Health and Wellbeing
Hospital-acquired Infections (NHS Ayrshire and Arran)
NHS Ayrshire and Arran has achieved significant reductions in the two key healthcare-associated infections for which routine surveillance is undertaken.
I thank the cabinet secretary for his reply. What impact has that had on hospital mortality in Ayrshire and Arran and how many lives have potentially been saved over the past five years as a result?
Since the period from October to December 2007, the hospital standardised mortality ratio has fallen by 12.9 per cent for Ayr hospital and by 30.7 per cent for Crosshouse hospital. That compares with a national fall of 11.4 per cent, demonstrating that NHS Ayrshire and Arran has made significant progress in reducing hospital mortality and improving patient care and clinical outcomes.
What funding is available for research to help protect against hospital-acquired infections, which will, I hope, offer benefits to patients in the longer term?
I had the pleasure last week of announcing additional funding of £1.8 million to help tackle the problem and to undertake necessary research so that we get on top of the problem and build on the substantial progress that has been made in recent times.
Pharmacy Applications (Regulations)
The NHS (Pharmaceutical Services) (Scotland) Regulations 2009, as amended, set out the provisions and arrangements by which applications to open a pharmacy are made. Those rightly leave decisions on applications in the hands of individual NHS boards.
I am grateful to the cabinet secretary for his reply. However, will he consider changing those regulations? I am sure that he has constituency examples from around Scotland of those regulations not allowing a health board to consider a range of applications at the same time, so as to come to the best decision with regard to taxpayers’ money and also the best clinical decision for people in a particular area. The cabinet secretary will know from the case involving the pharmacy in Scalloway in my constituency that the process needs to be seen to be fair—currently it is not seen to be fair.
My mind is never closed to change. If Tavish Scott would like to arrange a meeting with me to discuss those issues, I would be happy to discuss them. Obviously, I will need to be persuaded of the case and there needs to be evidence to justify any amendment.
NHS Lanarkshire (Meetings)
Scottish ministers and officials meet regularly with representatives of all national health service boards, including NHS Lanarkshire, to discuss matters of importance to local people.
I thank the cabinet secretary for that answer. Can he tell me on what date he, or officials acting at his direction, last contacted NHS Lanarkshire regarding the modernisation of mental health services in Lanarkshire?
In my previous answer to Siobhan McMahon on that issue, I made it clear that I decided early on in my tenure to give responsibility for that matter to my deputy Michael Matheson, as I did not want any perception of any potential conflict of interest between my role as the MSP for Airdrie and Shotts—where Monklands hospital resides—and my role as cabinet secretary. Therefore, I am happy to ask Mr Matheson to write to Ms McMahon again with the detail that she seeks.
Will the Scottish Government provide extra support to NHS Lanarkshire to cope during the winter months, given that we know that they bring additional pressures to the NHS?
We have made available £3 million for all health boards in Scotland, including NHS Lanarkshire, to deal with the additional pressures of winter. I am happy to write to Clare Adamson with additional detail on that if she requires it.
Is the cabinet secretary aware of the concerns that I have been raising over the past few years about junior and middle-grade doctor staffing? Those were dismissed by his predecessor, as always, as scaremongering, but today Lanarkshire NHS Board is reported to be concerned about its junior doctor recruitment and Greater Glasgow and Clyde NHS Board has reported significant problems with middle-grade recruitment. Those concerns come on top of the paediatric service problems in the south-east, of which the cabinet secretary is fully aware because he has provided additional finance. Has he abandoned the ill-thought-out plans to cut doctors’ senior training grades by 40 per cent by 2015 and the FY1 and FY2—foundation year 1 and 2—grades by 20 per cent?
There were quite a lot of requests for detailed information in that question. Generally speaking, I can say that it is no secret that the national health service in Scotland, like the NHS south of the border, faces some shortages in the availability of very specialist services, some of which were mentioned by Richard Simpson. I have recently spoken to Sir David Carter, who is chair of the Scottish academic board that deals with such matters, and we are reviewing all those aspects. The problem affects not just particular specialties, but rural areas. I am looking at the matter seriously and am considering whether any additional measures are required to deal with any of the specialist shortages. Clearly, if there is a specialist shortage, there is the potential for a gap in service provision, which is not what we desire.
NHS Ayrshire and Arran (Annual Board Review)
I thought that the board’s annual review was a challenging but largely positive meeting. As the member knows, I wanted to hear from the board on the areas that have been unsatisfactory in the past year, such as the local adverse events process, the management of information, including freedom of information compliance, and the systems in place for out-patient appointments. The board has made some progress in those areas, but the Government will keep matters under close review.
On the question of board governance and management accountability, how does the cabinet secretary propose to deal with the deficiencies and gaps that, from recent experience, are clearly evident in Ayrshire and Arran? The lack of accountability to the local public has long been evident—witness the board’s attempts to close Ayr hospital’s accident and emergency unit, at Labour’s behest—but more recent failures to implement learning from significant adverse events reveal an absence of effective scrutiny of senior management by the board and a reluctance to hold to account those who are personally responsible for those policy areas.
Adam Ingram raises a number of pertinent and fair points. I will give a specific answer on Ayrshire and Arran and then a general answer on accountability.
As the cabinet secretary will know, at NHS Ayrshire and Arran’s board meeting on 5 December, the board agreed the submission of an outline business case to the capital investment group in the Scottish Government health directorate for a £22 million upgrade to A and E services, which Adam Ingram mentioned, at Ayr and Crosshouse hospitals. Will the cabinet secretary please give favourable consideration to those proposals, which represent a substantial and welcome proposed investment in emergency and unscheduled care services in Ayrshire and which will underpin seven-day-per-week consultant-delivered A and E services at Ayr and Crosshouse hospitals?
Perhaps I should declare my interest as a resident of Ayr.
Infrastructure Projects (Grampian)
Mr Swinney will make an announcement on that extra funding following portfolio question time today. Our priority for additional investment is to address backlog maintenance, and NHS Grampian will share in any additional capital resources that are made available to NHS Scotland.
I thank the cabinet secretary for his answer, although I am not sure that I welcome it.
Under the normal due processes, I will make any announcement on that subject at the appropriate time.
Health Service (Policies and Priorities)
Healthcare provision is a devolved responsibility. I reiterate our continued commitment to a publicly funded and publicly delivered national health service in Scotland. We have categorically ruled out the reforms that are under way in England and have reaffirmed the commitment to continuing to provide world-leading, high-quality and sustainable healthcare for the people of Scotland that reflects the values of the national health service.
Parliament recently passed the Social Care (Self-directed Support) (Scotland) Bill, which will ensure that more disabled people can live with dignity and independence. Does the minister agree that the UK Government’s wrong-headed assaults on disability benefits will undermine the Scottish Government’s commitment to independent living?
It will come as no surprise to members that I agree absolutely with that point of view. I am extremely concerned; like many members, I can tell from my constituency surgery caseload that the impact of many of the reforms is extremely serious and worrying, particularly for the disabled community. I am genuinely concerned about the impact of those benefits reforms on the living standards and quality of life of disabled people in the future.
Pharmaceutical Care
Scottish Government officials meet regularly throughout the year with community pharmacy representatives to talk about the current and future funding of national health service pharmaceutical care and services.
The cabinet secretary will be aware that it is more than 10 years since the publication of “The Right Medicine: A strategy for pharmaceutical care in Scotland”. As we eagerly await and anticipate the outcome of the Wilson review into the positive role that pharmacists can play in enhancing the healthcare of patients in the community, particularly in relation to the self-management of their own care, will the cabinet secretary agree to meet me and representatives of the profession, such as Community Pharmacy Scotland, the Company Chemists Association and the National Pharmacy Association, in advance of the review’s publication so that the voice of community pharmacy will be not only heard but listened to and acted upon?
In due course, the Scottish Government will engage with all relevant stakeholders in implementing the outputs from the Wilson report and other key national policy initiatives. A large number of stakeholders, including the bodies that I mentioned, were consulted during the review process, and the review leads considered all oral and written evidence that was submitted to them. I hope that is a satisfactory response for Mr Eadie.
Waiting Times Data (NHS Greater Glasgow and Clyde)
The health directorate regularly meets with all boards, including NHS Greater Glasgow and Clyde, to discuss all aspects of waiting times, including data.
The cabinet secretary will be aware that an NHS Greater Glasgow and Clyde audit of waiting times data found that failures in the quality of the data made it difficult to verify the validity of the “unavailable for treatment” classification of patients. Will the cabinet secretary give me a clear guarantee today that NHS Greater Glasgow and Clyde is not involved in the waiting times scandal? Will he also be so kind as to publish the audit today so that we have an opportunity to see it before tomorrow’s statement?
At the request of Ms Jackie Baillie and the Labour Party, I have given two commitments, the first of which is that I will publish all 15 of the reports prior to the recess. Secondly, I have responded positively to the request for a ministerial statement, which will be made tomorrow. I undertake to publish the reports and place them in the Scottish Parliament information centre in plenty of time for members to have a chance to read them prior to my statement.
I very much welcome the cabinet secretary’s action in that regard. However, in addition to the problems with retrieving data from Glasgow—which makes one wonder how figures are supplied to the Scottish Government—the sampling of 100 patients by PricewaterhouseCoopers suggested that 56 in south Glasgow had periods of social unavailability applied while in north Glasgow the figure rose to a staggering 62 patients, one of whom waited as long as 168 days. Does the cabinet secretary consider such periods of unavailability in Greater Glasgow and Clyde to be in any way acceptable?
It would be wrong of me to comment on bits of a report without giving members the opportunity to read the whole thing and to see the report in its total context. As I said, I will publish the whole report. I do not intend to get into the habit of commenting on leaked reports or parts of leaked reports until the full reports are published and people see that the conclusion reached with regard to Greater Glasgow and Clyde is very positive indeed.
People with Visual Impairments
The Government is working with statutory and third sector partners to develop a Scottish sensory impairment strategy, which I expect to be issued for consultation early in 2013 and which will build on the success of the sensory impairment one-stop shops.
Recently, I have been representing a constituent with dry macular degeneration whose benefit entitlement has been removed as a result of the Atos process. What action can the Scottish Government take to assist people with dry macular degeneration who are suffering at the hands of the United Kingdom Government’s austerity measures?
I am sure that no member in the chamber will be unaware of the concerns and difficulties arising from the impact of work capability assessments on disabled people such as Stuart McMillan’s constituent. It is important that individuals who find themselves in such situations are provided with the best possible advice and support in pursuing their claims; indeed, I often provide my constituents with advice through a welfare benefits adviser or a specialist service. Over a number of years, we have rolled out 11 one-stop shops across the country to provide support and assistance, including advice on welfare benefits, to those with a sensory impairment. However, I fully recognise the concerns of Mr McMillan’s constituent and the difficulties that they are experiencing. I would far prefer it if we as a Government were able to take direct action on such issues and ensure that thing were more aligned with the views and values of the people of Scotland.
Childsmile Service (NHS Forth Valley)
Since rolling out childsmile services to schools and nurseries, NHS Forth Valley has recruited all private, council and partnership nurseries in its area into the toothbrushing programme and has also had 100 per cent engagement from all independent dental practitioners in childsmile practice. Within the past three months, the health board has achieved a full complement of childsmile staff, which, subject to parental consent and child participation, will increase the number of pre-school and primary school children able to access the fluoride varnish programmes.
The minister will be aware that members recently received the national dental inspection programme report, which highlighted the fact that there is a continuing trend of improvement in the oral health of primary 1 children in Scotland, with 67 per cent having no obvious experience of decay in 2011-12. What can the minister do to ensure that primary schools in areas of socioeconomic deprivation do not have the opportunity to opt out of the worthwhile childsmile programme?
The member makes a good point. Since the dental action plan was published in 2005, real progress has been made in improving oral healthcare in Scotland overall, and it is drawing a considerable level of international interest as a result of the success that is demonstrated by the fact that 67 per cent of children in primary 1 have no sign of obvious decay, which the member referred to. I am determined to ensure that we continue to build on that success.
Smoking
We are committed to maintaining Scotland’s position as a world leader on tobacco control. That is why we are developing a new tobacco control strategy for publication early next year. The strategy will set out ambitious targets for moving towards a smoke-free Scotland, underpinned by a range of actions that are focused on prevention, cessation and reducing health inequalities.
I am extremely pleased to hear about the plans to make Scotland smoke-free. Can the minister estimate how much money the national health service could save if Scotland were to become smoke-free?
It is important, when we use the term “smoke-free”, to state that we are talking about tobacco smoke—we do not want to put fear into the hearts of people with coal fires.
Health Inequalities
Addressing determinants of health and health inequalities requires concerted leadership along with targeted and tailored action in true partnership with the communities that are affected. It also requires a preventative agenda to break the cycle of inequalities that is repeated in a number of our communities.
NHS Health Scotland recently produced a paper for the task force on health inequalities, which stated:
I am sure that all members in the chamber will recognise that tackling Scotland’s health inequalities effectively requires a multi-agency approach and that a short-term approach will never be effective in dealing with inequalities that have developed over generations in our country.
It may be Christmas but, to be frank, I found that response astonishing because health inequality is not affected by borders.
Sadly, Jackie Baillie has just demonstrated a real lack of understanding about the complex nature of health inequalities. All the evidence demonstrates clearly that there is not a simple health solution to health inequalities. [Interruption.]
Order.
All the evidence demonstrates that fact clearly. We need to have a range of social policies to tackle health inequalities.
Fantasy, fantasy.
Order.
The Labour members may choose to stick their heads in the sand when it comes to tackling health inequalities, along with their colleagues on the Tory benches, but the reality is that matters such as welfare and finance are key to tackling health inequalities in Scotland.
Does the minister agree with the chief medical officer that tackling health inequalities requires all areas of Government policy to be in sync? If he does, will he explain how often he has met his colleagues who are responsible for housing, local government, sport and education specifically to discuss co-ordinated approaches to health inequalities in Scotland?
I fully agree with the chief medical officer, who has made my point clearly. We must ensure that all those policies work in an integrated way. One difficulty that we have in dealing with some of the issues is that we do not have control over such areas as welfare and benefits. No one should be in any doubt about the potential negative impact that the welfare reform agenda of the Conservatives and Liberal Democrats will have on tackling health inequalities in Scotland.
The Audit Scotland report on health inequalities highlighted one potential impact of the smoking ban: decreased rates of premature and low birth-weight babies. Can minimum unit pricing for alcohol have a similar positive impact on health inequalities?
A range of factors contributes to health inequalities. I have no doubt that alcohol and Scotland’s relationship with it contribute to such inequalities.
Cystic Fibrosis
The Scottish Government is committed to ensuring that patients in Scotland receive medicines that are of established cost effectiveness and therapeutic value. All newly licensed medicines are appraised for clinical effectiveness and cost effectiveness by the Scottish Medicines Consortium, which publishes advice for national health service boards. NHS boards and clinicians are expected to take full account of SMC advice in the planning and provision of NHS services.
One of my constituents—seven-year-old Maisie Black, who suffers from cystic fibrosis—urgently needs the drug Kalydeco. The provision of Kalydeco in Scotland lags behind that in the rest of the United Kingdom. I am led to believe that the SMC met on 4 December to discuss making Kalydeco available in Scotland but that its decision will not be known until 14 January. What is the reason for such a delay between the private decision and public announcement? Does the cabinet secretary agree that such a delay is unacceptable? Will he press for an early announcement?
James Kelly will know that I have set up a review of the introduction of and access to new medicines, which Professor Philip Routledge from Cardiff University is undertaking. I expect him to report early in the new year. He will address exactly the kind of issue that the member raises. Once we get his report, we will look at how we can take matters forward.
Prescription Costs
The majority of monitoring and reviewing of the cost to the NHS of prescriptions that GP surgeries issue is done at NHS board level by specialist teams of pharmacists, accountants and GPs.
According to ISD Scotland, generic prescribing accounts for 83 per cent of drugs that are prescribed, which represents a welcome 6 per cent improvement in the past 10 years. Can the cabinet secretary assure me that the costs of branded drugs, which tend to be much more expensive, will be kept under close scrutiny to ensure that value for money is taken into account?
Mr Coffey raises a valid and fair point. With the head of the Scottish Government’s pharmaceuticals section, Professor Bill Scott, we are looking at improving how we ensure the cost effectiveness and therapeutic value of medicines that are dispensed in order to maximise both value for money for patients and patient care.
Previous
Business Motion