Meeting of the Parliament

Meeting date: Thursday, January 13, 2011

Official Report 1179KB pdf

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Scottish Executive Question Time

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Health and Wellbeing

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Rape Crisis and Women’s Aid (Budget Provision)

1. To ask the Scottish Government what provision it has made for local Rape Crisis and Women’s Aid services in its 2010-11 draft budget. (S3O-12617)

In 2010-11, we made available £3.5 million pounds for the violence against women fund, which provides grants for a number of local Women’s Aid groups, and provided £700,000 for the rape crisis fund, which supports local Rape Crisis centres, and £4.16 million for the children’s services-Women’s Aid fund, which supports the network of children’s workers across Scotland. I was delighted to announce in the Parliament on Thursday 23 December that we will continue to fund all three of those important local services at the same level for 2011-12.

I thank the minister for that answer, which I know will be warmly welcomed by Rape Crisis and Women’s Aid staff and volunteers at national and local level across Scotland. The fact that they provide a vital service and show dedication and commitment to women of all kinds has led to Lanarkshire Rape Crisis Centre in my area being recognised as South Lanarkshire’s voluntary organisation of the year in 2010.

Does the minister agree that the wider preventive and awareness-raising work that Women’s Aid and Rape Crisis Scotland do, in addition to the services that they provide to individual women, is crucial? Will the Government encourage the police, the national health service and local authorities to take advantage of the training and information that Women’s Aid and Rape Crisis Scotland provide so that women across Scotland receive the highest possible quality of service from all the public agencies with which they come into contact?

I congratulate Lanarkshire Rape Crisis Centre on its excellent work and agree with all the sentiments that Christina McKelvie expressed.

A very good example of interagency work is the work that Strathclyde Police carries out with all those agencies in the run-up to, during and immediately after old firm games to reduce violence against women, which has resulted in an average decline of 30 per cent in violence against women in the periods around those games. That is an exemplar of interagency working that includes the police.

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Prescription Service (Costs)

2. To ask the Scottish Government what it expects the cost will be in 2010-11 and in 2011-12 to administer the prescription service and what the cost will be to dispense the items prescribed in each of those years. (S3O-12590)

The gross cost of dispensing prescriptions in the community to patients across Scotland between April 2009 and March 2010—the most recent full year for which figures are available—was £1.139 billion. That total includes net drug costs and related remuneration for dispensers. The outturn drug costs for 2010-11 and 2011-12 will depend on various factors, including individual decisions by prescribers. Those are not forecast centrally and as responsibility for meeting prescribing costs is devolved to national health service boards, each board sets its own prescribing budget.

I thank the minister for that helpful and detailed response.

If we leave to one side the cost of the drugs themselves, to what extent does the Scottish Government believe that there is scope to reduce the administration costs of the mechanism for prescribing and dispensing those drugs?

As I am sure the member is aware, continuing administrative savings of up to £500,000 are associated with the abolition of prescription charges, but the vast majority of the practitioner services division’s activity will remain necessary. Around £1.3 million will be saved in respect of fees that are paid to dispensers for sales of prescription prepayment certificates, and there will be a variety of other savings. For example, there will a saving in the time that pharmacists and assistants in pharmacies spend on checking patients’ exemption status, although such savings might be a bit more difficult to calculate.

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Milk Banks

3. To ask the Scottish Government whether it plans to increase the number of milk banks. (S3O-12599)

The Scottish Government currently has no plans to increase the number of donor milk banks in Scotland, but we are aware of the valuable service that donor milk banks can provide, particularly the donor milk bank in the NHS Greater Glasgow and Clyde area, which is collaborating in United Kingdom-wide research into the specific benefit of donor breast milk as opposed to formula milk for premature infants. Maternal and infant nutrition policy for neonates will be informed by the outcomes of that research.

I have been contacted by a constituent who wanted to donate some breast milk but was told that that was not feasible because she lived too far away from the nearest facility, which was in Glasgow. What are the constraints that prohibit breast milk from being taken from Aberdeen to Glasgow for donation? Are there any plans to overcome those problems?

The member may want to write to me with more detail of his constituent’s concerns. One issue is that the Glasgow facility must have a number of mechanisms for screening milk and ensuring that it is safe. A number of processes are involved, and it may not be feasible and, in the current climate, cost effective to set up a number of milk banks elsewhere. However, I am prepared to explore further whether there are issues vis-à-vis the transportation of breast milk from elsewhere that can be overcome. We can look at those in the context of the research that is under way and to which I referred in my initial answer.

I am pleased that the minister thinks that the Government could do more to help and encourage women to donate their milk. What can she do to advise women that birth plans can include a request for donated milk, rather than artificial formula, in case of problems? What plans does she have to promote the importance of breastfeeding more generally?

As I said in my response to Brian Adam’s question, I am happy to look at ways in which we may be able to do more on breast milk donation.

I know that Elaine Smith takes a close interest in the promotion of breastfeeding, so I am sure that she is aware of all the initiatives and campaigns that have been undertaken and of the fact that a great deal of work is done in our maternity services to ensure that mums are well aware of the benefits of breast milk for their babies. We will continue to do that work rigorously.

I am sure that the new infant nutrition strategy that will be launched later this month will be of interest to Elaine Smith, and I will ensure that she gets a copy.

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NHS Lanarkshire (Meetings)

4. To ask the Scottish Executive when it last met representatives of NHS Lanarkshire and what issues were discussed. (S3O-12540)

I meet all health board chairs regularly. The most recent meeting with representatives of NHS Lanarkshire was on 22 November. A range of issues were discussed.

When the cabinet secretary next meets representatives of NHS Lanarkshire, will she raise with them the continued problem of bed blocking in local cottage hospitals in Lanarkshire, the difficulty that people have in accessing appropriate care packages from those hospitals and the resultant problems that people have in accessing cottage hospitals from district general hospitals or community and home-based settings? Will she discuss with NHS Lanarkshire how the whole package is operating?

Karen Gillon raises an important issue that we discuss regularly with all health boards and their local authority partners. If she provides me with greater detail of her concerns, I will discuss them with NHS Lanarkshire at the earliest opportunity.

As Karen Gillon knows—the point is reflected in her question—reducing and getting rid of delayed discharge is very important both for the individuals concerned and to ensure that the right provision of beds is available in the national health service. We have made great progress in reducing delayed discharge but, as we have seen in recent times, the challenge remains on-going and we are determined to address it. In addition to the other steps that we are encouraging health boards and local authorities to take, we have set aside the change fund for next year, which will help local partnerships to accelerate progress towards better community care solutions and, in the process, reduce delayed discharge even further.

Has the cabinet secretary had any recent discussion with NHS Lanarkshire about the resources that are dedicated to lymphoedema services and the continued provision of protected hours—which, I understand, were increased last year—for nursing of lymphoedema patients in the health board area, to keep waiting times at an acceptable level?

I have had no recent discussions with NHS Lanarkshire specifically on the subject of lymphoedema, although my officials are in close contact with all health boards on a range of issues. I am more than happy to write to Margaret Mitchell with the updated position. Lymphoedema and the problems that its sufferers experience have been raised in the chamber many times before. There are serious issues associated with lymphoedema, and we are working hard to deal with them. I am happy to provide Margaret Mitchell with Lanarkshire-specific information.

In the course of the discussions with Lanarkshire Health Board, was any progress made on access to X-ray facilities for patients in the Cumbernauld area? I am given to understand that there have been some challenges regarding the hardware and the equipment involved.

Hugh O’Donnell has raised the issue of community radiology services in Lanarkshire before. He will be aware that, because of its age, the equipment in Cumbernauld and in Kilsyth can no longer be covered by maintenance contracts after the end of December last year. The safety of patients is absolutely paramount, and it would be in breach of national standards if any board was to continue to use equipment in those circumstances. As a result, patients from Cumbernauld and Kilsyth are being referred to the radiology department at Monklands. That will continue until a full review of radiology services has been completed.

No final decisions on the overall review have yet been taken but, as always, I expect the health board to progress any proposal for permanent change with the full involvement of patients, the public and other stakeholders. If such a proposal was deemed to constitute major service change, formal consultation and, ultimately, ministerial approval, would be required.

I have written to the cabinet secretary before about the X-ray service in Cumbernauld and Kilsyth, and I ask her to hold urgent discussions with NHS Lanarkshire on the matter. The board and the officials concerned should have known that the equipment was reaching the end of its life. Why have they not planned to improve the X-ray facilities in Cumbernauld’s Central health centre? I had understood that they were doing so. Why have we reached this disgraceful situation, where people from Cumbernauld and Kilsyth now have to travel to Monklands hospital for run-of-the-mill X-ray facilities? Such facilities provide a service to the local community and take pressure off acute hospitals.

I understand Cathie Craigie’s concerns. As I would always do in such circumstances, and as I am sure she has done herself, it is a matter of communicating those concerns to NHS Lanarkshire. I have explained the background to the situation and, as a local member, I am sure that she was already aware of it. Patient safety must take precedence and priority at all times.

A wider review of radiology services is continuing, and it is important for that review to be allowed to continue. As I said to Hugh O’Donnell, depending on the proposals that come forward, there are certain things that the review will have to go through. I am sure that Cathie Craigie will agree about patient safety being absolutely principal in all deliberations about those services.

For the benefit of other constituency members who might have an interest in the matter, I should stress that the services in Stonehouse, in Karen Gillon’s constituency, and in Coatbridge are unaffected, and normal service is continuing there pending the wider review.

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Helicopter Ambulance Service (Severe Weather)

5. To ask the Scottish Executive what impact the severe weather conditions in November and December 2010 have had on the operational availability of the Scottish Ambulance Service’s helicopter air ambulances. (S3O-12572)

The extreme weather conditions in November and December 2010 inevitably caused disruption to the operational availability of the air ambulance service fleet, not least because of the impact of airport closures at certain times. As always, however, Ministry of Defence helicopters were able to support patient transfer whenever that was required.

The Scottish Ambulance Service has assured me that, during the periods of disruption, the air wing manager on duty, in association with the emergency medical dispatch centre’s paramedic supervisor, monitored the clinical condition of all patients awaiting transfer and, as necessary, discussed cases with referring clinicians.

I take this opportunity again to thank all health care teams across Scotland, including Ambulance Service crews, who worked so tirelessly throughout the challenging conditions to ensure that the best possible care continued to be provided for patients across the country.

I thank the cabinet secretary for that response, and I associate myself with the thanks that she has offered to the staff involved.

Aviation experts have long warned that the helicopters could not fly safely in icing conditions that would not have grounded the Islander aircraft that were formerly used in Orkney. Can the cabinet secretary advise how often icing conditions prevented helicopters from undertaking missions in 2010?

Further, does the cabinet secretary agree that when the roads are closed by snow, demand for the two air ambulance helicopters increases, which worsens the problem of overstretch?

Can the cabinet secretary advise on progress on plans for the Scottish Ambulance Service to share a Kirkwall-based aircraft with the local council and NHS Orkney, so that a locally based air ambulance that is able to react quickly and use short weather windows to get to the north isles and back is once again available to my constituents?

On icing conditions, I am more than happy to provide Liam McArthur with the information in writing—I do not have it before me. It is worth pointing out that the Scottish Ambulance Service has advised that it has received no complaints about the air wing’s operation during the recent period of adverse weather. Delays to non-emergency transfers and admissions were experienced throughout the period, and I have explained the procedures that were put in place to deal with the situation.

Liam McArthur has asked a question in Parliament previously about the potential use of an Orkney interisland aircraft. He will be aware that a feasibility study has been produced and shared between the Ambulance Service, NHS Orkney and Orkney Islands Council. The report was discussed during the most recent conference call with the partners, which took place in December, and consideration of the proposal remains on-going. I am happy, as I am sure that the local partners are, to keep Liam McArthur fully updated on developments.

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Royal Hospital for Sick Children

6. To ask the Scottish Executive whether it will provide an update on the Royal hospital for sick children’s move to its new site at the Royal infirmary of Edinburgh. (S3O-12576)

Positive engagement is taking place between officials of NHS Lothian, the Scottish Futures Trust and the Scottish Government health department to develop a procurement strategy, which will seek to deliver the new children’s hospital as quickly as possible, building on the work that has been undertaken to date.

The cabinet secretary might be aware that the sick kids hospital is currently located next to the popular Sciennes primary school in my constituency, which is struggling for space. Parent groups at the school have an ambitious proposal to use space that is freed up by the hospital’s move to expand the school. Will she agree to meet the parents to discuss the proposals?

I am grateful to Mike Pringle for raising the issue. I am not familiar with the detail of the school’s proposal. It might be more productive for the parents directly to meet NHS Lothian, which is responsible for taking forward the plans to replace the sick kids hospital. I am more than happy to ensure that NHS Lothian is aware of the request and to encourage the board to take forward a meeting as soon as it can.

I thank the cabinet secretary for the detailed answer that she gave me when I asked her about the sick children’s hospital during a previous question time. She talked about revenue support for the annual charges that will be required for the new privately built hospital, but she did not say whether there would be 100 per cent revenue support or something short of that. Does she accept that if support is short of 100 per cent there will be further pressure on the revenue budgets of NHS Lothian, which are already under strain because, as she knows, the board is not yet receiving the full share that it is due under the funding formula?

Malcolm Chisholm takes a keen and welcome interest in such matters as a constituency member. He will understand that although I sympathise with the position that NHS Lothian is in—it is not the only board to be in such a position in relation to the NHS Scotland resource allocation committee formula—I am obliged to point out that that was also the position when he was Minister for Health and Community Care. The situation is not new and we are progressively working towards resolving it, as indeed Malcolm Chisholm was doing when he was the minister.

While the details of the new procurement strategy are being worked through there are questions about which we cannot yet be definitive. I hope that Malcolm Chisholm will take what I say in the spirit in which it is intended: we are determined to work with NHS Lothian to ensure that the new sick kids hospital can be delivered as quickly as possible, which will mean providing as much support as we can do to enable that to happen. There is a productive relationship, in which the pressures under which NHS Lothian and all health boards work are very much recognised. We all want the new hospital to be delivered as quickly as possible.

Can the cabinet secretary assure members that the Scottish Futures Trust will not discard the significant work that contractors and others have done, which was paid for by the national health service, as it tries to secure the new funding source? Can she assure us that the SFT will not go back to the drawing board on the project as a whole, which would potentially lead to worrying delays and extra costs?

As I am sure Margaret Smith recognises and appreciates, it is not in anybody’s interests to discard unnecessarily work that has already been done, so I assure her that, where possible, we will build on such work specifically to ensure that the sick kids project proceeds as quickly as possible and with the absolute minimum of delay.

I remind members that the context for the situation is a substantial cut in our capital budget from the Westminster Government. We have had to change the method of building the sick kids hospital, but we have not changed at all the commitment and determination to deliver it.

Margaret Smith makes a good point about ensuring that we build on work that has already been done and I assure her that that will be the case.

Question 7 was not lodged.

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Affordable Housing (Argyll and Bute)

8. To ask the Scottish Executive what plans it has to boost affordable housing provision in Argyll and Bute. (S3O-12588)

The Scottish Government works closely with Argyll and Bute Council to deliver affordable housing in line with the priorities that are identified in the council’s local housing strategy and strategic housing investment plan. In 2010-11, our planned expenditure of £20.19 million will allow 87 new homes to be approved.

Is the minister aware that housing associations in Argyll and Bute that are keen to build new homes to assist the housing needs of the 3,500 families and single people who are still on the waiting list there are alarmed at the proposed 19 per cent cut in the Scottish Government housing investment budget next year? What will he do to allay those concerns? Given the likely pressure on public sector budgets for the foreseeable future, will he pledge to engage with the private sector infrastructure investment funds that want to start lending to our housing associations?

The best way of dealing with that would be for George Osborne to reverse his decision to cut our capital budget by 25 per cent next year. It is a bit ironic that supporters of the Con-Dem Government in London complain about cuts that we have to impose as a result of the massive cuts that it is imposing on the Scottish Government’s budget. I suggest to the member that the best way forward would be to try to get his Prime Minister and chancellor to change course and reverse the daft policies that they are implementing.

I note that Argyll and Bute Council was not one of the local authorities in the first phase of the national housing trust initiative. Is that because it believes that the national housing trust model does not provide affordable housing, because the rent is set at a mid-market level?

We have a total of 11 local authorities, 20 developers and 50 sites engaged in the first round of the national housing trust. Argyll and Bute Council was one of the councils that decided that it was not a high priority. The reason that it gave was the profile of the people who are waiting for new housing in Argyll and Bute. The council reckoned that they would be more appropriately served by the existing housing development programme in the area rather than the national housing trust programme, the first round of which depended on relevant mothballed sites from the private sector being available. Such sites were not available in Argyll and Bute either.

For those practical reasons, Argyll and Bute Council has decided so far not to participate in the NHT initiative.

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Distinction Award Scheme (National Health Service Pensions)

9. To ask the Scottish Government what the added cost to NHS pensions was of the distinction award scheme for hospital consultants in the most recent year for which information is available. (S3O-12616)

The total budget for the distinction award scheme for 2009-10 was £28 million. That budget covered the cost of the actual awards and included a contribution to employers’ costs, such as national insurance and superannuation. Therefore, any additional pension cost is largely included in that £28 million budget.

However, the fact that distinction awards are currently consolidated and pensionable is one of the aspects of the scheme that I consider needs to be revised. The Scottish Government’s evidence to the Doctors and Dentists Review Body asks it specifically to consider that.

I share the cabinet secretary’s disquiet that what may be a temporary contribution to health care over and above what is normally expected from a consultant may be rewarded not only with a distinction award for the rest of that consultant’s working life, but with an inflation-proof pension addition of up to £38,000 until death. I accept that she has drawn the situation to the attention of the Doctors and Dentists Review Body inquiry. Does she reserve the right to take action to remedy it even if the resulting report fails to tackle the issue?

I hope that the DDRB will come up with a good set of proposals, and I look forward to that happening.

The member has been at the forefront of the campaign on this issue and I congratulate him on that. However, if the Scottish Government’s budget for next year is passed, I believe that I will be the first health secretary in the lifetime of devolution to reduce the budget for distinction awards. That is a step in the right direction.

When we are having this debate, it is important to stress the fact that I and everyone else in the chamber values highly the work that consultants do. However, I do not believe that a rewards scheme that rewards only about 3 per cent of the NHS workforce when we have a multidisciplinary workforce is sustainable for the future. That is why I argued for the review. The previous Labour UK Government resisted the idea of that review and, although I do not agree with the current UK Government on everything, it is a welcome step in the right direction that it agreed to the review, which is now under way.

It was reported in the Sunday Herald at the weekend that, in addition to distinction awards, some consultants are rewarded with additional salary points. What action is the cabinet secretary taking to address that system of additional reward?

Murdo Fraser refers to an article in the Sunday Herald about what are called discretionary points. I should say that, in addition to the distinction awards, discretionary points are the subject of the DDRB review, so in the longer term, I look forward to the DDRB’s recommendations.

Looking forward again to next year’s budget, I have made a proposal, which is currently out to consultation; that consultation will end in mid-February. The proposal is that, as we are doing with distinction awards, for next year and pending the DDRB recommendations for the longer term, we should freeze the discretionary points system. Once the consultation concludes and I have made a final decision on that, I will share it with Parliament.

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NHS Highland (Meetings)

10. To ask the Scottish Executive when it last met representatives of NHS Highland and what issues were discussed. (S3O-12562)

I meet all health board chairs regularly. The most recent meeting with NHS Highland representatives was on 22 November 2010.

The cabinet secretary will appreciate the concern of a number of communities in the Highlands about the prospect of not now benefiting from capital spending as a result of NHS Highland no longer being able to access £20 million of capital funding that was reserved for that purpose. Will she invite her officials to establish with NHS Highland a mechanism by which it can get early access to any future financial flexibility to restore that capital spending as quickly as possible?

As I am sure that Peter Peacock will acknowledge, the context of the question that he has just asked is the same as the subject that we were talking about a few moments ago: the huge cut in our capital budget for next year and the comprehensive spending review. Incidentally, that cut in our capital budget was planned in full by the previous Labour Government and is being implemented by the current UK coalition Government. That meant that we had to take a hard look at how we allocate capital to health boards. The new arrangements will take effect from April 2011.

One of the changes allows a health board to make a bid for project-specific public funding when new public capital becomes available. To ensure fairness in that system, funds that were previously banked by health boards will be included within project-specific funding. In following that path, the Government can ensure that we still give priority to publicly funded schemes and that the investment that has been made in our health service in recent years continues as far as possible.

I and my officials will continue to discuss those issues carefully and closely with health boards to ensure that we are able to implement as ambitious a capital programme in the NHS as possible.

An issue that should be discussed with NHS Highland is access to orthodontic services. At present, patients who live in the far north are obliged to make many long return journeys to Inverness for consultation and treatment. Recent winter weather has disrupted those journeys and led to appointments being missed. It would be far better if orthodontic consultation and treatment could be delivered locally in the far north, either by means of the presence of resident orthodontists or by orthodontists who are willing to travel out of Inverness to outlying areas to do their work. Will the minister discuss the potential of that proposal with NHS Highland?

The member raises an important issue and I will answer generally before I address his specific point about orthodontic treatment. One of the health themes of our time in government has been to provide health care as locally as possible whenever it can be provided locally. Across areas such as chemotherapy and dialysis, for example, as well as a lot of investigative and diagnostic procedures, patients who often would have been required to travel long distances to the central belt for those procedures can now access them locally. That is the general trend and direction of travel that we have set in the health service, and it is welcome.

The issue of orthodontic treatment in the Highlands is, as I am sure Jamie Stone knows, a long-standing one. He is absolutely right to say that patients should be able to access treatment locally and should not have to travel long distances unnecessarily. We—the Minister for Public Health and Sport, in particular—are working closely with NHS Highland to ensure that that is the case, and we are happy to keep Jamie Stone up to date on progress on the issue.

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NHS Board Chairmen (Meetings)

11. To ask the Scottish Executive when it last met the chairmen of national health service boards. (S3O-12598)

On 22 November.

I ask that the NHS 24 evaluation of cognitive behavioural therapy by telephone be discussed at a future meeting, given the recent positive and thorough evaluation of the pilot that cost only £176 for full completion of treatment. That highlights the benefits of addressing depression, particularly for people in remote and rural areas and patients who would not otherwise engage with or complete courses of therapy by conventional methods. Given the long waiting lists for access to psychology and psychiatry, what action will the Government take to ensure that more general practitioners can refer and that individuals can self-refer to the service?

I am happy to discuss the issue with health board chairs. I am sure that they, too, would welcome the opportunity to look at the work that is being done in the area. Mary Scanlon is absolutely right to point out the very good work that NHS 24 has done in that regard. She will be aware of the new health improvement, efficiency, access and treatment target for access to psychological therapies. I have been candid about that area with Mary Scanlon and others. We have a lot of work still to do, but good progress is being made and it is important that we properly evaluate that progress.

Since NHS 24 has been mentioned, I will indulge myself by placing on record my thanks to NHS 24 staff for the incredible work that they have done so far in this winter season, helping people through the difficult weather, and currently with the flu situation.

When did the cabinet secretary last speak to the chair of NHS Fife? Today’s Courier reports a senior member of NHS Fife health board stating that NHS Fife is in crisis over the bed-blocking situation, with staff being run ragged, operations being cancelled at short notice and patients waiting weeks to be discharged. One of my constituents, William Cook, has been waiting for more than 13 weeks to be discharged. Since I last wrote to the cabinet secretary, we are no nearer to a solution to the growing problem. I appreciate that the change fund will be available, but that will not be until April. What action can the Scottish Government take to alleviate the immediate situation in Fife?

Claire Baker is right to raise that important issue. I take the view—which is shared across the chamber—that delayed discharges are not acceptable. NHS Fife and Fife Council have been working hard to deal with the issue. They have recently invested additional resources to tackle the issue, but more needs to be done. I put on record the fact that they, jointly, in partnership, need to do more. The Minister for Public Health and Sport will meet both the council and the NHS board next week and will make it absolutely clear to them that we expect them to work in partnership and do what requires to be done to ensure that people are not being unnecessarily delayed in hospital.

Question 12 was not lodged.

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Patient Transport Service (Hospital Appointments)

13. To ask the Scottish Executive how many hospital appointments have been cancelled due to operational problems other than severe weather conditions affecting the patient transport service in each year since 2007. (S3O-12542)

Information about the reasons for cancelled hospital appointments is not held centrally. However, the Government and I fully understand the importance to patients of every hospital appointment and we continue to work with health boards, the Scottish Ambulance Service, local authorities and other partners to ensure that patients can get to their appointments. I hope that that is helpful to the member. I am more than happy to look into any further details that he is about to give me in his supplementary question.

A constituent of mine, a cancer out-patient who is nearly past the optimum time window for his effective treatment, has twice had his vehicle turn up on the wrong day and it has twice turned up with inadequate staff and equipment to cope with the fact that he resides in a tenement flat. No fault is attributed to front-line ambulance staff, but it appears that there is some bureaucratic inefficiency in the administration of the patient transport service. It has even been suggested that patients residing above ground-floor level need to book three or four weeks in advance, which is not usually possible. Will the minister gather statistics on such incidents, so as to facilitate improvement in the patient transport service?

Obviously, I am not aware of the personal details of the constituency case that Charlie Gordon cites, and it would not be appropriate for me to comment too deeply on it. However, if he provides me with the details, I will be more than happy to have the Ambulance Service investigate it because the situation that he describes seems to be unacceptable. Like him, I represent a constituency with a high number of tenemental properties, and the people who live in them have as much right to access patient transport as anybody else.

The Ambulance Service has been working hard to improve the patient transport service and has been making progress in that regard. Often, when we talk about the Ambulance Service in this chamber, we talk about the emergency service. However, most people who use the Ambulance Service use its patient transport service.

Some progress is being made. There has been a reduction in the number of cancelled journeys. In 2007-08, the figure was 0.9 per cent and in 2008-09 the figure was 1.5 per cent. So far in 2010-11, however, that has reduced to 0.5 per cent. That is welcome progress, but I am conscious that there are real people behind those statistics and that anyone whose journey is cancelled will suffer distress as a result. I am keen that we continue to work to improve the service, and I repeat my offer to Charlie Gordon to have the Ambulance Service look into the case that he cites.

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Autism (Adult Diagnosis)

14. To ask the Scottish Executive how many adults are awaiting a diagnostic appointment relating to autism. (S3O-12575)

That information is not held centrally.

As the member knows, the Scottish Government has recently issued a draft national strategy to address the needs of those on the autistic spectrum and their families. There are recommendations in the strategy for increasing access to and delivery of diagnosis in adults. The consultation has just concluded and it is anticipated that implementation will begin shortly.

Who will be responsible for the gathering of the data that result from the consultation, and what use will the health department make of that information?

A small research team, commissioned through the autistic spectrum disorder reference group, is putting together a two-tier proposal to tackle the issue of data and the lack of data. The first tier of the research will consider the issue of providing a national figure for those awaiting diagnosis. The information will also be available by national health service board areas. The second tier of the research will consider developing a system that will capture the data, so that the information on numbers will always be available. Officials are meeting the research team to discuss the proposals in more detail and I am happy to furnish the member with more information about that.

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Terminal Illness

15. To ask the Scottish Executive what it is doing to allow terminally ill patients to choose to die at home rather than in a hospital or hospice. (S3O-12580)

Since the launch of the Scottish Government’s “Living and Dying Well: A national action plan for palliative and end of life care in Scotland” document in October 2008, considerable progress has been made in improving many aspects of palliative and end of life care across Scotland. One area of development has been advance care planning, which promotes discussion and decision making with respect to future health, personal and practical aspects of care. That enables the preparation of a plan that is shared with everyone who is involved in the provision of subsequent care and support. That plan includes a patient’s preferred place of care at the end of their life.

The cabinet secretary will be aware that recent research by YouGov noted that the majority of terminally ill Scots would like to die at home, but that only 25 per cent are able to do so. That is an understandable aspiration. We applaud the work in that regard of Marie Curie Cancer Care. It is asking for certain actions that I think are reasonably affordable, even at the present time: improved training of district nurses and other generalists in palliative care; the introduction of monitoring of care of the dying as a key element of performance management for NHS boards; better co-ordination of care in relation to the assessment of need in delivery of specialist equipment; and improved discharge procedures from acute settings.

What is the Scottish Government doing on those issues so that we can deliver a better approach to the care of the dying and their families, bearing in mind that I am happy to acknowledge the work that the Government has already—

I think that we have got the gist of it.

Margaret Smith is right to raise this issue. Many people state that their preferred place of death is their own home. Where that is the case, they should be allowed, where possible, to do that.

I encourage Margaret Smith to read the “Living and Dying Well: Building on Progress” document when it is published. That is our evaluation of how we have implemented the living and dying well policy, which is currently being finalised—I have talked to the Health and Sport Committee about it. It will reiterate the importance of advance care planning and will provide practical resources to support the process. In that context, we work closely with stakeholders such as Marie Curie to ensure that we are doing what needs to be done.

Question 16 was not lodged.

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Learning Disability (Care Improvements)

17. To ask the Scottish Executive what steps it has taken to improve the care of people with a learning disability. (S3O-12564)

A 10-year programme, “The same as you?”, which was designed to improve services and support for people with a learning disability, has just concluded. It is currently being evaluated to analyse what has worked well and to identify the gaps in services that still exist. The final evaluation report will be submitted to me in the summer.

The minister will be aware of the report by the Learning Disability Alliance Scotland entitled, “Stuck! People With Learning Disabilities Resident In Care Homes For Older People In Scotland”. The report shows that there are 2,000 people with a learning disability in specialist learning disability homes, but 1,000 such people in homes for the elderly. Three hundred or more of those people are under 65, and they are much more fit and active than the elderly with whom they have to reside, and for whom the average age of admission is now 90.

What steps is the Government taking to ensure that Social Care and Social Work Improvement Scotland, or the Scottish Commission for the Regulation of Care as the current organisation, inspects the situation and ensures that those individuals are being housed appropriately? The Learning Disability Alliance Scotland certainly thinks that they are not.

I recognise the issue that Richard Simpson raises, and the report raises a number of concerns. The medical, nutritional and physical needs may be being met in the care home, but the question is whether quality of life issues are being adequately addressed when someone who is relatively young is placed in a care home for older people.

The solution to that is empowerment, choice and more control. One way forward is through the self-directed support mechanism, to enable people to consider whether they wish to receive support as an individual in their own home. We need more imaginative thinking around collective living to make that easier for people, and new models of care rather than the more limited models that we have at present. I am certainly keen to discuss that on a cross-party basis if the member so wishes.