Health and Wellbeing
NHS Greater Glasgow and Clyde (Meetings)
Ministers and Government officials regularly meet national health service boards, including NHS Greater Glasgow and Clyde, to discuss matters of importance to local people.
The cabinet secretary will be aware of the shocking results of the survey that was carried out by the Royal College of Nursing Scotland, which revealed that patients were being cared for in cupboards, in offices and in dining areas last year due to lack of space. Can he guarantee that that is not happening now and will not happen anywhere in Glasgow or Scotland in the future?
Obviously, we take any such complaints very seriously. In Glasgow and throughout the health service in Scotland, we immediately take action to ensure that, where something has gone wrong or should not have happened, it does not happen again. We have certainly done that in this case.
Health Visitors
Following a birth and for the first five years of a child’s life, all families receive universal services and contact from health visitors and/or the health visiting team. Contacts include child health reviews completed by health visitors or general practitioners and home visits by health visitors and/or a member of their team. Services include a number of home visits in the first year of a child’s life and a full family assessment and child development review at 27 to 30 months, which is undertaken by the health visitor.
At yesterday’s Education and Culture Committee, and also today at the Finance Committee, the Royal College of Nursing put on record its belief that the Children and Young People (Scotland) Bill is a wonderful opportunity to expand health visiting. It claims that in the region of 450 new health visitors are needed. Does the Government agree with that, and what costs will that incur?
Most members recognise that the Children and Young People (Scotland) Bill provides us with a good opportunity to expand the range of ways in which we help to support and develop children and young people in Scotland. We are undertaking work at present to review the existing arrangements for health visitors and the number of health visitors that we have, including our public health nurses, to see how we can use them much more effectively. I do not doubt that health visitors have an important part to play.
If we are to see an increase in the number of health visitors, we must ensure that they are targeted at the communities that need them most. What mapping is being done to see where health visitors are and what services they provide?
We are already aware of the services that health visitors provide by the nature of their job. However, there is patchiness in how different boards operate their health visiting teams. Some of the work that we are doing with boards just now provides them with guidance on how they should take forward their home visiting programme so that we can get a greater consistency of approach across the country. Work on the guidance will continue over the next couple of months. Alongside that, the children, young people and families nursing advisory group is reviewing Scotland’s health visiting capacity overall to see how we must develop it in the future to ensure that we build on the progress that has been made since 2007, which has seen a 13 per cent increase in the number of health visitors in Scotland.
I have the answer that the minister gave to Liz Smith, but what precise assessment has the Government made of how many extra health visitors are needed for two of its policies—having a health visitor as a named person for all young children and the admirable policy of having checks for all children at two and a half years?
We have already set out the programme for the checks at 27 to 30 months, which has been done within the existing capacity of health visiting. However, as I mentioned in my previous answer, the children, young people and families nursing advisory group is reviewing Scotland’s capacity for health visiting to see where we might have to add to it in years to come in order to meet any growing demand that might arise.
NHS Boards (Openness)
The Scottish Government continues to encourage and promote a culture of openness whereby NHS staff are actively encouraged and supported to raise any concerns about practices in NHS Scotland. My letter of 22 February reaffirmed the Scottish Government’s position on that matter.
The cabinet secretary told us about his letter in response to questions from my colleague, Jackie Baillie, about the use of compromise agreements within the NHS in Scotland. Clearly, it has not had the desired effect, as my research has found that, in the past year, the NHS in Scotland has spent £3.5 million on those secret agreements, which is more than the total that was spent on them in the previous five years. How does the cabinet secretary intend to follow up on the letter, as it is clearly not creating the transparency that we want to have?
The member should do a bit more research, because there is clearly a difference between gagging orders in respect of such documents and other aspects that might remain confidential. Often for very good reasons, it is agreed—or, indeed, requested by the individuals concerned—that certain aspects relating to a person’s departure should remain confidential. Those reasons might involve pension arrangements or a host of other issues. The important point is that such arrangements are not a cloak for gagging orders. Under my predecessor, we put an end to gagging orders, which were rife during the previous Administration.
Members across the chamber will know that many staff are concerned and frightened at their work, with increasing pressure being put on them every day. Cases of bullying and harassment are a serious issue.
It has already happened.
Carer’s Assessment (Stroke Patients)
We recognise the importance of the carer’s assessment in enabling local authorities and carers to jointly assess a carer’s need for services.
Recent studies have recognised that depression and a range of other mental health conditions are often consequences of stroke for stroke survivors and their carers. In light of that fact, will the minister advise the chamber of the progress that has been made in assisting the thousands of primary carers who are both suffering from and supporting others who are in significant psychological distress?
A range of measures have been taken to help to support carers in Scotland. Our carers strategy and our young carers strategy were published in 2010 and run to 2015. We have also provided a range of different funding streams to support greater information for carers. For example, we have invested £13 million in the carers information strategy, which is being delivered by NHS boards. In the member’s region, NHS Greater Glasgow and Clyde has received more than £1 million from that fund this financial year to help to provide further information. In the period 2010-15, we will invest some £70 million in other areas of support for carers. That aside, we have also been working with stakeholders on the provision of a range of short breaks for carers.
Following the minister’s remarks about the importance of local authorities, I bring to his attention just how many of my constituents come to me, as carers, never having been told that they are entitled to a carer’s assessment, never mind having had such an assessment. That is under the Labour-controlled East Dunbartonshire Council.
As the member will be aware, I have set out the legal responsibility on local authorities to provide the carer’s assessment. Everyone will recognise that we owe a great deal to the many thousands of carers in Scotland who daily provide support and assistance to their loved ones. We have a responsibility to do as much as we can to support them in a role that is challenging at times.
Free Health Checks (Middle-aged Men)
The Scottish Government recognises the importance of raising awareness of health issues among men and is committed to providing the best possible advice and support through NHS Scotland. Through the keep well programme, men and women aged between 40 and 64 living in the most deprived areas of Scotland are offered a free health check. The health checks are primarily focused on heart disease and its main risk factors such as blood pressure, cholesterol, smoking and diabetes. The checks can last approximately 40 minutes and may explore wider lifestyle issues with the individual, such as employability and benefits support. Over 180,000 keep well health checks have been delivered across Scotland so far.
I first raised this matter with Ayrshire and Arran NHS Board on 31 May. The answer, which I received on 4 September, completely missed the point. A constituent of mine called the free health check number. He was asked for his postcode, only to be told that he did not qualify. He was not asked whether he smoked, had a history of heart disease, was overweight, was in employment—anything. How can we deliver preventative health measures to difficult-to-reach males when their sole criteria is a person’s address?
I acknowledge the member’s concerns. It is worth emphasising that the keep well health check is targeted at those who live in our most deprived communities, who are at greatest risk of cardiovascular disease. I have outlined a variety of lifestyle factors that could contribute to that. However, a range of services is available in NHS Scotland for patients who may require assistance or support in addressing any other lifestyle issues. I would expect that, in instances in which a patient does not come from one of the geographical areas targeted through the keep well programme, and there are issues that need to be addressed, their general practitioner would consider which measures were appropriate for that individual and would signpost them to the appropriate support services.
PFI Service Charges (NHS)
In 2012-13, the NHS in Scotland paid £215.1 million in unitary charges under private finance initiative/public-private partnership contracts. Of that, £86.6 million related to service charges and £128.5 million related to financing costs.
Does the cabinet secretary share my concern about the figures and recognise that the money spent on servicing such disastrous contracts, which were agreed under a previous Government, would have been better spent on continuing to improve standards of patient care across the NHS in Scotland?
I totally agree with the member. This is another legacy of 13 wasted years under the previous Labour Administration. Even the Tories have abandoned PFI as a way of funding such projects. In Lanarkshire—in the area that the member represents—Hairmyres hospital is probably the worst example of a complete rip-off of the public purse by PFI contractors, probably not just in Scotland but in the whole United Kingdom.
Briefly, Jim Eadie.
Does the cabinet secretary agree that the sale of Balfour Beatty Workplace to GDF Suez Energy Services must not have an adverse effect on patients and staff at the Royal infirmary of Edinburgh? Will he join me in seeking assurances from NHS Lothian that the employment and terms and conditions of the staff at the hospital who deliver the vital services involved will be protected?
Absolutely. I am seeking such assurances and I also seek the assurance that the contractor will in no way hold the public purse or NHS Lothian to ransom in how it handles the situation.
“Review of NHS Pharmaceutical Care of Patients in the Community in Scotland”
I will announce imminently the publication of the Scottish Government’s vision and action plan for national health service pharmaceutical care for the next 10 years. I will send a copy to Rhoda Grant as soon as it is published. The vision and action plan will build on the direction of travel of our progressive and developing policy landscape for high-quality and sustainable health and social care and on the comprehensive study on NHS pharmaceutical care of patients in the community that Dr Hamish Wilson and Professor Nick Barber undertook last year. The vision and action plan will be placed on the Scottish Government’s website.
The cabinet secretary knows that the review found that opening pharmacies can have a detrimental impact on general practitioner services in remote and rural areas. Will he therefore place a moratorium on granting licences for new pharmacies in such areas until he has had time to consider, respond to and take action on the back of the review?
I share the concerns but, under current legislation, I am not allowed to place a moratorium on such matters.
As the cabinet secretary knows, I wrote to him about the potential impact on GP services of a couple of pharmacy applications in Drymen and Killin. Does he share my concern about the transparency of the process, the geographical parameters and the funding of GP services? I heard what the cabinet secretary said about a moratorium. He might not be able to go that far—and he might want to explain that a bit further—but what else can he do? It is time that we had an answer on the issue.
I share Bruce Crawford’s concerns, as I do Rhoda Grant’s, about the impact on rural communities. That is why I have decided to review immediately the regulatory framework that supports the pharmacy applications process and the powers that boards are given in relation to dispensing GP practices.
Does the cabinet secretary agree with the conclusion on page 9 of the review that services should be accessible and that patients should have
I am very much aware of the issues that have arisen in North East Fife, as they have in Uist, Killin, Drymen and other parts of the country. I am very sympathetic to the points that members who represent rural areas have raised. Roddy Campbell has made a good point, which we are taking cognisance of.
Female Genital Mutilation
Three reports of female genital mutilation have been made to the police by NHS staff since 2005.
Three reports does not seem very many, as 3,000 women in Scotland are at risk of having their clitoris cut out. The minister will know that girls who are born to mothers whose genitals have been tortured are at very high risk of genital mutilation. Pregnancy screening is a key point for medical staff to identify that risk. What is NHS Scotland doing during pregnancy screening to reduce the risk for baby girls?
We are aware that there is a risk of female genital mutilation to approximately 3,000 women in Scotland, and some of the work that we are taking forward includes the new strategy on violence against women, which will be published later this year. That strategy will have a strand on developing this area of work further—in particular to raise awareness and understanding among a range of staff on how we can reduce the risk and identify areas of risk more effectively. Alongside that, the strategy will help to ensure that those members of staff, in particular the staff within our maternity units, are better informed and are in a position where they can make referrals on as and when appropriate.
The experts tell me that asking questions during pregnancy screening is particularly important for identifying the risk. Can the minister assure me that those questions are being asked during the screening?
Female genital mutilation will be an important strand of the work that we will take forward through the new strategy on violence against women. Part of that will be to make sure that we have healthcare staff who are properly informed and understand what actions they should take when a case is presented and who, in doing so, also make sure that the woman receives the appropriate healthcare at that point, should there be any requirement for a follow-up.
NHS Greater Glasgow and Clyde (Vacancies)
The Scottish Government is in regular contact with all health boards on that, and on a number of other matters. The next meeting will be in November, when NHS Greater Glasgow and Clyde’s annual staff projections are reviewed.
I thank the cabinet secretary for that answer. I hope that he will be aware of figures that have been released by Unison that indicate that vacancies at NHS Greater Glasgow and Clyde are at an all-time high; Unison estimates that the board is short of some 1,800 staff. Will the cabinet secretary agree to meet representatives of Unison to discuss the concerns of front-line health service workers, and will he instruct the board at his meeting in November to fill every vacancy as quickly as possible in order to avoid further detriment to my constituents, whose quality of care is being affected by short staffing?
One of the reasons why there are more vacancies is because we are recruiting more staff, in particular into nursing and midwifery and consultant positions, including in accident and emergency. By definition, when we increase the number of people who are being employed, there will for a period be an increase in the number of vacancies.
The cabinet secretary, while talking about big numbers just now, will know that sometimes very small numbers matter and that if particular specialist posts remain vacant, as is the case in NHS Lanarkshire, it can create great problems for constituencies and for clients. Is the cabinet secretary able to discuss with NHS Lanarkshire how it can move forward out of that quite unacceptable situation?
Cabinet secretary, question 9 was primarily about NHS Greater Glasgow and Clyde. However, it was also about vacant posts, so perhaps you would like to answer the member.
I, along with my officials, monitor closely the length of time for which there are vacancies in each NHS area by employment category as well as more general total figures. However, I appreciate the point—being a Lanarkshire member myself—about some of the particular issues in relation to NHS Lanarkshire. We have raised those issues with NHS Lanarkshire to ensure that it fills those vacancies as soon as possible.
NHS Grampian (Meetings)
Scottish ministers and Government officials meet regularly with representatives of all national health service boards, including NHS Grampian, to discuss a wide range of matters that are of interest to local people.
Further to the questions from Drew Smith and Linda Fabiani, the cabinet secretary will be aware of the current problems in NHS Grampian in recruiting for certain specialisms, and the impact of that on waiting times.
We take the issue very seriously. Our 2020 workforce vision specifically addresses the question of how we fill vacancies and tackle issues around strategic shortages. Sir David Carter, who is the chair of the board for academic medicine, and his committee are also looking at the issue to consider the link between throughput of training and the need to fill, in the medium term, a number of strategic shortages.
On a different note, will the cabinet secretary join me in congratulating those who are about to graduate as the first physician associates in the pilot programme that is being run jointly by NHS Grampian and the University of Aberdeen? How does he intend to promote the programme throughout Scotland?
Absolutely, I will join Nanette Milne in congratulating the first graduates in Scotland to become physician assistants. From my experience in NHS Lanarkshire, I know that physician assistants have already been operating in a number of areas and making a substantial contribution. They have tended to be recruited from the United States, where use of physician assistants is widespread and is viewed as a major way to provide enhanced quality and safety in healthcare throughout the system.
Meningitis B Vaccine
As we do with all new vaccines, we will take advice from the Joint Committee on Vaccination & Immunisation on the use of that particular vaccine. Meningitis B is a devastating disease, and I am keen that we take appropriate steps to tackle it. Nevertheless, it is important that we fully understand how effective any new vaccine will be before we consider introducing it in Scotland. The JCVI is currently consulting further on the use of the vaccine, and I await its final recommendations following that process, after which we will carefully consider its advice.
I have constituents who have lost children to that terrible disease, and who are disappointed with the JCVI’s initial decision not to recommend the vaccine. If that decision is not reversed, could Scotland consider acting alone in vaccinating children against meningitis B?
I recognise the devastating impact that the condition can have on families, so it is important that we look at progressing a range of measures to try and prevent it in the future.
Treatment Room Services (Hamilton)
Statutory responsibility for service provision rests with national health service boards, so the issue is primarily an operational matter for NHS Lanarkshire. The aim of NHS Lanarkshire’s review of treatment rooms is to provide a high-quality, standardised and equitable service for all its patients—an aim that the Scottish Government supports.
Clearly, the cabinet secretary is aware of the concerns of patients and general practitioners in Hamilton that the centralisation of treatment at the Douglas Street centre has created more problems than it has benefits for patients. If such a model has the Scottish Government’s support, why will the cabinet secretary not just admit that to the people of Hamilton? Does he also support the rolling out of that model across the rest of Lanarkshire? The Minister for Public Health intervened to ensure that NHS Lanarkshire reversed its plans on mental health services—
You must hurry.
So why will the cabinet secretary not intervene now rather than claim that he has no power to intervene in relation to treatment centres?
I have made it clear that I am very well aware of the concerns of patients and their representatives, including GPs. I remind the member that, as I am sure he knows, NHS Lanarkshire reviewed all treatment room services in 2010—three years ago—and the proposals have been phased in across Lanarkshire. Hamilton was the last area to be taken forward, and a decision is yet to be taken with regard to the site for the treatment room suite for outer Hamilton practices. As I have said to the member, I am seeking assurances—and, where appropriate, action—from NHS Lanarkshire to address the specific concerns that patients, GPs and others have raised about that service.
I will allow a brief supplementary from Margaret Mitchell.
Given the difficulties associated with access and the level of concern about the relocation of services to the Douglas Street clinic, local residents have proposed an alternative whereby a shared treatment room service could be established at either the Low Waters medical centre or the Cadzow health centre to better serve the 10,000 patients in the local area—
I need a question.
Will the cabinet secretary encourage NHS Lanarkshire to look at that proposal?
As I have made clear, I have asked NHS Lanarkshire to address the concerns that have been raised. Obviously, if there is an alternative proposal, NHS Lanarkshire should at least give it some consideration.
NHS Continuing Care Beds
Decisions regarding the older people’s care in acute hospitals inspection programme are a matter for Healthcare Improvement Scotland. Currently, its programme of work is focusing on acute care.
Does the cabinet secretary not think that there is a glaring gap between the inspection of older people in acute care, which Nicola Sturgeon instituted, and the inspection of older people in care homes, which a previous health minister started? Is it not time for the cabinet secretary to take action and responsibility to ensure that frail older people who spend all their time in NHS continuing care beds also benefit from having a rigorous inspection regime?
First, let me say to Malcolm Chisholm that patients throughout the national health service in Scotland benefit not just from the particular quality objectives but from the requirements of the patient safety programme, which has been described by Professor Don Berwick as the best in the world. Those patients include the people that Malcolm Chisholm referred to.
Waiting Times (A and E Departments)
The Scottish Government has introduced a national improvement programme to support improvements in unscheduled care across NHS Scotland. An expert group identified five key themes of activities that will lead to improved sustainable performance: getting emergency patients to the care that they need; promoting senior decision making; assuring effective and safe care 24/7; making the community the right place; and improving the primary care response.
I wish the cabinet secretary luck with that, but the target of 98 per cent of patients being seen within four hours was missed significantly in June this year, with the figure at 94.6 per cent. That was down on the figure for June 2012 of 95.1 per cent. Before the cabinet secretary delivers standard answer number 3 from the Scottish National Party bumper book of ministerial excuses, I remind him that those figures are worse than the figures south of the border. Why is his Government failing?
First of all, the figures are not worse than those south of the border. The difference between us and south of the border is that our figures are improving, whereas figures south of the border are getting worse, because the priority there is to privatise the health service. That is not a priority north of the border. As the member should know, our interim target is 95 per cent, which we are achieving, more or less—
More or less!
Order, Mr Johnstone.
Well, we are. I think that 94.6 per cent is near enough to 95 per cent, and I assure the member that we are heading towards 98 per cent. Under previous Administrations, the figure was not even measured, except on one occasion, which was in the last year of the Lib-Lab pact in Scotland, when the figure was 86 per cent. So we are doing very well, thank you.
Bowel Cancer
We know that the earlier a cancer is diagnosed, the easier it is to treat, which is why, through the £30 million detect cancer early programme, we have introduced a HEAT—health improvement, efficiency and governance, access and treatment—target to increase the proportion of Scots who are diagnosed in the earliest stages of cancer by 25 per cent, initially focusing on breast, lung and colorectal cancers.
How many men have benefited from the national bowel screening programme since its inception in 2007?
In total, 1.95 million people in Scotland have so far taken up the screening programme since it was introduced in 2007. Of those, 896,724 males have participated in the programme, which has resulted in diagnosis of some 1,692 bowel cancers in men. That is an uptake of almost 52 per cent. It is an important element of the detect bowel cancer early programme that we continue to increase the number of men who participate in the screening programme because, in doing so, we can diagnose bowel cancer at a much earlier stage.
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Scotland’s Future