Health, Wellbeing and Cities Strategy
Healthy Diet
The Schools (Health Promotion and Nutrition) (Scotland) Act 2007, backed by the health promotion guidance for local authorities and schools, outlines the Government’s expectations of individuals, schools and local authorities in promoting the health and wellbeing of children and young people. In addition, the Government has a number of initiatives to promote a healthy and balanced diet to young people.
Does the minister agree that a healthy and balanced diet is key to giving Scotland’s young people the best possible start and chance in life? Does he therefore agree that it contributes to the Scottish Government’s preventative spending approach to health?
Yes, I agree. Indeed, I would go further and say that our approach to trying to improve the diet of people across Scotland is part of our overall preventative approach to healthcare. To support that, we are providing some £7.5 million over the next three years to promote a healthy diet across our population and in particular among young people. In addition, we have three new change funds worth some £500 million over the next three years, and we intend that they will ensure decisive action in delivering more in the way of preventative approaches.
Home Care (Needs Assessment)
Current policy and professional practice is that any individual who approaches or is referred to a local authority is entitled to a generic assessment of their needs. There is no presumption about a particular service requirement until a holistic review of a person’s needs and circumstances has been undertaken. Any unpaid carer involved is also entitled to a carers assessment.
Constituents have approached me to say that there appears to be a process in North Lanarkshire Council by which those who receive a care package that is switched to direct payments are having the financial support in the package cut. Does the minister agree that a switch to direct payments should be about empowering the individual and should not be used as cover for cost cutting?
I agree with the member. Our whole approach to self-directed support in the strategy that we launched last year is about trying to ensure that people get greater ownership of how their care arrangements are taken forward. In the next month, I intend to publish the self-directed support bill, which will underpin the way in which we intend to take the agenda forward.
I would be very grateful if the minister investigated a case in my constituency—I will write to him with the details. He just referred to a generic assessment, and the trouble is that, in the case in question, the generic assessment was done after the person was presented with a bill for £4,000. I do not think that that is right—does the minister think that it is right? A generic assessment should surely be done before a person is placed in a residential home. The person in question wanted to be at home rather than in a residential home. Does the minister agree that there is an issue and that the assessment should be done as early as possible?
It is difficult to comment on whether what was done was correct until I know the details of the case. If the member writes to me with the details, I will be more than happy to look into the matter.
Does the minister agree that the decision by the Labour-Conservative coalition in East Dunbartonshire Council to provide care only for those whose needs are assessed as substantial or critical not only is dangerous but defeats the preventative agenda?
It is important that local authorities take the most appropriate course to deliver the range of services that people in their communities require. I recognise that local authority budgets are under pressure as a result of the cuts that have come from the Tory-Liberal Democrat Government in Westminster, but I encourage local authorities to ensure that they provide a range of services to meet the needs of their local population and to help to support people to remain in their own homes in an independent way that is most appropriate to their needs.
Dermatology Services
In March 2010, the Government issued the report of the dermatology task and finish group, which included dermatology referral and management pathways to support work to improve and streamline the patient journey. In October 2010, the Scottish intercollegiate guidelines network published guideline 121 on the diagnosis and management of psoriasis and psoriatic arthritis in adults. There are no plans at this stage to issue any additional national guidance.
I thank the minister for that answer and I also thank the organisations and individuals who share their expertise on the cross-party group on psoriasis and psoriatic arthritis. The consensus of those experts is that there should be either national guidance on dermatology services or, perhaps, the creation of a national framework for skin disease and the development of a national managed clinical network for skin disease, to complement the regional managed clinical networks for skin cancer. Often, it is felt that the service is not given the attention that it requires to benefit those who suffer great distress as a result of psoriatic arthritis and other dermatological conditions. Will the minister please give the matter further consideration?
I am more than happy to engage with the member and the cross-party group to consider how we can further improve the way in which those services are delivered overall.
Multiple Sclerosis
Our top priority for people with MS is to ensure that the neurological standards that were published by Healthcare Improvement Scotland are implemented. They offer the best mechanism for achieving safe, effective and person-centred care.
What plans are in place for measuring health boards’ performance against the clinical standards for neurological health services after the implementation programme ends in March 2012?
Some of that work is going on right now. This month and next month, all health boards will carry out an assessment to evaluate what progress they have made over the past 18 months to two years. That will be followed by a peer review by Healthcare Improvement Scotland, which will look at and compare the progress that different boards have made. We expect the findings of that peer review to be published by the summer of this year. Those findings will inform boards in taking forward local improvement plans to make further progress in the implementation of the standards.
NHS Orkney (Meetings)
I will next meet the chair of NHS Orkney on 23 January during my routine monthly meeting with NHS board chairs. Ministers and Government officials meet representatives of all NHS boards on a regular basis. Forthcoming meetings with representatives of NHS Orkney will cover a wide range of matters of current interest to the NHS in general and to NHS Orkney in particular.
At that meeting, I urge the cabinet secretary to look into the tragic circumstances surrounding the death of one of my constituents on the small island of Shapinsay at the end of last year, which has caused profound concern among island residents about the ability of emergency services to deal with such incidents. Although NHS Orkney’s own investigations suggest that, even had the delays in responding been avoided, the life of the woman in question might not have been saved, the incident has reinforced in the most powerful way possible the need for a locally based back-up for the air ambulance.
I am aware of the incident on Shapinsay to which Liam McArthur refers, and I put on record my condolences to those who have been affected by it.
Rural Maternity Services
The Scottish Government launched “A Refreshed Framework for Maternity Care in Scotland” in January 2011. The refreshed framework contains a set of principles for NHS boards to apply in implementing local planning and delivery of a person-centred, safe and effective maternity service for women, wherever they live.
The minister is probably aware that NHS Grampian is carrying out a consultation on its maternity services. It carried out a similar consultation in 2006, when the then health minister, Andy Kerr, prevented it from closing the maternity unit at Aboyne, which I believe is now under threat again. Will the minister reassure constituents in my area of Aberdeenshire West that the Government will look at the position of the Aboyne unit and that, if the unit is under threat, it will come to the same conclusion as Andy Kerr did and prevent its closure?
I am aware of the review of services that NHS Grampian is undertaking, to which the member refers. I can inform him that NHS Grampian’s maternity service proposals have been designated as a major service change, so they will, ultimately, be subject to ministerial approval. It is important that we do not pre-empt the board’s consideration.
I appreciate that the consultation on the future of maternity services in Grampian is in its early stages, but I anticipate that, if the proposal to close the birthing unit in Aboyne is taken forward, there will be concerns in upper Deeside about the adequacy of emergency ambulance cover for mothers who require admission to Aberdeen maternity hospital, particularly out of hours, given the continuing issues with ambulance cover in the Braemar area, of which the minister is well aware. Will he insist that any proposals from NHS Grampian take that issue into account?
It is extremely important that, during the consultation exercise in which the board is engaging, it listens to all the views and concerns that are expressed about any changes that it proposes to make, including those on the potential knock-on effect on other services in the area and particularly the potential impact on transport provision. We expect the board to undertake that engagement and to look at the different factors before it reaches a final decision on the matter and submits proposals to ministers.
National Health Service Boards (Meetings)
Our last meeting was on 19 December 2011.
When the issue of emergency cover and a new district nurse in west Ardnamurchan was raised in the Parliament last year, the health secretary rightly said that it is crucial that the NHS and the Scottish Ambulance Service
I said previously and I say again to Mary Scanlon that I absolutely understand the concerns of local people. I believe strongly that people who live in the remotest parts of Scotland have a right to high-quality health services but, as I have said before in the chamber, how those are delivered in some of our more remote communities will sometimes differ from how they are delivered in urban Scotland.
In her future meetings with the chairman of NHS Lanarkshire, will the cabinet secretary raise the concerns of people in Cumbernauld and Kilsyth about the removal from the area of services such as radiology, which is being centralised elsewhere in NHS Lanarkshire’s area? For all the board’s capital investment programme, not a lot seems to be spent in Cumbernauld and Kilsyth. Is it not right that money should be spent across the entirety of an area that an NHS board covers?
I have spoken in the chamber before about radiology services in Lanarkshire. I understand the member’s concern. I have repeatedly said that, where possible, the Government wants services to be delivered locally. That is the presumption on which we fought and won the 2007 election and I remain committed to it. However, where boards can make a quality case for the redesign of services, they are right to do so. I have spoken in the chamber before about the quality reasons that lie behind some of the proposals that affect radiology.
I thank the cabinet secretary for requiring a report from NHS Lothian on waiting times management. Now that she has received the report, is she satisfied with it, in the light of the fact that no one from the public participation forum was on the group that investigated the problem; that not a single patient who had refused an offer that was regarded as inappropriate of treatment in England for minor illnesses was looked at, although that was the original source of the complaint that I placed before her in the chamber; and that nobody knows the cause of 330 out of the 1,150 suspensions, so the tracking system has not operated effectively?
As the member will know, Sarah Boyack has a question specifically on the issue, so we will come back to it later in question time.
Air Pollution
The Scottish Government supports a number of measures, both local and national, to tackle air pollution successfully. Those include the establishment of a statutory framework and clear strategic aims for both air quality and transport; supporting the development of renewable energy; providing grant funding for local authority actions; and providing advice and information through the Scottish air quality website and Scotland’s environment web.
The minister will be aware that in Edinburgh and Glasgow the reach of the air quality management zones is being extended as a result of continued breaches of air pollution objectives. In Glasgow, the entire city will be such a zone due to numerous breaches of pollution targets for particulates.
The member referred to the areas in the central belt that continue to exceed the limit levels. She should be aware that the Scottish Government, in partnership with Transport Scotland, the Scottish Environment Protection Agency, local authorities and the United Kingdom Government, is working on a range of measures to ensure full compliance as soon as possible.
Weight Reduction Programmes
All NHS boards are required to deliver effective weight management services that are consistent with the available evidence and subject to on-going monitoring of their impact. We expect that to include nationally a mix of NHS and commercial weight reduction programmes.
The minister will be aware of research that was published in the British Medical Journal last year that indicated from extensive work that was done in Birmingham that commercial weight reduction programmes were significantly more effective than their public service counterparts. Has the minister a mind to encourage the NHS to take up commercial programmes, where appropriate, and so enable the NHS to concentrate on patients who may be more difficult to deal with in that regard?
We are certainly aware of the study to which the member refers, which provided useful data that will help to inform the healthy weight management strategies in Scotland. However, we need to be careful about applying the study’s findings to alternative interventions that were not directly considered in the study. As I said earlier, we are committed to ensuring that health boards have the choice of which services they wish to develop. We have, of course, backed that up with a substantial commitment of £1.5 million a year to boards for the period 2012 to 2015. It is therefore up to boards how they use that money and which services they choose to purchase.
High Blood Pressure (Awareness)
The Scottish Government will continue to raise awareness of the risks associated with high blood pressure through its work to prevent ill health and to improve the health of the population. The quality and outcomes framework of the general medical services contract encourages general practitioners to assess the cardiovascular risk of all newly diagnosed patients with high blood pressure, as well as to ensure that people with certain diseases have their blood pressure checked on an annual basis. Checking blood pressure is also a core component of the keep well programme of inequalities-targeted health checks.
The minister may be aware of the Stroke Association Scotland’s excellent know your blood pressure campaign. In the village in which I live—Comrie, in Perthshire—the local first response team recently got together with fire service volunteers and held an extremely successful event in which 36 villagers took part and had their blood pressure checked, with three referrals being suggested to local GPs. What can the Scottish Government do to facilitate a wider roll-out of such excellent preventative initiatives?
I am aware of that scheme, and I encourage the Stroke Association Scotland to continue with its know your blood pressure campaign because of the particular benefits that can be gained from it, to which the member referred.
Cities Strategy
The agenda for cities—“Scotland’s Cities: Delivering for Scotland”—was published on 16 December 2011. It established the Scottish cities alliance—a partnership of Scotland’s six cities and me as cities minister—to optimise the contribution that our cities and their regions can make to driving economic growth.
Will the cabinet secretary ensure that our towns and villages are not disadvantaged by any leverage effect that the funding that is given to cities in support of the strategy may introduce?
There is absolutely no intention in any of the cities work to disadvantage other areas. As Willie Coffey will be aware, when I published the agenda for cities I also announced a £5 million cities investment fund. That is designed to accelerate the pace of investment in cities by developing programmes that can lever in other funding to support collaborative programmes between cities and develop programmes that allow for wider city region investment, which will be of particular interest to Willie Coffey.
Sporting Facilities (Young People)
The Scottish Government believes that access to quality facilities is important if young people are to enjoy the benefits of leading healthier, more active lifestyles. That is why we are committed to supporting the development of quality facilities throughout the whole of Scotland and why, over and above the £33 million that we have invested since 2007, we are developing 150 community sport hubs by 2016.
Does the minister agree that increasing charges for sporting facilities is a barrier to access? If so, would she discourage providers of sporting facilities from increasing charges?
The level of charge is down to the local authority. I would certainly encourage local authorities to view the community sport hub as a way of opening up the school estate in particular in a very affordable manner. One of the considerations that is uppermost for sportscotland in any bid for community sport hub funding is that access is affordable.
Waiting Lists (Lothian)
The response to the report is contained in a letter that I sent to the convener of the Health and Sport Committee on 9 January. A copy of that letter, along with a copy of the report, was placed in the Scottish Parliament information centre earlier this week.
I thank the minister for the copy of the report and the letter, and for her response to Dr Richard Simpson earlier today.
I thank Sarah Boyack for her interest in the issue. As I said in response to Dr Simpson, my officials are reviewing NHS Lothian’s demand and capacity planning to ensure that there is adequate activity available as locally as possible. I will be kept closely informed about that work, and we will work with NHS Lothian to ensure that any implications from it can be taken forward.
NHS Greater Glasgow and Clyde (Meetings)
Yesterday afternoon.
At that meeting, did the cabinet secretary discuss with the chief executive, Robert Calderwood, his view that the Scottish Government’s criteria for the provision of certain drugs for those with rare conditions have created a cross-border split in access to those medications? The cabinet secretary recently met my constituent, Joyce Juszczak, who is a case in point. Although the recently announced review involving the chief medical officer, Harry Burns, and the chief pharmaceutical officer, Bill Scott, which is to examine the existing process, is welcome, will the cabinet secretary give an assurance that the review will also examine the wider and more immediate issues relating to Scottish patients accessing treatment for very rare conditions?
I am well aware of the constituency case to which Duncan McNeil refers, but I will not go into the details of that. I ask Duncan McNeil to pass on my best wishes to his constituent, whom I met on a previous occasion.
Telehealth
The Government welcomes the recommendations that are contained in the Audit Scotland report. Although the report made no specific recommendations for Government, we have taken steps, and will continue to take steps, to encourage the use of telehealth across Scotland.
I thank the cabinet secretary for her answer. Does she agree, however, that more needs to be done to raise awareness of telehealth possibilities and initiatives within NHS boards? In particular, does she agree that NHS boards should have a dedicated clinical lead for telehealth to co-ordinate activity and development in the area?
Yes, I agree with the thrust of Rod Campbell’s question. I believe very strongly in the potential of telehealth to improve healthcare for patients and service users, but also radically to change and redesign how we deliver healthcare services. The Scottish centre for telehealth and telecare, which, as I said, is part of NHS 24, is actively engaging with all health boards across Scotland to support them in the development, planning and delivery of telehealth services. NHS boards have also been asked to identify a strategic lead for telehealth to support and co-ordinate activities within each health board. We rightly want to do better than we have done on telehealth to ensure that it is mainstreamed and that we take advantage of its potential. However, we are seen across Europe as something of a European leader in telehealth, and that should give us the confidence and the ambition to go even further.
Vitamin D Deficiency
The leaflets and covering letter from the chief medical officer that were sent to health professionals and the general public in 2010 and again in 2011 were an awareness-raising campaign on the present recommended vitamin D levels for at-risk groups. No formal evaluation of the impact has been carried out, as the cost of doing so would be disproportionate.
Has the Government considered the calls for vitamin D to be added to food products, given its proven health benefits and Scotland’s history of deficiency of the vitamin because of our latitudinal position?
Clare Adamson raises an important issue. I pay close attention to the debate and I do not take lightly the demands and calls that have been made recently. At present, we have no plans for fortification with vitamin D beyond the already mandatory fortification of margarine. The debate is important and should continue, and we welcome contributions to it from a variety of sources, but there would need to be broader scientific consensus than exists at present in favour of a new approach before any change could be considered. However, I am sure that the matter will remain under consideration and that we will return to it in the Parliament.