Health and Wellbeing
Question 1, from Paul Martin, has not been lodged, but I have received an explanation.
Bronchiectasis
All national health service boards in Scotland have local respiratory managed clinical networks that aim to deliver and improve respiratory services for people with all respiratory conditions. Patients with respiratory conditions sit on those networks to help to ensure that their voice is heard and that services are developed in a person-centred way.
Does the minister agree that people with bronchiectasis, and especially those who have clinically significant bronchiectasis, are as entitled as anyone else to receive high-quality care? I invite him to meet me and my constituent Robert Hunter, who is in the gallery today, along with the clinical and patient members of the bronchiectasis interest group in Lothian, to hear about their plans to develop a comprehensive patient-friendly website that will support people with bronchiectasis in self-management of what can be a debilitating and—in some cases—devastating condition.
I assure Jim Eadie that we are very much committed to ensuring that patients with any condition—regardless of what it may be—receive the highest quality care in the NHS. That is set out clearly in the Scottish Government’s equalities strategy, and we are focused on a person-centred, safe and effective healthcare system in Scotland.
Telehealth (Promotion)
The Scottish Government, working in partnership with the Convention of Scottish Local Authorities, is currently developing a national delivery plan for telehealth and telecare. I would be delighted to make that plan available to Gil Paterson when it is published next month.
Can the cabinet secretary clarify what is being done to ensure that national health service boards adopt e-health and telehealth systems for both cost and clinical benefits?
The document “eHealth Strategy 2011-17” sets out the key e-health deliverables that NHS boards will take forward over the lifetime of the strategy. The strategy has six strategic aims, four of which are concerned with different clinical benefits and one of which deals specifically with realising efficiencies and savings. The Scottish Government currently provides funding of £17 million per annum to deliver those strategic aims. Activity on e-health is integrated with each health board’s planning and delivery cycle, and all local and national e-health investment is subject to regular monitoring.
On a related issue, what progress has been made in expanding the use of the internet to improve contact with general practitioners’ surgeries in areas such as making appointments, access to repeat prescriptions, health records and test results?
The question is related, cabinet secretary.
Yes—and I am happy to answer it, Presiding Officer.
NHS Lanarkshire (Appointment of Chair)
Interviews for the chair appointment to NHS Lanarkshire are due to take place on 19 November 2012. It is hoped that the successful applicant will take up their appointment some time in early December 2012.
First, I thank NHS Lanarkshire for providing my successful eye operation last Sunday. I can now see the clock in the chamber.
I will not say that Mr Lyle and I see eye to eye on this.
While we await the appointment of a new chair, the cabinet secretary has recently intervened in provision of mental health services by NHS Lanarkshire. Does he intend to intervene on reviews of acute services in all areas prior to those reviews being considered by the relevant health boards and, of course, before crucial appointments are made?
There is an issue about the future of mental health services at Monklands hospital. Because it lies in my constituency, that matter is being dealt with by my ministerial colleague, Michael Matheson.
Cancer Patients (Choice of Drugs)
As Ms Goldie will be aware, the Scottish Medicines Consortium independently appraises newly licensed medicines to treat all conditions including cancer, and provides advice to NHS boards on their clinical and cost-effectiveness.
As the cabinet secretary might be aware, earlier this month the skin cancer drugs Zelboraf and Yervoy were approved for use in England. That those drugs are not available to skin cancer patients in Scotland is distressing and incomprehensible. Will the cabinet secretary ask Professor Routledge and Professor Bill Scott to consider how greater flexibility might be introduced into the system in order to avoid such anomalies occurring? It is a question not just of their occurring across Scotland, but of their occurring across the border.
We could go through a list of drugs for a range of conditions, some of which are available in England but not in Scotland and some of which are available in Scotland but not in England. The important point is that we should have a robust procedure that is independent of politicians—who are not qualified to decide either on the medical effectiveness or cost effectiveness of any drug. I believe that our system is very robust, although it is right for us to look at how we can improve it further.
The cabinet secretary will have received a letter from me about a constituent of mine who is paying privately for cetuximab. My constituent and his wife fully appreciate the SMC’s role, although I am glad to hear that a review will take place. In the meantime, there is the issue of administrative charges plus VAT on the invoice that my constituent has received for his private treatment. Is there any way to deal with those charges?
I do not want to discuss in the chamber the merits or demerits of an individual case. Christine Grahame has written to me and I will give due consideration to the points that she raises.
On the Labour Party’s behalf, I welcome the cabinet secretary’s announcement. We have looked for such a review, particularly in relation to the 14 area drug and therapeutics committees, which I have been banging on about for some time.
If Dr Simpson sends me details of where what he described has happened, I will be happy to investigate and to consider the matter.
One option that is available to cancer patients—especially those who are in the latter stages of their illness—is homoeopathic drugs and medicine. Does the cabinet secretary share my concern about NHS Lothian’s proposals to close the homoeopathic clinic at St John’s hospital and to end homoeopathic services across the Lothians? If those proposals are implemented, they will certainly impact on patient choice, especially for people with cancer.
The question was wide of the mark, but the cabinet secretary can answer it, if he wants to take it on.
I have a detailed response to give, because I anticipated Mr Findlay’s question. However, as the question was slightly out of order, I am happy to write to him with a detailed explanation of the current status.
On a point of order, Presiding Officer. The original question was about cancer drugs, and homoeopathic medicine can be part of cancer treatment. I fail to understand why my question was out of order.
The question was out of order because I said that it was out of order. We are talking about drugs for cancer patients.
I thank the cabinet secretary for recognising the concern of patients across Scotland about equity of access to new treatments. I urge him to ensure that, as well as tackling the barriers to access through the area drug and therapeutics committees and through the individual patient treatment request process, the need to provide patients with new and innovative treatments is at the heart of the review. It is important to recognise that, although cancer medicines and medicines for orphan conditions and ultra-orphan conditions can be high cost, they are often low budget across the whole population.
Mr Eadie has raised a valid point, and Michael Matheson and I have included in the review’s remit the specific point that he made. When they are considered only on a narrow accountancy basis, some drugs look as though they are very expensive. However, if they result in much more substantial savings, particularly on hospitalisation, the overall saving to the national health service would make them worth prescribing. We want to ensure that, in the future, a broad view is taken of a new drug’s costs and benefits, rather than a narrow view based on its cost effectiveness and on an accountancy basis.
Emergency Response Ambulance Cover (Smaller Orkney Isles)
The Scottish Government is in regular contact with the Scottish Ambulance Service on a range of issues, including the emergency response cover that is provided to our island communities. As my predecessor conveyed to Liam McArthur back in May, the Government is actively supporting the development of service models to support those communities, through dedicated project management support this year.
I thank the cabinet secretary for that comprehensive response. Notwithstanding what he said, I make him aware of the concerns that were raised with me recently by community leaders on the islands of Shapinsay and North Ronaldsay about continuing inadequacies in emergency medical cover. I have raised the concerns with the Scottish Ambulance Service and NHS Orkney and I understand that meetings are taking place.
I am more than happy to use what influence I have. It is extremely important that island communities—particularly remote island communities, but island communities in general—and rural communities have equal access to all aspects of the national health service. Meetings are taking place, as Liam McArthur mentioned, and I hope that they will lead to a satisfactory conclusion. If they do not, and if the member wants to raise with me any future issues on the matter, I will take them seriously and will proactively pursue a resolution.
Transcatheter Aortic Valve Implantation Procedures
Four transcatheter aortic valve implantation—or TAVI—procedures have been performed in Scotland to date. “TAVI” is a lot easier to say.
I whole-heartedly agree with the cabinet secretary. I welcomed his announcement that TAVI would be routinely available in Scotland. At that point, almost 100 patients were, as I understand it, waiting for treatment. Can he tell me whether direct referral from the patient’s cardiac consultant to Edinburgh royal infirmary is how the system works? Can he also tell me whether there is any delay or any barrier to patients receiving treatment, given that only four patients have received treatment so far?
The treatments have only just begun, so it is early days. I anticipate that the numbers will increase fairly quickly in the immediate period ahead. However, I make it absolutely clear that I am closely monitoring the numbers, because if they rise—for example, in line with our hypothetical analysis of the numbers if the position south of the border is extrapolated into Scotland—there might well be a need fairly soon to make TAVI available elsewhere other than, and in addition to, in Edinburgh.
While we are on matters aortic, will the cabinet secretary confirm whether screening for abdominal aortic aneurysms in men over 65 is now being offered by all health boards, in accordance with the Government’s policy and timetable?
That was wide of the mark.
Prescriptions (People with Long-term Conditions)
It is difficult to estimate the number of people with long-term health conditions who did not qualify for free prescriptions before charges were abolished in 2011 as we do not have a conclusive list of those long-term conditions.
Clearly the situation that the minister has described is still the case in other jurisdictions within these islands. Does he agree that an exercise that attempts to decide which long-term conditions are worthy or unworthy is doomed to failure and that instead of insulting people by classing those who receive medicines as being the deserving or undeserving ill, we must remain true to the national health service’s founding principles and continue to offer free prescriptions to all?
I very much agree with Marco Biagi. I remember that at the time the medical profession expressed concern about the difficulty of compiling a list of long-term conditions; indeed, we could have had a situation in which an individual with three or four conditions would have received free prescriptions for only two of them. Moreover, the list would have to be continually updated.
I understand the minister’s problem with extending the list of conditions, but I note that under the previous system people who had some conditions, including diabetes, were exempt from all prescription charges. Given his view on such disease-specific inclusions and exclusions, does the minister plan to abolish means testing for the minor ailments scheme, to which the previous system of inclusions and exclusions still applies? Moreover, dental and optical charges are not the subject of universal benefits. Will the Government continue with means testing in respect of illnesses for which some people are treated differently?
As I told Dr Simpson and his colleagues yesterday in the chamber, the Government remains committed to free prescriptions. I remind the member that he was elected last year on a manifesto that said that Scottish Labour remained committed to “no reintroduction” of prescription charges, and we as a Government remain committed to the promise that we made in our own manifesto last year to ensure that people get prescriptions free of charge.
Health Inequalities (Manual and Non-manual Workers)
Tackling inequalities in health is one of the Scottish Government’s top priorities. We recognise that work is a key social determinant of health and that one of the best ways of reducing inequalities in health in Scotland is to ensure that as many people who can work get the opportunity to do so. We support through NHS Health Scotland the Scottish centre for healthy working lives, which offers advice to employers on improving and promoting the health and wellbeing of their employees. Working in partnership with organisations such as the Scottish Chambers of Commerce and the Federation of Small Businesses in Scotland, the centre specifically targets small and medium-sized enterprises that have high levels of low-paid workers who are most vulnerable to inequalities in health.
I thank the minister for his very comprehensive reply. He will be aware of recent figures showing that the health divide between manual and non-manual workers in Scotland is among the worst in Europe. What is the Scottish Government doing to support initiatives such as the British Heart Foundation’s hearty lives programme, which targets health advice and assistance at people from less-well-off backgrounds?
Murdo Fraser has raised a very important point. The British Heart Foundation’s campaign can have real value in closing down some of the health inequalities in Scotland. However, the member should also recognise that some of those health inequalities have been around for many decades and that it will probably take many decades to address them effectively. We have a range of measures to ensure that we address them as effectively as possible in partnership with the national health service and the third and independent sectors, where they can play a part. That said, I must caution the member that the changes that are set out in the United Kingdom’s welfare reform programme are in danger of exacerbating some of those health inequalities and of undoing some of the good work that has been carried out in recent years to close the gaps.
Mental Health Services (Involvement of Families and Carers)
In the recently published mental health strategy, work with families and carers was identified as one of the key themes that emerged from the consultation. The involvement of families and carers is important in the provision of safe and effective care and treatment.
Does the minister agree that one way forward is to work with service users, their families and carers to develop home treatment centres, such as crisis houses, to offer support to help to resolve a severe mental health crisis in a residential rather than hospital setting—a service that is as yet unavailable in NHS Fife?
The member has raised an important point. One way in which we can make progress in how we deliver mental health services in Scotland is by being much more responsive to individuals who present themselves as being in crisis or in distress.
NHS Lanarkshire (Meetings)
I will meet NHS Lanarkshire in a ministerial capacity on 14 January 2013, at the next meeting of NHS chairs, when we will discuss matters of importance to the people of Lanarkshire.
The cabinet secretary will be aware that NHS Lanarkshire recently signed a contract with Atos Healthcare to deliver the personal independence payments assessment for sick and disabled people on benefits without seeing the contract first. Given the reported actions of Atos and how it carries out its work, I find that deeply disturbing.
I will monitor that situation closely. I want to do two things in particular. First, I want to be absolutely sure that the contract does not in any way damage the reputation of the national health service in Scotland. Secondly, I want to ensure that no resources of the national health service are diverted into that activity.
I would like to tease that out. Is it common or good practice for the terms of the contract for an agency directly contracted by the NHS not to be known before it is signed?
It has been standard practice. Indeed, if the NHS board had seen the terms of the private finance initiative contracts that were signed in Lanarkshire, I would hope that they would have never been signed, because they are now costing NHS Lanarkshire £45 million a year.
In his conversations with NHS Lanarkshire, will the cabinet secretary, on behalf of men aged 65 and over, establish whether abdominal aortic aneurysm screening is now being offered routinely in accordance with the Government’s policy and timetable? [Laughter.]
That was the clever way of asking the question that Mr Carlaw should have used earlier.
I think that it is only fair that Jackson Carlaw perhaps declares an interest in the question, given the age range being discussed. However, I am more than happy to double-check the situation and write to Mr Carlaw as quickly as possible to put his mind at rest.
With NHS Lanarkshire’s performance against the accident and emergency four-hour waiting times standard down in August of this year and continuing to worsen, and with eight-hour and 12-hour waits still a persistent problem, will the cabinet secretary ensure that he raises the issue with NHS Lanarkshire and looks again at the staffing situation for the provision of minor injuries services?
We are in constant contact with NHS Lanarkshire on that point, and we are working with it to ensure that the targets are met in future. I have been reassured both by NHS Lanarkshire and by my department, which has looked at the situation, that any problem with meeting the target is not related in any way to staff shortages. However, I should point out that, had the plans of the then Scottish Executive—under Labour and the Liberal Democrats—to close the accident and emergency department in Monklands gone ahead, the situation would have been much worse than it is at the present time.
Vitamin D (Health Benefits)
The Scientific Advisory Committee on Nutrition is in the process of reviewing all relevant scientific literature on vitamin D as part of its review of the current vitamin D recommendations. The review will consider a wide range of health outcomes associated with vitamin D status, and its findings will be published in late 2014.
I thank the minister for his answer and look forward to the outcome of that review. Taking into account the potential role for vitamin D in gaining a better understanding of multiple sclerosis and of its particularly high incidence in Scotland, will the minister undertake to explore whether European funding may be available to underpin much-needed further research?
I am aware that there is research linking vitamin D to a number of illnesses, including multiple sclerosis. My understanding is that, as part of its review, the Scientific Advisory Committee on Nutrition is examining all currently available and emerging research linking vitamin D to multiple sclerosis. A key part of the review will be to identify whether there are any gaps in the research and, if there are, what further research may be required.
NHS Ayrshire and Arran (Patient Care)
Ministers and Scottish Government officials regularly discuss matters of local importance such as patient care with all NHS boards, including NHS Ayrshire and Arran.
I thank the cabinet secretary for his full answer. He will be aware of recent concerns about the number of cancelled appointments and the dissemination of information to staff following critical incidents during the bedding in of the patient management system in NHS Ayrshire and Arran. Can he tell Parliament whether those matters have now all been resolved to his satisfaction?
One of the first meetings that I requested when I was appointed to the post of cabinet secretary was with the chief executive of NHS Ayrshire and Arran to discuss most of the issues that Mr Scott has raised in a very reasonable fashion. I have made it absolutely clear to the chief executive—and I will repeat this when I take part in the NHS Ayrshire and Arran board review in early December—that I expect a reasonable resolution to all those issues.
Recently, ward 3F of the medical high-dependency unit at university hospital Crosshouse won the Nursing Times 2012 award for emergency and critical care; the orthopaedic rapid-recovery team at the same hospital won the top team award at the Scottish health awards 2012; and the radiographer-led reporting team for NHS Ayrshire and Arran won team of the year from the Scottish council of the Society of Radiographers. Does the cabinet secretary agree that Ayrshire and Arran health board continues to carry out outstanding work on behalf of patients?
Absolutely. Where there are problems, we should always put them into the context of the excellent work that is going on. I presented the awards at the Scottish health awards ceremony this year. I was delighted to do so and to celebrate the tremendous work that is going on, not just throughout the Ayrshire and Arran area but throughout the national health service in Scotland. This morning, I visited the new laboratory at the Southern general hospital in Glasgow, which will be another exemplar of excellence—not just in the national health service in Scotland, as it is one of the leading-edge laboratories in Europe.
Rural General Practitioner Surgeries (Closure)
National health service boards have a statutory obligation to provide, and are accountable for, the services that they consider necessary to meet all reasonable requirements for their areas. I am particularly aware of the issues concerning the remote and rural areas of Scotland, and my officials are in regular contact with members of the Dewar committee, among others. That is why I have recently endorsed the proposal for a specific programme of work to be taken forward by NHS Highland to develop and test a model or models for the delivery of care in the remote areas of Scotland.
It is interesting to hear about the pilot in NHS Highland. Is it the Scottish Government’s expectation that more needs to be done not only to ensure that there is good cover but to publicise the GP surgeries that are open and the hours that they are working?
I hope that much of that is being done already in every area but, where it is not being done and if members want to draw it to my attention, I will certainly exert what influence I have to ensure that it is done. In parts of rural Scotland, there is undoubtedly a major problem with recruiting GPs and consultants in the acute sector. I am actively considering how we can do more to ensure that the vacancies are filled, and filled timeously.
In Vitro Fertilisation Treatment Waiting Times (NHS Forth Valley)
The issue of long waiting times for IVF treatment was specifically raised at NHS Forth Valley’s annual review in 2011. Since then, the board has committed to funding an additional 28 cycles on an on-going basis, and waiting times have reduced from four to three years.
I have constituents in the Forth Valley health board area who have been trying to conceive their first child for three years. They were recently referred to Dundee for IVF treatment and were told that the waiting list is four years. They have also been told—perhaps erroneously, in the light of what the minister has said—that if the first cycle of IVF treatment is unsuccessful, they will return to the end of the waiting list. That means that some couples could wait up to eight years for a second treatment. In those circumstances, what advice should I give to my constituents to aid them in securing earlier IVF treatment?
The practice of NHS boards throughout Scotland is for couples with unexplained infertility to try to conceive naturally for three years before being referred for IVF, although couples will receive some investigations during that period. That practice is followed for clinical reasons, as couples with unexplained infertility are more likely to conceive naturally in the first two to three years of trying to conceive than they are with IVF. However, the national fertility group is reviewing that particular criterion.
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