SCOTTISH EXECUTIVE
Health and Community Care
Elderly People (Care)
To ask the Scottish Executive what arrangements should be put in place before elderly patients are discharged from hospital and which agencies are responsible for ensuring that adequate home care is provided. (S2O-9392)
All relevant agencies should co-ordinate their efforts to ensure a safe and timely discharge from hospital once treatment has been completed. Local authorities have a statutory duty under the Social Work (Scotland) Act 1968 to assess what services people need in those circumstances and to arrange for them to be provided. Services may be provided either by the local authority at its own hand or by a voluntary or private agency on its behalf.
Unfortunately, in recent months a number of cases in which adequate care has not been put in place have been brought to my attention. The most recent case involves a constituent of almost 80 years of age, who lives alone, who was discharged from Dumfries and Galloway royal infirmary after suffering a stroke and having a pacemaker fitted and who is also a cancer sufferer. She receives less than one hour's care per day at home and is expected to stay in her bed from 8 o'clock at night until 10 or half past 10 the following morning, because she is not yet strong enough to get herself out of bed. Does the minister share my concern about that? Does he agree that it is unacceptable and that if it is not possible to ensure that adequate care is provided at home, elderly patients, especially those living alone, should be offered a period of recuperation in a residential or care home until such care can be provided for them?
I do not want to comment on individual cases. However, I reiterate the guidance from the Executive. The document, "NHS Responsibility for Continuing Health Care"—MEL (1996)22—states:
Last week I raised with the Deputy Minister for Finance, Public Service Reform and Parliamentary Business the waiting lists that are building up in some councils for people who have been assessed as worthy of free personal care and other care packages. He told me that officials were currently pursuing the matter with the councils in question. When will the talks take place and when will the waiting lists be able to be abolished?
Such discussions are on-going. I assure Nanette Milne that we take the matter seriously. There is an obligation on councils to provide services a person's need of which has been assessed; they should make that provision. How they do so is a matter for them but must be in line with their statutory obligations.
To ask the Scottish Executive on what date all local authorities will be in a position fully to deliver free personal care for elderly people. (S2O-9359)
It is the duty of local authorities, under the Social Work (Scotland) Act 1968, to assess the needs of people who appear to be in need of community care services and to meet those needs. The obligation to meet an assessed need for personal care, without charge, has been in place under the Community Care and Health (Scotland) Act 2002 since July 2002.
Can the minister explain why in many areas of Scotland free personal care is not provided automatically when people have been assessed as needing it? In some areas people have to wait for assessment. Overall, local authorities tell us that they do not have the funding to carry out what the act to which he referred envisaged.
Funding is negotiated between local authorities and the Scottish Executive. The funding that is currently provided for community care services is in line with the discussions that took place at the beginning of the spending review period. Naturally, as part of the next spending review, those matters will be considered again. As I said in a previous answer, the obligation on local authorities to provide services to meet the needs that they have assessed people as having is in place and is something to which all local authorities should have proper regard.
Given what the minister said, are local authorities that operate waiting lists not meeting their statutory obligation? If so, will the talks in which officials are taking part with local authorities end with a clear instruction to local authorities that operate waiting lists that they should cease to do so immediately?
The matter that we are pursuing with local authorities is about ensuring that they provide access to the services to which people are entitled. As I said a moment ago, how a council meets those assessed needs will be up to it. For example, if a local authority has assessed a person as being in need of certain services and would wish, ultimately, to provide those in a care home setting, it would be meeting its obligation if it were to provide them to an adequate level in a domestic setting, as long as the service of which that person has been assessed as being in need is provided.
On 18 September 2003, I asked the First Minister to confirm that the legislation that the Parliament passed makes it clear that
The policy position is clear. A local authority should carry out an assessment and, having made that assessment, should provide the services in question. Clearly, the issue of free services depends on the circumstances of the individual and the nature of the services that are to be provided. Where that service requirement is assessed to be one that should be provided free of charge, that is exactly what should happen.
In the minister's discussions with the Convention of Scottish Local Authorities, what progress has been made on the issue of food preparation charges under the free personal care for the elderly arrangements?
We have made significant progress, although the conclusion of the discussions has not yet been reached. I met the president of COSLA earlier this week and I look to my officials and those of COSLA to take forward those discussions very soon.
Since the introduction of free personal care for the elderly by the Scottish Executive, South Ayrshire Council has had to subsidise the programme to the tune of £2.5 million and, in this year's budget, has been forced to divert in excess of £1 million to meet its commitments on free personal care and to reduce waiting lists caused by the Executive's failure to fund the programme fully. Will the minister give a commitment to review the free personal care funding settlement for South Ayrshire Council and undertake to provide a level of funding that meets the guarantee that was previously given to fund the programme fully?
I do not intend to give to one council an undertaking that I would not give to the others. The position is the same across Scotland. Local authorities have been provided with funding that is in line with what we discussed with them at an earlier stage. This year, we are undertaking a thorough examination of the funding provision that is in place and of local authorities' effectiveness in securing services for that funding. We will carry that forward, continuing discussions with COSLA as we do so, to reach conclusions about future funding.
Partnership Agreement (Health)
To ask the Scottish Executive whether the section of the partnership agreement relating to health will have been implemented in full by 2007. (S2O-9352)
The partnership agreement contains 61 commitments related directly to health and community care. We are making good progress and 95 per cent are completed or are on track. Those that remain are challenging, but we are doing our best to achieve them.
One of the more challenging commitments that remains must be the commitment to deliver free dental checks for all by 2007. Will the minister guarantee that that will occur and say whether any follow-up treatment that is deemed necessary at those checks will also be available to patients under the national health service? Further, will the commitment be delivered by NHS dentists or will the minister seek to use dentists from outwith the NHS?
Free dental checks will be available as of 1 April. They will be available to NHS patients.
NHS Western Isles (Meetings)
To ask the Scottish Executive when the Minister for Health and Community Care last met the chairman and chief executive of NHS Western Isles and what issues they discussed. (S2O-9349)
I meet all the chairs of health boards regularly, most recently on 27 February 2006, when David Currie was present. I met all of the chief executives on 18 January. On both occasions, a wide range of national health service issues was discussed. I last met the chair and chief executive together at the annual review, which I conducted in Stornoway on 12 September.
I am sure that the minister will agree that NHS Western Isles has a highly committed and professional workforce, but does he understand why they have no confidence in the chair, chief executive and board medical director, who are alleged by many to bully and bluster but who have failed to publish a financial recovery programme that protects medical services and delivery? Will Mr Kerr listen to the people of the Western Isles, who are represented by their council, and to the staff, who are represented by the Royal College of Nursing, Amicus, Unison, the Institute of Healthcare Management and now by the consultants group? All those people want the minister to intervene to remove the gang of three and to rebuild trust and confidence in the future of NHS Western Isles.
No. These matters must necessarily be addressed locally. The issues are largely local. They are largely to do with relationships and I want those relationships to be sorted out. I reflect on the fact that, in Mr Gibson's cursory involvement in the matter—he has written three letters to me on the issue—he has not mentioned the true value of services to patients in the Western Isles. In my visit to the Western Isles during the review, I saw the huge effort that is being put in by the staff and the huge benefit that patients are getting from the services.
Will the Minister for Health and Community Care join me in condemning the irresponsible nationalist politicians who consistently perpetuate the myth that he, Lewis Macdonald and the First Minister are all involved in a process to close down the Western Isles health board? Will he join me in impressing upon the management of the board its duty to involve its staff in meaningful dialogue and to implement the much-needed changes?
We must all work together. The Scottish Executive Health Department is working with those in the Western Isles to resolve the challenging issues. The financial recovery plan is being worked on as we speak. The futile round of accusations and political posturing will do no one any good. My focus is on patients, services and the innovations that continue to be developed in the service locally.
Herceptin
To ask the Scottish Executive what advice has been issued to national health service boards regarding the prescribing of Herceptin. (S2O-9377)
Herceptin is currently licensed for the management of HER2-positive breast cancer that has spread to other parts of the body. I understand that the manufacturer has applied for Herceptin also to be licensed for use in early-stage breast cancer. Decisions on whether to prescribe a treatment are made according to the clinical judgment of the doctor concerned, in consultation with and with the consent of the patient or carer, and bearing in mind the risks and benefits of treatment.
I advise the minister of a constituent inquiry that I received on 31 December. My constituent was advised by her consultant that she was suitable for treatment with Herceptin but the treatment was not financially approved by NHS Ayrshire and Arran. It was not until 25 January that NHS Ayrshire and Arran was advised that consensus has been reached throughout the national health service in the west of Scotland on the use of Herceptin and the funding for that. Does the minister agree that a clinician is the appropriate person to determine the treatment a patient receives and that finance should not be the only determining factor?
As I said in my initial answer, clinicians must certainly make a clinical judgment. However, it is important to recognise that they do so in the context of whether a treatment has been licensed, and Herceptin is licensed for treatment of HER2-positive breast cancer that has already spread and is not currently licensed for early-stage breast cancer, so the judgment that clinicians must make is clearly different. It is appropriate that any treatment goes through a proper process of assessment before being licensed for use in clinical circumstances.
National Health Service (Public Participation)
To ask the Scottish Executive what efforts it is making to increase the level of public participation in the NHS. (S2O-9367)
"Delivering for Health" recognises the importance of supporting the public to participate as full partners in the planning and delivery of national health service services. We believe that it is important that NHS boards implement the proposals in "Delivering for Health" by engaging with, and winning the support of, the people and communities they serve. We have taken important steps to promote an increased level of public participation in the NHS, and we have legislated in the National Health Service Reform (Scotland) Act 2004 to place a new statutory duty on NHS boards to involve the public.
Those are welcome initiatives. The minister will be aware of my proposal for a member's bill on direct elections to NHS boards. The bill is currently at the pre-introductory stage and will be formally introduced on 31 March. Will the minister agree to meet me to discuss the bill after its introduction, so that we can explore the many ways in which direct elections to NHS boards would complement the admirable public participation strategy that he outlined in his initial response?
I always wish to add to the process by which the public can become involved in our health service. The Scottish health council and the local forums and advisory councils are being set up as we speak, and changes are being introduced as a result of the annual review meetings that I hold. The development of public partnership forums and the statutory duty to engage are substantial measures, but I am happy to meet Bill Butler to discuss his bill, which I have been following closely.
Did the minister approve of the efforts of John Scott and of other MSPs and community leaders in Ayrshire, who publicised in a responsible manner the consultation process on the accident and emergency service at Ayr hospital? If so, does he agree that the 5,000 people who turned out to the procession led by John Scott provided an excellent example of the kind of public participation that the Executive wishes to encourage, and will he ensure that they are listened to?
In relation to Mr John Scott, no, I absolutely did not approve of his actions. Parliament debated "Delivering for Health" and our response to Professor David Kerr's report, and there was universal approval of the substantive elements of that report yet, at the first whiff of any changes or reconfiguration, the member to whom Mr Gallie referred did not wait for a consultation process to be completed or until matters had been discussed fully with the board, but simply went straight to the press, and I condemn that.
Medical Centres
To ask the Scottish Executive what progress is being made with the development of a new Vale of Leven medical centre and a new Garelochhead medical centre. (S2O-9363)
Those projects were initially commissioned by NHS Argyll and Clyde. NHS Highland is now progressing the Garelochhead medical centre, while NHS Greater Glasgow is currently reviewing the business case for the new Vale of Leven medical centre before proceeding further. I expect to see both projects delivered, but in each case it is for the incoming NHS board to satisfy itself that the project is robust in all respects.
The minister will be aware of the concerns that I and my local community have expressed about the fact that NHS Argyll and Clyde had agreed the capital for both projects but had somehow neglected to agree the revenue for them. Will he take this opportunity to make it absolutely explicit that both boards must proceed with those projects, not least because the developments are very much in line with the Executive policy of delivering health services as locally as possible?
I share that view. The replacement of Garelochhead medical centre is essential. I know that the property is dated and not fit for purpose, which is not the vision that we have for the future of our health service here in Scotland. The same is true of the other developments.
Environment and Rural Development
Grocery Market (Inquiry)
To ask the Scottish Executive whether it will make a submission to the Competition Commission inquiry into the grocery market in respect of relationships between Scottish farmers and major supermarkets. (S2O-9429)
The Office of Fair Trading is currently consulting on a proposal to refer the market for the supply of groceries by retailers in the United Kingdom to the Competition Commission for a market investigation. Once I have details of the terms of any investigation by the Competition Commission, I will decide how best to engage.
The minister will be aware of the importance of Kettle Produce in my constituency, which is a major supplier of fresh produce to supermarkets throughout the UK. He will also be aware that it had to shed 100 jobs last year because of the price pressures that were placed on it by the supermarket giants. Does he think that it is reasonable that supermarkets should be able to boost their profit margins by requiring suppliers to take price cuts or to meet the costs of promotions such as buy-one-get-one-free offers? Also, does he share my concern that the unfair farm-gate price for milk is threatening the existence of our dairy industry? Will he agree to support the OFT's referral of the matter to the Competition Commission?
If that referral is made, I will clearly do so. As I said in my first answer, I will decide how best to make a submission.
Does the minister agree with the farmers that we need to establish an enforceable supermarket code to ensure that those at the bottom of the supply chain—the farmers—get a fair share of the profits that are earned by the supermarkets?
To be honest, I think that discussion of the issues that are involved would be better informed if there were an investigation by the Competition Commission. There might then be greater clarity about the issues on which an enforcer or any such body might be required to act. Although a huge volume of evidence points to the need for improved regulation and control, all of us who are engaged in the food industry in Scotland must understand that there must be better engagement up and down the whole chain. The combination of both those aspects would be of great benefit to the Scottish food industry.
Does the minister share my concern that the inquiry might not touch on the relationship between primary producers and supermarkets? It seems to me that the announcement of the inquiry focused on the impact of the mini-supermarkets that are proliferating in our towns and cities on our traditional corner shops and independent retailers. Is he in a position to confirm that the relationship between primary producers and supermarkets will come under the Competition Commission's consideration? If he shares my concern, can he assure us that the Scottish Executive will take whatever steps are necessary to ensure that the investigation addresses that relationship?
I am grateful to Alex Fergusson for spotting the way in which I couched my initial response. I am indeed waiting to see the terms of reference. I share his concerns that what appears to be a helpful potential referral might, if the terms of the investigation are not properly drawn, do as Alex Fergusson suggests: it might focus attention on the direct relationships with the smaller supplier, the major supplier and perhaps the consumer but miss out the relationships down the chain. If that were to be the case, I would be deeply concerned.
Scottish Water (Financial Strategy)
To ask the Scottish Executive whether it will make a more substantial response than it has to date to the criticisms of Scottish Water's financial strategy and the role of the Executive and the water industry commissioner in framing that strategy that have been published by Jim and Margaret Cuthbert in their recent paper. (S2O-9344)
The Water Industry Commission for Scotland has considered the criticisms contained in the Cuthberts' recent paper and concluded that they are without substance. The Cuthberts' approach involves borrowing without regard to the consequences for future charges or the financial sustainability of the water industry. That is the opposite of the Executive's policy, which the commission has confirmed will deliver below-inflation charges now and in the future and allow Scottish Water to deliver one of the largest-ever capital investment programmes in the United Kingdom water industry.
I thank the minister for that answer, but I regret its tone, because the Cuthberts have perennially suggested prudent borrowing. The current situation is that, of the capital expenditure for the three years to 31 March 2005, current water charge payers paid 86p in the pound. Is that fact, together with the silence of the Executive, which has not made a formal and complete response to the Cuthberts, and the silence of the commission, which refuses even to discuss the 2002 to 2006 strategic review of charges—the foundation of Scottish Water's finances—not prima facie evidence that there is something far wrong with Scottish Water's financial management?
We would not accept what the member has said. As he is aware, we have required the Water Industry Commission to ensure that Scottish Water remains financially sustainable. That means ensuring that charges are sufficient to cover the business's annual costs and operational costs, depreciation and interest charges. New borrowing is used to enhance the business's asset value. If we were to lend to fund current costs, we could rightly be accused of poor stewardship of the industry. We would in effect keep adding to Scottish Water's debt without adding to the value of the infrastructure, which would mean higher charges in the long run. Future customers would be paying for the service that today's customers receive. The current model is the best one for Scottish Water. We operate within a regulatory framework that was agreed by the Parliament and we are confident that that is the right way to fund Scottish Water.
What consideration has been given to whether Scottish Water should be given a licence for retailing to business users?
I am prepared to give the member up-to-date information on that. We await final confirmation from Scottish Water.
Scottish Water (Chairman)
To ask the Scottish Executive when it expects to appoint a new chairman of Scottish Water. (S2O-9361)
Following a competition run in compliance with guidance from the commissioner for public appointments, we expect to announce an interim chair for Scottish Water shortly.
I thank the minister for her response. It is instructive that Ross Finnie seems to be ducking answering questions on Scottish Water by passing the responsibility for doing so to his deputy. Perhaps we should read something into that.
We are aware of concerns about development constraints and we have stated clearly that we will put funds into relieving development constraints in Scotland. Clearly, economic development is the number 1 priority for the Scottish economy. We remain convinced that Scottish Water can remove development constraints in Scotland. The funding exists and we need to get on and do it.
If the Scottish Water business plan is so fundamentally flawed that it required the removal of the chairman of Scottish Water, does the minister understand the bewilderment that exists about the length of time that it has taken the Executive to fill the vacancy? There is no business plan, credible investment plan or agreement from the regulators. Is this not just further evidence—confirmed by the Minister for Environment and Rural Development at yesterday's meeting of the Environment and Rural Development Committee—that the Executive has been sleepwalking in its management of the water industry in Scotland?
That is nonsense. The chairman's resignation was on 20 February. The appointment of a new chairman is a critical public appointment. The interim chair will have the task of ensuring that Scottish Water is able to deliver all the objectives that we have set within the financial limits set by the Water Industry Commission. We will, of course, announce the appointment as soon as we can, but the absence of a chair is not delaying the delivery of Scottish Water's 2002 to 2006 investment programme or, indeed, planning for the 2006 to 2010 programme.
Get the chairman back.
Mr Swinney!
Rural Postal Services
To ask the Scottish Executive, in the context of its rural development strategy, what role rural postal services play in promoting a more diverse rural economy and thriving rural communities. (S2O-9423)
Rural post office services and post offices can certainly make a contribution to the rural economy and rural communities. The postal services regulator guarantees a national universal postal service, a delivery and collection every day and a uniform and affordable price. That plays an important role in connecting people and businesses in rural Scotland.
Does the minister agree that, where the only postbox servicing a community has to be removed, a year after the removal of the postbus service, Royal Mail must then ensure that a replacement facility is put in place without delay? Can he exert influence in any way on Royal Mail to ensure that the rural community of Gilmerton has a postal collection service that does not require people to walk along a busy road with no pavements?
I recognise the particular problem that exists in Gilmerton, but the member will agree that there are general concerns about the availability of postal and post office services throughout rural Scotland. For that reason, I met representatives of the Post Office and the Royal Mail Group as recently as 14 February. More recently, I met Barry Gardiner MP, who is parliamentary under-secretary of state at the Department of Trade and Industry and has responsibility for these matters. We are concerned about the erosion of rural postal services and the notification of changes that is given. At this stage, I cannot provide the member with an answer on the restoration of services. However, we are keeping the matter very much under review, because we are concerned that any erosion of rural postal services can have impacts on the provision of other services in rural communities.
Question 5 has been withdrawn.
Toxic Waste (Disposal Sites)
To ask the Scottish Executive what plans it has to introduce a scheme to clean up toxic waste disposal sites. (S2O-9410)
Responsibility for cleaning up toxic waste dumps that are no longer in use rests with the local authority, as primary regulator of the contaminated land regime under the powers set out in part IIA of the Environmental Protection Act 1990.
It would seem that those provisions are not being adhered to. The minister will be aware of the precautionary principle, which states:
We are well aware of the precautionary principle. As Rosie Kane knows, there are a number of sites throughout Scotland—including those to which she refers—where local authorities are carrying out examinations to determine the nature and extent of waste. Under the Environmental Protection Act 1990, they are under a clear obligation to deal with any toxic substances that are found. The precautionary principle clearly applies in the application of the act.
Animal Cruelty
To ask the Scottish Executive what action it is taking to address issues of animal cruelty. (S2O-9393)
The Animal Health and Welfare (Scotland) Bill, which is being considered by the Environment and Rural Development Committee, will make significant improvements to animal welfare and will increase the penalties for offences of animal cruelty and animal fighting. We expect it to complete its parliamentary stages before the summer recess.
The minister will be aware that, during the stage 1 debate on the Animal Health and Welfare (Scotland) Bill, I raised the issue of performing animals in circuses. I was delighted with the deputy minister's assurance at that time that the Executive would introduce secondary legislation to deal with performing animals, including those in circuses. Will the minister inform me of the timescale for that secondary legislation and whether it will be constructed in similar terms to the recent Department for Environment, Food and Rural Affairs guidelines banning the use of certain species of animal in circuses in England and Wales?
I cannot give the member a precise timescale because it depends on the Parliament taking the democratic decision to pass the bill at stages 1, 2 and 3. However, I can confirm absolutely what my depute said at committee: we will introduce secondary legislation to create regulations. Given the nature of the different proposals, it will be necessary for us to consult on which animals should be banned from use on the basis that their welfare needs cannot be met adequately in travelling circuses. Although the regulations will be framed to deal with similar circumstances, they will not necessarily be identical to those from DEFRA, but they will certainly have statutory backing.
It is my understanding that the Executive's position on a ban on tail docking was that it would exclude working dogs. That was changed in anticipation that England and Wales would approve a ban on tail docking across the board. Now that they have changed their minds in England and Wales, will the Executive move back to its original position?
The member is right. The Executive's initial position suggested that there might be exemptions for working dogs. As he is well aware, it is our practice to read carefully what is said in stage 1 committee reports. He will be equally aware that the overwhelming evidence heard by the committee, and backed by all the veterinary organisations, was that that proposal could not be sustained. Since our announcement of a change in the policy, the veterinary associations have confirmed their position.
Question 8 is withdrawn.
Avian Flu (Contingency Planning)
To ask the Scottish Executive whether it has any plans to bring forward the planned test of contingency planning measures as the threat from avian flu increases. (S2O-9358)
Contingency planning arrangements are tested regularly by exercises or routine responses to cases of suspect notifiable disease. The Scottish Executive will participate in a Great Britain-wide avian influenza exercise on 5 and 6 April.
I hear what the minister says with some relief. Does he agree that, although we should not be motivated by some of the more extreme articles that appear in the press about the threat of avian flu, we must ensure that all the necessary measures are in place? Will he confirm that the Executive will review any measures that need to be reviewed in the light of an increased threat?
I give both Bill Aitken and the Parliament the assurance that animal health disease contingency planning is reviewed on a regular basis. We are very susceptible to outbreaks of exotic disease, particularly among large animals, so we keep contingency planning under constant review.
Environmental Courts
To ask the Scottish Executive when it expects to publish a consultation on environmental courts. (S2O-9430)
My officials are currently holding a series of consultation meetings with interested organisations such as the Scottish Environment Protection Agency and environmental non-governmental organisations to consider further their views on the wide range of issues covered by our partnership agreement commitment. We shall take account of those views when we move to public consultation in the next few months.
I will be pleased when we make progress on the matter. Does the minister agree that if we had environmental courts with expertise in the area, we would avoid the situation that happened in my constituency when a building contractor who was illegally burning waste on site was taken to court and fined a sum that was one tenth of what it would have cost to dispose of the material legally and correctly? Does the minister agree that that situation is to be deplored?
The member has raised two separate questions: how environmental justice cases can be brought to court and the appropriate level of fine for particular cases. We are reviewing all such matters, including the most appropriate form of justice for such cases; the preparedness of the Crown Office and others in dealing with environmental offences; and the level of penalty that a sheriff court, the High Court, an environmental court or, indeed, any court is able to impose as a proper deterrent in such offences.
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