First Minister’s Question Time
Engagements
1. To ask the First Minister what engagements he has planned for the rest of the day. (S4F-01394)
The murder yesterday in London of a member of the armed forces was one of extraordinary brutality and will be condemned by all people who have any sense of humanity. We should remember that one of the purposes of terrorism is to divide communities from each other. Our purpose should be to hold communities together, and that is what we will continue to do.
I fully agree with the First Minister. I believe that he speaks for all of us in the chamber and for those beyond, throughout Scotland, in condemnation of those terrible actions. We are determined to hold together in the face of that terrorism.
Last week, I asked the First Minister about Maureen Fleming. Her immense dignity in challenging the unfair system of accessing cancer drugs captured the attention of the people of Scotland. We know that Maureen met the Cabinet Secretary for Health and Wellbeing, Alex Neil, this morning, at the First Minister’s request. Can we presume that she is now getting the drugs that she needs to prolong her life?
Certainly, that meeting took place this morning, and I met Mrs Fleming last week. I hope that the situation will be one of the factors that lead us to getting the best possible system of drug distribution in Scotland. It should be our aim and intention to have the best possible system of drug allocation, so that is what we intend to do. I was delighted that Mrs Fleming was able to meet the health secretary this morning.
Of course, we share the First Minister’s aim to get this right in the future, but it is the business of Government to address the problems that Mrs Fleming and others face right now.
On Monday, the health secretary Alex Neil told a radio phone-in programme:
“If the clinicians thought she would benefit from it, she would get the drug”.
Mrs Fleming’s clinician believes that she would benefit from the drug, which is why he prescribed it, and so do many other clinicians who have been consulted about Mrs Fleming’s case. The people who have denied her the drug do not have the same degree of clinical expertise on her condition.
The Health and Sport Committee was told this week that cost was the main issue. Since last week, we have been contacted by other people whose circumstances are similar to those of Mrs Fleming. Whom should they believe? Should they believe the doctors who are at the front line trying to keep people alive, or a Government that has form for misleading the public?
The Scottish Medicines Consortium was introduced a number of years ago in Scotland—under a different Administration, as it happens. That is our chosen system for deciding which drugs should be allocated. Very demanding formulas need to be used to do that.
Individual patient treatment requests, which are for people who have not had drugs allocated to them within the SMC system, are judged not on economic grounds, but on clinical grounds. The decision is about whether there is something particular to the patient that makes it important that a drug be prescribed.
The system is under review at present—which is well known. We have had the Routledge report, which made some substantial recommendations while accepting that the vast majority of opinion says that the SMC system is robust and effective. We are also looking at the individual patient treatment request system to see whether it can be improved. There have certainly been a number of indications in evidence that improvement is necessary and possible.
It should be remembered that it is simply not the case that individual patient treatment requests are not successful; two thirds of IPTRs are successful. However, improvements are being identified in the system. In particular, the evidence that was given to the Health and Sport Committee this week is very important. There is a consensus that we should not go down the road of having a cancer drugs fund. There was substantial evidence from a range of people and charities, who gave very substantial reasons for why we should not.
That does not mean that we cannot make improvements to the system, and that is what the Cabinet Secretary for Health and Wellbeing and this Administration are determined to do.
I say to Johann Lamont that there cannot be anyone in the chamber—or in the entire country—who does not want the best possible system of drug allocation for Scotland; that is a joint interest for us all. The way in which the Health and Sport Committee is conducting its business is important, because that information will be vital in getting a better system.
The point that we are making to the First Minister is that the system is not working. Examples such as Mrs Fleming’s case mean that it is simply not working, and we need to address that problem. We are seeking reassurance that such decisions are made on clinical grounds and not on ground of cost.
The First Minister has said that Mrs Fleming has been refused the drug on clinical grounds. Let us look at the case. Last week, the First Minister told members in the chamber that Mrs Fleming could not get cetuximab because she had had chemotherapy, and the health secretary, Alex Neil, has repeated that. Alex Neil told the BBC that there were
“a number of conditions suggested by the drug company Merck. One of those conditions is that anyone who has had chemotherapy will not get this drug.”
Why would Mrs Fleming’s doctor prescribe the drug for her if she was precluded? Why would he appeal that decision?
We contacted Merck Serono Ltd, and it issued, at five to 10 this morning, a statement that says:
“Cetuximab has been proven to be effective and is licensed for use in bowel cancer patients previously treated with chemotherapy, and is widely used for such patients in England.”
Whom should we believe—the clinicians who seek to prescribe the drug, the company that manufactures the drug, or Alex Neil?
In the last part of her question, Johann Lamont—perhaps unintentionally—put her finger on the real issue, which is that we should not be in a position in which politicians decide which drugs are, or are not, allocated. That is why we set up the SMC system in the first place, and why individual patient treatment requests are clinically determined. That is the point and purpose of the system.
The SMC’s decision on licensing cetuximab for prescription came in January 2010. The SMC made clear that
“The submitting company has requested that SMC review a niche within the licensed indication specifically for patients who have not previously received chemotherapy for their ... disease. The efficacy and safety data presented reflects this niche.”
There is no doubt that that was the basis on which the drug was submitted and approved by the SMC. Incidentally, those are the same guidelines that have been used in England by the National Institute for Health and Care Excellence.
It is also the case that, because there is a cancer drugs fund in England, one can get the drug through that means, but it is certainly not—even on those conditions—licensed for everyone. The guidance says that the drug is for specific conditions and that there are restrictions on its use. There is no guarantee that patients with that cancer type would receive the drug through the cancer drugs fund.
Other serious questions—of which Johann Lamont must be aware—about the cancer drugs fund came up in evidence this week. There is a huge consensus that we should not go down that route in Scotland. However, it is possible—and relevant—that we can make improvements in both the SMC system and the individual patient treatment request system. We should certainly do that, and find the best possible system for the distribution of cancer drugs and drugs for other serious diseases.
I absolutely do not dispute that it should not be for politicians to decide whether someone gets a drug or not, but the cases should be clinically decided. I do not think that the First Minister listened to me. Clinicians in large number believe that Mrs Fleming’s case is suitable, and the drug company says that the drug is suitable. The only person who is now saying that it was somehow a clinical decision is the First Minister himself. His point that Mrs Fleming does not qualify because she had chemotherapy has been disputed and denied by clinicians who understand her case.
Mrs Fleming’s case was first raised eight months ago and another letter was sent to Alex Neil six weeks ago, but she received a reply and was offered a meeting only after her case was raised in this chamber. People may recall that Ian Morrison was refused treatment until his case was highlighted in the chamber, but he is now getting the cetuximab that he needs, despite his having previously had chemotherapy.
Maisie Black needed a rare drug, but it was not until she was on the front page of the Daily Record that a £21 million fund for orphan drugs was established. We recall John McGarrity, who was ignored on a trolley for eight hours, but once his experience made it into the papers, £50 million was conjured out of thin air to deal with a problem that we were initially told did not exist anyway.
That is no way to run a health service. We all agree that the NHS should be free at the point of need, but is it not the case that, for too many patients, the health service becomes free only at the point that it embarrasses the First Minister?
Because of the issue’s importance, because we are discussing individual patients and because of the nature of the discussion, I will not even begin to rise to that bait. That is not how such things should be discussed.
Let me just take Johann Lamont through the situation. The SMC licenses cetuximab as it does because the drugs company made that specific request, so it was licensed on that condition. That is where the chemotherapy aspect comes in; it is not applied in individual patient requests, which by definition are to apply a drug to a particular patient for particular reasons, which are outside the SMC licensing process. That also is part of the system. Therefore, Johann Lamont should take the point that the conditions on which the SMC licensed cetuximab were identical to the conditions—[Interruption.] They were identical to the conditions on which the NICE system licensed the drug in England. That was the request that was made.
An individual patient treatment request decision is based on clinical grounds and on the specific characteristics of the individual patient, which are also clinically judged. Of the individual patient treatment requests for cancer drugs, two thirds are accepted. Nowhere in the process that I have identified is there any intervention from the health secretary, the First Minister or any other politician. Those matters are determined clinically .
On the orphan drugs fund, Johann Lamont does herself no credit by not welcoming that announcement. If she cares to remember, the announcement was based on a clinical recommendation that arose from the Routledge review. Therefore, the health secretary acted to set up such a fund.
The overwhelming body of evidence—I can quote expert after expert, from Professor David Webb, Eric Low, the east of Scotland cancer research network representative, and Leigh Smith of Melanoma Action and Support Scotland, who all gave evidence to this week’s Health and Sport Committee meeting explaining this point in substantial detail—is that a cancer drugs fund is not the way that we should proceed in Scotland. [Interruption.]
Order.
Those experts said that they believe that the cancer drugs fund will not be renewed in England because of its faults and failures.
However, what we can do in Scotland is find a better system in respect of the SMC and take forward the recommendations of the Routledge review. I also believe that we can find a better system for individual patient treatment requests. As we get to that system, I hope that we will all remember the joint ownership of the current system, which was not devised by this Government but was inherited by us. As we improve that system, as we are duty bound to do as parliamentarians who represent our constituents and as human beings who genuinely care about the health of Scotland, I hope that we will have the support of the Parliament on a non-party-political basis.
Prime Minister (Meetings)
2. I, too, associate myself with the First Minister’s comments regarding the violent death of a soldier outside the Woolwich barracks yesterday. Our thoughts are with the soldier’s family. All our efforts are in playing our part in bringing our communities together following that terrible act.
To ask the First Minister when he will next meet the Prime Minister. (S4F-01393)
No plans in the near future.
This week, the First Minister published the Scottish National Party’s economic case for independence. Rather than give the people a clear picture of a separate Scotland’s economic future, it posed more questions than answers. As if his wee “booklet”, as he called it, had not caused enough confusion, a rather frustrated First Minister blurted out afterwards that the SNP was prepared for an independent Scotland not only to use sterling without proper agreement but to embark on this brave new world by defaulting on its debts. Will he explain how an independent Scotland would pay its way if, right from the start, it would not have a legally supported currency or be able to borrow from anyone other than a back-street loan shark?
I am tempted to answer Ruth Davidson with two words: Denis Healey. In addition to providing the Scottish people with a fascinating insight into the machinations of the London Treasury in the 1970s, the tremendous interview with the former chancellor in Holyrood magazine, in a little reported aspect, states:
“On Scotland keeping the pound, he says Scotland would gain but adds that so ‘would the rest of us’ and he doesn’t see why Westminster could say the Scots couldn’t have it.”
Rather than listen to the rather ungainly and suspicious advice from the patched-up coalition of Treasury ministers in London, Ruth Davidson should listen to the authentic words of Denis Healey—someone who does not have to disguise his words or underestimate oil revenue any more and who can tell us the truth—and take her marching orders from a man who knows.
I am glad that the First Minister raises nonagenarian Denis Healey as the way forward because, to pay for the First Minister’s plans, the First Minister would have to tax everyone until the pips squeak. [Interruption.]
Order.
The First Minister’s economic plan for Scotland would turn this country into a central American-style basket case. It is no wonder that, when he made his way to Alexander Dennis, he kept his finance secretary back at home on the naughty step. Instead of the reality check that we got from honest John’s document—a truthful briefing paper that tells us what would really happen—we got the First Minister giving us increasingly fantastic claims.
Come on, Murdo, get on the front bench.
Order.
Oh, sorry—the finance secretary wants to speak now, does he? He did not have anything to say on Tuesday.
Ms Davidson, your questions are to the First Minister.
The First Minister would not be able to borrow at anything other than exorbitant rates under his plans. He would be spending money that he did not have like water, but he expects us to believe that, all the while, he would be squirreling away money for a rainy day.
There are only two conclusions. Either the First Minister would be printing money faster than Zimbabwe or he would be taxing the people of Scotland up to their oxters. Will he show us exactly where in his wee booklet it tells us how a country that would have instantly defaulted on its debts and would have no control over its monetary policy would finance an oil fund, a 3 per cent cut in corporation tax and an ever-expanding welfare and benefits system?
I have a rich opportunity and a variety of things to cover. I remind Ruth Davidson that our position is that the responsible thing to do is to take a share of the assets and liabilities of the United Kingdom. The point is that that would involve both sides of the balance sheet: the assets and liabilities.
The irresponsibility in the debate comes from some in Ruth Davidson’s party and the UK Government, who seem to suggest that they live in a world where the UK can claim all the assets of the UK but still share out the liabilities. The problem with that, legally, has been set out by, for example, Professor David Scheffer, who points out that people cannot make that argument. If people argue that there is a sole continuing state, that of course has advantages, but one disadvantage is that it ends up with all the liabilities that were issued in the name of that state. It is therefore far better to stick to the responsible attitude of the Scottish Government.
I will ignore the ageist remark about Denis Healey—I really do think that it was a bit much. I will turn to somebody much younger. Writing in The Scotsman today, he says:
“Albert Einstein”—
we should bring him into the debate as well—
“reputedly defined insanity as doing the same thing over and over again ... The Scottish Conservative and Unionist Party has been slow to learn the truth of this observation from the great scientist.”
There are many more gems, climaxing with that rallying call that he is not sure whether the Conservative Party is the right vehicle for centre-right politics in Scotland. With loyalty such as that on the back benches, I am surprised that Ruth Davidson even bothers to ask me a question.
Cabinet (Meetings)
3. To ask the First Minister what issues will be discussed at the next meeting of the Cabinet. (S4F-01399)
Issues of importance to the people of Scotland.
I associate myself and my party with the First Minister’s remarks about Woolwich. Last night’s attack was sickening and can never be condoned. Our thoughts are with the victim’s family.
What discussions has the First Minister had with the Home Secretary, the chief constable in Scotland, military chiefs and the United Kingdom security services following last night’s attack? Some steps have been taken on security around military installations and other sensitive buildings. What steps has the First Minister taken in response to last night’s events?
The Cabinet Secretary for Justice had a conversation with his counterpart in the UK Home Office this morning to look at some of those aspects and to be updated on the meetings that took place in London yesterday. The Police Service of Scotland yesterday implemented its contingency plan on such matters and is taking appropriate steps in Scotland. Willie Rennie will understand if I do not specify what those appropriate steps are, but they are very much part of the contingency planning that the Police Service does for such events.
I thank the First Minister for his very helpful answer. I am sure that he agrees that it is important that fear must not turn into hate in such circumstances. I will do all that I can to work with him to keep peace between and within our communities. These were not the actions of Britain’s Muslim community; it feels as wounded by the attack as anyone else. Will the First Minister report back to the Parliament in due course once we have had time to consider the consequences of this attack for Scotland, so that we have an opportunity to reflect on and explore what we should do?
I thank Willie Rennie for his question and the manner in which he asked it. Just as this Parliament unites in our condolences to the family of the murdered member of the armed forces and our condemnation of a horrendous attack, so we also unite on what the response across Scotland’s diverse communities must and shall be.
Willie Rennie knows that we have had challenges in the past, such as the attack on Glasgow airport in 2007. One of the most splendid things to come out of that evil attack was the response of Scotland’s communities. Across the faiths and across the communities, people bound together to make it absolutely clear that we would not allow acts of terrorism to divide our communities in Scotland. That will apply equally to the murderous attack that took place in London.
One of the things that enable that to be the case in Scotland is this Parliament’s ability to speak with one voice in our condemnation of a murderous attack and our absolute determination to ensure that such acts of terrorism do not divide the communities of Scotland. I thank Willie Rennie very much for the way in which he asked his questions.
Independence (Protection for Savers and Pensioners)
4. To ask the First Minister what assessment the Scottish Government has made of the claims in the Treasury analysis paper regarding an independent Scotland’s ability to provide protection for savers and pensioners. (S4F-01398)
I agree with Jim Spowart, the former managing director of Direct Line and the founder of Intelligent Finance, who said about the Treasury paper:
“There is a huge credibility gap between the claims made in this report and how financial services operate in the real world.”
The truth of course is that an independent Scotland would be an attractive place for savers, pensioners and indeed financial services. Our financial sector is hugely important, of course, but it accounts for 8.3 per cent of our gross domestic product, compared with 9.6 per cent of the United Kingdom’s GDP. The simple fact is that, like every other independent nation in Europe, we will fulfil all our requirements and obligations. Every other nation in the European Union has protection schemes for savers and pensioners. Despite the no campaign’s rather desperate efforts to suggest otherwise, Scotland will be no different from that.
The First Minister will note that the Treasury is acting not as an honest broker but as an integral part of the no campaign. How concerned is he that the Treasury will again deliberately deceive the Scottish people about Scotland’s oil wealth, as it and the then Labour Government did in the 1970s? The McCrone report exposed that some years ago and the former Labour Chancellor of the Exchequer Denis Healey admitted that only last weekend. Does the First Minister agree that, whether it is scaremongering over an independent Scotland’s place in the world, over pensions or over the currency, people cannot trust a single word that the no campaign says?
I agree. Denis Healey’s interview deserves a second mention. I hope that every single member of the chamber—and people outside it—reads that incredibly revealing interview. So much of it was substantial, including the very important admission that the Treasury deliberately underplayed the significance of oil in the 1970s to stop the advance of the Scottish National Party. If it was prepared to do that in the 1970s, surely it is prepared to do that in 2013 when life is much more sophisticated and the black arts of Treasury politics much more pronounced. Of all the great quotations, the best one was this:
“we would suffer enormously if the income from Scottish oil stopped but if the Scots want it [independence] they should have it and we would just need to adjust but I would think Scotland could survive perfectly well, economically, if it was independent.”
So says Denis Healey; so say all of us.
Government Grants (Tax Levels)
5. To ask the First Minister what action the Scottish Government is taking to ensure that its grants are awarded only to companies that pay correct levels of tax. (S4F-01407)
The Scottish Government’s job is to attract jobs and investment to Scotland—as we are doing noticeably successfully, given that for the past five years we have been first or second in the Ernst & Young inward investment league table. The United Kingdom Government’s job is to collect corporation tax, which it seems to be incapable of doing, whether it is the present Government or, indeed, the past Labour Government, which was apparently even worse at it.
I am unclear from that answer whether the First Minister is defending the award of more than £10 million of our taxpayers’ money to a successful multinational such as Amazon, given its apparent unwillingness to pay correct levels of corporation tax in this country. Is it credible to talk about a socially just Scotland while extolling a race to the bottom on corporation tax and handing out millions of pounds of Government grants to companies that dodge tax and avoid recognising workers’ rights?
Ken Macintosh should reflect on the fact that Amazon was awarded support by the former Labour Administration in Scotland—I can detail that if he wants, cite the quotes that went along with it and say why it was a tremendous success—and by the present Labour Administration in Wales, which is boasting of its success and role in attracting investment from Amazon to Wales.
In case Ken Macintosh does not want to be reminded of the past and, given that we are always told that what Labour is doing in Wales is irrelevant, I will reflect on the words of Helen Eadie from not that long ago on 13 December last year. She was so concerned at the threat to investment grants by the Scottish Government from—as she saw it—the European Commission that she wrote to the European commissioner. She said:
“Amazon’s recent decision to locate significant operations in part of my home area of Fife that suffers from a severe lack of job opportunities is just one example of an investment that would be put at risk if RSA”—
regional selective assistance—
“had to be limited to small and medium-sized firms.”
While Ken Macintosh is telling us that we should not be generating thousands of jobs in Scotland, Helen Eadie is warning us that we must absolutely continue grants to Amazon. Once the Labour Party gets its own act together, it can come and ask me a few questions.
Domestic Violence Disclosure Scheme
6. To ask the First Minister whether the Scottish Government will consider piloting a domestic violence disclosure scheme. (S4F-01397)
The Scottish Government is examining with substantial interest the Clare’s law pilots in England and Wales. We will take on board any evidence from the pilots when they conclude in September. However, we will also discuss the matter fully with our partners, such as Police Scotland and Scottish Women’s Aid, to ensure that we make the right decisions to protect victims in Scotland.
I am pleased that the operation of the pilots in England is being monitored, as I have concerns that, although we all wish to protect women from violent partners, there are issues relating to human rights, the confidentiality of any disclosures and, indeed, the possibility of vigilantism. Does the First Minister agree that the matter is complex and that careful and that full consideration of all the implications of such a scheme would be required?
Christine Grahame is absolutely correct to say that this is not an easy area and that all the complexities and, indeed, the evidence from the pilot studies have to be explored before taking action. I know that she also appreciates that victims have human rights as well, among which is the right not to be subjected to inhumane and degrading treatment. That is why the Government has substantially increased—by 62 per cent—the funding for campaigns against violence against women, and that is well recognised by those who work in the field. For example, Dr Mairead Tagg said on the BBC on 10 May 2010:
“To be fair we have seen a huge improvement in the services for domestic abuse since the Scottish government came into being.”
It is hugely important that we take the lessons from the pilot studies and examine the complexities but, above all, we must have a real conversation and discussion with our partners, including Scottish Women’s Aid, to ensure that we are doing the right thing to further extend the protection of people against domestic violence.