clinical standards, will the Scottish Government consider as a matter of urgency any case that the local health board makes for a new facility?
I give Alasdair Allan that assurance. As he is aware, I have had the opportunity to visit St Brendan’s hospital. When I was there, I was struck by two things: first, the excellent standard of care that is delivered by the staff who work in the hospital; and secondly, the clear need for improvement to the physical facilities there. That case was made to me strongly.
I imagine that the hospital will need to be replaced, because I do not think that it is fit for purpose. It is not possible even to move trolleys around the building, because the corridors are so narrow. When the cabinet secretary is considering the matter, will she also look at the accident and emergency part of the hospital? There is no piped oxygen and the facilities are not really capable of dealing with some of the emergencies that come in. Although staff are not trained to do so, they need to hold patients while they wait for emergency retrieval teams to come. They must have the expertise and equipment that are required to keep people stabilised at that point.
I hear the point that Rhoda Grant makes about the possible need for replacement of the hospital. All the options must be considered; local partners will do that. Having been to the hospital, I have some sympathy with the member’s comments, but the decision is one for the local NHS and the council.
New Housing (West of Scotland)
We recently published “Homes Fit for the 21st Century: The Scottish Government’s Strategy and Action Plan for Housing in the Next Decade: 2011-2020” and announced details of a competitive innovation and investment fund to support the delivery of new affordable homes during 2011-12. The investment programme will secure the approval of new affordable council and housing association homes throughout Scotland. The level of activity in West of Scotland will depend on the participation of housing associations, local councils and developers.
What impact will yesterday’s budget have in the West of Scotland region on organisations such as Clydebank Re-built and on resources for housing projects?
Yesterday’s brilliant budget by John Swinney will add £22 million to the housing and regeneration budget. [Interruption.] I will move my phone, but it is actually switched off, Presiding Officer.
I invite the minister to be a wee bit more specific. How major is major? Will he put a figure on how much money will come to Clydebank Re-built? I have asked the minister about that before. Can he offer any indication of what funding will be available for housing in West Dunbartonshire in the forthcoming year?
We would not, of course, have been able to allocate any money if Mr McNulty had had his way, because he tried to vote down the budget. He would have been voting down £6 million extra for the urban regeneration companies and £16 million extra for housing. It is rather ironic that he demands money for Clydebank that he was not prepared to vote through yesterday. However, I can tell him that we will announce the allocations to the URCs in the near future and that Clydebank will feature in those allocations of funding, because it is a deserving case. The total budget that we are investing in Clydebank and the five other URC areas far exceeds anything that was ever invested in them by the previous Labour and Liberal Administration.
Question 8 is withdrawn.
Balfour Hospital
NHS Orkney has developed an outline business case and submitted it to the capital investment group for consideration. At this point, we are aware that further work is required by the national health service board on the clinical strategy and clinical model, which will define fully the requirement for facilities. Issues regarding funding, both capital and revenue, also require to be addressed and officials and the Scottish Futures Trust are working with the board on options for funding and procurement.
The cabinet secretary will be aware from her visits to my constituency of the difficulties that are created by the age, layout and general state of the current Balfour hospital. I am sure that she would agree that the excellent standard of care that is provided by local NHS Orkney staff comes despite, rather than because of, the facilities in which they are required to work. Although I welcome the efforts that have been made to date towards delivery of a new hospital, will the cabinet secretary accept the need for the matter to be taken forward with the utmost urgency, particularly in light of the impact of any delay on decisions about a Kirkwall-based care facility? Although I note what the cabinet secretary said in relation to decisions about capital and revenue, she will be aware of the tight capital budget, so perhaps she could elaborate on whether she sees a role for revenue spending in delivering what is a vital facility.
In recent weeks, the Cabinet Secretary for Finance and Sustainable Growth has made comments and provision around funding on the non-profit distributing model. However, the project that the member raises must go through certain processes before any decisions of that nature are taken.
Active Schools Co-ordinators
There are 451 individuals employed as part of the active schools network who are helping to provide opportunities for children and young people to be engaged in physical activity and sport. In addition, there are over 10,000 volunteers, made up of teachers, parents, coaches and students, who all help to provide opportunities for children to take part. In 2009-10, they delivered 5 million opportunities for children to take part in sport and physical activities in and around schools. Discussions are on-going with local authorities for 2011-12, but I understand that all have indicated a commitment to the active schools programme and that sportscotland will continue to provide investment of £13 million this year.
Will the minister work hard with local government to try to ensure that the active schools projects continue? As she said, there are some valuable outcomes in local authority areas right across Scotland as a result of this worthwhile programme. It would be unfortunate if the programme were to be reduced further than it has been over the past two years. If it can be given priority and work can be done to achieve its continuation, I am sure that that would be in everyone’s interests.
Yes, we are working hard to ensure that that happens, as is sportscotland, which has developed a close relationship with each local authority. I am very confident that not only will the active schools network go from strength to strength but—and this is important—we will see even more opportunities for children to take part in sport and physical activities in and around schools. When we link this investment to the investment in community sport hubs around Scotland, we have good reason to be optimistic about it delivering real progress.
Scottish Ambulance Service (West Highlands)
The Scottish Government is in regular contact with the Scottish Ambulance Service on a wide range of issues. I also meet regularly with national health service board chairs and did so most recently on 31 January.
Recently, a number of communities in the west Highlands have experienced considerable delay in emergency response times. In a recent case on the Isle of Raasay, it took up to five hours for an ambulance to attend an incident. NHS Highland has had to employ on-call community nurses because of the inadequate emergency cover on Ardnamurchan. Is the cabinet secretary satisfied that the Scottish Ambulance Service’s operations in the west Highlands are fully fit for purpose? When she next meets the service, will she examine with it operational practices in our more remote communities?
The Scottish Ambulance Service does a very good job across Scotland but, as the member will be very aware, it faces particular challenges in rural and remote areas. The issue on Ardnamurchan was raised with me previously and I made it very clear that I expect NHS Highland, the Ambulance Service and other local partners to work collaboratively to ensure that the community is properly supported. I have also said that I will follow developments there very closely. Generally, Ambulance Service response times have improved greatly in recent years but, if the member’s constituents have been experiencing particular issues with response times, I ask him to raise them with me, as I will be happy to ask the service to look into them.
Child and Adolescent Mental Health Services (Referral-to-treatment Target)
National health service boards are making progress towards delivering the target by 2013. We have committed £6.5 million over three years for NHS boards to increase the number of psychologists in specialist child and adolescent mental health services. We are also investing £2 million each year to support the further development of specialist CAMHS. As a result of that investment, child psychology posts grew by 26 per cent between October 2009 and September 2010. We expect that to make a significant impact on waiting times for those services.
I welcome the progress that has been made. If ever there was a good case for early intervention, it is in tackling mental health problems.
I agree whole-heartedly with Alison McInnes’s point that early intervention is particularly important when dealing with mental health issues and with mental health problems that young people experience. The aim of the Government and of health boards is to ensure that the right care and treatment are available for young people in the right place and at the right time.
I welcome the 26 per cent increase in the number of psychologists and I agree about the need for the right care and treatment. What is the Government doing to identify at the earliest possible stage children who need specialist child and adolescent mental health services?
Health boards are working and have a responsibility to work to ensure early intervention in a range of specialties. We have discussed the importance of that for mental health services. That work involves early identification and early diagnosis to ensure the earliest access to treatment. That is part of the general drive to improve the delivery of mental health services for children and adolescents. I am happy to write to Mary Scanlon with further information, perhaps with reference to examples.
Audiology Services Advisory Group
A publication date for the report on bone-anchored hearing aids, to which Linda Fabiani’s question refers, has yet to be agreed. However, when the audiology services advisory group met yesterday, it discussed the report’s final draft, so I fully expect it to be published very soon. I will send Linda Fabiani a copy of the report as soon as it becomes available.
The minister is aware that I have a constituent who is concerned about the lack of provision of bone-anchored hearing aids in Lanarkshire NHS Board’s area. Will she assure me that that was discussed at the audiology services advisory group’s meeting?
Yes. I recognise Linda Fabiani’s interest in the matter, which she has pursued rigorously. She will be aware that the group’s report very much deals with that issue. As far as I am aware, it would have been discussed at yesterday’s meeting, although I will write to the member to confirm that. As I said in my initial answer, the report will be coming out very soon indeed, and its contents will, I hope, help to take the matter forward.
Chronic Pain Services
The Scottish Government is committed to ensuring that people living with chronic pain get the care and support that they need.
I welcome the cabinet secretary’s response to my question. I take heart from some of the efforts that are being made regarding chronic pain management.
The Royal national hospital for rheumatic diseases in Bath is a highly specialised residential pain management facility. Scottish patients are transferred and referred there only if their clinician believes that it would be of benefit. All referrals to Bath have been in cases where it has been entirely appropriate. We are reviewing the role of that sort of residential facility as part of the integrated service model for chronic pain that we have been developing. Our general approach is that people should not have to travel for specialist treatment unless there are clear benefits from doing so in terms of outcomes.
Question 15 should have been from Willie Coffey, but I understand that he is stuck in traffic. Perhaps he could have left home earlier.
Carers Forums (Support)
Local authorities, with their strategic partners at local level, are responsible for supporting local carers forums. In some areas, their responsibility might be devolved to regional umbrella voluntary bodies. Local authorities are also responsible for taking decisions on how regional care forums are supported.
In June, Highland Council and Highland NHS Board are ending their contract with Highland Community Care Forum for the provision of support for users and carers forums, with a replacement not due to be in place for some time. There is concern that the gap in provision might lead to the collapse of some of the most fragile forums in Highland, and that the new contract might not support the independent advice of local forums. Has the minister had any discussions with the health board and the council about ensuring that there is no gap in provision?
I am aware of the issue, and my understanding is that Highland Community Care Forum has a service delivery contract with the Highland Council and the health board, covering a number of elements including support to some of the local forums in the authority area. The contract will end next month, although I understand that there are extensions for some elements, so as to maintain continuity of service.
Insulin Pump Therapy
National figures on the use of insulin pumps show that provision more than doubled between 2007 and 2009, albeit from a low baseline. We fully expect that when the Scottish diabetes survey for 2010 is published in April, it will show that that trend is continuing.
The minister will be well aware of my long-term interest in this area. Although I welcome her comments, she will probably agree that the results are still not great throughout Scotland, as provision varies from 1 per cent to 5 per cent. I am particularly concerned about the low use of insulin pumps for young people. It is crucially important that those who are reliant on insulin can use insulin pumps as a way of normalisation, which is in the National Institute for Health and Clinical Excellence guidelines. Will the minister accept my view that we should increase the use of insulin pumps to at least the English level of around 5 per cent?
I very much recognise David Stewart’s long-standing interest in this area. As he is aware, we continue to encourage NHS boards to increase access to insulin pumps, but we must recognise that it is quite a complex process. A key factor is the availability of staff to deliver the very structured education programme that is associated with being on a pump; I know that David Stewart knows about that in great detail. It is step-by-step progress. We would all wish that it was quicker, but I am heartened that we are going in the right direction, albeit perhaps a bit more slowly than we would hope. As I said, it is hoped that the report will offer some more room for optimism when it is published in April by showing that the trend in the right direction is continuing.
Monklands Hospital (Bed Numbers)
NHS Lanarkshire has assured me that any changes to the number of beds and the way that they are used in hospitals is driven by the primary consideration of maintaining the highest quality of care. The same number of patients are being treated, and NHS Lanarkshire continues to meet its waiting times and all other performance targets.
Is the minister aware of the concerns of a number of my constituents who, while visiting relatives at Wester Moffat hospital in Airdrie, witnessed taxis bringing staff and cleaners to open up a mothballed ward in the middle of the night? Can she confirm that that is not an example of good practice but a direct consequence of bed reduction at all three acute sites in Lanarkshire, which could no longer cope with the number of patients being admitted through their doors?
If Karen Whitefield wants to send me the particular details of what she alleges, I am more than happy to look into it—
It was my constituents.
As I have said to Karen Whitefield, I am more than happy to look into it. However, as she surely understands, any health board will flex its number of beds depending on demand, much of which will be seasonally driven. The idea that a health board will increase the number of beds at particular times should not come as a surprise to anybody, and she would not expect a board to keep beds open at other times of the year when they were not needed.
That concludes questions on health and wellbeing.
On a point of order, Presiding Officer. I was in the chamber from the start of questions on health and wellbeing and I know that you only got to the 18th question. Although 10 members of the Labour group were listed to ask questions, at one point only one was in the chamber and a number of them came into the chamber only one or two minutes before they were due to ask their questions. One or two who came in late even got to ask supplementary questions. Is it appropriate to remind all members that they should be here from the start to the end of questions and that those of us who are here from the start to the end should get an opportunity to ask our questions?
Come on, come on, Presiding Officer.
I will not take directions from members from a sedentary position.