Meeting of the Parliament

Meeting date: Wednesday, June 11, 2014

Official Report 797KB pdf

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Portfolio Question Time

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Health and Wellbeing

Good afternoon. The first item of business is portfolio questions. As ever, I would prefer short and succinct questions and answers, in order to get in as many people as possible.

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National Health Service Boards (Meetings)

1. To ask the Scottish Government when it last met representatives of national health service boards. (S4O-03326)

Ministers and senior officials meet regularly with representatives of NHS boards to discuss issues of interest to the people of Scotland.

Will the cabinet secretary confirm whether there have been any discussions about the use of robots in the surgical treatment of prostate cancer following Prostate Cancer UK’s highlighting of the fact that it can deliver better outcomes than other forms of surgery? Moreover, given that England has 33 of these robots and Scotland none, can he advise why they are available in England but not in Scotland, when they will be available in Scotland, and whether any arrangements are in place to ensure that in the meantime Scots can use the facilities in the English NHS?

There have been extensive discussions on the use of robots in prostate operations, particularly in the west of Scotland and Grampian. The national planning group is looking at the issue in great detail, including the lessons that can be learned from America, where robotic surgery is used much more extensively. The group will report in due course, and I will update the Parliament at that time.

When did the Scottish Government last meet Lanarkshire health board? Has it received an update on the norovirus outbreak at Hairmyres that has closed two wards, restricted patient places in four others and led to patients being sent away or directed to Wishaw general hospital? If it has received such an update, can we in the chamber also receive it?

We are in regular touch with NHS Lanarkshire about the very exceptional outbreak of norovirus at Hairmyres hospital, the extent of which has led to some disruption in the provision of services. The outbreak at the hospital is unprecedented in scale, and the action that has been taken by NHS Lanarkshire has focused on the safety of patients and, indeed, staff. I will ask NHS Lanarkshire to ensure that all Lanarkshire MSPs are updated as soon as possible on the current situation and are kept up to date with any further changes.

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Waiting Times (NHS Lothian)

2. To ask the Scottish Government what action it is taking to address waiting time challenges in NHS Lothian. (S4O-03327)

I am aware that the board has been experiencing capacity difficulties delivering the waiting time guarantee and standards. Indeed, that is why it has already indicated that it will be investing more than £8 million in the current year to increase capacity by recruiting around 80 full-time equivalent staff, including consultants, nurses and other clinical support staff in specialties such as ear, nose and throat, ophthalmology and orthopaedics.

That additional capacity will come on stream soon and should enable a significant reduction in waiting times over the coming months, with the 12-weeks legal treatment time guarantee being delivered by the end of this year and the out-patient waiting times standard by March 2015. My officials will continue to work closely with the board to support the delivery of waiting times.

I thank the cabinet secretary for his reply, particularly his commitment to his officials working closely with NHS Lothian.

NHS Lothian struggles to meet these targets; it is one of the worst performers with regard to the 18-week and 12-week targets, and every month it is spending £1.5 million on private procedures. Does the cabinet secretary accept that, despite the best efforts of the staff, there is a serious capacity problem and that the sheer demand of patients needing treatment must be addressed? Given that shifting resources into this area will inevitably impact on other areas in NHS Lothian, is the cabinet secretary confident that NHS Lothian has the resources to increase capacity and to meet the increasing demand that it is currently challenged in meeting?

I have two points to make in response to that question.

First, I am absolutely confident that the health board has the money to deal with this issue without adversely affecting other areas. It has had a real-terms increase in its budget for this year, and it will get a real increase in next year’s budget.

Secondly, the fundamental problem in NHS Lothian is that the capacity planning that was done 10, 12 or 15 years ago grossly underestimated the population growth in Edinburgh by up to 20 per cent. As a result, NHS Lothian has had to invest in additional capacity in the Royal Victoria hospital and elsewhere to cope with the demand for day-to-day services.

I am confident that NHS Lothian has a workable plan that will be delivered. As I have always made clear, I expect the board to deliver the TTG for in-patients by the end of this year, and the TTG for out-patients by March next year.

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Healthy Eating (Children)

3. To ask the Scottish Government what action it is taking to promote healthy eating choices for children. (S4O-03328)

We are progressing a range of activities to support children to eat a healthy balanced diet, including nutritional standards for school meals and our £3 million food education fund to support teaching children about the food that they eat and its impact on their health.

Last week, I launched “Beyond the School Gate—Improving Food Choices in the School Community”, which offers guidance on how we can positively influence the food environment around schools. It builds on “Better Eating, Better Learning—a new context for school food”, which was published in March and sets out refreshed guidance to support further improvements in school food and food education. Together, those strategies offer a holistic package to help partners to support children to make healthier choices inside and outside school.

The First Minister announced earlier this year that the entitlement to free school meals would be extended to all children in primary 1 to 3 from January 2015 to support the development of healthy eating habits at a young age.

I welcome the Scottish Government’s announcement of its “Beyond the School Gate” strategy, among others. It is important that local authorities do all that they can to ensure that healthy options are available for children.

Does the minister share my disappointment, however, that our shared local authority, Falkirk Council, has failed to sign up to previous initiatives such as the seafood in schools project? Will he do all that he can to encourage Falkirk Council and other councils to embrace those healthy eating initiatives more positively?

As Angus MacDonald will recognise, everyone has a part to play in trying as best they can to encourage schoolchildren to eat a balanced and healthy diet. That includes those in the retail sector, local authorities—particularly education departments—and Government and other agencies, which can all help to achieve that aim.

I am aware that Falkirk Council has not proceeded with the seafood in schools programme. I share Angus MacDonald’s disappointment in that respect, and I encourage the council to reconsider. We need to encourage children to eat seafood, as it is an important part of a balanced diet. The seafood in schools initiative is very positive, and Falkirk Council could take it forward.

Is the minister aware of the responsible retailing of energy drinks campaign that the Educational Institute for Scotland has recently endorsed?

The campaign in Scotland is led by Councillor Norma Austin Hart and seeks to encourage retailers not to sell energy drinks to children, building on Scottish Labour’s ban on those drinks being sold in schools. When children consume energy drinks, they often come to school agitated and unable to concentrate and learn, and they can be disruptive in class.

In addition, the wider health implications are not known. Retailers—especially those who are close to schools—are being asked not to sell those drinks to young people under the age of 16. Will the minister back the campaign in order to ensure that children come to school ready to learn and are not disruptive?

A number of important factors must be addressed. One issue is the need to encourage schoolchildren to remain in the school environment for eating, and another concerns the type of food that is provided in schools.

Local authorities are progressing a range of approaches in order to address those issues. For example, a school that I visited just last week has had a 40 per cent increase in the number of children who remain in school to consume food as a result of the approach that it has undertaken.

Secondly, we need to work with the retailers that are in close proximity to our school gates and consider what action they can take. As the guidance for local authorities sets out, councils can take action in areas such as licensing in order to address some of those issues.

The combination of those factors is extremely important. The “Beyond the School Gate” strategy focuses not only on fizzy drinks but on foods that are high in fat, sugar and salt, which have a significant impact on children’s health.

We have to deal with all those factors, not just one, if we are to tackle the issue comprehensively. Our schools and local authorities have a key role to play in helping to deliver that approach through their policies in areas such as licensing.

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Malnutrition (Vulnerable Older People)

4. To ask the Scottish Government what measures it is taking to combat malnutrition, which affects some of the most vulnerable older people. (S4O-03329)

The Scottish Government is doing many things to tackle malnutrition among older people. Since 2008, we have provided £1.75 million to improve nutritional care for older people through measures including malnutrition screening of all patients when they are admitted to hospital, nutrition champions in every national health service board and the introduction of protected meal times. Scotland was the first country in the United Kingdom to make screening for malnutrition a mandatory requirement. The Care Inspectorate expects all care for older people and support plans to detail specific food likes and dislikes.

We have made available £2 million for 2012-15 to Community Food and Health (Scotland) to promote healthy eating in the least privileged communities and improve food access and awareness of nutritional guidelines, with the aim of tackling health inequalities. Another initiative that we support is Scotland’s national oral health promotion, training and support programme, caring for smiles, which aims to improve the oral health of older people, particularly those who live in care homes.

There is a worrying lack of data about the number of older people in Scotland who are malnourished. In fact, the estimated figure of 100,000 malnourished older people in Scotland is projected from UK data. Is the cabinet secretary aware that, although Age Scotland welcomes the MUST—malnutrition universal screening tool—initiative to which he referred, it is concerned that there is no screening for malnourishment of older people in the community? Furthermore, is he aware that, although screening occurs when older patients are admitted to hospital, a 2013 Healthcare Improvement Scotland report was critical about the effectiveness of the screening and the limited information about patients’ nutritional needs in the five hospitals that were inspected? Does the cabinet secretary agree that there is now a compelling argument for having more data on the issue so that we can properly assess and address the problem, whether in hospitals, care homes or among older people living in the community?

We are implementing the recommendations of the HIS report. On the data, the estimates that we have are that up to 30 per cent of older people who are admitted to acute hospitals are at risk of malnutrition; that between 30 and 42 per cent of those who are admitted to care homes are at risk; and that 10 to 14 per cent of people in sheltered accommodation might be at risk. Over the population, it is estimated that 14 per cent of older people are at risk of malnutrition. We have a fairly good handle on the scale of the problem.

I agree, however, that we need to do more to tackle the problem outwith hospital. Of course, the best way to do that is to ensure that older people have the necessary income to be able to afford to buy the food that they need to sustain themselves. That is extremely important, and it is why we are supportive of the proposals to improve the pension for older people, many of whom, particularly women, have a very low income indeed and sometimes find it difficult to buy the food that they need to stave off malnutrition, as food is increasing in price all the time.

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Pharmacy Application Process (Community Involvement)

5. To ask the Scottish Government what steps it is taking to increase community involvement in the pharmacy application process in remote areas. (S4O-03330)

I am pleased to say that I announced on 30 May the laying of amendment regulations that will ensure that there is direct community engagement and participation in the consideration of pharmacy applications. The new regulations will also ensure greater transparency in the decision-making process so that people who are affected by decisions have a better understanding of how and why decisions are taken.

It is becoming increasingly difficult to recruit and retain health professionals in remote areas. What support is the Scottish Government providing to health boards to tackle that issue and to support local accessible health services?

I assure members that the Scottish Government recognises the current challenges in remote and rural areas and is committed to ensuring that all communities in Scotland receive high-quality and sustainable healthcare services. In particular, the Scottish Government continues to promote a range of initiatives to recruit and support general practitioners working in remote and rural areas. Those include proposals for a specific programme of work to be taken forward by NHS Highland to develop and test a range of innovative ways of delivering healthcare in rural parts of Scotland. That will involve exploring approaches to building sustainable health and care services with all key stakeholders, including local communities.

I welcome the changes to community involvement in pharmacies and look forward to receiving more detail. What steps will the cabinet secretary take to ensure that people in remote rural areas access pharmacy services? I was recently in Skye, where Macmillan, Boots and NHS Highland are working on a palliative care community pharmacy project, which works really well and underlines the need for pharmacy services, not only among general practitioners who work in rural areas but also among their patients.

It is primarily the responsibility of each board to ensure that pharmacy services are accessible through every part of their geography. I am well aware of the initiatives that have been taken by NHS Highland, which I think will be very successful. We wish to roll out to other parts of rural Scotland the initiatives that have been proven to work.

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Boarding Out (National Health Service)

6. To ask the Scottish Government what progress the NHS is making in recording and reducing the levels of boarding out. (S4O-03331)

The Scottish Government is leading the way in the United Kingdom in tackling boarding. Health boards record and monitor boarding levels daily. We have taken a range of initiatives to reduce boarding. Those include a £30 million unscheduled care programme; the integration of health and social care; our commitment to seven-day working; the development of a bed-planning toolkit; and a programme to improve patient flow and reduce boarding and other delays to treatment. However, there is more to be done and we will continue the work to improve the quality of care in our hospitals.

Since the monitoring of the boarding out system was introduced under Nicola Sturgeon, we have undertaken a freedom of information inquiry. The response shows that the number of patients being boarded out between 11 pm and 6 am in the morning was 10,500 in 2011-12, 12,700 in 2012-13 and an estimated 13,000 for the full year last year. If that is not bad enough, these shocking figures are derived from only seven out of 14 health boards. Lothian NHS Board, Tayside NHS Board, Greater Glasgow and Clyde NHS Board and Grampian NHS Board could not even produce figures for movements at that time. Similarly, when we asked about multiple moves, five large health boards—Lothian NHS Board; Lanarkshire NHS Board; Greater Glasgow NHS Board; Tayside NHS Board; and Grampian NHS Board—were unable to say how many multiple moves had occurred.

Is the cabinet secretary really satisfied with the management of boarding out when the boards are not even recording the information? Will he issue an instruction now for the boards to comply with recording requirements—including recording of times—and to include a cross-reference to the presence of patients with cognitive impairment, a group which he and I would agree are least able to cope with boarding out? Will he invite Healthcare Improvement Scotland to make consideration of the matter part of its inspection regime?

I believe that Dr Simpson said that the figures that he quoted relate to the period up until the end of the last year. He will be aware of the work that we have done on boarding with the Royal College of Physicians of Edinburgh and others and the very big, substantial report that was produced last year. I accept that far too much boarding is going on, particularly when it involves people with cognitive problems. The whole purpose of the report’s recommendations, which we are now implementing, is to improve the situation in relation to recording and, most important, to reduce the need for boarding in the first place. I will certainly take on board Dr Simpson’s additional suggestions.

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Health Inequalities (Most Deprived Communities)

7. To ask the Scottish Government what steps it is taking to tackle health inequalities in the most deprived communities. (S4O-03332)

As a Government, we have been clear that health inequalities in our most deprived communities cannot be addressed by health solutions alone. The interventions that are most likely to reduce health inequalities are those that utilise taxation, legislation, regulation and changes in the broader distribution of income and power.

We have demonstrated our commitment to that approach with measures such as free prescriptions, free eye examinations, the expansion of free school meals and the provision of childcare, and through our work on youth employment.

We will continue to take forward a range of policies that will assist in tackling health inequalities, in partnership with our colleagues in the national health service, local authorities and the third sector.

I read in the press recently about a pilot scheme concerning general practitioner link workers who can help people to deal with financial, emotional or environmental problems that arise as a result of housing, debt, social isolation, stress or fuel poverty issues. Will the minister provide more details of that pilot scheme?

The pilot scheme was launched by the Cabinet Secretary for Health and Wellbeing in the past few weeks. It is a partnership that was developed with several of the deep-end practices. The pilot project will see a link worker being placed in seven of those practices in Glasgow and Dundee, with eight comparator practices, to evaluate the effectiveness of the link workers. Their purpose will be to consider what support they can provide to patients whom GPs refer to them. That support can relate to housing, finance or other environmental issues.

We have worked with the deep-end practices on developing and implementing the pilot, which will be evaluated over the next couple of years. The initial intention was that it would be a two-year pilot. However, following discussion with the deep-end practices, we have agreed to extend it to five years. We will take the learning from it over the next five years and determine how we can extend it to other practices in deprived areas.

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Young People with Cancer (Clinical Trials)

8. To ask the Scottish Government what action it is to taking to help young people with cancer access clinical trials. (S4O-03333)

The chief scientist office of the Scottish Government funds several research networks, two of which—the Scottish cancer research network and the Scottish children’s research network—operate to enhance access for children and young people with cancer to clinical trials. The CSO has entered into discussion with those two research networks to ensure that they work closely to provide support to patients in that transitional age range to take part in clinical research.

Given the importance of access to clinical trials in helping to treat young people’s cancer, will the cabinet secretary advise me what progress is being made on the recruitment of a new cancer clinical research champion, when he expects the announcement of a new champion to be made and how the champion will tackle the inequity of young people’s access to clinical trials?

I am pleased to be able to tell Aileen McLeod and the chamber that, after a competitive recruitment process, Professor David Cameron—who I do not think is any relation to another David Cameron—of the University of Edinburgh has been appointed as the new Scottish cancer research champion. A formal announcement will be made in the near future.

In its early discussions with Professor Cameron, the chief scientist office will ask him to examine access to trials for young people with cancer and to obtain reliable data.

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Ayr Hospital (Standard Mortality Rates)

9. To ask the Scottish Government when it will review the standard mortality rates at Ayr hospital. (S4O-03334)

Hospital standardised mortality ratio—HSMR—figures for all acute hospitals in Scotland, including University hospital Ayr, are routinely considered quarterly. The next figures will be published in August 2014.

The latest data available, to the quarter ending December 2013, indicated that there had been a national reduction of 14.2 per cent in the HSMR in Scotland since such data began to be recorded in the quarter ending December 2007.

The data for Ayr hospital indicated a higher single data point on this quarter’s analysis. Although the HSMR cannot be used in isolation as a marker of quality and safety of care, it can be used as a smoke alarm to trigger further evaluation. As a result, NHS Ayrshire and Arran is already undertaking further investigation of that data point and Healthcare Improvement Scotland is engaged in supportive dialogue and interaction with the board.

Healthcare Improvement Scotland and the Scottish Government will continue to work with NHS Ayrshire and Arran to ensure that its HSMR continues to fall in accordance with the national trend.

I thank the cabinet secretary for his comprehensive answer.

Against the background of the standard mortality rates throughout Scotland having dropped by 14 per cent since 2007, it is regrettable that, in the last reported quarter, Ayr hospital was above the national average. However, that should not hide the fact that the hospital and its staff have a good longer-term record in reducing the standard mortality rates.

Despite the serious economic recession, specific problems—such as methadone deaths and deaths as a consequence of social issues such as energy poverty—are being addressed. However, I ask that the Government ensure that the hospital continues its drive to improve the appropriate standards of care that reduce the levels of mortality.

The Scottish Government expects all health boards to implement measures to prevent avoidable harm and deaths as part of the Scottish patient safety programme. It is committed to improving the safety of healthcare further and expects NHS Ayrshire and Arran to continue improving the quality and safety of care for the population that it serves. I will keep a close eye on the board to ensure that it does that.

The cabinet secretary is aware of the shortage of available beds at Ayr hospital, which may or may not have influenced the standard mortality ratio. Will he tell Parliament what can be done to better manage bed availability at Ayr hospital, which is also key to reducing accident and emergency waiting times?

Two specific issues affect the availability of beds at Ayr hospital. One is delayed discharges, although South Ayrshire is not one of the worst authorities in terms of dealing with those. The other is the flow of patients during the day. Too high a percentage of patients who are discharged each day are discharged fairly late in the day—for no good reason, quite frankly. A key aim of the implementation of our unscheduled care plan for all hospitals, including Ayr, is to improve dramatically the percentage of patients who are discharged before lunchtime, as those patients are medically fit for discharge and it is important to free up beds for people who are coming in through the A and E department and, indeed, through general practitioner referrals.

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NHS Greater Glasgow and Clyde (Meetings)

10. To ask the Scottish Government when it last met the NHS Greater Glasgow and Clyde Board. (S4O-03335)

Ministers and Government officials regularly meet representatives of NHS Greater Glasgow and Clyde to discuss matters of interest to the people of greater Glasgow and Clyde.

As the cabinet secretary is aware, patients in north and north-east Glasgow and beyond who require chemotherapy more often than not have to make their way to the Beatson centre to receive such treatment. The journey is often not very easy, particularly when taken by public transport, and is an additional difficulty for people who perhaps are already unwell.

Has the cabinet secretary discussed with NHS Greater Glasgow and Clyde the possibility of providing chemotherapy at Stobhill hospital, which would save the patients involved a great deal of stress and anxiety?

I am well aware of that issue, and I have been in touch with many of the people from north of the river who are very keen to establish such services at Stobhill. I have studied the information provided by NHS Greater Glasgow and Clyde and that provided by the people who are campaigning for the change. I think that NHS Greater Glasgow and Clyde is taking the right decision on the matter, but I am happy to share information with Patricia Ferguson, and I am happy to meet her, with representatives of NHS Greater Glasgow and Clyde, to discuss the issue in detail. It is a very detailed issue, in terms of the statistics about the postal code areas from where people come for such treatment.

Will the cabinet secretary confirm, as a result of his discussions with the health board, what arrangements or contingencies it has made to cope with the large international presence in the city during the Commonwealth games and how it intends to ensure that those who attend have access to information, should the need arise?

The health service, like all other essential public services, has been part of the resilience planning for the Commonwealth games. The health board has played a full part, along with the organising committee for the games, Glasgow City Council and a range of other bodies, to ensure that all contingencies, and arrangements to meet all contingencies, are in place during the Commonwealth games. I am happy to write to Jackson Carlaw with more detail on that, although for obvious reasons I cannot give him too much information, because, by its very nature, some of it has to remain confidential.

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Children with Asthma (Identification and Diagnosis)

11. To ask the Scottish Government what measures are being taken to improve early identification and diagnosis of children with asthma. (S4O-03336)

The Scottish Government is committed to providing the best quality care and treatment for people living with asthma in Scotland. Last year, Healthcare Improvement Scotland published “Asthma priorities: Influencing the Agenda”, which includes information about the early and accurate diagnosis of asthma in children.

What work is being undertaken with general practitioners on referrals to specialist asthma services? What asthma treatments are available? I am asking particularly about new treatments that are being developed for young children, especially those under the age of four.

John Wilson will be aware of the recent publication of the report of the national review of asthma deaths. The review looked at the way in which asthma services are delivered across the whole of the UK, including in Scotland.



The report contains a range of recommendations. There are key aspects with regard to how services are delivered at a primary care level, such as ensuring that regular reviews are undertaken of patients who have been diagnosed with asthma, that patients are encouraged to participate in those reviews, that patients receive the appropriate preventative medication as and when appropriate, and that medication is being used appropriately.

The national advisory group for respiratory managed clinical networks is now considering all the detail of the recommendations and the actions that we need to take in Scotland to improve services yet further.

With regard to specific treatments, I am sure that the member will appreciate that the nature and type of treatment that a patient is prescribed is a clinical decision. We would expect general practitioners and clinicians in the secondary care setting to ensure that patients—particularly children—who require a particular form of treatment for their asthma are provided with that treatment in a timely and appropriate way.

I thank the minister for his response and for addressing the problem of asthma deaths.

What is the minister doing in relation to the report’s recommendation that patients who are prescribed more than 12 reliever inhalers in a year be looked at? It is reckoned that there are higher levels of deaths in relation to such prescribing, so what monitoring system is he putting in place to ensure that those people are picked up and reviewed quickly?

I recognise the point that the member makes. That is why the national advisory group for respiratory managed clinical networks is considering the relevant recommendations. Once we have received its report and its recommendations on which measures should be taken forward—including on aspects of monitoring, if that is what it recommends—we will consider how measures can be rolled out nationally. There is an issue about ensuring greater consistency of approach in how we manage conditions such as asthma, and I think that the national review provides us with very helpful information on how we can do so that more effectively.

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Licensed Premises (Health Impact of Overprovision)

12. To ask the Scottish Government what its position is on the health impact of overprovision of licensed premises in urban areas. (S4O-03337)

The provision or overprovision of licensed premises within a local area is a matter for local licensing boards to consider. One of the grounds for refusal of a premises licence is that granting it would result in overprovision, having regard to the number and capacity of existing premises. In assessing the extent of any overprovision in a locality, the board must consult relevant interests, including the police and local health board.

In central Edinburgh, there is an outstanding planning application for a 900-seat superpub, which is currently under appeal. One chain is looking at converting three properties into large new pubs and, last month, two new supermarkets were—controversially—licensed, against the advice of NHS Lothian and the police.

What advice would the minister give to local authorities and licensing boards on how they should weigh up the advice that they receive on health and law and order interests against other interests to ensure that we can tackle the problem of overprovision and overconsumption of alcohol, especially in city centres?

There is well-established evidence that demonstrates that availability is a key factor in driving overall alcohol consumption. That is the type of factor that boards should take into account when they submit their evidence to licensing boards on the potential health impact of any further provision of licensed premises.

The member will appreciate that, ultimately, it is for the local licensing board to make a decision on the matter. I would encourage licensing boards to ensure that they consider in detail the responses that they receive from their colleagues in local health boards in any decisions that they make on the provision—or overprovision—of licensed premises in their local authority area.

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Unpaid Carers (Expert Working Group on Welfare)

13. To ask the Scottish Government how unpaid carers could be supported by the findings of the expert working group on welfare. (S4O-03338)

Within its existing powers, the Scottish Government provides significant support to unpaid carers, underpinned by considerable investment of nearly £114 million since 2007. The expert working group on welfare is clear that, with independence, we could go much further in supporting that vital sector. We have already committed to raising carers allowance to the rate of jobseekers allowance, as recommended by the group, if we are the Government of an independent Scotland.

The report outlines some longer-term measures to support unpaid carers, such as addressing disincentives to working and caring in the benefits system and the workplace, and tackling the current rules limiting studying and receiving carers allowance.

As the First Minister said in the chamber last week, the Government will take forward and consider fully the recommendations of the expert working group.

I recently met a representative of the Scottish Youth Parliament to discuss its care fair share campaign, and it is clear that the issues that the working group outlined that affect carers, such as low income and variable levels of support, also affect young carers. Has the Scottish Government looked at any additional assistance for young carers in the area of, for example, education maintenance allowances?

I am aware of the Scottish Youth Parliament report on the issue. We have done a range of work, particularly in the area of education, to help to support young carers to remain in education because it is important for them to be able to do so, whether it be in the primary and secondary setting, or in higher and further education.

We have worked with the College Development Network to look at what policies individual colleges can put in place to support young carers in education. We recently issued new guidance on education maintenance allowances to ensure that the needs of young carers are accommodated in the way in which colleges assess EMAs.

That combination of measures can help to support young carers in the education setting, but we can clearly do more and we are considering what further measures we can implement under carers legislation in the coming years.

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Homoeopathic Medicines (Prescription)

14. To ask the Scottish Government what its position is on prescribing homoeopathic medicines. (S4O-03339)

The strategic direction and funding for healthcare in Scotland is set by the Scottish Government. Decisions on the allocation of funding to provide access to services, including complementary and alternative therapies, is a matter for individual health boards based on the needs of their local populations and in line with national guidance. The prescription of specific treatments is a clinical decision for practitioners.

Is it becoming more difficult to get homoeopathic medicines?

A number of health boards have carried out reviews. A review is being carried out in Lanarkshire and I believe that Lothian has also carried out a review recently. It is clear that there are different approaches to the availability of homoeopathic medicines in different parts of the country.

There is sometimes confusion between the issue of access to homoeopathic medicine and access to the services of the centre for integrative care at Gartnavel in Glasgow. The centre for integrative care provides a much wider range of effective and efficacious services than just homoeopathy. Although it is often referred to as the Glasgow homoeopathic hospital, it provides many other holistic services in addition to homoeopathy, so I make that distinction in answering the member and bringing to the attention of members the excellent provision of services by the centre.

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Oral Cancer (National Health Service Treatment)

15. To ask the Scottish Government what secondary dental treatment for oral cancer is provided without charge by the NHS. (S4O-03340)

All dental treatment for oral cancer should be provided free of charge when a patient is referred to hospital dental services. The care should be provided as part of a consultant-led medical treatment plan. It should also be the case that failure to provide the care would impact detrimentally on that patient’s medical condition or prospect for recovery.

On discharge and once the oral cancer team is content that the surgery and treatment has been completed and the patient’s condition is now stable, the patient will return to the care of their dentist.

I was made aware of the problem by a member of the public who told me that he was fundraising for an individual who had been told that he needed to have dental extractions that were not covered, although he had also been advised that they would be required as part of his treatment. The individual in question is not my constituent so I am not pursuing the issue through casework, but I am grateful to the minister for setting that out.

Is the minister confident that that guidance is being followed by every board in Scotland?

Obviously, there are different stages in any course of treatment that a patient might require if they have been identified as having oral cancer. If the member is referring to some pre-operative work, including dental extractions, that might be required as part of the process, it would be part of the consultant-led medical treatment provision and patient’s treatment plan and, if it was being provided by public dental services, it would be free of charge.

If the member has specific details that he wants to provide me with, I am more than happy to ensure that they are thoroughly investigated because any patient who receives medically led treatment for oral cancer should receive their dental treatment free of charge.