Health and Wellbeing
Family Nurse Partnerships
Studies have shown that the family nurse partnership programme has an impact not only on parents’ confidence in their parenting ability by developing their self-efficacy but on the whole family’s long-term wellbeing. That is demonstrated by outcomes such as reduced smoking in pregnancy, reduced accident and emergency attendance, increased workforce participation and partner involvement.
What progress has the Government made in rolling out the family nurse partnership programme and what benefits has it had so far?
Family nurse partnerships have been implemented by seven of our territorial boards including NHS Lothian, NHS Tayside, NHS Fife, NHS Greater Glasgow and Clyde, NHS Highland and NHS Ayrshire and Arran, and we will see some delivery from NHS Lanarkshire by early this summer. The other seven territorial boards are taking forward work to establish family nurse partnerships and we have given a commitment that the partnerships will be available in all 14 territorial health boards by 2015.
As members of the Health and Sport Committee, Mr Paterson and I recently heard evidence about family nurse partnerships, particularly their roll-out in NHS Lothian, during our inquiry into teenage pregnancy. Although I believe that we are all supportive of the initiative, I was concerned to hear that recruitment into the partnerships is having an impact on health visitor numbers because health visitors are applying to be family nurses. Does the minister share those concerns and what action will he take to ensure that there is no detrimental effect on overstretched health visitor provision?
It is important that health boards take forward family nurse partnerships in a way that allows them to continue to provide their other broad services for children. It is worth bearing in mind that the family nurse partnership is a licensed programme and that all family nurses have to undertake a programme of training over a period of time to ensure that they have the required skills to implement the model effectively. I am sure that Drew Smith will recognise the importance of having staff who have the right skill set to deliver the partnerships effectively and who are supported with the necessary training. However, it is important that, alongside that, health boards ensure that they meet their other commitments to support children in the community through the use of health visitors.
NHS Greater Glasgow and Clyde (Meetings)
Ministers and Government officials meet representatives of NHS Greater Glasgow and Clyde regularly to discuss matters of importance to local people.
Will the cabinet secretary assure me that, with regard to any future discussions he might have, the provision of maternity and accident and emergency services both north and south of the river will be given the utmost importance in any reviews that take place and that every single option will be considered in such reviews?
The member will be aware that NHS Greater Glasgow and Clyde is conducting a comprehensive review of local services. It is right that health boards keep their services under review to ensure that they are consistent with national policy such as the 20:20 vision and that they continue to offer the highest-quality services to local people. Obviously, any recommendations that arise from that review need to be widely consulted on and will eventually come to me for approval. I will look at any recommendations in detail, including the provision for the local area and the extent to which there has been proper consultation. I will also ensure that all possible options have been examined.
Glasgow’s A and E waiting performance times are among the worst in Scotland. That is a matter for concern across the chamber. Some have suggested that the problem is in part due to staffing shortages; others point to a lack of beds. What does the cabinet secretary think the problems are and what action has he put in place to resolve them?
We have a £50 million unscheduled care and emergency action plan in place, which obviously includes Glasgow. I think that we will see a major improvement—not just in Glasgow but in many other board areas—in the weeks and months to come. There are two streams to that work: one is in hospital and the other one is external. We are looking at the profile of demand in A and E services and at the internal resourcing of those services.
Even as it moves towards completion, is the cabinet secretary discussing with the chief executive the progress of the new Southern general hospital? Are they continuing to review the provision of services there? Does the cabinet secretary share the concerns that some clinicians and consultants have expressed to me over whether the new children’s hospital, which is planned to have significantly fewer beds than there are currently at Yorkhill hospital, will be able to meet the emerging demand that will be required of that facility?
It so happens that I was at Yorkhill hospital this morning. As a result of a range of initiatives that have been taken to address the balance between capacity and demand, in particular since January this year, the performance of Yorkhill—with regard to accident and emergency, for example, and the reduced number of breaches, and so on—has improved quite dramatically in the past four or five months. Before the move to Southern general, we will want to ensure that there will be adequate bed capacity in the new Yorkhill at the Southern general.
Community Transport (Older People)
Age Scotland’s still waiting campaign calls for the national concessionary travel scheme arrangements to be extended to all community transport services. There are some practical issues around that, over and above affordability, but ministers are listening to the points that are being made as the campaign progresses.
I thank the cabinet secretary for his very full answer. It is most encouraging and I take it that he has had a good look at the summary at least of the still waiting report.
Will the member ask her question, please?
Will the cabinet secretary and the Minister for Transport and Veterans take a cross-cutting look at the research and address the points other than affordability that are of concern?
Claudia Beamish makes a fair point. The Minister for Transport and Veterans, Keith Brown, and I have agreed that we must take a cross-cutting approach to the matter. We are very conscious of the issue and of the level of unmet demand. I expect the health board and the relevant transport partnership to work together to reach local solutions for local problems, where they are identified, including in the Borders.
The cabinet secretary may be aware that Dumfries and Galloway Council participated in the European Union-funded rural transport solutions project, which was piloted in Wigtownshire. That brought together various public and third sector partners, including the south-west of Scotland transport partnership, NHS Dumfries and Galloway, the Scottish Ambulance Service and Wigtownshire community transport, to address transport issues in a vast rural area, particularly with regard to health and social care services. Will the cabinet secretary look at the project’s evaluation report, which was published in February, to assess whether it could be rolled out on a larger scale?
Absolutely—we will look with interest at that and at the experience in Dumfries and Galloway with the rural transport solutions project to see what lessons we can learn more generally on how to tackle transport issues, including those relating to health and social care in rural areas.
I encourage members to make their questions and answers succinct. We will then have a chance to get through more of them.
Alcohol (Harm to Others)
We welcome the research report. It further highlights a truth that is sadly only too evident in communities the length and breadth of Scotland: alcohol misuse does not only impact on the individual but impacts negatively on the people around them. We know that alcohol misuse impacts on children living with parents with a drink problem; that heavy drinking is a common factor in family break-up; and that the impact of our excessive consumption of alcohol is estimated to cost Scots £3.6 billion each year—that is £900 for every adult in Scotland.
“The Range and Magnitude of Alcohol’s Harm to Others” is the most detailed study of alcohol’s impact ever, drawing on and analysing a wide variety of existing and newly developed data for the police, health services, treatment and child protection agencies, helplines and so on. The work enumerated the types of harm that can occur due to another’s drinking and the different types of relationship between the drinker and the person harmed. Australia is not Scotland, but I am sure that we can see parallels between our two societies. Given the scale of Scotland’s problems with alcohol, are there policy implications that we can consider deriving from the study?
The study confirms a number of factors that we are aware of and that are similar to the alcohol problem that we have in Scotland. I have studied the Alcohol Focus Scotland report that I mentioned. That will help to give us a wider understanding of the impact that alcohol has not only on a minority of individuals who may misuse alcohol, but on the wider community who are impacted. That was recognised at the time when we took forward our alcohol framework—the framework has more than 40 measures in it—in which we have taken a whole population approach. That approach recognises that alcohol misuse affects the whole community and not just individuals. We must build on that in order to deal with a complex and harmful part of our society.
In light of the minister’s response, will he undertake to revisit the proposals in the member’s bill consultation “Shifting the Culture”, which Dr Simpson and I published last year, which addressed many of the issues to which he has alluded?
Over a number of years now, the Scottish Government has taken bold action to address our alcohol problem in Scotland. Those important measures include minimum pricing for alcohol, which attracted a large degree of support from across the chamber, although not, unfortunately, from the Labour Party. We believe that minimum pricing is an important measure that can assist us in tackling the issue, but we are always prepared to look at other constructive ideas. If Graeme Pearson and Dr Simpson feel that they have constructive ideas to contribute towards this whole agenda, I can assure them that those will always be considered in detail by the Government.
Swimming (Cumbernauld and Kilsyth)
We are committed to providing all children with the opportunity to learn to swim. The top-up swimming programme, which started in 2010, supports the improved delivery of swimming lessons to schoolchildren throughout Scotland. To date, £1.2 million has been invested in the programme, and I hope shortly to announce what additional support will be made available. I understand that North Lanarkshire Council, which previously participated, is not participating in this year’s top-up swimming programme.
As if that was not bad enough, North Lanarkshire Council is shutting six swimming pools at six high schools, five of which are in my constituency. That will affect organisations that have regular lets of those pools. Does the minister agree that the decision by North Lanarkshire Council not to participate in the top-up swimming programme and to shut those school swimming pools is counterintuitive and runs totally counter to encouraging local young people to learn to swim?
Whereas, obviously, local authorities are responsible for the management of their school estate, they also have a statutory responsibility to ensure that there is adequate provision of sports facilities for local residents. Swimming is not only one of the best forms of physical activity but a way of giving young people confidence in the water as well as being a fun way of keeping active. The top-up swimming programme was particularly aimed at those children who had not learned to swim, a disproportionate number of whom come from more deprived backgrounds. Therefore, the top-up swimming programme is good at helping those children from more deprived backgrounds to be confident in the water and to be able to swim. I would hope that every local authority would want to be part of that excellent programme.
Heart Disease
Through delivering the actions in our comprehensive heart disease action plan, we are seeing significant improvements in outcomes for people with heart disease. The plan focuses not just on providing the best possible hospital care, but on supporting people’s longer-term recovery in their communities.
Jeff Holt from Galston had a heart attack last summer. Thankfully, he has since recovered, both physically and mentally, and he has returned to work thanks to the exceptional period of support that he received following his referral for cardiac rehab—
Question?
Unfortunately, not all patients like Jeff benefit from cardiac rehab. Will the minister confirm whether the Scottish Government is prepared to introduce a health improvement, efficiency and governance, access and treatment—HEAT—target for cardiac rehab, following the referral of the matter to the national advisory committee on heart disease? When does the cabinet secretary next plan to discuss the matter with the chief medical officer and the British Heart Foundation?
As the member is aware, many of our health boards provide cardiac rehabilitation for patients who, following a cardiac episode, can benefit from it. Many health boards work in partnership with a range of third sector organisations to deliver that type of programme to patients in a controlled way in order to maximise their recovery.
I call Neil Findlay. Please be brief.
In West Lothian, heart disease patients and others who have used the accident and emergency services at St John’s are extremely unhappy that NHS Lothian’s A and E contingency plan contains proposals that include as one of the options an end to 24/7 doctor-led services at St John’s. Will the minister join me in demanding that that option is removed from NHS Lothian’s contingency plan?
These matters are always best dealt with through facts rather than by misinterpretation of proposals that are put forward by boards. It is extremely important that patients receive the best quality clinical care that they can receive close to their home. Over a number of years, the Scottish Government has shown determination to ensure that we provide the best possible clinical care close to individuals in their communities. The cabinet secretary will ensure that we continue to pursue that with all our NHS boards, including NHS Lothian.
I call Nanette Milne. Please be brief.
I know from last week’s meeting of the cross-party group in the Scottish Parliament on heart disease and stroke, which he attended, that the cabinet secretary is supportive of the excellent work that is done in my region by the Grampian Cardiac Rehabilitation Association and the equivalent organisation in Angus. Will the minister speak to the cabinet secretary about the possibility of voluntary organisations like that being rolled out across Scotland? Those two organisations do a fantastic job.
I agree. I am more than happy to talk to the cabinet secretary about that, as the member suggests. In my constituency, I have witnessed the quality of service that can be provided by third sector organisations such as Braveheart, which runs walking programmes for patients who are recovering from cardiac episodes. Real benefit can be gained. The way in which the NHS can best affect that in communities is to work in partnership with third sector organisations to deliver such programmes effectively for patients.
Multiple Sclerosis National Therapy Centres
Although policies, frameworks and resources are provided by the Scottish Government, individual national health service boards are responsible for planning and funding services in their areas and securing the staff to deliver them. It is for NHS boards to determine their workforce requirements, including training, based on the clinical needs and service developments in their areas. That includes multiple sclerosis services. However, we have supported centres through funding and given grants from the self-management fund, which is administered through the Health and Social Care Alliance Scotland. For example, the Multiple Sclerosis Centre Mid Argyll received more than £200,000 and the Multiple Sclerosis Therapy Centre Lothian received £68,000.
I recently visited the Multiple Sclerosis Centre Mid Argyll and I was impressed by the services on offer. However, given that Scotland could be seen as the MS capital of the world and that this serious condition is particularly common in the west Highlands and the islands, which I represent, will the minister detail any work that is being done to incorporate such services into NHS provision for individuals with MS?
As I mentioned in my initial reply, we have provided more than £200,000 to the MS centre in mid-Argyll to allow it to develop an outreach programme to support patients in remote areas. In taking forward such initiatives—this is similar to the issue around cardiac rehabilitation—it is not for the NHS to take over third sector organisations and the services that they provide, but the NHS should work in partnership with them and help them to extend the services that they provide to patients who can benefit from them. [Interruption.]
Can we have Mr Matheson’s microphone on, please?
I am sure that it is nothing personal.
Waiting Time Target (Accident and Emergency)
The 98 per cent four-hour accident and emergency performance level—to be treated, admitted, transferred or discharged—was set by the previous Administration in 2004 and was never met by that Administration. An Information Services Division sample survey for April 2006 shows that the performance standard at that time was 87.6 per cent. ISD statistics show that the 98 per cent standard was first exceeded in May 2008 and last exceeded in September 2009.
Well, that was succinct. Clearly it is the case that the Scottish National Party has not met the A and E target across Scotland since 2009. By current performance, it would fail to meet its new improved and reduced target.
In the interests of being succinct—
Indeed. Numerous reasons are given for the difficulties and commentators observe that winter pressures are now faced all year round.
As a supporter of an Administration that never once achieved a target that it set and a member of a party that made no promise to sustain the budget for the national health service, Ms Baillie is not in a very strong position to criticise others. It is highly irresponsible to describe the situation in accident and emergency in Scotland as a crisis. She is referring to the position south of the border, where the Tories are implementing Labour’s cuts of £20 billion in the health service.
Cardiac Rehabilitation
NHS boards should provide cardiac rehabilitation in line with the published clinical standards for heart disease, which were published in April 2010. Those standards state that people with heart disease should be assessed and have access to a menu-based cardiac rehabilitation programme.
I thank the minister for that answer and for his previous answers to Mr Hume et al.
I agree that cardiac rehabilitation nurses have a very important role to play in helping to support patients with cardiac disease. That is set out in our heart disease action plan, which makes it very clear that cardiac specialist nurses have that role. It is important that all NHS boards, such as NHS Grampian, have services in place and ensure that they have sufficient specialist cardiac nursing provision to meet the needs of their local patient group.
Question 10 has not been lodged and an explanation has been provided.
Care Inspectorate (Recommendations)
The Scottish Government is satisfied that the current regulation and enforcement powers of the Care Inspectorate are appropriate and allow it to discharge its statutory responsibilities, but obviously we will keep that under review.
I am delighted to know that that is being kept under review.
I believe that the chief executive of the Care Inspectorate has met the Highland Senior Citizens Network to discuss these issues. She has reassured the network and me that whatever action is necessary to deal with any risk in any care home, in the Highlands or anywhere else, the Care Inspectorate’s full panoply of powers will be employed appropriately to deal with that situation. As the member knows, the Care Inspectorate ultimately has the power to seek the closure of a care home when it fails to satisfy the implementation of any recommendations. The Care Inspectorate also has emergency powers that it can employ as and when required.
20:20 Vision (National Health Service)
I expect all national health service boards to work towards delivering the 20:20 vision by providing sustainable, safe, effective and person-centred services that are designed to meet the healthcare needs of their resident populations.
What part of NHS funds can aid the provision of day facilities and respite care in remote communities such as Torridon, Kinlochbervie and Tongue? There are deep concerns in those places that the merger of health and social care is not working as smoothly as it could.
If the member has specific concerns, he can write to me and I will certainly address them. More generally, the Public Bodies (Joint Working) (Scotland) Bill was introduced to Parliament on 29 May to provide the legislative framework for integration of health and social care services. Integration is a prerequisite to providing the quality and range of services required and the co-ordination required to ensure that we deliver the best possible services in healthcare and social care. If the member has specific concerns, I will certainly investigate them.
Individual Patient Treatment Requests
The review that I commissioned into individual patient treatment request processes was carried out by Professor Swainson. The review recently identified unacceptable patient experiences, such as that of the member’s constituent, and has demonstrated that there is clearly room for improvement. A recurring theme is the lack of good communication between the national health service board and the patient, an issue that we must address when we consider the outcomes of the Health and Sport Committee’s on-going inquiry.
Question 14 is from Bruce Crawford. [Interruption.] I beg your pardon, Mr Pearson. Please ask your supplementary question.
I do not take it personally, Presiding Officer.
Please do not.
I am pleased that, in his response, the cabinet secretary acknowledges that Mrs Rankin did not receive the service that she deserved. Can he now identify the means by which she can achieve justice and obtain the treatment that she requires from the NHS to combat her bowel cancer?
I understand that the chief executive of NHS Ayrshire and Arran has recognised the failings in the way in which Mrs Rankin’s case was dealt with, and has reiterated his offer to her to carry out a very short-term expert review to hear all the evidence in her case so that a clinical decision can be reached in relation to the availability of the medicine that she has requested. I am not aware of whether she has agreed to that, but I know that on Monday, when the Healthcare Improvement Scotland report was agreed—it was published on Tuesday—the chief executive was going to make that offer.
Many thanks, and my apologies to Mr Pearson.
Waiting Times (Forth Valley Royal Hospital)
A detailed delivery plan to improve capacity and flow across the health and social care system has been in development for some months. That work will inform the basis of the board’s local unscheduled care plan, which includes both a workforce framework and a financial investment framework.
I thank the cabinet secretary for his constructive answer.
The unscheduled care programme team is working closely with the Forth Valley team to support its performance improvement. All national health service boards, including Forth Valley, will submit their strategic plan for sustained unscheduled care performance improvement at the end of June. That will be reviewed by the national programme team and signed off by it and the respective NHS board by the end of July. The sign-off of each strategic board plan will see the second tranche of the 2013-14 national unscheduled care programme investment funds being released to boards. I totally agree with Bruce Crawford that while Forth Valley has made significant improvements, there is still much to be done.
Motor Neurone Disease
Our top priority for people with motor neurone disease is to ensure that the neurological standards published by Healthcare Improvement Scotland are implemented. They offer the best mechanism for achieving safe, effective, person-centred care.
The minister will be aware that June is motor neurone disease awareness month and that families are attending an event in Parliament tonight. The minister mentioned safe and effective care. Will he give us his thoughts on the negative impact on the health and life chances of people with MND when they are forced to deal with the stress of the insidious welfare reforms?
I recognise that June is motor neurone disease awareness month. I am aware that the cabinet secretary is attending an event this evening as part of a programme in Parliament to raise awareness of motor neurone disease.
Cost of Drugs (Prisoners)
That information is not available from routine prescribing data held by the national health service’s Information Services Division. The prescribing and dispensing activity that takes place in prisons is the responsibility of the Scottish Prison Service and local NHS boards.
I am disappointed that there are no centrally held records. NHS Health Scotland and the Scottish Government class depression as a mental illness. However, the Scottish Prison Service does not, stating that only 14 per cent of the prison population has an enduring mental health issue, despite the wealth of information suggesting that the percentage is far higher. Will the minister re-examine the mental health strategy for Scotland’s prisons, with a view to including in it depression as an enduring mental illness to ensure that prisoners can access the correct level of help and support?
We have no plans to review the strategy, which was published only last year. However, the member will be aware that it was only in the past year or so that responsibility for the provision of healthcare services for prisoners in Scottish Prison Service establishments was transferred to NHS boards. We need to ensure that boards provide a range of services that are appropriate to those prisoners. It is the responsibility of the local territorial boards, if treatment to support those who have a condition such as depression is to be included, to ensure that they have appropriate services in place to support those prisoners.