Roads (Highlands and Islands)
To ask the Scottish Government what action it is taking to improve the condition of the road network in the Highlands and Islands. (S4O-03226)
Since 2007, the Scottish Government has spent in excess of £336 million to maintain and improve trunk roads in the Highlands and Islands. Local roads are a matter for local authorities.
Does the minister share my constituents’ concerns about the poor condition and potholed state of many local roads throughout the Highlands and Islands, which is damaging to cars and dangerous to motorcyclists and can give tourists a bad impression? What discussions has the minister had with local authorities in my region on this subject recently? Does he believe that enough is being done to address concerns that have been highlighted repeatedly by Audit Scotland?
The member is right to say that we can always do more. That is true for both the trunk road network and local roads. The Scottish Government is in charge of the trunk road network, which accounts for around 6 per cent of the roads in Scotland, and the other roads are the responsibility of local authorities. With regard to local road maintenance programmes, I point out that local authorities are under financial pressure. For example, there has been a 26 per cent cut to the Scottish Government’s capital budget, and there is pressure on public finances, which is bound to work through to the issue that the member raises.
The discussions that the member asks about include, for example, those that we have had with Argyll and Bute Council about trunking the A83 road from Kennacraig to Campeltown. Those discussions are going well, and we expect responsibility for that road to transfer from the local authority to the Scottish Government around July.
On the issue of resources, which is at the root of this issue, the pressure on public finances was not helped by voting for around £776 million to be spent on trams in Edinburgh rather than on road works around the country.
National Health Service Boards (Private Finance Initiative Contract)
To ask the Scottish Government what recent discussions the Cabinet Secretary for Health and Wellbeing has had with national health service boards regarding the operation of private finance initiative contracts. (S4O-03227)
The Scottish Government is committed to the non-profit-distributing model as its preferred procurement option for revenue-financed projects. Unlike under PFI, the level of private sector returns is capped under NPD. In addition, services that are provided as part of NPD contracts are limited to those that relate to the maintenance and fabric of the buildings.
However, 28 historical PFI agreements remain in NHS Scotland. The NHS in Scotland pays £215 million in unitary charges under PFI contracts. Of that, £86 million relates to service charges. An NHS Scotland group, including all boards with PFI contracts, the Scottish Government and the Scottish Futures Trust, has been working to improve contract management and deliver savings on those contracts. That work has already achieved £1.3 million-worth of annual savings, which will save £20 million over the remaining life of the contracts. By the end of 2014-15, savings over the remaining life of the contracts will rise to £26 million. Those savings will be reinvested in NHS services.
Is the cabinet secretary aware that, notwithstanding the savings that the Government is negotiating, the PFI contract at the Royal infirmary of Edinburgh stipulates that, if the health board does not walk away after 25 years of the 30-year contract, it is bound to pay Consort Healthcare an annual management fee for the next 25-year period? Can he confirm the net value of the management fee that would apply in that circumstance? Does he agree that those golden handcuffs shackle the NHS to a land deal and a contract that are against the public interest?
I am aware that an on-going payment made during the secondary period is for facilities services to be provided by the contractor, rather than a management fee, if the board does not walk away. The precise cost of those services cannot be precisely defined at this point but is determined by provisions in the contract that base the calculation on all expenditure on the facilities over the previous five-year period. Of course, that was approved by the then Labour Government. Clearly, those on-going obligations are not helpful, which is why contracts that have been signed since around 2000 either use leases that end with the contract or, more recently, including the NPD and hub projects, grant only licence to service provider, and therefore do not face the same issues.
Opencast Coal Sites (East Ayrshire)
To ask the Scottish Government what progress is being made to resolve the environmental issues arising from the abandonment of opencast coal sites in East Ayrshire. (S4O-03228)
The Scottish Government’s “Consultation on Opencast Coal Restoration: Effective Regulation” closed in February this year and sub-groups on financial instruments and compliance monitoring will report back in due course. The restoration of sites is a long process. However, active restoration is now under way on sites in Dumfries and Galloway, in Fife, in South Lanarkshire and in East Ayrshire. My officials and the Scottish Mines Restorations Trust continue to work closely with relevant councils to assist them in their restoration planning.
Can the minister also provide an update on discussions with the United Kingdom Government about the return of Scotland’s share of the coal levy to assist with the restoration of opencast coal sites?
I wrote to the UK Government on 17 September and 20 November, requesting that the royalties that are collected by the UK Coal Authority for coal that is produced in Scotland, which amount to more than £15 million, be made available to fund the restoration of legacy opencast sites in Scotland. A holding response from Michael Fallon, the UK energy minister, was received on 8 January, which said that that request is being actively pursued with the UK Treasury. We have received no further written communication.
I raised the matter again with the Department of Energy and Climate Change at the cross-party Scottish coal industry task force, which I chair, on 7 April. I also spoke with Michael Fallon on the issue when we met in Houston, Texas, last week, and we continue to pursue that line of inquiry with the UK Government. I recognise Adam Ingram’s continued campaigning efforts to ensure the return to Scotland of that money, which is much needed to deal with the urgent task of restoration.
Hearing Loop Equipment (Local Authority Provision)
To ask the Scottish Government how many local authorities have adapted the loop equipment that they provide to people with hearing loss since the introduction of digital televisions and radios. (S4O-03229)
That information is not held centrally by the Scottish Government. It is a matter for individual local authorities to assess which hearing loop equipment they will provide to people with a hearing impairment.
Hard-of-hearing people rely on loop equipment to get any enjoyment from their television or radio, but some local authorities have not adapted the equipment since the switchover from analogue to digital. Is the cabinet secretary willing to write to local authorities to get an understanding of the situation nationally? Will he issue guidance to local authorities, encouraging them to switch over to the modernised equipment as soon as possible?
We have been encouraging local authorities to make the switchover, but I am more than happy to write to them again, encouraging them to do so. As the member rightly says, that would be of huge material benefit to the recipients of the equipment.
Blood Glucose Test Strips
To ask the Scottish Government what guidance it provides to national health service boards on prescribing blood glucose test strips. (S4O-03230)
We expect clinicians to refer to Scottish intercollegiate guidelines network guideline 116 on the management of diabetes, which makes it clear who would benefit the most from self-monitoring of blood glucose.
According to Diabetes UK, many members of the public are concerned that the provision of test strips is patchy and inconsistent. Can the cabinet secretary assure me that the Scottish Government is taking steps to avoid that situation in Scotland and to ensure parity of access across all health boards?
It is for clinicians to determine the treatment regime that is best for each individual patient, taking into account the relevant local and national clinical guidelines, to which I referred in my previous reply. National clinical guidelines make it clear that people with diabetes who are treated with insulin should be provided with blood glucose test strips. However, current guidance suggests that, for people with diabetes who do not use insulin, self-monitoring of blood glucose may lack significant benefit, with little or no effect on glycaemic control, and is unlikely to be clinically effective or cost effective in addition to the usual care.
Ophthalmology Services (Shetland)
To ask the Scottish Government what assistance is being provided to deliver ophthalmology services in Shetland. (S4O-03231)
It is a matter for NHS Shetland to utilise its funding in the most appropriate way to meet local health needs and priorities, including the provision of ophthalmology services. The payments made by NHS Shetland for general ophthalmic services for the years for which data is available have risen from £342,000 in 2008-09 to £360,000 in 2012-13.
Is the cabinet secretary aware that the eye scans that many Shetland patients need can be carried out on a machine in an optician’s in Lerwick? Does he understand that that would save the national health service money, because patients would then not have to travel to Aberdeen royal infirmary? Will he undertake to cut through any NHS red tape that is stopping that process beginning in Shetland, so that the service is available at much greater convenience to patients and at a great saving to the NHS?
I would absolutely like to take up that suggestion and I will do everything that I can to facilitate that change. If the member writes to me with more detail, I will make sure that we cover every possible angle, because that is a commonsense approach to dealing with this issue.
Will the cabinet secretary update us on the progress of the provision of information technology links between optometrists and ophthalmic departments in Shetland and in other parts of the country?
We are making significant progress, but I will write to the member to give him a detailed update.
Accident and Emergency (Waiting Times)
To ask the Scottish Government what progress has been made toward meeting accident and emergency waiting times targets. (S4O-03232)
It is almost like portfolio question time for me today.
The Scottish Government is making good progress towards meeting accident and emergency waiting times targets. Since the February 2013 launch of the £50 million, three-year, national unscheduled care programme, there has been a measured improvement in the overall four-hour performance target from 90.3 per cent in December 2012 to 93.5 per cent in December 2013. There has also been a significant improvement in the number of patients waiting more than 12 hours. A comparison between December 2012 and December 2013 shows an 87 per cent reduction in patients waiting more than 12 hours, which is very welcome.
Each health board has a local unscheduled care action plan, which supports improvement in A and E waiting times. Additionally, boards are implementing lessons and best practice from across the country in order to bring about improved performance.
The Scottish Government works closely with the health boards to ensure that A and E performance reaches a sustained level of performance by not only reaching the interim target of 95 per cent but striving continually towards the 98 per cent standard.
I thank the cabinet secretary for that most extensive and thorough response. Last week’s Audit Scotland report states that 19 out of 31 A and E departments receive no referrals for admission from general practitioners. Is it the case that many patients are bypassing their GP, putting additional pressure on A and E departments? Is the Government doing any work to understand the issue?
In many cases, the GPs bypass the A and E procedure, rather than the patients bypassing the GPs, and the figures reflect that. That is all part and parcel of getting improvements rolled out in A and E across the country. Essentially, the key issue is patient flow. Therefore, rather than clogging up A and E, many health boards have an arrangement whereby, if the GP wants to make an admission, they can do so directly into the ward, rather than the patient needing to go through the A and E department.
What progress has the Scottish Government made in increasing the number of A and E consultants since taking office? What further progress is being made through the £50 million unscheduled care action plan?
Since taking office, we have increased the number of A and E consultants by 86.5 full-time equivalents from 75.8 to 162.3 full-time equivalents. That is a 114 per cent increase. The unscheduled care action plan has supported recruitment of an additional 18 of those A and E consultants. In year 2 of the three-year action plan, we will maintain a focus on achieving the A and E target, sustaining improvements and on whole-system approaches, creating local community partnerships where hospitals and primary community care services are aligned and focused on patients getting seen by the right member of the multidisciplinary team at the right time.
Does the cabinet secretary share my concerns about A and E waiting times in NHS Ayrshire and Arran and targets that have not been met? As he knows, that problem is exacerbated by a lack of available beds. What can the Scottish Government do to help resolve it?
Although NHS Ayrshire and Arran has not consistently met the 95 per cent target, it is much better than it used to be and is averaging just over 93 per cent.
The issue is not lack of bed capacity in Ayrshire; it is the flow of patients. Too low a percentage of the daily discharges are made in the morning or early afternoon, which means that beds in the wards are not being freed up to receive incoming patients from A and E and, indeed, normal admissions. That flow is at the core of many of the issues. We are doing many things, but that is why we are, for example, rolling out the use of electronic whiteboards across the country, because it improves the management of beds, patients and staffing throughout a hospital.
Cataract Operations
To ask the Scottish Government how many cataract operations the national health service performs each year. (S4O-03233)
The latest available information shows that activity has risen from 31,892 cataract procedures being carried out in NHS Scotland in 2008-09 to a provisional figure of 36,340 during 2012-13, which is an increase of 13.9 per cent.
Will the cabinet secretary outline to me what additional procedures are in place in patient treatment plans after cataract operations that lead to complications and how elderly patients can be reassured about the procedures, particularly if they are waiting for a second operation and did not have a good experience the first time round?
I will give a two-pronged reply to that. First, a standard follow-up procedure for every patient who gets a cataract operation is laid out in clinical guidelines and protocols. Under that, the consultants and related services follow up with the patient to check progress, to check, in particular, that the operation has been successful and to deal with any side effects that may arise.
Secondly, if a patient has had an unsatisfactory experience, they should use the complaints procedure in the health board to register their complaint or concern and ensure that it is dealt with. One of the changes that we are making across the national health service in Scotland is that complaints will be used not only to deal with the specific complaint but to provide management intelligence on where things are not running as smoothly as they could and should. In a number of health boards, every complaint is already treated as an adverse event. That is why I encourage every patient to use the complaints procedure.
Independent Scotland (State Pension)
To ask the Scottish Government what assessment it has made of the payment of the state pension in an independent Scotland. (S4O-03234)
It is time for a different cabinet secretary.
This week, the Scottish Government published updated research on the state pension and its impact in Scotland. It showed that men and women will get less in Scotland than those in the United Kingdom as a whole who have the same pension entitlement if we stay tied to the Westminster pension and welfare system. Our assessment of the payment of the state pension in Scotland is that we are well placed to afford a decent social security system, with welfare, including pensions, being consistently more affordable than in the United Kingdom. We are also well served in having much of the infrastructure in place to deliver a strong social security system.
Given the less than inspiring comments that we have heard from Labour over the past couple of days, does the cabinet secretary agree that it is a disgrace that Labour Party politicians are more interested in toeing the Tory line on the state pension age than in standing up for their constituents?
Annabelle Ewing highlights an issue of fairness. It cannot be fair that a 65-year-old can expect the lifetime value of their state pension to be about £11,000 less for women or £10,000 less for men in Scotland than in the UK as a whole based on the same entitlement. It is worth remembering that previous UK Governments do not have a strong record when it comes to protecting the state pension. They reduced its long-term value when they abolished the link between the state pension and earnings, and that was not restored by the Labour Government. We have already said that it is right and proper that, in an independent Scotland, we look again at raising the state pension age. We will do what we always do—act in the best interests of the people of Scotland.