Meeting of the Parliament

Meeting date: Wednesday, March 20, 2013

Official Report 852KB pdf

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Portfolio Question Time

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Health and Wellbeing

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Diabetes (Insulin Pumps)

1. To ask the Scottish Government what recent progress has been made on rolling out insulin pumps to people with diabetes. (S4O-01925)

Our target to ensure that 25 per cent of children and young people have access to insulin pump therapy is due to be reported on after March 2013. Although it is clear that good progress has been made in a number of areas, we are disappointed that some boards will not meet the target by the end of March 2013. We remain determined that boards continue to work towards this rightly ambitious target and ensure that equal access to pumps across Scotland is available. We are working closely with boards to ensure that they have plans in place to achieve the target safely.

Given the understandable shortage of staff to carry out insulin pump training in Grampian, will the minister consider issuing guidelines to allow trained representatives from the companies supplying the pumps to help to roll them out to patients who require them?

The work that we have undertaken with boards over the past year and a half was to make sure that they have an increasing level of capacity among their staff to support patients moving on to insulin therapy.

I understand that NHS Grampian has a service level agreement in place with an insulin pump provider to help to support the training and to provide advice to adults who are moving on to insulin pumps. However, the situation is more complex in the paediatrics sector, where there has to be a much more integrated approach across a number of services, such as education and health services, and families and carers, which makes things more difficult. However, I understand that NHS Grampian is continuing to look at what further measures it can take to build on its existing capacity and staff levels to support patients moving on to insulin pumps or getting further advice on them.

The minister will be aware of my interest in this issue, given that I am the co-convener of the cross-party group on diabetes.

I agree with the Scottish Government’s targets for under-18s and the target to triple provision of pumps for all age groups over the next three years. However, how will the minister tackle the postcode lottery whereby some laggard health boards are simply not performing and will not meet the first target by the end of this month?

I recognise Mr Stewart’s long-standing interest in this issue. He is right to recognise that the target is about improving not only the way in which insulin pumps are provided but the way in which services for those with diabetes are provided. I share his disappointment that a number of boards have not made the progress that I would expect. For example, the performance of NHS Highland, which covers the member’s constituency, is unacceptable. Both the chair and the chief executive need to show much clearer leadership in taking forward this ambitious target much more effectively. We are working with the boards to make sure that they have adequate plans in place locally to increase the provision of insulin pumps in their area. We have asked them to report to us on a monthly basis on how they are building on that progress over the months to come.

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Health Services (Rural Areas)

2. To ask the Scottish Government what importance it places on the delivery of health services in rural locations. (S4O-01926)

I place great emphasis on the need to ensure sustainable healthcare services in remote and rural areas, and I recently announced that NHS Highland will develop and test models of healthcare delivery in remote and rural areas.

The residents of Letham in my constituency have been pressing for general practitioner provision in the village since early 2011. A Forfar-based practice has confirmed its willingness to set up a satellite operation and the Angus community health partnership is to progress a business plan. I am sure that the cabinet secretary will understand the frustration that is felt locally that after two years still nothing definitive has happened. Will he join me in encouraging NHS Tayside to treat this now as a matter of urgency?

I am happy to do so and I can confirm that the Angus community health partnership has been working closely with Letham residents on the issue. It is also in dialogue with the local Forfar practice, as Mr Dey said, with a view to extending the service provision that independent contractor GPs already deliver to Letham residents. It is anticipated that services will be developed as quickly as possible, subject to the satisfactory conclusion of on-going negotiations. I will certainly do all that I can to encourage all sides to reach a quick conclusion.

The cabinet secretary will be aware of the challenges in providing GP cover in Mallaig, Acharacle and the small isles, and indeed in finding a permanent GP for Applecross. What steps is he taking to ensure that health boards that cover remote and rural communities have the finance and resources to recruit and retain GPs in their areas and can offer the contracts and support needed to make those positions attractive to possible candidates?

Generally speaking, I think that the issue is not so much the availability of resources as it is other factors to do with recruiting and retaining GPs in rural areas, particularly in more remote and island communities. That is why, for example, three practices on the Ardnamurchan peninsula have come together to form one practice, which will allow every GP to have to work only one weekend in eight instead of one weekend in two.

A range of other factors influence the recruitment and retention of GPs in rural areas; we are addressing those and we are looking at different models in different parts of the country, particularly in the Highlands, to see what works best in particular situations. In Grampian, for example, one way in which GPs are retained is by extensive use of GPs with special interests. When I was at the Turriff hospital two weeks ago, one of the GPs there, who has a special interest in ultrasound technology, was examining people using ultrasound. I asked her whether one reason why she stayed there was the opportunity to develop such other interests and she said, “Absolutely.” There are different ways to tackle this problem, but tackle it we must.

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Acquired Brain Injury

3. To ask the Scottish Government how it ensures that people with acquired brain injuries receive appropriate treatment. (S4O-01927)

It is thought that acquired brain injury is the most common cause of disability in working-age adults, and people with ABI can require treatment and care for a complex range of needs. For many people, the effects of ABI will often be lifelong. The emphasis on treatment will be through a multidisciplinary approach involving a wide range of services from different specialities, including accident and emergency, general surgery, orthopaedic surgery, neurosurgery, neuro-rehabilitation and psychiatric services.

We understand that co-ordination of care for such complex needs is challenging and we have supported the development of the national managed clinical network for ABI. That national network works to promote consistency of treatment across Scotland and improve the quality of services for children and adults with ABI.

I recently visited Momentum in Aberdeen, which works with individuals who have an acquired brain injury. One concern that was raised was that individuals with an acquired brain injury often find it difficult to access appropriate support, as they often fall between the two stools of learning disabilities and mental health services. Will the cabinet secretary look into what can be done to ensure that appropriate treatment and support pathways are available to individuals with acquired brain injuries?

As I mentioned previously, the national managed clinical network for ABI works to promote consistency of treatment across Scotland and to improve the quality of services for children and adults with ABI. In 2009, the network published its standards for traumatic brain injuries in adults, which cover a number of areas and are available on the network’s website. I am happy to provide the member with the details on that.

Although the standards were developed for TBI, many of the recommendations are equally applicable to ABI. The network is exploring the potential to evolve into a managed care network that will help to support and recognise the long-term social care needs of people with ABI. I understand that that work is in its early stages and will take time. However, it is envisaged that the network will include developing pathways between health and social care to deal with the very issues that Mark McDonald has rightly highlighted. That work will be helped by the recently published Scottish intercollegiate guidelines network—SIGN—guideline 130 on brain injury rehabilitation in adults.

I thank the cabinet secretary for that comprehensive answer on the issue of brain injuries.

One form of brain injury is alcohol-related brain damage. There was a specialist working group on that particular area, in which there is intensive and increasing national health service demand. Can the cabinet secretary say whether there has been progress on that group’s recommendations, or can he provide a report on the matter to Parliament at a later date, as the area is important?

The group’s work is fairly detailed, so perhaps it would be best if I wrote to Dr Simpson and placed a copy of the letter in the Scottish Parliament information centre so that every member has access to it.

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Access to Green Space (Health Benefits)

4. To ask the Scottish Government what analysis it has made of the health benefits of access to green space. (S4O-01928)

The Scottish Government funded the green health project to look at the health benefits of access to green space, building on the existing evidence base. That project found that more green space in urban neighbourhoods is associated with a lower risk of mortality among Scotland’s poorest men. In respect of middle-aged Scots who were not in work and lived in the most deprived urban areas, the research found healthier levels of the stress hormone cortisol among those who had more green space in their neighbourhoods compared with those who had less. Furthermore, the project found that Scots who use green spaces for physical activity have a lower risk of poor mental health than those who use non-natural environments, such as the gym and streets.

I draw the minister’s attention to the pioneering work in Forth Valley royal hospital, which is in my region. A local partnership that works in the surrounding woodlands there has created a green oasis for patients, which aids their recuperation and levels of stress. That oasis is available for staff, visitors and the local community. Will the minister ensure that that good practice is shared across the national health service estate?

I am very aware of that project, as Forth Valley royal hospital is in my constituency. The hospital site is fairly unique, as it is on the old Royal Scottish national hospital site and it has an extensive woodland and grassland area associated with it. The hospital has made good use of that for the benefit of patients and relatives.

We have taken forward a number of pieces of work in the area at the national level through the green exercise partnership, which involves the Forestry Commission Scotland, Scottish Natural Heritage and NHS Health Scotland, to look at what further programmes could be used to improve NHS healthcare in green space settings. That partnership is working with eight area health boards in Scotland to support them in collaborating on how they can improve the use of green spaces in local hospital areas.

There is a lot of evidence that shows that benefits can be gained from social prescribing, through general practitioner practices referring patients on to different activities that are based in green spaces. That is a way in which primary care can help with the effective use of local green spaces to improve people’s health and wellbeing.

Question 5, which was lodged by Dave Thompson, has been withdrawn for understandable reasons.

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Dentists (NHS Orkney)

6. To ask the Scottish Government how many adults in the NHS Orkney area are on a waiting list to be registered with a national health service dentist. (S4O-01930)

Responsibility for the overall provision of NHS general dental services in the area rests with NHS Orkney. As at 14 March 2013, 1,093 adults were waiting to register with an NHS dentist in the NHS Orkney area.

I thank the minister for his engagement on the issue over a number of months, and I certainly welcome the progress that has been made over recent times, but I am sure that the minister will acknowledge that adult registrations with an NHS dentist and participation rates in Orkney remain far below the national average. Therefore, I urge him to look at what specific steps could be taken to ensure that adults in my constituency enjoy the same access to NHS dental treatment that others across Scotland enjoy.

We have had a considerable level of contact on the issue over the past year or so, and it is fair to say that, as Liam McArthur recognises, NHS Orkney has made significant progress in the area. As I mentioned, 1,093 adults are waiting to register with an NHS dentist in the NHS Orkney area. In July 2012, the figure was 2,120, so there has been almost a 50 per cent reduction over a relatively short period of time.

However, I recognise that further progress needs to be made. I understand that NHS Orkney has two permanent dental officer posts that are vacant, for which it is about to advertise. It also has a temporary post that is vacant, into which it hopes to recruit someone.

In addition, I have asked the chief dental officer to maintain contact with NHS Orkney to ensure that it is getting the right support and advice to allow it to continue to make progress. The most recent report that I had from the chief dental officer was that the board was confident that it was moving in the right direction and that, should it require any further support from central Government, it would request that. I have asked the board to keep us informed of progress so that we see the improvements that have been made in the NHS Orkney area continuing to be made.

Question 7, in the name of Helen Eadie, has been withdrawn. Ms Eadie is representing the Parliament on other business.

Question 8, in the name of David Torrance, has not been lodged, for perfectly understandable reasons.

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Psychological Therapies

9. To ask the Scottish Government what steps it is taking to encourage the use of so-called talking therapies across the national health service. (S4O-01933)

The Scottish Government has established the health improvement, efficiency and governance, access and treatment target to

“Deliver faster access to mental health services by delivering 18 weeks referral to treatment for Psychological therapies from December 2014”.

Since the HEAT target was set, we have already made improvements in service performance across Scotland. The target is acting as a driver for service improvement.

We have published “The Matrix: A Guide to Delivering Evidence-based Psychological Therapies in Scotland”, which gives guidance on what treatments are effective for which conditions. It also stresses that services must provide adequate supervision for staff who deliver psychological interventions, to ensure patient safety and the delivery of evidence-based care. Through NHS Education for Scotland, we are working to assess and develop workforce capacity to ensure that a range of staff are equipped to deliver such therapies.

I welcome the role that psychological therapy plays in the Scottish Government’s mental health strategy for 2012 to 2015. However, does the minister accept that less than 1 per cent of elderly patients with depression are referred to psychological services and that, more often than not, such patients are prescribed medication? What steps can the Scottish Government take to improve those figures?

The member raises an extremely important point. More than any other group, older people are less likely to have mental illness diagnosed and less likely to receive treatment, although some prescribing data suggests that the situation is improving.

Delivery of the psychological therapies HEAT target applies to older people in the same way that it applies to the rest of the population, and we will monitor progress on that. In addition, we established a working group to focus on the psychological needs of older people. The group identified the need to improve access to services across the whole of the mental health system. We are working with NHS boards and other partners to take forward the group’s recommendations and to develop outcome measures that are related to older people’s mental health.

Some local authorities are taking forward such work through service redesign under the change fund, and NHS Education for Scotland is delivering training to NHS staff on psychological interventions for older people. That work includes the training of a cohort of older people cognitive behavioural therapists.

A range of measures are being taken, which I believe can help us to improve the way in which services are delivered to older people with a mental illness. We will monitor that as we move towards achieving the HEAT target in December 2014.

The minister knows that the issue of psychological therapies for older people was discussed at the last but one meeting of the cross-party group on mental health, but has he heard that, at the group’s most recent meeting, we were presented with quite a lot of evidence about the range of psychological therapies that could be beneficial for a variety of people of different ages across Scotland? In particular, does he understand the concern that was expressed that, for many NHS boards, psychological therapies are identified with cognitive behavioural therapy? Useful as that therapy is, can he do anything to extend the range of therapies that are available, because we were told that there is a sound evidence base for a wide range of humanistic psychotherapies and counselling?

I recognise the issue that the member raises. It is why we published “The Matrix”, which presents a range of psychological therapies and sets out where they can best be applied. It is extremely important that any psychological therapies that are made available in the NHS in Scotland have a good evidence base. We are always open to considering other therapies that can be provided, where there is a good evidence base and if they can be included in “The Matrix”. That was considered prior to the publication of “The Matrix” last year.

It is important that we ensure that people can access services in a way that best suits them. That is why, in delivering the services, local authorities and health boards must work in partnership to design services that allow older people to access those services as and when appropriate.

I recognise the constraints on the Government relating to the workforce for talking therapies. I also recognise the progress that the Government has made and its aspirations. The Government is trying to achieve the 18-week target by December 2014, but I draw to its attention the fact that a constituent of mine who has recently been referred to psychological services in Tayside has been told that they will wait three years. As the implementation date for the 18-week target approaches, I hope that the Government will consider existing waiting lists and ensure that individuals do not wait for an extended period but benefit from the Government’s aspirations to ensure an 18-week waiting time.

The waiting time for the member’s constituent is unacceptable. The target has been brought in to deal with such issues and to drive improvement. It is worth noting that, as I understand it, the target is the only one of its nature in the world for access to psychological therapies. It is ambitious, but we need to have a target that helps to improve the way in which services are delivered, drive up standards and speed up access to therapies.

Some of the work that we are doing is to ensure that boards record information consistently, because the reality is that some boards have not been recording the information. We need to ensure that we have good-quality data so that we have confidence in the progress that boards are making. We can then publish the data so that people can make an informed judgment about how boards are performing. The target is ambitious, but it can help to improve the way in which the services are delivered overall.

The minister will understand the value of speech and communication services for children and families, particularly in nursery, where they provide a great socioeconomic advantage. Does he therefore share my disappointment that the Labour and Tory administration in Stirling Council has recently withdrawn the services of an organisation called CHAT—the communication help and awareness team—which is having a significant impact on my constituents?

I am aware that some communication skills services, such as speech therapy, if provided at an early age, can address communication disorders that can become more difficult in later life, which can lead to a range of issues. That type of early intervention is crucial in tackling some of the issues much more effectively. It is important that all local authorities consider taking a much more preventative approach on the issues. The best way in which local authorities can achieve that is through early intervention. They should seek to support services to allow that to happen effectively in their areas.

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Neurological Conditions

10. To ask the Scottish Government how it plans to improve services for people with neurological conditions and their carers. (S4O-01934)

We are committed to ensuring that everyone with a neurological condition is able to access the care and support that they need, including support for their families and carers. The national neurological advisory group, which was established with Scottish Government funding to support implementation of the clinical standards for neurological conditions, has reported that all national health service boards now have improvement plans and improvement leads in place and are providing reports on progress. Prior to that, the Scottish Government provided NHS boards with funding of around £1.2 million over two years to assist them in developing local neurological improvement networks.

People with neurological conditions are often at the mercy of a postcode lottery. What steps is the Government taking to tackle that postcode lottery in care for people with neurological conditions?

As I mentioned in my response, the national neurological advisory group was established to help to support the implementation of the clinical standards, which should help to address some of the inconsistencies that Mary Fee has recognised. That is why each board was asked to produce an improvement plan and to put in place improvement leads who can allow that to happen in a consistent way. I recognise that there will continue to be some inconsistencies in how boards take such matters forward, but we now have the infrastructure in place to assist us in ensuring that there is much more consistency. Some of the feedback that I have heard from some organisations is that they are starting to see some improvements as a result of that, but I recognise that further progress needs to be made and I will be keen to see that progress continuing.

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Independent Living Fund

11. To ask the Scottish Government when it will launch its consultation on the use and administration of the resource that it will receive as a result of the United Kingdom Government’s decision to close the independent living fund in 2015. (S4O-01935)

This spring, the Scottish Government will launch a consultation on the future use of the resources that will be devolved following Westminster’s decision to close the independent living fund.

Will the minister indicate his thinking at this stage on the Scottish Government’s intention for the fund and on the consultation questions, including on whether the fund will be open to new applicants? If he is not able to answer that question, will he at least give us the fundamental assurance that the consultation will start from the premise that no current recipient of the ILF will be disadvantaged—in other words, no one who currently receives ILF will lose it?

The member is inviting me to give a commitment on the basis of information that I do not yet have from the Westminster Government on exactly what level of resource will be devolved to the Scottish Government. Once we have some of that information, we will be in a better place to be able to take forward what may be the appropriate measures here in Scotland.

I recognise that many disability organisations were extremely disappointed by the way in which the UK Government conducted the consultation on its decision to close the independent living fund. I can give a commitment to Parliament that we will have a genuine consultation that will seek people’s views on what might be the best approach in Scotland. However, that will be largely dependent on the level of resource that is devolved to the Scottish Government by the UK Government. As yet, we do not have that detail confirmed.

As the minister will know, all Scottish National Party MSPs deplore the changes being imposed by the UK Government. Is it not the case, though, that, three days before the 2010 general election, the then UK Labour Government brought in changes to the qualifying criteria such that, when they were implemented, of the 3,660 people in Scotland who received ILF, only 16 would have qualified if they had reapplied? Therefore, was not one of the last actions of the Labour Government, in effect, to close the ILF to new applicants?

I know that, over several years, the ILF has been subject to a number of changes, which started with the previous Government and continued with the existing Government. We are in a situation in which the UK Government has decided that it wishes to bring the independent living fund to an end. I recognise that that causes uncertainty and anxiety for those who are currently recipients of the fund.

I am keen to take forward in a genuine, open and transparent way a consultation with stakeholders that can allow them to express their views on what future plans we can take forward here in Scotland. However, I again issue a note of caution, in that we are not aware of the exact level of finance that will be devolved by the UK Government to the Scottish Government. That will have a significant bearing on any future plans that we have here in Scotland, but there is a willingness on the part of the Scottish Government to engage with stakeholders in a genuine way to allow them to express their views on what the future shape of any service should be like in Scotland.

Question 12, in the name of Patricia Ferguson, has been withdrawn.

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Liverpool Care Pathway

13. To ask the Scottish Government what its position is on how national health service boards apply the Liverpool care pathway. (S4O-01937)

The Scottish Government’s position is that any organisation caring for dying people should be able to demonstrate best practice in care of the dying. The Liverpool care pathway is recognised as one pathway that national health service boards can use to support high-quality end-of-life care. The responsibility for use and monitoring of the Liverpool care pathway lies with the organisation using it. The use of the Liverpool care pathway should be part of a continuous quality improvement programme within an organisation’s governance structure and must be supported by a robust education and training programme.

The cabinet secretary will be aware of recent press reports that have painted a negative picture of the Liverpool care pathway. It is always concerning when families are left upset following the loss of a loved one and when the care that they receive is considered to have been unsatisfactory, but would the cabinet secretary agree that the application of the Liverpool care pathway has a good record overall and that it is being used as a positive care package in end-of-life situations? Will the cabinet secretary therefore commit to working with practitioners in the hospice and palliative care sector to promote the LCP, and to support public education on what the LCP can provide in order to overcome the negative perceptions that might have been promoted by some in the media?

I wholly agree with the sentiments that have been expressed by Michael McMahon. I am prepared to work with all the relevant stakeholders to ensure that the reputation of the Liverpool care pathway is enhanced, which it should be.

From time to time, obviously there will be levels of dissatisfaction among patients, their carers and their family with particular issues. I draw the Parliament’s attention to the Patient Opinion website, which I launched yesterday, through which any patient, carer, family member or visitor will be able to record any concerns, which can immediately be brought to the attention of ministers. We are administering the website in relation to both the Liverpool care pathway and any matter that people are concerned about with regard to service provision in the national health service.

I appreciate the cabinet secretary’s response to Michael McMahon. As he will recall, I wrote to him in November last year, asking what discussions he has had with the Department of Health in relation to its inquiry into the Liverpool care pathway. Will he take this opportunity to inform members of what progress has been made in explaining to the wider public the benefits of that form of palliative care? Does he agree with me that the term “Liverpool care pathway” is no longer helpful, given the misguided connections that it now has, as referred to by Michael McMahon?

Both north and south of the border, this is very much work in progress. We recognise that there is a major education and training programme to be undertaken, and part of that is about communicating with the public, patients, carers and families.

I know of some incidents. Indeed, there was a case recently, which was highlighted by the cross-party group on palliative care, in which a patient was having Liverpool care pathway treatment administered, and the family expressed a number of concerns primarily around the lack of proper communication with them, as they perceived it. I do not think that there is a silver bullet here, and education and training continue to be required at all levels. It is undoubtedly the job of all of us to reassure people that the Liverpool care pathway, properly administered, is a very acceptable pathway in the circumstances.

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Scottish Ambulance Service (Caithness)

14. To ask the Scottish Government what action the Scottish Ambulance Service takes to meet patients’ travel and emergency needs in Caithness. (S4O-01938)

The Scottish Ambulance Service is responsible for providing the patients of Caithness and all other parts of Scotland with high-quality, safe, effective and compassionate care. It is responsible for the delivery of the 999 emergency ambulance service, the air ambulance service and the non-emergency patient transport service for those patients who have a medical or mobility need for the support of an ambulance crew to access their healthcare appointment.

I expect the Scottish Ambulance Service to work in partnership with the communities that it supports to ensure that it meets their needs in a way that is underpinned by the NHS Scotland healthcare quality strategy.

Could the minister provide a comparison of the costs of patient transport between Caithness and Raigmore hospital in Inverness with those of providing more services in Caithness general hospital in Wick and the Dunbar hospital in Thurso?

I would be more than happy to provide that information and to have a meeting with Mr Gibson to discuss the various issues. I draw members’ attention to a very comparable situation in Inverness, which I saw for myself last week. A mental health consultation was held from Raigmore hospital, where the mental health consultant was, with a patient who was a resident of a care home in Ballachulish. That is a very good example of where telecare services can be extremely helpful. We have given high priority to the development of telecare services, particularly in the Highlands, Grampian and Islands, where it can make transport unnecessary without in any way diminishing the quality of care; indeed, it can improve it.

One of the points made to me by that patient and their carers and family was that the fact that they did not need to make a five-hour trip between Ballachulish and Inverness was a major benefit to the patient and meant that the extreme stress of the journey was avoided. I am more than happy to have a discussion with Mr Gibson about such issues around Caithness.

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Queen’s Baton Relay

15. To ask the Scottish Government when the Scotland route of the Queen’s baton relay will be announced. (S4O-01939)

On Commonwealth day, 11 March this year, the route that the Queen’s baton relay will take around the Commonwealth was announced. When the baton arrives in Scotland in mid-June next year, it will spend 40 days travelling around every part of Scotland, visiting every local authority area. The relay will finish at the Commonwealth games opening ceremony in Glasgow on 23 July.

The Glasgow 2014 organising committee is working with the Scottish Government, local authorities and others to develop the route that the Queen’s baton relay will take as it travels around Scotland. That route will be announced in October this year.

As the baton travels around the country, it will provide a fantastic opportunity for people in communities across the whole of Scotland to take part in celebrating the games.

Will local people be prioritised to carry the baton in their home town? Will there be any costs to the participants? My questions arise from constituents’ experiences as Olympic torch bearers, which left some of them out of pocket and others many miles from home. They still enjoyed the experience but I hope that we can learn from it.

We have been working hard to learn the lessons of the Olympic torch relay. For the Queen’s baton relay, the organising committee has committed as far as is operationally possible to enabling baton bearers to run in their local area. No fees are associated with being a baton bearer, and those who are fortunate enough to be selected will have a tremendous opportunity to contribute towards a great spectacle and the excitement of the games coming to Scotland.

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Healthcare (Remote and Rural Areas)

16. To ask the Scottish Government what progress it has made since 2007 on delivering healthcare to rural and remote areas. (S4O-01940)

The remote and rural implementation group that oversaw the implementation of the Scottish Government’s report “Delivering for Remote and Rural Healthcare” was disbanded in 2010. Its final report confirms that 63 recommendations were delivered. The north of Scotland planning group continues to provide support to delivering sustainable remote and rural healthcare in that part of Scotland.

Does the cabinet secretary agree that, given the progress that has been made in delivering better health services across rural Scotland, this Parliament is best placed to meet the needs of rural and remote Scotland across all policy areas?

I could not agree more. Indeed, having listened to the budget before I came in here, I am even more firm in my view that it would be far better for Scotland to have full control over all aspects of the governance of Scotland.

We can take question 17 if everyone is brief.

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NHS Lanarkshire (Meetings)

17. To ask the Scottish Government when it last met the chief executive of NHS Lanarkshire and what issues were discussed. (S4O-01941)

Ministers and Government officials regularly meet national health service boards, including NHS Lanarkshire, and a range of matters of importance to local people are discussed.

It has been brought to my attention that some of my constituents face the inconvenience of having to travel to a centralised X-ray service at Monklands hospital instead of being able to use the service that was previously provided at Coatbridge and Cumbernauld health centres. What impact has the centralisation of X-ray services at Monklands hospital had on patient attendance at Monklands hospital X-ray department? Is Monklands hospital able to cope with the demand made by centralising the service?

I am aware of the issue that my colleague has raised. He and Jamie Hepburn have raised it on a number of occasions. I am monitoring the situation closely to make sure that the capacity at Monklands is satisfactory, that it can cover Coatbridge and Cumbernauld and that the quality of the service is in no way diminished as a result of its relocation last year.