SCOTTISH EXECUTIVE
Health and Community Care
Medical Training Application Service
To ask the Scottish Executive what action it is taking to address doctors' concerns regarding modernising medical careers and the medical training application service. (S2O-12347)
I am aware of concerns about modernising medical careers and the medical training application service across the United Kingdom, but we need to keep a sense of proportion from our perspective in Scotland. Delivery of MMC in Scotland remains on track, thanks to the hard work of all those who are involved. We continue to work closely with the British Medical Association, the medical royal colleges in Scotland and national health service boards to manage the process. I am advised by senior clinicians who are involved that round 1 selection is going well and that we continue to enjoy their support in delivering the improvements to postgraduate medical education.
I accept that there has been movement on the issue since my question was lodged. Will the minister confirm the extent to which the Scottish Executive will have input into the review that he mentioned? Does he plan to attend the rally of junior doctors in Glasgow this weekend to speak to them so that confidence in the recruitment process can be restored?
I have been involved with the royal colleges and junior doctors and have had many meetings with the chief medical officer to seek to reassure doctors. In Scotland, we have managed the process of modernising medical careers professionally and our systems are working well. The member does not need to take my word for that; he can take the word of the Royal College of Physicians of Edinburgh, the Royal College of Surgeons of Edinburgh, the Royal College of Physicians and Surgeons of Glasgow and the Royal College of General Practitioners. I accept that we are to a degree suffering from matters elsewhere in the UK, but we in Scotland are nonetheless handling the process well. We can always improve, which is why we will play a substantial role in the review. Nonetheless, I want to reassure the member and junior doctors that the process is working well in Scotland.
The minister may be aware that concerns have been expressed about doctors from other parts of the UK in effect flooding the application process in Scotland. I appreciate that those concerns are based simply on press reports, but has he talked to counterparts in other parts of the UK to be sure that there is an even process throughout the UK and that we do not have distortions in parts of the UK?
It has always been the case in medical education and training that people move round the country. We train many doctors in Scotland who work elsewhere in the UK and, likewise, many doctors who trained elsewhere in the UK come to work in Scotland. We are confident not only that we can manage the process well in Scotland, but that we can, through the process, retain those much-needed skills in Scotland, which is what I want. We need to keep our eye on the issue that the member raises, but the evidence to date suggests that Scotland is doing well on ensuring that we recruit and train medical practitioners in Scotland in a way that keeps them in the national health service in Scotland, which of course is good for patients and the NHS in Scotland.
Question 2 was not lodged.
Health Care (Patient Experience)
To ask the Scottish Executive what action is being taken to ensure that the experience of patients informs the development of health care. (S2O-12362)
NHS Scotland's focus on patient focus and public involvement, including in particular the establishment of public partnership forums, has ensured the routine involvement of local people in influencing local priorities and improving the design and delivery of the health services that they use. We have also established a patient experience programme, which will ask patients and carers directly about their experience of the health service and make better use of the information that we already collect from patients. The lessons that emerge from the programme will be used by national health service boards, supported by NHS Quality Improvement Scotland and the Scottish health council, to drive forward year-on-year improvements in the quality of the patient experience.
I welcome the programme described by the minister and the work that NHS Lothian has been doing in that area for some time. Will the minister ensure that there is a focus on the full range of patients' qualitative experience of care, rather than simply patient satisfaction surveys? Will he ensure that the initiative draws on the work of those who are already experts in the field, such as the team at the cancer care research centre at the University of Stirling? Crucially, will he ensure that the information about patient experience is acted upon to improve patient care further?
I am happy to give Malcolm Chisholm assurances on all those areas. I pay tribute to the work of the cancer care research centre at the University of Stirling, which has, to a substantial degree, scoped out and informed the patient experience programme that we are introducing. The purpose of the programme is to build on the centre's work, to extend it beyond cancer to the whole range of patient experiences, to go beyond—as Mr Chisholm suggests—patient satisfaction surveys or complaints processes to gather as wide a range of qualitative information as we can about patient experience, and to ensure that that information is used to drive up the quality of patients' experience in the future.
Many of us—some of that group are here in the chamber—attended a presentation the other night by the Long-Term Conditions Alliance Scotland. How much are ministers listening to people who suffer from chronic conditions, with a view to helping with self-management work and prevention?
Again, I am happy to assure Linda Fabiani about the extent of our engagement with the Long-Term Conditions Alliance Scotland, which was created partly in response to propositions from the Health Department on shifting the balance of care, increasing support for those with long-term conditions, and bringing together the experience of different patient groups in order to inform the NHS. Ministers have met the alliance regularly and responded to its requests for meetings. At our request, the alliance has met the chief medical officer to address some of its issues of concern.
Small Pharmacies (Medicine Distribution)
To ask the Scottish Executive what impact the proposal by Pfizer to distribute its medicines through a single United Kingdom wholesaler will have on small pharmacies, particularly those in rural areas of the Highlands. (S2O-12372)
As far as the impact of this proposal on pharmacies is concerned, the Office of Fair Trading is currently considering whether the proposal by Pfizer is uncompetitive. As regards the impact on patients, we have contacted Pfizer to express our concerns, including specific concerns in relation to patients in remote and rural areas.
The minister will be aware of my letter to him about the difficulty that Mr David Raeburn, the pharmacist in Strathpeffer, had in accessing a painkilling drug prescribed for a patient, which meant that the patient was, distressingly, without pain relief for a whole week. I understand that the matter will ultimately be decided by the OFT, but in the meantime will the minister tell me what reassurances he has had from Pfizer that patients will not be left in distress because of its actions?
As I said, we have raised our concerns with Pfizer—and we have had an initial response. We are continuing to have a dialogue with Pfizer to ensure that it fully understands the concern of those involved in the provision of medicines at local level, and others, that patients should not be disadvantaged by any changes that are made for commercial reasons.
The minister is aware of the concerns of small independent pharmacies about Pfizer's action on deliveries. The pharmacies see that action as threatening twice-daily deliveries, patient care and the smaller wholesalers. To be fair, the minister has perhaps already answered this, but will he assure Parliament that he will ensure that Pfizer's move to cut costs, and perhaps to establish an even stronger foothold in the market, will not endanger patient care in Ayrshire and the rest of Scotland?
The concerns to which John Scott refers have been raised directly with ministers by Maureen Macmillan and other members. I assure John Scott that we will reflect those concerns in our continuing discussions with Pfizer.
As the minister will be aware, another concern that pharmacists have is the potential reduction in discounts under the new arrangement. Will the next review of reimbursement to pharmacists be undertaken quickly so that, if there is a reduction in discounts, there will not be a long gap before pharmacists receive a corresponding increase in reimbursement?
It is certainly our intention that there should be no loss of income as a consequence of the changes. We will continue to monitor the situation closely with a view to ensuring that NHS patients continue to receive the services and medicines that they require. Any commercial changes that are made in the marketplace will be taken into account in future reviews.
Question 5 was not lodged.
Prescription Charges
To ask the Scottish Executive what impact the recent increase in the cost of prescriptions will have on patients with chronic conditions. (S2O-12390)
Some 92 per cent of prescriptions are dispensed free of charge, including all those for patients with one of a number of specified chronic conditions. For those patients with other chronic conditions who pay prescription charges, a pre-payment certificate will cover the costs of all the medicines that they need for up to a 12-month period. The cost of the annual certificate will increase from £95.30 to £98.70 from 1 April this year.
Four years ago, the Executive promised to review national health service prescription charges for those who suffer from long-term conditions. The charges have since risen year on year and are now £6.85 for each medicine. The unfairness of the system, like the number of sufferers languishing in pain and financial hardship, has grown and grown, but the Executive has done nothing about the promised review. Can the minister explain why, unlike the National Assembly for Wales where his Labour colleagues have now abolished prescription charges completely, the Scottish Executive has failed to deliver even on the much-promised review of prescription charges? What does he say to those who are predicting that, after four years of silence, he intends to announce a sudden prescription charges policy U-turn in the pre-election period so that he can play political games with patients who have long struggled to get by and who badly need NHS treatment that is unavailable because of the prohibitive cost of prescriptions?
Clearly, the matter is too serious to play political games with. If there were glib and simple answers to the questions raised, they would no doubt have been heard by now. We are seeking to take into account all the responses to the consultation—we have indeed carried out the review to which Mr Fox referred—and we will continue to consider those responses carefully. We will publish our response in the near future.
Given that we are still waiting for those options for reform and that the Parliament has only two weeks until dissolution, when and how will the outcome of the consultation be made public? Does the delay in publishing the report not do a great disservice to organisations such as the Long-Term Conditions Alliance Scotland, which my colleague Linda Fabiani mentioned, which has campaigned for some time for those who have a long-term condition to be exempt from prescription charges? Is not this unacceptable delay totally kicking the issue into the long grass?
I am sorry to hear that Shona Robison is disillusioned, but I can tell her that we are seeking not to disillusion others. We want to provide an informed and thoughtful response to the consultation and we intend to do that as soon as we can.
National Health Service (Best Value and Efficient Government)
To ask the Scottish Executive what guidance has been issued to NHS boards to take account of co-location and dispersal of non-patient interface services to meet best value and efficient government objectives. (S2O-12370)
NHS boards are expected to implement Scottish Executive policy on public service reform and relocation. Work is being taken forward on shared support services for NHS Scotland and consultation with NHS boards has taken place. The preferred option provides for shared support services centres at each mainland health board location. Two of those centres will also provide national support for finance and procurement and for payroll operations. A final business case is currently being developed. In addition, the relocation and co-location of a number of special health boards in Glasgow was announced in June 2005 as part of the Scottish Executive's relocation policy.
Will the minister investigate Ayrshire and Arran NHS Board's current proposals to build modular office accommodation for non-patient interface staff at a cost of £2 million without considering the facilities that are being made available by local authorities, which are pursuing a regeneration strategy that is contained in their agreed community plan?
I am always happy to consider issues that members raise. In Ayrshire and Arran in particular we see many good examples of partnership working between the national health service and local authorities. I understand that the new unit is intended to house administrative and executive staff. Relocating them from their current location will release a capital asset, given the lease that will expire. The new building—a modular unit at Ailsa hospital with a life expectancy of 50 years—will be a modern suite of office accommodation. I have managed to ascertain that it looks like a reasonable investment to make, but I will seek to consider whether opportunities might have been missed to work in partnership with other public sector organisations, such as local authorities, and how that might affect regeneration activities. We are always keen to have partnership working, but we must also ensure that we look after our national health service in a way that allows staff to continue working in good accommodation.
Cataracts (Fife)
To ask the Scottish Executive how it is improving the diagnosis and treatment of cataracts in Fife. (S2O-12374)
NHS Fife, alongside other NHS boards throughout Scotland, is taking action to transform patients' access to fast, high-quality cataract services. Five years ago, an elderly person might easily have waited more than a year between seeing their general practitioner and having a cataract operation. Today, most patients are being operated on within 18 weeks of seeing their GP or optometrist. On behalf of all patients in Scotland, we have set the NHS the target of no cataract patient waiting more than 18 weeks between referral and treatment by the end of this year. Some boards, including NHS Fife, have already met that target and the rest are on track to achieve it.
The development of the service at Queen Margaret hospital in Fife has resulted in a stratospheric improvement in referral, diagnosis and treatment times for cataract sufferers throughout Fife. Will the minister join me in wishing well all the patients who have been treated, and in commending the partnership working among all the health care staff—primary care staff as well as acute care staff—who are involved?
It is right to recognise the achievement of NHS Fife in introducing one-stop clinics, reducing the number of times that a patient has to travel to hospital and allocating resources to provide a purpose-built cataract assessment and treatment unit.
Prescription Charges
To ask the Scottish Executive what plans it has to extend the list of conditions exempt from prescription charges. (S2O-12404)
We are currently considering responses to our recent consultation on prescription charge and exemption arrangements and we will announce our conclusions in the near future.
I impress upon the minister the particular complaint of asthma sufferers, who might be asked to have three different types of inhaler to deal with three different aspects of their condition. Those inhalers are delivered via three different prescriptions—at £6.85 each, we see how expensive it gets. Given that the yearly prescription charge is almost £100, people who suffer from asthma have a particular case. I make a plea to the minister to come up with a favourable response.
I appreciate the points that Margo MacDonald makes. A number of the responses to the consultation reflected such concerns from people with asthma. With the recent launch of personal asthma action plans, we have endeavoured to respond to some of those concerns. In addition, we have provided nurses with specific training on the condition. I am pleased to say that, when some of the campaigners on asthma were in the Parliament yesterday, it was clear that they got a positive response from members of all parties.
Southern General Hospital (Maternity Services)
To ask the Scottish Executive whether its capital investment group agreed at its meeting on 6 March 2007 with the recommendation of NHS Greater Glasgow and Clyde's expert body that public-private partnership/private finance initiative should not be the preferred procurement route for the modernisation of maternity services at Glasgow's Southern general hospital. (S2O-12341)
The outline business case for the modernisation of maternity services at Glasgow's Southern general hospital was recommended for approval at the capital investment group meeting on 6 March. Given the nature of the project, and particularly the elements of refurbishment and the interface with the existing estate, NHS Greater Glasgow and Clyde considered public capital funding to be the most appropriate procurement route for the project. Provision of the capital funding has been made available within NHS Greater Glasgow and Clyde's capital plan.
I thank the minister for his support in opposing the use of PPP in this case. Lack of ability to profiteer was one reason for rejecting PPP as the procurement route. Will the minister ensure that private companies do not continue to make huge profits from PPP projects? The initial cost of the Edinburgh royal infirmary was £180 million, but the final cost will be £900 million. Will the minister commit the Executive to rejecting the use of PPP in Glasgow's new children's hospital?
The member should raise her game. She compared the initial capital cost of a building with 30 years of full maintenance and cleaning of that building with all the risk transferred to the private sector. As ever, the Scottish National Party lacks an understanding of economics and puts political dogma before the needs of patients. The public capital investment that we are making in Glasgow could not be afforded by the SNP under its ludicrous proposals for the management of our economy and the £11 billion black hole in its plans.
Environment and Rural Development
Flood Prevention Schemes
To ask the Scottish Executive what action has been taken to progress flood prevention schemes throughout Scotland. (S2O-12387)
It is for local authorities to take the initiative in promoting flood prevention schemes. Schemes follow a statutory procedure under which they are made and advertised by the local authority and then submitted to Scottish ministers for confirmation.
I know that the minister is aware of the problem of flooding in the Whifflet area of my constituency as I raised it with the Executive some years ago and I discussed it with her recently. Can she give me further detail on the flood prevention work that is taking place in Whifflet and update me on the status of the work, which has been delayed? Can she reassure my constituents that they will soon be able to live and work free from the distress and upset that are caused by the flooding of their homes and businesses?
Yes. I am happy to do that. I met Elaine Smith to discuss the matter, which is a long-standing issue on which she has campaigned.
Given that detailed research is being done into future needs arising from the impact that global warming might have, has the minister's department estimated the additional capital funding that might be required and considered future budgets in the light of that? If so, do those estimates include the need for work on coastal protection as well as flood prevention, given that global warming will make the situation in coastal areas more severe?
In April 2005, a major United Kingdom research project—the foresight project—considered future flooding problems. That provides a challenging vision of flood and coastal management for the UK between 2030 and 2100 and it contributes significantly to our understanding of the longer-term challenges.
The Flood Prevention (Scotland) Act 1961 locks us into building hard flood defences. What consideration is the Executive giving to funds that will allow us to put in place softer flood defence measures, which are effective? The minister will be aware of WWF's good work on the River Devon to reduce the flood risk to surrounding communities.
The member makes the valuable point that many of the procedures and much of the legislation guiding how we act on flooding could be regarded as out of date. The Executive is working on that.
I know that the deputy minister cannot be involved in a decision about the Water of Leith flood prevention scheme, because it affects her constituency, as well as mine. However, will she convey to the minister, Ross Finnie, the extreme frustration and anger of many of my constituents that, three years after that vital and necessary scheme received planning permission, no Executive decision has been taken about it? What progress has been made since I previously raised the matter at environment and rural development questions? When exactly will Ross Finnie say something about it?
As the member is correct to say, I agreed not to participate in the decision about that scheme, on which my views are well known, so I have not seen the paperwork. However, having consulted the minister, Ross Finnie, I am allowed to say that he will announce a decision very shortly.
On the management of flood risk, I wrote to the minister and raised at environment and rural development questions some weeks ago the possibility of allocating some unspent resources from the flood prevention budget to strategic studies of areas such as the River Tay catchment area, which produces several flood risk difficulties in my constituency. Has she considered undertaking some of that strategic work in concert with Perth and Kinross Council and other authorities, to identify ways of alleviating the flood risk by using information that is available today?
The member's suggestion is helpful. Our officials are considering how we can think more up front about better managing flood risk, rather than just putting in place physical schemes. That work continues.
Land Reform (Scotland) Act 2003<br />(Countryside Access)
To ask the Scottish Executive whether it is satisfied with the implementation of the provisions of the Land Reform (Scotland) Act 2003 in respect of access to the countryside. (S2O-12342)
Hear, hear.
I am satisfied with the progress that has been achieved in implementing the access provisions of the Land Reform (Scotland) Act 2003. However, there will be scope within the wider review of the act, which we have indicated will be undertaken during 2007, to consider any matters relating to the access provisions.
Is the minister aware of the complaints that have been made about the diversion of access funding, given that local authorities received £29.2 million in access funding up to March last year but spent only £17.4 million on access-related activities? Is she also aware of complaints that have been made that the access code is being breached in some areas, including on Balmoral estate, and that some landowners are challenging the 2003 act in the courts? Will she investigate those complaints and remind local authorities that they have a statutory duty to uphold and facilitate access? Will she remind them that selfish landowners must not be allowed to undermine one of the most radical and progressive pieces of legislation that the Parliament has passed?
Further funding of £8.1 million for 2006-07 and 2007-08 for access-related activity has been made available to local authorities across Scotland in the grant-aided expenditure assessment. That money is not ring fenced, but I hope that local authorities will take seriously their responsibilities to implement the provisions of the Land Reform (Scotland) Act 2003.
Will the minister provide an update on the latest situation with the Pairc court case, which involves crofters from the Lochs area of Lewis? Those crofters are trying to secure the land that they live on, in spite of the best efforts of an absentee landowner, who is trying to thwart the crofters' legitimate aspirations. That landowner is similar to the landowners to whom President Canavan referred. Furthermore, will the minister outline what the Executive is doing to help to ease the problems that are posed by interposed leases?
The minister must be careful, as sub judice considerations may be involved.
The Scottish Land Court is now considering the Pairc case. A contribution of £16,000 has been received from Highlands and Islands Enterprise. It is expected that the first substantive hearing will take place in June. Matters are therefore progressing.
I return to the issue of access. There appeared to be difficulties with the definition of "curtilage" in relation to access. I was among the majority who agreed that "curtilage" should not be defined in the act. In the light of the legal actions that have been taken, is it time for us to reconsider the difficulties that might arise as a result of the lack of a formal legal definition of that word?
As I said, we intend to carry out a wide review of the Land Reform (Scotland) Act 2003 in 2007. I do not want to comment on any court cases. If members who were on the committee that examined the 2003 act have specific concerns—I know, from questions that Pauline McNeill has asked me, that concerns exist—we would be keen to hear from them.
Does the minister agree that the Scottish outdoor access code was intended to be a guide to the Land Reform (Scotland) Act 2003 for all matters within that act and that it was not meant to deal with responsible access only, but was meant to deal with what land was accessible? Does she further agree that the spirit of the act was to provide no less access than was previously enjoyed and that there is a danger that Parliament's will when it passed the 2003 act, which was to give wide access, might be undermined by some local authorities and court decisions? Can the minister reassure me that, when the act was passed, it was compliant with the European convention on human rights and that it is still compliant? If she has any concerns about the act's not being compliant, will she advise members of that?
The Executive certainly has no concern about the 2003 act's not being compliant with the European convention on human rights.
Scottish Natural Heritage<br />(Single Farm Payment)
To ask the Scottish Executive what discussions it has had with Scottish Natural Heritage regarding levels of compensation paid under management agreements following the introduction of the single farm payment. (S2O-12396)
Ministers have asked Scottish Natural Heritage to bring forward proposals to resolve the difficulty that has arisen. Those are expected in the next six to eight weeks.
The minister will acknowledge that I have been in correspondence with her and her predecessor for some time about this matter. Indeed, we are dealing with farmers whose management agreements are up for review or, in some cases, renewal. They are the very people who were pioneers in accepting management agreements over land that had been designated as sites of special scientific interest. Does the minister agree that it seems very unfair that they should now be penalised with any loss of income because of the introduction of the single farm payment, as a result of decisions that they took 20 years ago not to increase the number of livestock units? Although it might not be possible to do anything through the single farm payment mechanism, it is open to ministers to give financial guidance to SNH to ensure that proper compensation is made available.
The issue is complex. Jim Wallace has made several representations to me and previous ministers. SNH is clarifying the position in relation to state aid. That must be done properly. It also has to check whether there are any vires issues. Unfortunately, investigating the scope and financial implications of the issue has been a significant task for SNH, which has involved examination of the basis of payment and determination of the number of production units involved for all the management agreements that were active during the single farm payment reference period of 2000 to 2002. As Jim Wallace rightly points out, the majority of those agreements were negotiated individually and many date back to the 1980s. I am very keen that this matter be resolved. As I said, we expect to receive SNH's proposals within six to eight weeks and I am keen that that date will be stuck to.
Scottish Water
To ask the Scottish Executive on how many occasions it has reviewed the current structure of Scottish Water since its creation. (S2O-12340)
None. Our focus has been on supporting Scottish Water to deliver dramatic improvements to drinking water quality, the environment and customer service at the same time as making huge cost reductions.
Given that Sarah Boyack's boss seems to have moved from ridiculing the concept of Scottish Water as a mutual company to supporting it, does not it seem rather odd that the Executive has not even considered changing the structure of Scottish Water?
No. We have been down these tracks before. Scottish Water is doing a very good job. Record levels of investment are being made throughout the country. Day after day, I see press articles about improvements in rural Scotland. The £2.45 billion investment programme is huge. Scottish Water is considering its structures to see how it can deliver improvements to the quality of customer service—that issue is firmly on its agenda—and it is looking forward to managing the issue of retail access and competition.
Financial Instrument for Fisheries Guidance Funding
To ask the Scottish Executive how the fishing and fish processing industries in the north-east will benefit from the latest round of funding allocated through the financial instrument for fisheries guidance programme. (S2O-12360)
Of the £2.3 million of financial instrument for fisheries guidance funding announced in the latest round of awards, £0.95 million went to fisheries businesses in north-east Scotland. The investment in fishing vessel modernisation, processing plant and port infrastructure projects will contribute to enhancing the sustainability and profitability of the sector while safeguarding long-term employment.
I thank the minister for his helpful answer. Does he agree that, although there is much good news in the fishing industry, this investment is especially welcome for people in the fish processing sector, given that a number of fish processors specialising in Scottish stocks have gone out of business over the past few years? Will there be continued dialogue between the Executive and processors to ensure that maximum benefit for the industry is gained through the funding, so that it may have a rosier future ahead of it?
Five processors in the area benefited from the latest round of funding. I agree entirely that the focus must be not just on fishing but on the whole chain. For that reason, we are and will continue to be in dialogue with the sector, especially on the allocation of the new funding that will shortly become available not from the financial instrument for fisheries guidance but from the European fisheries fund.
Community Buyouts (Neilston)
To ask the Scottish Executive how it can support and learn from local residents such as those in Neilston responsible for the successful community buyout of the former Clydesdale bank. (S2O-12376)
I am delighted that the Neilston Development Trust has been successful in buying the former Clydesdale bank building. The Executive sought to offer advice and assistance throughout the process to enable the local community to take advantage of the provisions of the Land Reform (Scotland) Act 2003 on the right to buy. As we move forward to review the act, we will want to draw any lessons about its operation from the experience of those involved.
I thank the minister for her positive answer and for the support that the Executive has provided. Is she aware that the Neilston buyout is a particularly good example of how the land reform legislation can be used to support regeneration of communities in more urban areas, especially some of the former industrial towns and villages in Scotland? Is she also aware that, even with the overwhelming support that the people of Neilston showed for this community buyout of a main street property, the population voting threshold and other aspects of the legislation almost derailed the project? Will she agree to look at how the legislation works, especially for similar-sized communities, so that we do not raise expectations about community buyouts only to dash them?
The member makes some interesting points. In the local area to which he refers, it was a challenge to get a high turnout in the ballot. Although the 50 per cent turnout that the 2003 act requires was not achieved in Neilston, an overwhelming majority of those who voted—1,122 out of 1,156 people—supported the proposal for community buyout. In those circumstances, ministers believed that there was strong justification for approving the right to buy. We are interested in hearing local communities' views on the issue, but we set the 50 per cent target to ensure that there is genuine support in communities for such proposals.
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