Oncology (Aberdeen Royal Infirmary)
If everybody is sitting comfortably, we will begin. The next item of business is a members’ business debate on motion S4M-08606, in the name of Tavish Scott, on oncology at Aberdeen royal infirmary. The debate will be concluded without any question being put.
Motion debated,
That the Parliament understands that there is a continuing shortage of specialist clinical oncologists at Aberdeen Royal Infirmary to provide radiotherapy treatment and that patients across the north of Scotland including Orkney and Shetland who would normally be treated at Aberdeen Royal Infirmary have had to be transferred to other parts of Scotland; recognises that, during what can be an extremely turbulent and distressing time for patients and their families, high quality care is preferable as close to home as possible; considers that patients undertaking radiotherapy treatment from Orkney and Shetland have benefited greatly from the comfort, convenience and support of being able to stay at Aberdeen CLAN Haven but that patients are deprived of this service if they are transferred to other parts of the country, and recognises the need for NHS Grampian to have both the support and staff necessary to provide the people of the north of Scotland with high quality care.
12:34
In 2012, cancer was the cause of one third of all deaths of men and women in Shetland. The disease and how islanders tackle it are the reasons why I have initiated this parliamentary debate. I thank colleagues from my Liberal Democrat benches, the Conservatives and Labour for supporting the motion on oncology services at Aberdeen royal infirmary.
The shocking death statistics for Shetland highlight why the rising number of people who are in need of specialist cancer care is one of the great health challenges of the 21st century. Medical advances are enormous, but the investment in cancer research still has much further to go. Treatment of the disease depends on specialist medical staff across the varieties of cancer that afflict men and women. Trained staff are essential, and having enough trained staff is even more essential. Today in Parliament, I wish to highlight the importance of ARI having a full complement of trained expertise to diagnose, treat and continue helping people to fight cancer.
It is not just the granite city that depends on ARI for cancer care. Patients arrive from across the north-east and the islands. Orkney and Shetland send islanders to ARI for a variety of specialist care and procedures. Aberdeen is the closest major hospital to Shetland, but travel still means an hour’s flight south and a hospital transfer, or a 12-hour overnight ferry crossing. That is straightforward for the hale and hearty, but for those who are sick, worried and fearing the worst, a flight or the north boat is a major factor. I have shared too many planes home from Aberdeen with Shetlanders after hospital treatment, so I know that it is no picnic. With cancer treatment, and chemotherapy and radiotherapy in particular, the medical advice is to limit the stress of travel.
Let me share a couple of observations that have been made to me by Shetland general practitioners. Bixter’s GP said:
“The service provided by Aberdeen to all Shetland patients means keeping travel times and stress on patients and family to an absolute minimum”.
Citing the challenges for accompanying families, Yell’s GP said:
“Aberdeen is far enough to travel as it is, and if it were further relatives may not be able to visit.”
The arduous nature of cancer treatment dictates what the body and mind can endure. Resting between bouts of radiotherapy is essential. Returning home to Shetland between treatments is unrealistic and for many, frankly, impossible. Liam McArthur will mention that point, and I hope that the minister will listen carefully to what he says on it.
Geography dictates much of the cancer treatment pattern, which is why CLAN Haven in Aberdeen is so important. It is much more than just a place to stay; it is a centre of peace, love and emotional support for Shetlanders who are going through the mental and physical efforts of care. Cancer patients stay for free and families accompanying them stay for a fraction of the cost of a hotel in the overheated Aberdeen economy. I stress the importance of a loved one accompanying a cancer patient. The emotional turmoil of the disease is absolutely enormous, so a wife, husband, nephew or just a friend is absolutely critical. They need somewhere to stay, which is why CLAN is so good.
Shetland raised more than £600,000 for the new CLAN Haven. The redoubtable Debbie Thomson has shown me round. It is a wonderful place with wonderful staff. Last year, 39 Shetlanders stayed at CLAN while they received radiotherapy, which was for an average of 27 nights each. That is how important it is.
Just last week, the national health service north of Scotland planning group acknowledged that. It said:
“What has been evident in organising external support has been the difficulties in co-ordinating accommodation”.
It continued:
“NHS Grampian in collaboration with CLAN provide a first-class service for accommodation support which other Boards find difficult to match.”
That is a powerful testament to the service, which is arranged to help islanders in Aberdeen and which is not replicated elsewhere. It is also why, for islanders, being referred elsewhere should be the last resort and should be based on a particular clinical need and not a shortage of oncology staff at ARI.
When people started approaching me last year saying that ARI’s oncology department was understaffed, alarm bells rang. In October, a constituent wrote to me saying:
“I was down in Aberdeen yesterday seeing my oncologist half way through my chemo. Part of this was to plan my radiotherapy. He hit me with a bit of a bombshell. It turns out that due to a lack of oncologists who specialise in radiotherapy I may have to receive my treatment in Glasgow, Edinburgh, Dundee or Inverness.”
As it turns out, following pressure from NHS Shetland, Shetland-based GPs, patients and many other people, such travelling has been minimised. In his letter to me on 18 November, in response to my representations, the Cabinet Secretary for Health and Wellbeing said that ARI was three consultants under the complement required to cope with the workload. I understand that the number has now been reduced to one.
The chief executive of NHS Grampian has said that the number of north isles patients who have been referred elsewhere in Scotland is very small, which I very much welcome. That proves that pressure can pay off, but it is clear what would have happened if the matter had not been pushed. I thank the cabinet secretary, who responded to my representations, and I hope that Alex Neil will maintain the pressure.
NHS Grampian tells me that oncology is still understaffed. I thank Mr Carey for his candour. There has been a variety of temporary staff—locums—and that is not good for continuity of care or keeping NHS Grampian’s budget in order. Shetland GPs have made me aware of complaints regarding a locum at ARI, who is no longer practising in Aberdeen. That rather makes the point about permanent staff and the importance of quality of care; it also highlights the inherent weaknesses of a system that depends on locums.
The wider picture must surely be addressed. Why is there a shortage of oncologists? Is the power of medical schools and the teaching hospitals across the United Kingdom too great? The training of specialist cancer care staff for five or more years into the future is taking place now. There must be an argument for training more staff rather than fewer. The quantity of temporary appointments, not just in cancer care but across other specialisms, means that too much of the NHS budget is spent on higher payments to short-term staff. That is not desirable, and I hope that ministers are giving the matter considerable attention.
Shetland and Orkney patients need cancer care of the highest quality, in the closest hospital to the isles. The NHS faces the challenge of reducing the enormous stress and worry of a killer disease, which is responsible for a third of male and female deaths in Shetland. That challenge is best met not by referring people across Scotland but in Aberdeen and in as local a health setting as possible, where the support of family and loved ones is easier to arrange and maintain throughout treatment.
I ask the Scottish Government to recognise the issue, not just in January 2014 but for every January, and to work with NHS Grampian and the island health boards to deliver the cancer care that my constituents need.
12:42
I congratulate Tavish Scott on bringing this important issue for debate. He has rightly highlighted the impact on patients and their families from Shetland and Orkney who must now travel to the central belt for care and treatment that used to be but is currently not always available in Aberdeen.
I have family connections with Shetland, as Mr Scott knows, and I am keenly aware of the close ties between the islands and Aberdeen, in healthcare and much besides. One such tie is CLAN—Cancer Link Aberdeen and North—which provides outstanding support for cancer patients and their families who travel to Aberdeen for treatment from across the north and north-east of Scotland, as well as the northern isles. I pay tribute to that work, as Mr Scott did.
I also mention CALICO—Cancer and Leukaemia in Children Orientated—which works to support children with cancer and their families in the north-east. Last year, CALICO drew my attention to its concerns about the planned retirement of the radiation oncologist at Aberdeen royal infirmary, who has specialised in radiotherapy for children with cancer—that was one of three oncologist retirements in the offing. If the individual is not replaced by a consultant who is able to deliver the same service, far more children might have to travel to the central belt for treatment in future.
Although it was willing and able to provide information, NHS Grampian could not tell me whether or when a new consultant with the same level of specialism will be recruited. It would be a tragedy if such a valuable service were to be lost from Aberdeen, particularly if that were to happen by default. It is one thing to plan the delivery of services in the context of a managed clinical network; it is quite another to lose local services through an inability to recruit staff.
Families understand that there will be times when a child is required to travel to Glasgow or elsewhere for a specific treatment, but most curative and palliative radiotherapy has been delivered locally in Aberdeen in the past, and the families very much want that approach to continue.
It is not just an issue for children. Over the past few months, as has been said, many other patients have had to travel to the central belt for cancer treatment. That can be extremely hard for seriously ill adults as well as for children and families. Again, that comes down to difficulties with recruitment. It is up to the Scottish Government to help to meet those difficulties.
Last month, Alex Neil told Parliament that every post that had been reported to be vacant for more than three months had been filled as a result of joint working between the relevant NHS board and the Scottish Government. Clearly, that is welcome, but three months is a long time for cancer patients who need treatment. When a number of oncologists are reaching planned retirement dates at much the same time—as has happened recently in Aberdeen—more could and should be done to recruit consultants and ensure that properly trained people are available in advance of those dates. That is surely the point of workforce planning.
In the meantime, I hope that the minister can undertake today to work with NHS Grampian to ensure that the post of radiation oncologist specialising in radiotherapy for children will be filled. I also hope that ministers will look again at the case for supplementary pay for NHS staff in Grampian, where recruitment at all grades is hampered by a high cost of living that is comparable only with that of greater London.
Quite apart from pay, the funding of NHS Grampian still falls more than £30 million short of what it should be under the NHS Scotland resource allocation committee formula that was calculated and endorsed by the Government as long ago as 2007. There is surely scope for a positive initiative to support recruitment and retention in NHS Grampian, as well as specific action on oncology. I hope that ministers will take steps in that direction after the debate.
12:46
I, too, congratulate Tavish Scott on bringing this very important debate to the chamber. Patient care is of great concern to all of us, and those who are suffering from cancer certainly require the utmost care.
NHS Grampian has said that there was an unprecedented problem with recruitment due to the specialism of oncology, and it basically said that there were the same problems in NHS Highland and NHS Tayside. It seems to me that there is a lack of recognition of those posts in recruitment. There was maternity leave, but surely NHS Grampian would be able to put in place appropriate cover for things such as maternity leave.
NHS Grampian has had 33 patients receiving treatment outwith its area—in Glasgow and Edinburgh—based, it says, on clinical need and priority. That is 33 patients too many. As Tavish Scott and Lewis Macdonald rightly said, the anxiety of those patients and their families and carers has been compounded by the fact that they have had to move outwith the area. The logistics involved in patients having to go to Edinburgh or Glasgow may often not be supported by their friends or relatives.
The work and support that CLAN provides in Aberdeen are immeasurable. Obviously, the support that is given is welcomed, and what it does for patients is immeasurable. We need to acknowledge that. NHS Grampian is failing if it does not recognise the absolute importance of that on-going care.
I recognise that NHS Grampian took steps on recruitment in October and November, and that, just last week, it recruited a new oncology specialist. That is to be welcomed, but it still begs the question: why did that take so long? If there is a national problem in oncology recruitment in NHS boards in Scotland, the minister and the cabinet secretary should ask why.
To provide appropriate care for our cancer patients throughout the Grampian area, especially those who come from islands such as Shetland and Orkney, we need to ensure that they are given an even higher priority than perhaps those who live within city boundaries.
We need to ensure that NHS Grampian has a plan to ensure that we do not get into the position of, as the board has said, facing an unprecedented and very difficult problem, such as it has experienced recently. It is definitely down to a lack of planning. NHS Grampian needs to resolve that problem for the future.
We have to look at what else could be done to provide appropriate care for those who are having to travel from Shetland and Orkney, who Tavish Scott mentioned. He said that it is “no picnic” for them. Absolutely, but it is no picnic for those who travel from the far reaches of Aberdeenshire either. Patients have to travel into the city of Aberdeen from areas such as Braemar and Aboyne, and I assure Tavish Scott that it takes just as long to get to the Aberdeen royal from those areas as it takes to fly there from Shetland.
I believe that NHS Grampian needs to resolve this problem quickly. Richard Carey and the board are taking the appropriate steps. However, if we look at the target for referral to treatment, we can see that the board did not perform particularly well in 2013.
You might want to draw to a close soon, please.
Yes, Presiding Officer.
I know that the board hopes to resolve that problem and to reach the 95 per cent referral to treatment target in the very near future.
I congratulate Tavish Scott on bringing this important debate to the chamber. I sincerely hope that NHS Grampian can resolve this problem for the patients of the future.
12:51
I congratulate Tavish Scott on gaining the cross-party support to allow this important and topical issue to be discussed here today. Although the debate focuses specifically on the recent staffing problems experienced in Aberdeen, the issue is a further illustration of the sort of pressures on today’s NHS that were discussed in the chamber only yesterday afternoon.
I am grateful to NHS Grampian for sending an up-to-date briefing on the oncology service in that part of my region. It is clear that the board has faced serious workforce challenges, which it has been tackling since October last year, with some positive outcomes.
During the second half of 2013, Grampian was affected—as were other health boards in the north of Scotland, including NHS Highland and NHS Tayside—by a national shortage of suitably qualified oncologists, especially specialists in neuro-oncology and head and neck cancers. That was compounded by a number of short-term vacancies due to maternity leave, for example.
To overcome that, the board has been actively trying to find new staff, such as by recruiting a new full-time consultant clinical oncologist, who is now in post, as Dennis Robertson said; advertising for a part-time consultant medical oncologist post, which is currently attracting experienced applicants; getting locum cover for maternity leave; appointing a nurse specialist in genitourinary oncology; and opening up bed space capacity with healthcare worker support in the new emergency care centre, among other specific actions to try to overcome workforce problems.
All that comes at a significant estimated extra cost for 2014-15 of more than £1.3 million, which is largely to be funded from NHS Grampian’s own resources—which, as Lewis Macdonald said, are currently underfunded compared to other health boards—with a small contribution from the Scottish Government via its detect cancer early initiative.
The situation is therefore now better than it was three months ago, but in the meantime patients have had to go elsewhere for specialist treatment, hence this debate.
Clearly the first priority has to be to ensure that patients with cancer or any other serious condition are given the most effective and safest treatment for their condition. If that means that they have to travel some distance for it, so be it, but I have a great deal of sympathy for Tavish Scott’s constituents from Shetland, and patients from Orkney, for whom Aberdeen is the nearest specialist centre.
Those islanders have, over many years, accepted the journey to Aberdeen and the need to stay there during treatment, and they have become familiar with the excellent facilities provided by CLAN, particularly its new CLAN Haven residential wing, which I visited recently and which is indeed very impressive. For those patients to be told that they will have to go even further for their treatment, to hospitals in the central belt, must put significant added stress on them and their families, who are already traumatised by a devastating diagnosis.
Treatment for cancer, be it chemotherapy or radiotherapy, can be very unpleasant and very tiring for patients, and the psychological stress can be even worse. That is only compounded by their being far from home in unfamiliar surroundings and away from family and friends, which in itself can hinder recovery.
It is extremely important to give patients every possible support, both physical and psychological. That is where CLAN Haven is so effective. Great appreciation for its facilities has been expressed to me by friends in Aberdeenshire who have stayed there while having treatment at Aberdeen royal infirmary.
The recent situation at the infirmary is a worrying indicator of the workforce pressures on the NHS in Scotland, which are undoubtedly going to increase as the population ages and the incidence of cancer and degenerative diseases grows as predicted. NHS Grampian has clearly been trying very hard to resolve the situation, but I fear that we can expect to hear of similar experiences throughout Scotland as time goes on.
Again, I thank Tavish Scott for highlighting the very serious issue of oncology provision in Aberdeen on behalf of his constituents, and I wish them well for the future, with treatment hopefully available at least a little closer to home.
12:55
Like others, I offer my congratulations to my friend and colleague Tavish Scott on allowing Parliament to debate this serious issue today. The issues that Tavish Scott outlined in relation to the experience of his constituents reflect very much the experience of my constituents in Orkney. I echo his remarks and will try to make some additional points that I think are relevant to the debate.
At the outset, like Lewis Macdonald, Nanette Milne, Dennis Robertson and, indeed, Tavish Scott, I put on record my admiration for and gratitude to the staff and volunteers at CLAN, who do such tremendous work on behalf of cancer sufferers and their families, not just on the islands but across the north-east, as Lewis Macdonald highlighted.
I declare a personal interest, in that my father was diagnosed with prostate cancer a couple of years ago. Thankfully, surgery and treatment proved highly effective, further illustrating the importance of getting oneself checked regularly and the markedly improved recovery and survival rates for those whose cancer is detected and diagnosed early. I know how invaluable not just my father but my mother found the support provided by CLAN both in Aberdeen and in Orkney. The advice, the therapies and the opportunity to talk to others going through a similar experience all helped at the most difficult of times. Of course, the accommodation provided by CLAN was particularly welcome. Again, that does not just apply to Aberdeen. As residents of one of the outer north isles in Orkney, my parents were often required to overnight in Kirkwall en route to and from appointments or treatment in Aberdeen. They were therefore extremely grateful to be able to access CLAN’s facilities in the toon. My parents’ experience was highly typical of that of many of my constituents.
As Tavish Scott intimated, I will highlight a specific concern that I have about changes that I believe are being considered to the way in which the health boards in Grampian, Orkney and Shetland support those from the islands who are undergoing cancer treatment. During a visit that I made to CLAN earlier this week, I was told that, despite its popularity with patients and their families, the Haven is currently operating at a loss of around £100,000 per year. Although fundraising efforts, not least in Orkney and Shetland, have proved phenomenally successful over the years, there are issues around core funding.
Debbie Thomson explained that CLAN has requested an increase from £30 to £35 a night, which would still not cover the full costs but would at least reduce the overall deficit. However, I understand that NHS Grampian and the island health boards are considering a scheme whereby patients would have their costs paid Monday through Thursday but would be expected to return home on Friday for the weekend. I am not clear about the circumstances in which that would apply, but it strikes me as utter madness in terms of the welfare and wellbeing of patients undergoing or trying to recover from surgery or treatment. As Tavish Scott highlighted, the strain placed on patients from travelling back and forth for treatment takes its toll, and it would be bordering on the intolerable if they had to do that every weekend. For those who live in the smaller islands, such as my parents, it would be logistically impossible. Moreover, I cannot see any cost saving. The travel costs would be borne centrally, rather than by individual boards, so perhaps that provides boards with a perverse incentive to act in the way that is proposed. Perhaps the minister can address the proposal in his winding-up speech, or at least give an assurance that he will look into it as a matter of urgency for the sake of patients in my constituency and in Shetland.
CLAN is not just a resource for those from the islands. The importance of the support structure that it, the Red Cross and others provide for those who find themselves far from home for lengthy periods, often under severe physical and emotional stress, really cannot be overstated. That is why there has been such concern about the implications of staffing shortages in the oncology department at Aberdeen royal infirmary. I know that other hospitals and health boards have been similarly affected, but I believe that nowhere else has the same concentration of patients being treated for a variety of cancers who have to travel such long distances and find themselves so far from their network of family and friends.
As Tavish Scott said, the numbers of Orkney and Shetland patients who have been unable to receive treatment in Aberdeen have been mercifully low, and it appears that Aberdeen now has only a single consultant vacancy left to fill. Like Tavish Scott, I acknowledge the efforts of Richard Carey and his team at NHS Grampian, as well as the intervention of the health secretary at the back end of last year. However, I associate myself with some of the questions that Dennis Robertson asked about how things were allowed to get to the stage that they were at during the latter part of last year. I also think that Tavish Scott’s points about the need for permanent appointments to ensure continuity and quality of care were well made.
A careful watching brief will certainly need to be kept on the issue. For now, I congratulate Tavish Scott once again on giving the Parliament an opportunity to debate these important issues. With my Movember ambassador hat on, I conclude by urging anyone who is watching, listening to or reading this debate to get themselves checked.
13:00
I congratulate Tavish Scott on bringing the debate to the chamber. Clearly, I am not speaking as a local member, but I am pleased, with Nanette Milne, to be co-convener of the cross-party group on cancer. I also think that the debate raises interesting general issues. First, it raises the issue of the staffing of radiotherapy centres, but it also reminds us of what I regard as an important principle: that healthcare should be provided as near to home as is clinically appropriate.
At a fairly recent meeting of the cross-party group, which discussed radiotherapy, Professor Alan Rodger, former director of the Beatson centre, reminded us of the importance of radiotherapy, which not everybody recognises. He talked about a survey that showed that 89 per cent of people had heard about radiotherapy but only 9 nine per cent thought that it was a modern cancer treatment. How wrong the rest are. Quite apart from its palliative role, far more people are cured by radiotherapy than by chemotherapy. Again according to Professor Rodger, research suggests that 52 per cent of cancer patients can benefit from radiotherapy; he also said that the percentage receiving it in Scotland is 45 per cent, ahead of England, where the figure is 37 per cent.
Because of the increasing incidence of cancer with an elderly population, there is clearly a rising demand for services, and some of the general pressures are illustrated by what has been happening in Aberdeen. It took me back to the beginning of the century, when we had the enormous crisis at the Beatson cancer centre based on several staff shortages in different clinical grades, but particularly a shortage of clinical oncologists. Since then, there has been a general improvement with far more clinical oncologists being employed across Scotland and the development of new forms of radiotherapy such as intensity-modulated radiotherapy. However, today we hear that, once again, there is a problem with the number of clinical oncologists—and not just in Aberdeen, as there are also great pressures on cancer centres in the central belt. There are clearly other shortages as well, particularly of physicists, but clinical oncology is the particular focus of the debate today.
I mentioned the principle that care should be provided as near to home as is clinically appropriate. Clearly, for radiotherapy, that cannot be on people’s doorsteps. People have to go to one of the five cancer centres in Scotland, and Aberdeen is certainly the appropriate one for Tavish Scott’s constituents. Chemotherapy can be delivered in Shetland, Orkney and all sorts of localities, and I believe that that is increasingly happening. That has been a great development. However, for radiotherapy, Aberdeen is the appropriate place. I share the local members’ concerns about the problems that have arisen in Aberdeen, particularly in relation to clinical oncology.
I am told, and Tavish Scott reminded us, that the situation has improved recently, no doubt partly due to his campaigning and that of my colleagues Lewis Macdonald and Richard Baker, but it illustrates the problem that there is a national shortage of clinical oncologists, which has been even more serious in Aberdeen than in some other places. The matter clearly continues to demand the attention of the Scottish Government and indeed the UK Government.
The other important point that Tavish Scott made is that there are particular reasons for his constituents wanting to receive treatment in Aberdeen given the superb services that are provided by CLAN Haven. I watched the video on its website before the debate and I was impressed, as others have been who have seen the service at first hand. It reminds us of the importance of person-centred, holistic care as part of cancer treatment. CLAN Haven clearly provides that. That is another reason why treatment must be provided in Aberdeen for all those for whom it is the appropriate centre.
13:05
Like others, I offer my congratulations to Tavish Scott on securing time for this important debate. I have listened with interest to all the local members who raised concerns about services in the north of the country. I fully understand the concerns that Tavish Scott and Liam McArthur raised about their constituents, who are going through a stressful and difficult time in undergoing cancer treatment, with the stress and the difficulty compounded by the associated travel. I fully appreciate the challenges that that creates. Those challenges are why we are particularly grateful for the hard work and generosity of the CLAN organisation in Aberdeen and at CLAN Haven, which provides invaluable support to people who are affected by cancer.
I understand Liam McArthur’s concerns regarding the changes that NHS Grampian is considering. I will have those issues looked into and will provide a response to him. I stand ready to meet him to discuss the matter if he continues to be concerned by the board’s approach.
I recognise the stress and strain that the staff in NHS Grampian have been under. Our NHS staff have worked tremendously hard to sustain services as best they can within the staff limitations that they have faced. I acknowledge that and thank them for their work during what has been a stressful period.
Tavish Scott recognised that the Scottish Government acknowledges that the problem is a priority that must be resolved and dealt with effectively, as was set out in the cabinet secretary’s response to him last year. Unfortunately, the situation that has developed in the north of Scotland has come about as a result of a unique combination of factors, some planned for and some not planned for. For example, people have retired or gone on maternity or sick leave, and there have been multiple failed attempts to recruit to the workforce to deal with the pressures. Those have all impacted on the service’s capacity and capability to deliver all the cancer services that it would wish to deliver, including radiotherapy.
Radiotherapy is extremely important, because 40 per cent of people with cancer receive it. Only surgery cures more patients; radiotherapy cures more patients than many of the new cancer drugs put together. We are absolutely determined to deliver radiotherapy services across the country and to ensure that they are on a secure and sustainable footing now and into the future. We are working with a range of parties to make that happen.
The minister is seeking to sustain radiotherapy services. Will he confirm that that will include curative radiotherapy for children in Aberdeen?
I will address some of the local issues, including, I hope, that point. As Lewis Macdonald will be aware, two people have been recruited: one started in a clinical oncologist post on 6 January, and the other is expected to start at the end of this month. Between them they will cover a range of areas, from head and neck and neuro-oncology to gastrointestinal, colorectal and urological cancers. I will ensure that Lewis Macdonald gets details on further recruitment, particularly around services for children.
Once the Scottish Government became aware of the problems that were being experienced in the north of the country, we put in place a working group, led by the national planning forum, to address the wider issues of sustainability and specialist services.
I hear members’ questions about why some of the issues, particularly the planned issues, were not picked up earlier. I think that there are some lessons for boards to learn about having proper succession plans in place to deal with such things. Of course, some of that is compromised by the challenge that boards can face in recruiting the right clinical specialists; indeed, that can be a challenge for the whole United Kingdom, not just Scotland.
To ensure greater sustainability in services, we have also reached agreement on creating a virtual single service in the three cancer sites across the north—in NHS Tayside, NHS Highland and NHS Grampian—to ensure that they work more closely together, provide cross-cover and support continuity of care.
Does that collaborative work across the three areas mean that the consultants and trained staff will cover one another, instead of patients having to move between Inverness, Aberdeen and other locations?
There might be an opportunity for both approaches. As the member will acknowledge, certain technical aspects of a patient’s treatment might need to be provided in a particular setting. The aim is to use staff much more effectively over the three areas but, on occasion, there might need to be a more effective use of resources. That might be more the case with regard to arrangements between NHS Highland and NHS Grampian than those between NHS Grampian and NHS Tayside, given the facilities at NHS Highland’s Raigmore hospital.
I am satisfied that we are trying to do everything possible to retain and maintain local radiotherapy treatment but I am sure that all members will recognise—indeed, some have pointed this out already—that that will not always be possible, given the specialist nature of the care, for which, at times, patients will have to travel elsewhere. That is why we have reached agreement on care pathways into the cancer centres in Glasgow and Edinburgh for patients who need expertise that cannot be delivered locally. That agreement will allow them to receive treatment much more quickly and will avoid delays. I hope that the use of such an approach will be kept to a minimum, but it will be clinically determined instead of being a policy matter.
I believe that 42 people have had to be referred out of the north of Scotland for treatment during this particularly trying period. Of that total, 33 have begun their treatment; I understand that the others have not begun theirs for clinical reasons. However, all members will agree that we must ensure that patients access the specialist services that they require as quickly as possible.
I reassure members that we are determined to continue to provide across the NHS in Scotland clinical services of the best quality and standard in cancer and other areas. Over the past number of years, we have put additional investment into services and taken forward a range of measures to improve them, and we will continue to monitor the progress that is being made in the north of Scotland to ensure that the shortfall that was experienced over several months is being sufficiently addressed and that we have in the north of Scotland sustainable services in the medium and long term for all patients who require them.
13:13
Meeting suspended.
14:00
On resuming—