SCOTTISH EXECUTIVE
Health and Community Care
Palliative Care
To ask the Scottish Executive how it expects national health service boards to provide support for specialist palliative care across Scotland. (S2O-9894)
We expect NHS boards to have in place a palliative care strategy for their area and, in that context, to fund 50 per cent of the agreed annual running costs of voluntary sector hospices that provide palliative care.
Does Lewis Macdonald agree that it is unacceptable that the Western Isles NHS Board has failed to agree and put in place a service level agreement for medical cover at the Bethesda hospice in Stornoway? Does he agree that it is far from acceptable that many of the letters on the matter that the Bethesda management have sent to the NHS board since January have not even been acknowledged? Further, does he agree that we need a degree of tolerance and common sense to prevail in the regulation of facilities such as Bethesda, which is a four-bed hospice in the Western Isles? Will he support me in trying to put in place a system that will allow the continuation beyond the end of this month of specialist palliative care in the one and only hospice in the outer Hebrides, avoiding the closure of what is an excellent and highly regarded facility?
It is important to ensure the provision of palliative care to people as close to their communities as possible, although any hospice provision must meet the appropriate statutory requirements. In the circumstances that Alasdair Morrison described, I expect payments to continue under the previous year's service level agreement until a new agreement is in place. I certainly expect the management of Bethesda and the health board to engage in constructive dialogue to resolve the issues.
We welcome the support for the Bethesda hospice. I understand that, once again, services are being put in doubt because of the Western Isles NHS Board's financial situation. We hope that ministers will acknowledge that. A positive outcome could be achieved through a new arrangement under which care homes would upgrade their services to provide palliative care. Does the minister have that in mind as a future option for the Bethesda hospice?
As I said, the expectation is that NHS boards throughout Scotland will support voluntary sector hospices. We acknowledge that hospices provide a significant service that is particularly sensitive to patients and their families. We want that to continue, which I expect to happen in the case of the combined care home and hospice facility that Alasdair Morrison asked about and in other cases. However, the statutory requirements must be complied with, including the requirement for the Scottish Commission for the Regulation of Care to inspect homes biannually. We must also ensure that the standards of medical support and provision are appropriate for the circumstances.
I draw to the minister's attention the extent to which fundraising is required to maintain our hospices. The largest hospice in Scotland, St Margaret's, is in my constituency. Although it receives substantial support from Greater Glasgow and Clyde NHS Board, I would welcome proper negotiations around solidifying the level of support from boards and, ultimately, the Executive. I would like to discuss that with the minister.
I am happy to meet Des McNulty to discuss issues that he wants to raise in connection with the hospice that he mentioned, but it is important to understand the basis on which negotiations of the type that he mentions could take place. The hospice movement does not seek full funding from health boards, because it appreciates and values its independence. That independence is delivered and protected by the funding arrangement, under which we expect health boards throughout Scotland to provide funding in the order of 50 per cent.
Community Care (Older People)
To ask the Scottish Executive what timescale it has set to implement the recommendations on care in the community, set out in the Kerr report, to allow older people to remain in their own homes rather than in residential care. (S2O-9820)
When we published "Delivering for Health", our response to the Kerr report, in October 2005, we made it clear that we envisaged implementation over the next 10 years. We will publish proposals in the next few weeks for a rehabilitation framework to support services for older people and those with long-term conditions. The chief medical officer will shortly begin to draw together existing work on identifying the frailest people in our communities, in order to provide co-ordinated care that will allow them to remain independent in their own homes for as long as possible. We expect work on the integrated care that they need to be completed and implemented by all health boards before the end of next year.
Does the minister agree that there will require to be a considerable increase in the provision of home helps and meals-on-wheels, nursing and ancillary staff to give proper care to all those who can and should be treated in their own home? Other disciplines, such as physiotherapy and chiropody, should also be made available. The major benefit of that would be that people would be allowed to remain in familiar surroundings, instead of going into residential care, which all too often entails their homes being sold. In the final analysis—
Mr Swinburne, you are not here to provide a final analysis. You have asked a question. Do you have a further question to ask?
I am nearly finished.
I do not want you to finish what you are saying. I want you to ask a question.
Does the minister agree that, in the final analysis, where required, the availability of palliative care in the home would be the final piece in the complex jigsaw of care in the community?
John Swinburne raised number of points, and I support the principle underlying his question. We want people to stay in their own homes for as long as possible, and we recognise that the implication of that is that we will provide the services—either directly or, more commonly, through a partnership between health boards and local authorities—that will enable people to do so. The issue of palliative care at home is a difficult and complicated one; it is not always an appropriate form of care or the best way in which people should spend their final days, but, where it is appropriate, we would want to make it possible.
Mesothelioma
To ask the Scottish Executive whether it is aware of the work being undertaken by Clydebank Asbestos Group in conjunction with West Dunbartonshire Council to address the health needs of mesothelioma patients. (S2O-9893)
Yes, not least because of the constructive meeting earlier this week involving those groups, Des McNulty and Hugh Henry, at which justice issues arising from that work were discussed.
I hope that my proposal for a bill will get a lot of support.
The bill to which Des McNulty referred relates to issues that require to be resolved. That was acknowledged by Hugh Henry when he met Des McNulty earlier this week.
Emergency Hospital Treatment (Target)
To ask the Scottish Executive what the advantages are of the four-hour target established for casualty and accident and emergency departments, which means that staff must process patients from registration to discharge or admission within that timescale. (S2O-9840)
The four-hour target is about ensuring that patients get the treatment they need as quickly as possible—in other words, a high-quality, responsive service for patients using emergency services. The Health Department, through the centre for change and innovation, is supporting national health service boards to ensure that the target can be met by the due date of the end of 2007. The target applies not only to patients attending all accident and emergency departments but to patients attending community casualty and minor injuries units and acute receiving and assessment units across Scotland. I believe that the target is welcomed by patients and will be achieved by NHS Scotland.
Some patients, especially those who had 12-hour waits last month, would probably not see the advantages. ISD Scotland figures show that the lack of beds is the commonest cause for long waits in casualty departments. Stobhill hospital has an added problem, due to the loss of wards there in preparation for the new ambulatory care and diagnostic unit. It has not had extra winter beds or—
Dr Turner, you must ask a question.
I am about to ask a question.
Yes, but this is not speech time; it is question time.
I have my reasons. However, I will do it the way that you have asked me.
I do not think that I will ever convince Jean Turner about the targets that the Executive sets, which drive performance in the health service. Already, nine out of 10 patients do not wait any more than four hours. The extreme timescales to which Jean Turner refers sit with individual cases in which inappropriate treatments should not be given and in which a patient cannot get out of the accident and emergency ward to go on to further treatment or discharge for good clinical reasons. That happens on many occasions, particularly with elderly patients, so it can happen that people wait too long. However, the work that I do with accident and emergency consultants and patient groups shows that the target has clinical support and is an effective means of driving up performance.
What reassurance can the minister give patients in rural areas on the clock that starts to tick at registration but which, for the patient, might have started ticking some two hours earlier when they started their journey to the emergency centre?
It depends on the specific circumstances. The Scottish Ambulance Service has rigorous targets to meet, of which responding to patients is clearly part. However, I appreciate the additional time that is involved for people from rural communities. That is exactly why, throughout Scotland, innovative models of best practice are being developed for rapid response units, first responders and the provision of care outside the traditional environment. There are many ways of approaching the matter. The Kerr report and our response to it, "Delivering for Health", offer us a way of ensuring that our rural communities receive the first-class service that they deserve. We should work with that approach and ensure that it applies equally to accident and emergency waits.
Does the minister agree that when accident and emergency services are reconfigured, consideration should be given to the impact that reconfiguration might have on waiting times and that any reconfiguration of accident and emergency services must improve the level of service, including waiting times, that constituents such as mine enjoy?
The targets and performance standards that we set are for all patients in Scotland, and any reconfiguration of any service in any part of Scotland must meet those requirements.
National Health Service Dental Treatment
To ask the Scottish Executive what progress is being made in ensuring that all children and adults have access to NHS dental treatment. (S2O-9860)
We are making progress on increasing the number of dentists, building up a salaried service where required and providing incentives for high street dentists to continue to treat patients on the NHS. I am pleased to report that the number of practices treating all categories of patients in the NHS, and therefore qualifying for enhanced NHS funding, increased from 566 in December 2005 to 579 in March 2006.
Although I welcome that progress, I am sure that the minister is aware that MSPs continually get letters from their constituents saying that they cannot get access to NHS dentists. I appreciate the efforts that Fife NHS Board in particular has made to provide a salaried service and dental access centres, but does the minister accept that those can provide only a limited service to patients? Will he and the NHS boards consider ways in which they can expand the salaried service to provide full general dental treatment facilities to NHS patients who cannot register with a dentist?
I am delighted to report again that the number of salaried dental posts across Scotland has now risen to 196. That provision is enabling a significant level of treatment of the kind that Iain Smith described, such as emergency access. Clearly, we want to ensure that both adults and children are able to access NHS treatment in their own communities wherever possible. That is why our approach has involved not only building up the important salaried service but providing incentives for high street dentists to continue to treat NHS patients or, indeed, to resume treating patients on the NHS, as a number of such dentists are now clearly doing. That is the direction of travel.
What progress is being made against the Executive's target that, by 2010, 60 per cent of Scottish five-year-olds will have experienced no obvious tooth decay? Does the Executive believe that it will meet the target, given the current shortage of NHS dentists?
We are making good progress. Last year's figures for dental decay in children starting primary school were the best ever in Scottish dental history. That is clearly significant progress. We still have a good way to go, but we are confident that we are heading in the right direction to meet that target.
Is the minister in a position yet to respond to my recent letter on dental provision in Leslie in my constituency?
I will certainly respond to Christine May's letter shortly.
I hear what the minister is saying and I am grateful for all the effort that is being made, but problems still continue. Is he aware that Kinross-shire has recently lost a practice from the NHS? Obviously, the trend is continuing. We have a significant problem in Kinross-shire. Will he commit himself to entering into discussions with Tayside NHS Board, and perhaps the neighbouring Fife NHS Board, to see what can be done to resolve the situation, perhaps by bringing salaried dentists to that small hard-pressed community, which is finding it difficult to ensure the availability of dental services?
Although the number of practices that treat all categories of patient on the NHS has increased over the past quarter, I am aware that the figures include not only practices that are coming back to the NHS but some practices that have opted out. Clearly, we are seeking to discourage that trend. The additional funding that we have provided, which I believe amounts to something in the order of £25,000 per practice per year, will encourage dentists to continue to provide treatment to all categories of patient on the NHS. That is a significant incentive to dentists to commit to NHS patients. However, where commitment to the NHS on the part of high street dentists is lacking, we look to NHS boards to put in place other provision, including a salaried service, in localities such as those that Bruce Crawford has described.
National Health Service Dental Services
To ask the Scottish Executive which of the milestones, targets and impacts set out in "An Action Plan for Improving Oral Health and Modernising NHS Dental Services in Scotland" will have been achieved within the stated timescales. (S2O-9833)
The vast majority of targets for the first year of the dental action plan have been met. For example, we have introduced fissure sealant fees for the treatment of children and a fee for the treatment of adults with special needs. We have extended the patient registration period from 15 months to three years. We have introduced free dental checks for all NHS patients. Last year, we increased the number of vocational training posts to 135. We have made significant new payments to NHS-committed dentists for rent reimbursement and practice improvements. We have increased general dental practice allowance for NHS-committed dentists to 12 per cent of NHS earnings. In addition, we expect the number of dentists graduating from Scotland's dental schools this year to be nearly 30 per cent higher than the number who graduated five years ago. Later this year, we will introduce a new bursary for dental students, committing them to the NHS after graduation.
Will the minister publish, target by target, an assessment of the progress that there has been? Can he clarify precisely how many NHS dentists have left the NHS and how many private dentists have gone into the NHS since the action plan was published? That would be useful information to have.
I recognise Derek Brownlee's point in requesting a publication. I set out as many targets as I thought that I reasonably could, within the Deputy Presiding Officer's tolerance. I would be happy to make public the full list of targets and our achievements against them over the past 12 months. We will undoubtedly do that on completion of the action plan period.
Recent statistics show that Glasgow has the second highest incidence of tooth decay among children. Across Scotland, the incidence of cavities among three to five-year-olds is alarming. Does the minister see merit in focusing on that age group to tackle dental decay? Does he agree that the debate is not simply about the number of dentists, but about the fact that we must identify the key factors? The action plan identified sugar intake as one of the key causes of decay. Does the he agree that there is a need to consider whether the intake of calcium and fluoride can help us to tackle dental decay among Scottish children?
I am pleased to report the significant commitment of practices and the NHS in the west of Scotland to addressing the significant issue of tooth decay in children in the area. We have focused on five-year-olds, whom Pauline McNeill mentioned. The fissure sealant fees that we have introduced are for the treatment of children who are acquiring their adult teeth, which is very significant. I accept Pauline McNeill's point that we should examine all the methods that are available to us, to ensure that the trend of improving oral health among children continues.
I would like the minister to add one more target to his action plan—that of ensuring that every single adult and child in Scotland is able to access a dentist in their own country.
I am delighted to hear John Swinney's commitment to having yet more targets on the NHS dental front. That is a positive sign. Of course, had he read the dental action plan, he would know that we have a commitment to increase registration for adults and children for NHS dental services.
Environment and Rural Development
Discarded Bottles
To ask the Scottish Executive what action it is taking to tackle any problems associated with discarded bottles. (S2O-9873)
Local authorities are responsible for dealing with litter, including discarded bottles, in their areas. To help them in that task, we have tightened the law on litter with increased fixed-penalty fines and new powers for the police to issue fixed-penalty notices. We also continue to fund campaigns against littering.
Will the minister join me in congratulating pupils in primary 6 and primary 7 of Woodlands primary school in my constituency, who have highlighted the serious problems that are caused to people and animals by discarded glass bottles? Will the Scottish Executive consider introducing legislation that forces all soft drinks and alcoholic drinks manufacturers that sell their product in glass bottles to have a refundable deposit scheme, such as the scheme that is run by AG Barr, which operates from Cumbernauld in my constituency?
I have no hesitation in joining the member in congratulating the Woodlands school on the work that it has done and, in particular, on drawing attention to the real danger that discarded bottles present generally and, in particular, to people in the countryside. The member asked about the Executive's plans for legislation to force companies to have returnable bottle schemes. We will have to give consideration to that matter. The other issue is individual responsibility for the way in which people deal with bottles.
Climate Change Strategy
To ask the Scottish Executive what action its Environment and Rural Affairs Department has taken, as part of its strategy on climate change, to encourage other Executive departments to meet its targets for energy conservation and renewable energy by promoting energy conservation and the use of micro-renewable power schemes. (S2O-9862)
As the member will be aware, we have set an ambitious overarching Scottish target for carbon savings that provides a framework for encouraging all departments to meet their commitments. We have also committed to mainstreaming climate change and carbon proofing throughout the Executive to ensure that momentum is maintained. In particular, the first Scottish energy efficiency strategy will be published later this year, setting out total carbon savings for all energy efficiency measures as a contribution to the overarching Scottish target. Linked to that, we will set out a range of measures to help cut energy-related emissions from buildings, including the use of micro-generation from local and renewable heat.
Will Mr Finnie reassure us that his enthusiasm and that of his department will be transmitted effectively to other departments in which officials might attach a lower priority to energy conservation and renewable energy? Will he encourage them to lead by example? The other day, some of us were speaking at a primary school that had a windmill in the playground, which is really great. Every school could have that. Hospitals, jails and all sorts of places could practise energy saving—
Will you return to the question, Mr Gorrie?
Will the minister ensure that all departments lead by example in the way that I have described?
I assure Donald Gorrie that I very much take his point and that my department is in constant dialogue with other Executive departments. In the same way as the eco-schools project has done a great deal to encourage and ensure the use of renewable energy in our schools, the Minister for Health and Community Care is determined to ensure that the use of energy-saving measures and renewable energy in hospitals and other departments is to the fore.
Will the minister say how he intends to monitor the effectiveness of energy conservation measures, given evidence that after such measures are applied to domestic space heating, many people—understandably—use the same amount of energy to heat their houses to a higher temperature than hitherto?
Yes, indeed. We are looking at a range of ways to monitor and measure the effectiveness of energy conservation. In response to Donald Gorrie's question, I offer a very small example of what we are trying to do at the Scottish Executive's Victoria Quay building. We are currently monitoring the total amount of energy that is consumed in that establishment, which we can display daily. We are trying to keep track of what individual departments do in Victoria Quay to discover whether making more efficient use of energy reduces its consumption or whether through more efficient use, all we do is to produce a higher temperature, as Alasdair Morgan suggested. Such examples need to be followed throughout the Executive.
Woodland (Urban Communities)
To ask the Scottish Executive what action it is taking to ensure that urban communities have access to woodland. (S2O-9898)
The woods in and around towns initiative, led by the Forestry Commission Scotland, increases the contribution of woodland to quality of life and provides easy access for urban communities, so I am pleased that the initiative is proving to be so successful. Since its introduction in 2004, it has brought some 5,200 hectares into active management and created more than 600 hectares of urban woodland; in all, more than 20 square miles. We now have 180 partnership projects in urban areas over Scotland.
Does the minister agree that the creation of woodland areas in urban communities is about more than just environmental improvement? Does she agree that woodland areas can make a contribution to the well-being and lifestyle of local communities as well as stimulate local economic activity?
Absolutely. As well as creating more woodlands in urban areas and bringing more urban woodlands into active management, the WIAT initiative has helped to create and upgrade more than 55,000m of woodland paths, which helps to increase the number of school pupils who visit woodlands and significantly boosts the number of participants in the Forestry Commission's active woods campaign.
Scottish Environment Protection Agency
To ask the Scottish Executive what discussions it has held recently with the Scottish Environment Protection Agency. (S2O-9902)
The Scottish Executive has on-going discussions with SEPA on a variety of topics in relation to the agency's role in protecting the environment.
Will the minister confirm whether the Executive has discussed with SEPA the volume of radioactive waste that will be produced in Scotland by the end of the century? Is she aware that, according to Nirex, the amount of such waste is expected to increase from 14,000m3 to an incredible 82,000m 3 by 2020 and to 166,000m3 by 2099? Given that massive increase, does she not accept the patently obvious fact that the last thing that Scotland needs is an even greater increase in deadly waste from new nuclear power stations? Is it not time to say no to the new nuclear ambitions of Brown and Blair, or will Labour in Scotland simply do what it is told by them? Will—
Come to the point, Mr Crawford.
Will Labour members stand up for Scotland or will they dae what they're telt by London?
The member knows perfectly well that we are awaiting final advice from the Committee on Radioactive Waste Management on the management of radioactive waste. I reiterate that the issue of building new nuclear power stations will not be considered until that issue has been resolved.
What action are the Scottish Executive and SEPA taking to target private raw sewage outfalls that cause serious pollution in publicly sewered areas, including what has happened with the new £3.5 million contract that Scottish Water has carried out in Connel, Argyll?
I do not have specific information on that matter with me, but I am more than happy to send it to the member.
Biodiversity (Urban Areas)
To ask the Scottish Executive what action it is taking to conserve biodiversity in urban areas. (S2O-9869)
Conserving biodiversity in urban areas is a priority in our biodiversity strategy and under the urban plan a wide range of local and national projects is being developed. The guidance on local nature conservation sites in Scotland, which was published in March 2006, is a key achievement. Local sites are places of special importance for biodiversity and public bodies can use that guidance in implementing their biodiversity duty.
Does the minister agree that reliable data are vital in ensuring that biodiversity is protected and that, in that respect, the Fife environmental network's volunteer species surveyors play an essential role? How will the Executive broaden and encourage community participation in wildlife surveys?
I congratulate the Fife environmental network, which is a group of local people, on its work in monitoring biodiversity in their local area. We need more volunteers to take part in such activity—indeed, at this point, I should also mention the work of local red squirrel groups throughout Scotland—to ensure that we maintain a focus on local species and habitats and develop local knowledge.
Greenhouse Gas Emissions
To ask the Scottish Executive what its estimate is of the total level of CO2 and other greenhouse gas emissions in 2010 if both the Scottish and United Kingdom climate change programmes deliver as expected. (S2O-9847)
The Executive is preparing projections of Scottish carbon dioxide and other greenhouse gas emissions for 2010, taking into account the measures in the Scottish and UK climate change programmes. Those projections will be available later this year.
Will the minister say a little more about what those projections might look like? The most recent figure for carbon emissions is 14.8 million tonnes, and the Scottish Executive has set a reduction target of 2.7 million tonnes. Does that mean that Scotland will have carbon emissions of 12.1 million tonnes if the programmes deliver as expected? I am concerned that the Executive's calculations—
You are elaborating on your question, which the minister may now answer.
May I finish what I was saying?
If you have another question.
Just to make things clear, will the minister say what the Executive thinks Scotland's carbon emissions will be in 2010 if both Scottish and UK climate change programmes deliver as expected?
I think that you have already asked that question. No doubt the minister can answer it.
I am getting confused about what the member's question is. I agree with the Presiding Officer: we have gone all the way back to the member's first question, to which the answer is simple. We are preparing projections of Scottish carbon dioxide and other greenhouse gas emissions. I will be delighted to give full answers to the member when those projections are available.
Scottish Community and Householder Renewables Initiative
To ask the Scottish Executive what assessment its Environment and Rural Affairs Department has made of how significant the environmental impact of the Scottish community and householder renewables initiative has been. (S2O-9829)
Carbon savings from the Scottish community and householder renewables initiative are currently estimated at 1,250 tonnes per year, which is a relatively small contribution to our recently announced Scottish carbon savings target, but the initiative has been successful in stimulating demand for micro-renewables, among other things.
Is the minister aware of the Energy Saving Trust's research for the Department of Trade and Industry that shows that domestic renewables could meet 113 per cent of total domestic electricity demand by 2050? If he is, does he agree that the recent uncertainty about grant availability for domestic renewables schemes has not been helpful? What pressure can he bring to bear to ensure that, in the interests of joined-up government, such uncertainty does not happen again?
The member will be aware that we recently announced additional funding of £3 million for the fund in question to try to create a degree of certainty. I accept that there was an unhelpful hiatus in respect of our scheme and the DTI's scheme, but now that we are clearly committed to a climate change programme, we intend there to be no future disruption in the provision of such schemes.
Does the minister agree that there is a clear distinction in the SCHRI between individuals who benefit from the scheme and community projects, such as the Glenkens Community and Arts Trust project in my constituency and the Dunscore community initiative? Such community initiatives often require countless hours of voluntary input, even before an application is made. Will the minister use his no doubt considerable influence with his ministerial colleague, Allan Wilson, to assure us that the SCHRI will continue to receive a level of funding that will ensure that the many community initiatives that have come about as a direct result of the SCHRI and which are currently being considered at all levels will not be rejected because of a lack of funding?
As I said in answer to Roseanna Cunningham, we recently announced a further £3 million increase in funding to the scheme. The Scottish scheme, which should be compared with other schemes in the United Kingdom, focuses exclusively on communities and households. We intend that that should continue to be the case and that there should be no disadvantage to communities, as the member hinted there might be.
Community Halls (Rural Areas)
To ask the Scottish Executive what representations it has received regarding the future viability and development of voluntary and community halls in rural areas and what part these halls will play in delivering the objectives of the Scottish rural development plan. (S2O-9822)
The Executive has recently received a number of communications regarding the future funding opportunities for the revitalising of community halls. The consultation on the Scottish rural development programme for 2007 to 2013 includes proposals to provide recreational and community infrastructure and an opportunity to ensure future funding arrangements to support viable facilities for the benefit of rural communities.
I hope that those words are followed up in practice. Is the minister aware that, in the Government's rural development plan for Scotland, the terms "voluntary", "charity", "benevolent", "charitable trust", "equine" and "equestrian" do not appear even once? The word "volunteer" appears only once, in connection with the single farm payment, and the word "horse" is used only in relation to horse chestnuts and gates. What kind of rural policy does not place our village halls at the centre of village life; does not ensure charitable status funding exemptions for those halls; and totally neglects the contribution of the equine industries?
I am grateful to the member for his extensive research into the content of the programme. I might ask him how many times certain other words occur in the document—I will perhaps have that conversation with him afterwards.
We are well over time and need to move to the next item of business.
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