SCOTTISH EXECUTIVE
General Questions
Methadone
To ask the Scottish Executive what steps it is taking to ensure that the prescription and dispensing of methadone take account of patients' social factors, such as employment, in accordance with existing guidelines. (S2O-10194)
Decisions on prescribing and dispensing methadone are taken by individual prescribers in the context of the current United Kingdom 1999 guidelines, "Drug Misuse and Dependence: Guidelines on Clinical Management" and of any local health board protocols and policies. There is no specific reference to social factors such as employment in the guidelines. The guidelines on supervised consumption may be relaxed if the patient is stable and the prescriber is satisfied that compliance will be maintained. That allows the prescriber to consider social factors when deciding on what basis methadone should be prescribed and dispensed. Scottish Executive officials will be participating in the forthcoming update of the UK guidelines, and that will provide an opportunity to consider their scope more widely.
The guidelines to which the minister refers indicate the importance of methadone being made available at a time that allows the patient to work. I am sure that we are all aware of concerns around this issue, and that we recognise the legitimate issues regarding child safety in particular. Will the minister ensure that, in considering policy and practice in this regard, we recognise the vital role that methadone can play in enabling many individuals to enter and hold down employment? Does he recognise the importance of consistency with the Executive's employability framework, which was published this week? Will he ensure that each individual's needs are taken into account in deciding how, when and where methadone is prescribed and dispensed?
I absolutely agree with the member's view that methadone is a critical aspect of our approach. Like all health services, its prescription should be designed around the needs of the user. We should be more flexible in allowing people to go to work and fully participate in society. That underpins our methadone programme. If a user is stable and compliant and if methadone can be dispensed to them in a way that enhances their employment opportunities, I believe that that aids rehabilitation and results in what we all want, which is that person getting back into society and not being reliant on methadone. I will happily take up the matter and consult health board chairs and chief executives to ensure that, like all services in the health service, methadone services are designed around the needs of the user. If it is appropriate—if the patient is stable and compliant in relation to methadone use—we will seek to work with them to ensure that they gain full employment.
Can the minister outline what action the Executive is taking to establish exactly how many people in Scotland are prescribed methadone?
We are working on the matter now. The current estimate is that about 19,200 people are on methadone programmes, but we want to investigate that figure further, in relation not only to the global number, but to the other factors concerning those who are currently receiving methadone. That research will contribute to our work in reviewing the UK policy, and it will allow us to pursue further a number of our agendas, including that around hidden harm, with the aim of ensuring that no one is at risk of methadone abuse—or indeed of finding themselves in situations similar to those that have applied in recent tragic cases.
Out-of-hours Health Care
To ask the Scottish Executive what account it takes of the views of members of the public when designing the out-of-hours health care service. (S2O-10174)
The design of out-of-hours health care services is a responsibility that transferred to national health service boards on the introduction of the new general medical services contract. The National Health Service Reform (Scotland) Act 2004 places a duty on NHS boards to involve the public in service redesign. In addition, each community health partnership needs to maintain an effective and formal dialogue with its local communities through public partnership forums to ensure the systematic, continuous engagement of local users and carers in determining priorities and the quality of the services that are delivered to local people.
The minister will be aware that the first NHS appeals panel to decide that a general practitioner should be permitted to opt out of providing 24-hour medical cover—against the wishes of the health board—made that decision in the remote Rannoch and Tummel area in my constituency. Does the minister share my concern that, while the panel considered evidence from the health board and the GP practice involved, it undertook no meaningful consultation with the local community? Does the minister agree that that contravenes the standards of consultation that he has set for boards and which he enforces? As a result of that, will he order a re-examination of this flawed decision, which is putting at risk the safety of patients in my constituency?
The member has, quite correctly, raised this matter in a number of different ways on a number of occasions and I share some of his concerns.
In the 2005 social attitude survey of the health service, the public expressed a low level of satisfaction with NHS 24, which plays a crucial role in the out-of-hours arrangements. What is the minister doing to improve that perception? Will he go further in developing the localised system of mini-centres that, I believe, will help to improve response time and patient relations and satisfaction levels?
I am not sure where the member has been for the past 12 months but I have to say that the revolution that has taken place in the service that is provided by NHS 24 is evident. It performed extremely well under great pressure at the Christmas and new year period. Similarly, over the Easter weekend when NHS 24 was again the front line of our national health service, it provided a high-quality service.
Schools (Healthy Eating)
To ask the Scottish Executive what progress it is making in promoting healthy eating in schools. (S2O-10200)
The Scottish Executive is making good progress in promoting healthy eating in schools, principally through its hungry for success programme.
I am sure that the minister is aware of examples of good practice in some schools. For example, pupils in Burgh primary school in my constituency have set up a scheme called groovy smoothies, which makes healthy, fresh-fruit smoothies twice a week to help pupils increase their fruit consumption. Can the minister assure me that the Executive will use such examples of good practice to ensure that other schools can benefit from healthy eating initiatives?
The primary school that Janis Hughes mentioned is doing exactly the kind of work that we want to happen in many primary schools. The intention of the hungry for success programme, with all the co-ordinators and other staff who are employed in relation to it, is that such best practice can be shared with other schools. I am glad to say that the kind of programme that Janis Hughes mentioned is becoming much more common across Scotland, because we are making a great deal of progress in our primary and secondary schools towards changing the eating habits of the nation. We have much further to go, however, and I am more than happy to mention any examples of good practice to any school that I visit.
Is the Executive content that the latest figures show that only 18 per cent of children are eligible for free school meals while, shockingly, the percentage of children in poverty is now 23 per cent? Will ministers use their powers under the Education (School Meals) (Scotland) Act 2003 to extend eligibility for free school meals to at least all those children who are living in poverty?
Robin Harper raises an important point. Notwithstanding his point that it might be possible to extend entitlement, one issue that confronts our school meals service is that those who are entitled to free school meals are not taking them up. That is related to poverty in our society.
Young People Leaving Care
To ask the Scottish Executive what percentage of young people leaving care are not in employment, education or training, broken down according to whether the last care placement was in (a) foster care, (b) residential care or (c) a children's home. (S2O-10208)
At 31 March 2005, 59 per cent of care leavers who were receiving aftercare support and whose economic status was known were not in employment, education or training. That is unacceptable. That is why, earlier this week, we announced a full strategy to tackle the issues around those who are not in employment, education or training, including looked-after children.
I am alarmed that almost two thirds of young people leaving care are not in education, employment or training. Does the minister share my view that young people in care are our most vulnerable young people in Scotland and that anything that can be done to reduce the figure of 59 per cent would be welcome? Does he agree that it is appropriate to focus resources for NEETs—that is the acronym for those who are not in education, employment or training—on individuals who are in care?
Frank McAveety is right to suggest that the figure is unacceptable. I said that it is unacceptable in my answer. This is one of the biggest challenges that we have in our education system. We know that, historically, educational outcomes for young people who are looked after by the state in one way or another—whether they are in foster care, in residential care, living with their own family while under a supervision order or in another setting—are significantly poorer than the outcomes for the remainder of the population. That is why we are trying to focus more action on looked-after children through our NEET strategy.
In spite of the best efforts of those who are involved in the care and education systems, outcomes for those who are in public care stubbornly remain poor. Does the minister agree that some vulnerable young people are inappropriately left at home rather than becoming looked after? If we are to improve the life chances of those youngsters, it is vital that we have a properly joined-up care and education system so that outcomes are dramatically improved and we make a real difference, rather than the situation being equally bleak whether the child is left at home or placed in public care.
Scott Barrie raises an important point. He has a depth of understanding of the issues because of his background. The group that I am chairing, which brings together interests from the care sector, the education sector and the voluntary sector, is specifically considering how we can remove the impediments to improving performance in the area; how we can change procedures; and how we can raise our expectations—and those of the agencies and people who work with them—for that group of young people. We want to ensure that nobody in our society is left behind. That is a major challenge and victory will not be won overnight, but we are determined, in time, to turn things around and the matter will get more and more attention.
Affordable Housing
To ask the Scottish Executive how it ensures that local authorities implement plans to provide affordable housing. (S2O-10190)
The Housing (Scotland) Act 2001 places on local authorities a statutory requirement to assess housing needs in their areas and to produce local housing strategies to address those needs. Those strategies inform the allocation of funding through Communities Scotland for the development of new affordable housing. If a housing needs assessment says that affordable housing is needed, the local authority should translate that need into planning policy, to gain affordable housing contributions from private housing developments.
Does the minister share my concern that, in Aberdeen, developers are being allowed to buy themselves out of their commitment to provide affordable housing on new developments through commuted payments that might never be used to provide affordable homes? Does he agree that there are no barriers to ensuring that such developments include affordable housing now? Does he share my concern that Aberdeen City Council's administration should put into action its stated intention to provide more affordable homes?
Affordable housing is needed in Aberdeen, so I am concerned that the council there has not translated that into planning policy to gain affordable housing contributions, as described in my previous answer. That is a very important tool that councils have; we introduced planning advice note 74 last year to facilitate its use. The council should take action on those lines.
Does the minister consider that it would be useful for councils to include housing association developments for rent in their biennial housing land supply audits? Will he consider issuing guidance to councils to require them to do that? Will the minister consider requiring those audits to be submitted to the Executive, so that he can monitor the emergence and maintenance of an adequate land supply for housing association developments for rent?
I am extremely concerned about land supply for affordable housing, which is why I will chair an affordable housing group, which will meet in the near future. We shall certainly consider the issues to which Murray Tosh referred, as well as all the other issues that are relevant to the acquisition of land for affordable housing.
Given that the ability to connect to mains sewerage is one of the main obstacles to the development of affordable housing and other housing in rural areas, is the minister happy with the progress that Scottish Water is making on developing its plans for quality and standards III?
Scottish Water has just produced its delivery plan, which is an important step forward. I have expressed several times my dissatisfaction hitherto, but we know of the new significant investment that the Executive will make from this year for the next eight years. I am sure that that will address substantially the issues about which Alasdair Morgan is understandably concerned.
Education (Guidance)
To ask the Scottish Executive how many pages of guidance on education have been issued to schools and local authorities since 1999 and how many pages have been withdrawn. (S2O-10188)
The requested information is not held by the Scottish Executive.
That is disappointing, because the Government in England and Wales holds such information. How on earth can the minister manage the paperwork and bureaucracy that are passed on to schools and local authorities if he cannot even tell us how many pages of guidance are in force?
Education is not about producing and counting pages of guidance. I can imagine few less productive tasks for Government officials than that, and I seem to recall that, under the Conservatives, counting lamp posts under their job creation schemes was an issue.
Before First Minister's question time, I welcome a delegation in the gallery from the National People's Congress of China. [Applause.]