Engagements
We move to First Minister’s question time. I call question 1 from Iain Gray. [Applause.]
I do not remember that ever happening before. [Laughter.]
To ask the First Minister what engagements she has planned for the rest of the day (S4F-02885)
I welcome Iain Gray back to First Minister’s questions, albeit briefly—although with Labour, who knows these days?
This afternoon, I will attend the Royal Highland Show, and this evening, I am travelling to Dublin for tomorrow’s meeting of the British-Irish Council. In addition, I have a range of engagements to take forward the Government’s programme for Scotland.
I thank the First Minister for her kind-ish words. I cannot promise her that my questions will be up to Jon Stewart’s celebrity standards, but I promise to do my best. I also promise not to compare her to Saddam Hussein—unless the opportunity presents itself. [Laughter.]
I am sorry, Presiding Officer, but I might be a little rusty—it has been 183 weeks since I last did this. That is a lot of weeks, but can the First Minister tell us how many weeks it has been since the Scottish National Party Government last met an accident and emergency waiting time target?
Across Scotland right now, around nine out of 10 patients are being seen at accident and emergency departments within the four-hour waiting time target. We are working hard to improve that, and we are taking a range of measures in partnership with health boards to make sure that performance improves.
The health secretary has been focused on this, and additional investment has been made available across the country where issues have arisen. I know that Iain Gray was not responsible at the time—although he was a minister in the last Labour Administration—but I point out that we did not really know how the last Labour Government did on accident and emergency waiting times, because it did not bother to gather the data or publish the statistics.
Part of the problem with that answer is that nine out of 10 is not the target. The truth is that, last week, the SNP Government missed its four-hour A and E waiting time target for the 296th week in a row. Welcome though they might be, the reassurances about Ninewells that we saw this morning from the chief medical officer cannot hide the problems elsewhere.
We previously asked the First Minister about A and E waiting times in January, and she blamed the problem on winter pressures. I know that jet lag can mess up a person’s body clock something terrible, but even she must realise that it is now midsummer and thousands of patients are still waiting far too long in A and E departments. We know, for example, that when the SNP took office in 2007, 95 per cent of A and E patients in NHS Greater Glasgow and Clyde were seen within four hours. After eight years of the SNP Government, that figure is now 87 per cent. In the new south Glasgow university hospital, almost a quarter of patients waited more than four hours. Can the First Minister tell us why things are so much worse in Glasgow than anywhere else in the country?
I will deal with Iain Gray’s points on a Scotland-wide basis first and then come back to the specific situation in the new south Glasgow hospital.
The problem with Iain Gray’s question and its comparison between the situation now and during the winter is that we have seen a significant improvement since the winter period. Since 22 February, when we started to publish weekly statistics on our accident and emergency department performance, performance has improved by more than six percentage points. That is not good enough—we intend to meet the target— but that is a significant improvement.
All 14 boards in Scotland now treat around nine in 10 patients within four hours, and 10 boards are meeting the interim target of 95 per cent performance. Of the 30 A and E core sites, 28 are seeing nine in 10 patients under four hours, 19 are exceeding the interim 95 per cent target and 10 are exceeding the 98 per cent target. Progress is being made.
In addition, we have seen an 80 per cent reduction in the number of eight-hour waits and a 90 per cent reduction in the number of 12-hour waits—all since we started to publish the weekly statistics. There is more work to do; I am not for a second suggesting otherwise. However, that is improvement and I pay tribute to the staff who are working hard to achieve that.
On the new south Glasgow hospital, I hope that all members across the chamber recognise that the transfer of services that has been undertaken there has been one of the biggest and most complex that has ever been undertaken anywhere in the United Kingdom. It was anticipated that there would be initial performance challenges as a result of the migration of services from three acute hospitals to a single site, and that has proven to be the case. That said, performance in accident and emergency has been below the standards that we expected, which is of considerable concern to me and the health secretary. That is why we have done the right and responsible thing in making available to Greater Glasgow and Clyde NHS Board additional support and expertise. The expert support group has already agreed actions with the health board and is, for example, looking at enhanced bed management and improved discharge planning. We will keep Parliament fully updated on progress on that issue.
I am sure that the First Minister intends to meet her waiting time target and that she intended to meet it 296 weeks ago, but she has failed to hit it for 296 weeks in a row. If there is one place where we might expect the target to be met, it is the new south Glasgow hospital. It seems obvious that, if we spend £850 million on a brand new hospital, it should be the best in Scotland; however, the new hospital has the worst accident and emergency waiting times in the country, and they are getting worse. The hospital was opened with great fanfare just two months ago, and now it is being described as a “war zone”.
The First Minister says that that is down to the challenge of the transfer of services from other hospitals. She might have a point. In May, we suggested to the Government that it postpone the transfer of A and E patients to the new hospital to prevent the chaos that has now developed, but it dismissed that suggestion out of hand and told us that there was no problem. Does the First Minister now agree that she should have delayed the closure of other A and E departments in Glasgow until the new hospital was ready and able to cope?
First, the term “war zone” is not appropriate to use in relation to any of our hospitals. I hope that Iain Gray will reflect seriously on his choice of words.
Secondly, it may be however many weeks he said since Iain Gray last led First Minister’s question time, but he has not got any more coherent in the intervening period. When Kezia Dugdale—I think that it was her; I am losing track of the acting Labour leaders that I am taking questions from at First Minister’s question time—last asked me about accident and emergency services in Glasgow, one of the hospitals that she was criticising was the Victoria infirmary, which has now migrated into the new south Glasgow hospital. I do not think that it would have been right to delay the transition to the new hospital.
Any transition of the scale and complexity that we are dealing with in Glasgow right now will throw up initial challenges. The important thing to do, the responsible thing to do and the right thing to do is to make that transition and support the board throughout that.
I have said that, notwithstanding the initial challenges, A and E performance in Glasgow has been below what I would expect it to be. That is why, as a responsible and competent Government, we have sent in a support team that is made up of clinical expert advisers from the Royal College of Physicians of Edinburgh, the Royal College of Physicians and Surgeons of Glasgow, the Scottish Government and health boards. They are working with the health board to ensure that we see rapid improvements, so that that great new facility—it is a great new facility—delivers for all patients.
I will say one final thing to provide context. Although we are seeing challenges—which I do not deny—in accident and emergency services, the new hospital is generally performing very well on planned and scheduled care. The transition of the new children’s hospital was made last week. This is a big exercise and we should all get behind the staff who are working so hard to make it happen and make it a success.
Frankly, the First Minister is damn right that calling a new hospital a “war zone” is not appropriate, so she should ask herself why staff and patients in that hospital have had to say that.
We know that, less than two months after the new hospital opened, an expert team has been sent in to rescue the A and E situation there. That is not a good thing; it is a bad thing. It is not something to boast about. It is in addition to similar hit squads that were sent into the Royal Alexandra hospital in Paisley and the Western infirmary in Glasgow earlier this year.
How many A and E hit squads does the First Minister have to send in before she does the right thing—the responsible thing—and admits that there is a fundamental systemic problem? How many winters have to come and go? How many patients have to spend all day waiting in a corridor, on a trolley or in an ambulance queue before she admits that there is a problem? People are tired of the excuses. They are weary of piecemeal solutions that are not working. Just how many weeks and months and years does the SNP Government have to be in office before it sorts out this accident and emergency mess?
I have to say that it is somewhat gobsmacking to hear the member say that there is a fundamental systemic problem of capacity in our accident and emergency departments. It is gobsmacking to hear him say that because he is a member of a party that, had it had its way, would have shut two of our accident and emergency departments.
You have shut three.
Order.
If Iain Gray and his colleagues had had their way, Scotland would be dealing with the increased demand on our A and E departments with one fewer accident and emergency department in Lanarkshire and one fewer in Ayrshire. Thank goodness Scotland did not follow the Labour Party’s advice.
We are doing the right thing by our national health service—we are protecting its budget; making sure that more people are working in it; and, where there are challenges, making sure that we are working with our health boards to address them head on. That is what a responsible, competent Government does and it is probably the reason why I am standing here and Iain Gray is not standing here right now.
We will continue to do that because the national health service is precious to all of us. It must deliver the highest standards for patients across this country, and I and the health secretary will continue to remain absolutely focused on making sure that it does just that.
Prime Minister (Meetings)
To ask the First Minister when she will next meet the Prime Minister. (S4F-02886)
I have no plans in the immediate future.
The Southern’s accident and emergency figures are a red flag for deeper problems within the NHS—problems that were relayed to the Scottish Government more than a year ago. Last May, Audit Scotland warned that around a third of patients delayed in accident and emergency units were waiting because hospital beds were not there when they needed them, with more delays caused by a lack of staff. Specifically, since that Audit Scotland report last May, what improvements have been made in those two areas, and does the First Minister think that they are working?
When I launched the programme for government, when I put the issue of delayed discharge at the centre of this Government’s priorities for the weeks and months that lay ahead, I said that the Cabinet would be monitoring delayed discharge figures on a weekly basis. It has been doing exactly that. The efforts that the health secretary has been making with health boards around additional funding and in working systemically with health boards and local authorities to tackle delayed discharge have been beginning to bear fruit. The most recent figures that were published—I think two weeks ago—on delayed discharge demonstrate that while there is work to be done we are starting to see success there.
On staff numbers in the national health service, I think I said to Ruth Davidson the last time we exchanged questions and answers at First Minister’s question time that there are more people working in our national health service today than was the case on day 1 of this Government taking office. There are 10,500 more people working in our NHS today than was the case in 2007. That is more doctors, nurses, allied health professionals and support staff in our national health service. [Interruption.]
Order.
That is this Government’s response to the challenges that we know about in our health service—the changing demographics and the demands of changing technology. In many ways, those are all good developments in our society. That is why, as well as making sure that our health service is equipped to meet those challenges, the health secretary has said very clearly—I thought that there was agreement across the chamber on this—that we need to have an open debate about how we make sure, not just in the short term but over the longer term, that we equip our NHS to deal with those changes in our society.
We will continue to do the hard work in supporting our national health service, and I hope that members across the chamber will support that.
The First Minister’s good intentions aside, let us look at what she is not saying.
Since the Scottish National Party came to power, the number of hospital beds in Scotland has gone down by more than 1,000—nearly half the drop in the Glasgow region alone, and that is before the latest reorganisation is counted. The number of consultant vacancies across all specialties rose from just over 100 in 2010 to more than 400 in March this year. Over the same timeframe, the number of nursing vacancies shot up from more than 500 to nearly 2,000.
Dr Nikki Thompson, who chairs the British Medical Association’s Scottish consultants committee, said that the number of vacant consultant positions was “extremely worrying”, and the director of the Royal College of Nursing Scotland, Theresa Fyffe, said:
“The boom and bust approach to Scotland’s nursing workforce simply isn’t working.”
There are fewer beds, more vacancies, Audit Scotland alarms, criticism from consultants and warnings from nurses. The Scottish Government has sent a hit squad to the Southern. Fine—but what about the rest of our NHS?
Let me take those points in turn.
On staffing, health boards will have vacancies that they need to seek to fill on an on-going basis. That is the nature of managing staff in the national health service.
Ruth Davidson mentioned consultants. There was an increase of 1,363 whole-time equivalent consultants between September 2006 and March 2015. Even taking account of what Ruth Davidson said about vacancies, there are more consultants working in our NHS today than when the Government took office.
Qualified nurses and midwives are up 5.7 per cent. That is 2,357 more whole-time equivalent qualified nurses and midwives in our hospitals now than was the case when the Government took office.
On beds, Ruth Davidson will be aware of what we are seeking to do, which is what the previous Administration sought to do: we are seeking to shift the balance of care from acute hospitals to the community. In the past year, the number of acute medical beds has increased by 4.3 per cent.
We are doing the hard work to support our national health service.
Ruth Davidson again mentioned south Glasgow and seemed to suggest that somehow the reorganisation of hospitals was reducing the number of beds. That is simply not the case. Pre the migration to the new hospital, there were 3,100 staffed adult acute beds in Glasgow; post the migration to the new hospital, there will be 3,060 acute beds plus 88 intermediate care beds. On the south Glasgow campus alone, there are marginally more adult acute beds than there were in the three hospitals that have been replaced by the new hospital.
Let us get our facts right on all those things and then let us together say that we need to ensure that we collectively support our national health service not just today and tomorrow, but in the five, 10, 20 and 50 years to come. I hope that the other parties will be a constructive part of that. As a Government that wants to listen, we will listen to any suggestions about how to do that that they want to put forward.
There are a number of important constituency questions that I would really like to take. I would appreciate members’ co-operation with brief questions and brief answers.
The First Minister will be aware of a serious Scottish Water incident in North Lanarkshire. Several communities have been advised not to use tap water. Is she able to offer an update on the situation and advise of any support that the Scottish Government can give to the communities that are affected by that incident?
I have assurances that all necessary steps are being taken to return the situation to normal as quickly and safely as possible. Scottish Water is working closely with the relevant agencies to ensure that alternative water supplies are available to those who are affected, and it is making additional support available to vulnerable people.
The Scottish Government and the drinking water quality regulator are monitoring the situation closely and will ensure that any additional support that is needed is co-ordinated efficiently through established Scottish Government resilience response arrangements.
I know that it is a matter of great inconvenience to those who are affected and I hope that those reassurances will be welcome.
The First Minister will be aware of the proposed strike action by CalMac Ferries staff. What discussions has she had with the National Union of Rail, Maritime and Transport Workers and CalMac and what steps is she taking to alleviate the fears of CalMac staff, which are shared by the wider community, in relation to the privatisation of those ferry services?
Keith Brown and Derek Mackay have met the trade unions on several occasions and have provided assurances that a fair, affordable and sustainable pension scheme will be written into the new Clyde and Hebrides ferry services contract. CalMac and the unions are meeting, today I think, to discuss both pensions and terms and conditions. I encourage both parties to continue to engage and have a dialogue with a view to reaching a satisfactory outcome.
I want to say clearly that the services are not being privatised: bidders are required to deliver services to a detailed specification, based on our ferries plan and subject to strict contractual conditions; the Scottish ministers will retain public control of the ferry services throughout the contract period, regardless of the ownership status of the successful bidder; and the vessels and ports that are currently in public ownership will remain so.
We are required to put the services out to tender because of European law. The current contract was awarded to CalMac in 2007, following a similar exercise to the one under way right now. That exercise was initiated by the previous Labour-Liberal Administration.
Does the First Minister agree with the Scottish Fishermen’s Federation? It has said that protecting the marine environment is “vital” and that her Government’s proposals for marine protected areas are
“a piece of overt political posturing”.
What will she do to fix that before 1 October, when the plans are due to be implemented?
Tavish Scott will not be surprised to hear that I do not agree with that characterisation.
It is right that we listen carefully to fishermen as we take such decisions forward. As Tavish Scott will be aware, Richard Lochhead has been looking carefully at the issue and consulting all those with an interest in the arrangements that we are making for marine protected areas. Richard Lochhead will be very happy to meet Tavish Scott to discuss any remaining issues and concerns that there are. We will do our best to make sure that we address those issues constructively.
What impact will the UK Government decision, announced this morning, to close the renewables obligations support for onshore wind a year early have on business confidence, consumer bills and climate change targets?
The decision is wrong-headed, perverse and downright outrageous. It severely undermines any Tory claims to be pro-business.
Scottish Renewables estimates that Scotland could lose £3 billion of investment because of the decision. Scottish Power estimates that ending onshore wind support could cost consumers £2 billion to £3 billion, as more expensive generation will be required instead. What makes this worse is that the decision comes despite the UK Secretary of State for Energy and Climate Change admitting on radio this morning that onshore wind is one of the most cost effective ways to develop renewable energy.
As for climate change targets, cutting support for low-carbon energy is a terrible example to set for the rest of the world as we run up to the Paris climate talks.
The decision is completely and utterly wrong-headed and wrong. We will do everything in our power to persuade the UK Government to see sense and to change it.
Cabinet (Meetings)
To ask the First Minister what issues will be discussed at the next meeting of the Cabinet. (S4F-02881)
Matters of importance to the people of Scotland.
Primary healthcare in Scotland is also heading towards a crisis. Doctors are retiring early or going part time, leading to a major shortage. How has the Government allowed that to happen and what is it going to do to address the looming crisis?
Again, I do not accept that characterisation. I do not think that it is a fair characterisation of either the Scottish Government or, more importantly, the services that are being provided across the country.
Primary care is one of the keys to making sure that our national health service is equipped for the challenges of the future. The Scottish Cabinet had a discussion on that very issue at its meeting this week. We need to make sure that we are equipping primary care to do more in primary care, which is the way to relieve pressure on the acute services. Frankly, it is also a better way of treating people with long-term conditions in particular.
That will be part of the discussion that we take forward over the summer about how we reconfigure our health service, not because it is in “crisis”, to use the word that the member uses, but to make sure that, as the demographics of the country change and the nature of the demand on the health service changes, we are equipping the health service to do that job and to do it properly and well, as it has always done in the past.
I thank the First Minister for that answer, but in among all that there was no explanation as to how the Government has allowed this situation to happen. It is not all fine, because 12 medical practices in Fife are short of general practitioners; a practice in Aberdeen has slashed the number of appointments; elderly patients in Edinburgh have been told to go elsewhere because their medical centre cannot cope; and shortages are reported in Forth Valley, Dumfries and Galloway, Lothian, Fife, Grampian, the Highlands and many other areas.
The First Minister needs to recognise that this is a crisis, because that is exactly what it is. The Royal College of General Practitioners and the British Medical Association have been specifically warning about the situation for a long time. When will this Government end the complacency, change its approach and sort out this crisis?
The member referred to a number of specific parts of the country, so let me just give some information on those areas: in Grampian, the NHS board has taken over the running of the Brimmond medical practice; NHS Forth Valley is taking over the running of Bannockburn, making sure that that service is delivered with directly employed GPs; and NHS Lothian has that option open for Leith, but the 2,000 patients affected by that practice have been reallocated to alternative practices already. Those are the things that happen when there are issues with GP practices, because the health board has a responsibility to make sure that all patients have access to a GP.
In terms of the action that this Government is taking, it may or may not come as a surprise to Willie Rennie to know that we have invested an additional £10 million in general practice this year. We are also working jointly in Scotland with GPs to redesign the GP contract for implementation from 2017, which is focusing specifically on addressing workload pressures and supporting and sustaining general practice for the future. We have already introduced measures to increase the number of former GPs who are returning to practice. We have given practices contractual and financial stability while we look at the changes to the contract—the first time that that has happened anywhere in the United Kingdom.
There is a theme emerging here today, and it is this: the Opposition—[Interruption.]
Order.
The Opposition likes to come to the chamber with problems; this is the Government that focuses on finding the solutions.
Diabetes
To ask the First Minister what the Scottish Government’s response is to Diabetes Scotland’s finding that diabetes levels are “at an all-time high”. (S4F-02890)
This is diabetes week, of course, so I would like to take the opportunity to recognise the good work that groups like Diabetes Scotland do to raise awareness of the condition. The Scottish diabetes survey shows that 2014 had the lowest annual percentage increase in diabetes since 2008, but it also suggests that people are now living longer with diabetes, rather than there being a marked increase in the number of new cases. Through our diabetes improvement plan, we are committed to helping to prevent diabetes through the promotion of healthy lifestyles and supported self-management of the condition. Through structured education, we are looking to improve self-management and to improve diabetes care in acute settings.
I thank the First Minister for her answer and strongly agree that the development of structured education is vital in efforts for self-management of diabetes. However, with regard to care in acute settings, the First Minister will be aware of Healthcare Improvement Scotland’s think, check, act pilot. Does she agree that the benefits of that programme should be shared widely to help to improve acute diabetes care?
Yes—I agree with that. The Minister for Public Health, Maureen Watt, visited the Western general in Edinburgh this morning, which has one of the 12 wards across four health board areas that are participating in the think, check, act pilot. The pilot has seen a 20 per cent reduction in the incidence of hypoglycaemia, which is a potentially dangerous drop in blood sugar. I know that Maureen Watt will be ensuring that lessons from the pilot are shared across the national health service in Scotland.
Will the First Minister undertake today to revisit introducing a high-risk screening programme for type 2 diabetes for those who are most at risk in our most disadvantaged communities?
We will consider any suggestions that are made. Obviously, we follow expert advice when it comes to screening programmes; we will continue to do that. However, we are absolutely focused on making sure that we prevent diabetes, and I think that there are many examples to tell us that a good lifestyle and healthy choices in our lives can reduce the incidence of diabetes and, sometimes, clear people of diabetes. We also need to ensure that there are services. We will continue to focus on both those issues.
Question 5, in the name of Jackie Baillie, has been withdrawn, for understandable reasons.
Cervical Screening
To ask the First Minister whether the Scottish Government will introduce cervical screening for women over 60. (S4F-02883)
Following the report of the Scottish expert review group into the age range and frequency of cervical screening, and in accordance with the recommendations of the United Kingdom national screening committee, as of 1 April 2016 the Scottish Government will introduce cervical screening for women up to the age of 65.
I welcome the raising of the age limit to 65. However, BMJ recommends that the age for routine screening should be raised to 70, given that half the deaths from cervical cancer occur among women over 65. Would the First Minister give consideration to that recommendation by BMJ, not least because—as I can attest—70 is the new 60?
Members: Hear, hear.
I am probably safer not to say anything in direct response to Christine Grahame’s last comment.
We will always consider expert evidence in taking such decisions, which have, for obvious reasons, to be taken on the basis of expert advice. When it comes to screening programmes, we follow the recommendations of the United Kingdom National Screening Committee. I hope that all members will agree that that is the right thing to do. The decision that we have taken to increase to 65 the age limit for cervical screening has been taken in line with the recommendations of the UKNSC. We will continue to ensure that the decisions that we take are rooted in evidence and in the views of experts.