Meeting of the Parliament

Meeting date: Thursday, September 23, 2010

Official Report 1133KB pdf

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Scottish Executive Question Time

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Health and Wellbeing

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NHS Greater Glasgow and Clyde

1. To ask the Scottish Executive when the Cabinet Secretary for Health and Wellbeing last met the chief executive of NHS Greater Glasgow and Clyde and what issues were discussed. (S3O-11411)

Ministers and Scottish Government officials regularly meet senior staff from NHS Greater Glasgow and Clyde to discuss many issues that are important to local people.

The cabinet secretary is aware of changes to community health and care partnerships in Glasgow to create a citywide partnership and three area partnerships. Some communities in the north Glasgow CHCP, such as Milton and Possilpark, will merge with communities in the east Glasgow CHCP. She is also aware that many of those communities rate poorly in the Scottish index of multiple deprivation—indeed, 10 of the 20 worst zones are in the area. Will she therefore assure me that she will make the case to NHS Greater Glasgow and Clyde for distributing that funding to the new area CHCPs on the basis of need rather than population?

Of course I will convey to NHS Greater Glasgow and Clyde Patricia Ferguson’s concerns and comments. I encourage her, as a local MSP, to make her points directly to the health board, too. She is right to raise the relationship between how we spend money—not least in the health service—and how we tackle deprivation and poverty. I am sure that health board officials would be happy to discuss those issues with her further.

Has the cabinet secretary discussed with Greater Glasgow and Clyde Health Board its decision earlier this year to cease the provision of specialist services—particularly for back pain—to patients in the Ayrshire and Arran Health Board area? If she has had no such discussions, will she look into the situation? A number of patients now appear not to be getting the treatment that they require.

I have not had specific discussions about that issue with Greater Glasgow and Clyde Health Board, but I am of course more than happy to look into it. I will raise it directly with the health board if that is necessary.

Question 2 has been withdrawn.

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Services for Vulnerable People (Equality Duties)

3. To ask the Scottish Government what legal requirements regarding equality legislation local authorities have to take account of when considering changes to services for vulnerable groups. (S3O-11467)

Local authorities are subject to the public sector equality duties. They must have due regard to the need to promote race, disability and gender equality across all their functions.

The minister will be aware of the statement by United Kingdom equalities bodies that they may seek judicial review of the UK budget should it fail to comply with equality laws. Will that apply to local authorities, too?

I am aware of the Fawcett Society’s challenge to the emergency budget south of the border. There is no doubt at all that local authorities, like every other public body, must adhere to the law, which states that we must have due regard to our specific and general equality duties. The new Equality Act 2010 will start to come into force next month, and the full new public sector duty will come into force no earlier than April 2011.

Likewise, will the minister clarify whether health boards consider equality legislation? Was NHS Lanarkshire required to undertake an equality impact assessment before withdrawing podiatry care from my elderly vulnerable constituents, who are now expected to cut their own toenails, which is impossible for most of them; to pay about £20 for that service each time; or to face possible impaired mobility and the pain of ingrowing toenails?

I am very much aware of the toenail issue in Lanarkshire, as I am dealing with several constituents who have raised the matter. Like all health boards and other public bodies, NHS Lanarkshire must abide by the equalities legislation. Whether to undertake an equality impact assessment of any decision is a matter for the health board.

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Breast Cancer Ward (Victoria Infirmary)

4. To ask the Scottish Executive whether it is aware of any patient concerns regarding the proposed closure of the breast cancer ward at the Victoria infirmary in Glasgow. (S3O-11426)

Yes. I have been in correspondence with some members of the Parliament and members of the public in relation to concerns about the closure of ward B at the Victoria infirmary. I take those concerns seriously.

NHS Greater Glasgow and Clyde has told me that ward B had not been a dedicated breast surgery ward for many years, and that in recent times an average of three breast patients were cared for in the nine-bed ward. The board has also explained that the demand for in-patient beds has significantly decreased as a result of many treatments increasingly being provided on a day-case basis. Indeed, I understand that discussions with the local breast surgery service are under way to explore the opportunities to increase further the use of 23-hour beds within the new Victoria hospital.

I ask the cabinet secretary to expand on some of her remarks. She is aware that, under the remit of the south Glasgow monitoring group—of which she was a member for many years—no named services were allowed to be moved from the Victoria to the Southern general hospital. As far as I am aware, when she and I were members of that group, the breast cancer unit was not closed or moved, so I am trying to work out when exactly it was closed down. Was it since she refused to renew the group’s remit? More important, was she consulted on the unit’s closure and the treatment of breast cancer patients at the Victoria infirmary? Is she aware that the closure of the ward may mean breast cancer patients ending up on a mixed-sex ward?

I gave Ken Macintosh the detail behind the reasons for the actions that Greater Glasgow and Clyde Health Board has taken.

He was also a member of south Glasgow monitoring group and will be aware that it was set up by one of my predecessors—if memory serves me correctly, it was Malcolm Chisholm—for a set period of time. It actually operated for longer than that period and fulfilled the remit that it was given. He will also be aware of the Government’s policy on mixed-sex wards. That pertains in this case as it does elsewhere.

I remind members from all parties that the plans to concentrate in-patient breast surgery beds were made in the context of the acute services review, which ministers approved in 2002. Labour members seem to have short memories these days, but I must remind them that the Labour Party was in office at that time. I will continue to ensure that all decisions in all health boards reflect the best interests of patients and the ambitions of our quality strategy, which is to ensure that we have quality services throughout the health service.

The cabinet secretary will be aware that the planned provision at Gartnavel royal hospital has yet to happen. Does she agree, therefore, that the closure of ward B was precipitate, because a gap has been left in the service for women suffering from breast cancer?

If Jackie Baillie had listened to my initial response, she would have heard me outline the reasons behind the decision that the health board has taken: the demand for in-patient beds is decreasing—that is a good thing, because it means that many more patients receive their treatment in the community—and the average figure for the number of breast patients in the nine-bed ward over recent times was three.

Such decisions must be made carefully. I understand the concerns that have been expressed and will always discuss them with NHS Greater Glasgow and Clyde. However, Jackie Baillie should reflect on the answer that I have given and on the various factors that are at play in the decision.

I ask members who have asked a question to allow the minister responsible to give a response without interruption.

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NHS Scotland Resource Allocation Committee Formula (Rural Areas)

5. To ask the Scottish Executive what action it is taking to ensure that rural areas are fairly treated by the NHS Scotland resource allocation committee formula. (S3O-11393)

A review of the impact of the NHS Scotland resource allocation committee formula on remote and rural areas of Scotland has been undertaken by the technical advisory group on resource allocation—TAGRA—as agreed in the Parliamentary debate on remote and rural health care in June 2008.

TAGRA has examined two issues in the policy area. First, it has investigated the relative impact of the formula in island, remote and rural areas compared with urban and city areas. Secondly, it has looked at the sustainability of heath services in those areas and whether there are greater relative challenges than in other areas. As part of that work, TAGRA has conducted a series of interviews with a group of national health service boards to identify whether there are unavoidable cost pressures that are not captured in the current resource allocation formula. I expect the group to report its findings to me in the next few weeks.

I am very grateful to the cabinet secretary for that extremely full answer. She will be aware of the concerns that I and other members have raised for more than two and a half years about the fact that the additional costs in rural areas are not reflected in resource allocation. Just yesterday, in the debate on telemedicine and telecare, special reference was made to the extra burdens on rural areas in the provision of health care. Health boards have been given illustrative figures for the new capital allocations using the NRAC formula. Will she look favourably on the additional burdens on rural areas when she receives TAGRA’s report?

I am aware of the concerns that Jeremy Purvis and others have expressed on the issue. It was those concerns that led directly to the establishment of the technical advisory group. I will not pre-empt the group’s report, but I assure Jeremy Purvis that I will look carefully at all those issues.

It is important that I stress, and that he is aware, that no capital allocations have been made to health boards for the next financial year. That will, of course, remain the case until we know the detail of the comprehensive spending review.

The three island health boards receive quite different levels of funding per capita under the current funding formula, much of the basis of which is historic. I ask that that be investigated and research be done to ensure that NHS Orkney, NHS Shetland and NHS Western Isles receive the funding that they need to meet the health needs of their populations.

Mary Scanlon will be aware that NRAC’s remit was to refine and improve the Arbuthnott formula. The new adjustment that is used by NRAC is based on the urban/rural classification, which includes specific categories for islands. That allows the adjustment to be built up from smaller and more meaningful geographical units, which makes it fairer for boards with mixed geographies. However, I take on board the point that she has made about islands, and I will reflect on it when I receive TAGRA’s report in the not-too-distant future.

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People with a Visual Impairment (Health Information)

6. To ask the Scottish Executive how it is supporting access to health information for people with a visual impairment. (S3O-11391)

The Scottish Government is committed to the provision of accessible health information that is clear, accurate, up to date and available in formats that meet the needs of all citizens. We are working with a wide range of partners, including NHS inform and health rights information Scotland, to ensure that people with a visual impairment have access to the health information that they need.

In light of the minister’s comprehensive answer, what action does the Government intend to take in relation to the Royal National Institute of Blind People’s recent report on the implications of failing to provide health information in a suitable format to people who are partially sighted? What action will the Government take on the recommendations in that report?

We will certainly look at the report in some detail to see what improvements require to be made. I add to what I said in my original answer that we have developed the translation, interpreting and communication support strategy, which is very much about equal access to health care and the provision of information for all groups, including people with a visual impairment. NHS Health Scotland is working with a range of partners to implement the strategy, to ensure that boards can achieve effective communication between services and service users who have communication support needs.

The health service has done a lot to make improvements in this area. Is the situation perfect everywhere? No, it is not, but there is a recognition that sometimes more imagination needs to be used, along with a bit of common sense, when dealing with patients who have a variety of communication requirements.

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Life Expectancy (Effects of Deprivation)

7. To ask the Scottish Government what its position is on the findings regarding the effects of deprivation on life expectancy made by the registrar general for Scotland in the latest annual review of demographic trends. (S3O-11468)

The Scottish Government recognises the effect that deprivation has on life expectancy. Our commitment to tackling Scotland’s health inequalities was set out in “Equally Well: Report of the Ministerial Task Force on Health Inequalities”. The review of “Equally Well”, which was published in June, confirmed the importance of early intervention in realising the task force’s vision for addressing inequalities and of the need to ensure that resources are allocated accordingly.

Presently, the Government’s success is measured predominantly by gross domestic product. Does the minister agree that success could be better measured by criteria that reflect the population’s health and wellbeing than by GDP, which in developed countries does not relate to those issues?

As a small aside, I have surveyed a large number of non-governmental organisations, and I have yet to find one that likes GDP.

Bill Wilson makes a valid point about using health and wellbeing as a measurement. Although GDP has an important role to play in measuring success, health and wellbeing are—as he notes—important.

I mentioned the equally well initiative in my first answer, and we are, across Government, taking forward initiatives in a number of other important areas, such as the achieving our potential framework, which has been designed to have a lasting impact on poverty and deprivation.

I make the point, however, that—as I am sure everyone is aware—the issues are long standing and will not be resolved overnight.

The latest registrar general report shows a continuing drop in deaths from alcohol-related diseases, which over a number of years have fallen by 20 per cent for men. After rising for 15 years, the equivalent death rate for women has now been stable for a number of years. We all agree that the levels are still far too high. However, does the minister have any idea from her advisers which factors underlie that drop, so that we can identify, support and improve the positive factors?

There is no doubt that the impact on health of alcohol misuse continues to be a real issue for Scotland, and in fact has doubled in the past 10 years. We cannot be complacent about that. I tell the member—although I am sure he is aware—that recent statistics have shown that women in Scotland are more likely than men in England to die from alcohol misuse. That shows the scale of the challenge.

The Government cannot be criticised for presenting a set of radical proposals to begin to address the issue of alcohol misuse. It is just a pity that members on Richard Simpson’s side of the chamber have not seen fit to support many of those radical measures.

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Computed Tomography Scanner (Orkney)

8. To ask the Scottish Executive what its position is on there being no CT scanner available in Orkney and what the implication of this is for patients. (S3O-11389)

Within our framework of national priorities and guidance, it is for national health service boards to assess local service needs and to provide or obtain services to meet those needs.

I know that NHS Orkney has been examining a range of options for future hospital service provision in the islands, and part of that is a business case for a local CT scanner. I understand that the NHS board will consider the recommendations that emerge from the business case later this year, and I look forward to learning the outcome.

I thank the cabinet secretary for her response, and I acknowledge the personal interest that she has taken in the issue. However, I hope that she acknowledges that there is now a real sense that the continued absence of a CT scanner locally is impeding the delivery of the type of care to which my constituents, like those of other members, are entitled.

The cabinet secretary mentions the consideration of the business case. However, does she understand that there is an intense sense of frustration that any savings that arise from a locally based scanner would accrue largely to NHS Scotland and the Scottish Ambulance Service budgets, while the capital and revenue costs of the scanner would fall to NHS Orkney?

I absolutely recognise the strength of feeling. Liam McArthur will remember that I met him and some local campaigners when I was last in Orkney, towards the end of last year.

Having said that, it is not only right but essential that NHS Orkney looks at the issue and balances the importance—which the member has acknowledged—of having that type of provision with affordability and other factors.

We will continue to work closely with NHS Orkney to help it to deal with any issues that it confronts in relation to the matter. I do not want to pre-empt the business case that will emerge and the recommendations that will flow from it, but I assure Liam McArthur that I will continue to take a close interest.

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Cleft Palates

9. To ask the Scottish Executive what it is doing to support children and young people with cleft palates and related conditions. (S3O-11388)

We remain committed to improving the lives of children and young people with cleft palates and related conditions. Indeed, the long-established national managed clinical network in cleft lip and palate has a strong children’s component. The provision of specialist paediatric surgery is key to successful treatment, as are the range of services and follow-up care that are available locally, such as specialist speech and language therapy services and orthodontic treatment.

I have in my hand a letter to the cabinet secretary from the Cleft Lip and Palate Association, which expresses its concern that, from the end of October, no specialist speech and language therapists will be available at the Royal hospital for sick children in Edinburgh. Without those therapists, children with speech problems will be unable to undergo surgery due to the lack of the required pre-operative assessments. The repercussions stretch beyond the Lothians, as the two therapists involved also serve Fife and the Borders. Will the minister guarantee that replacements are actively being sought and will be in place as soon as possible to ensure that there is no gap in provision?

I am aware of the letter to which the member refers. As the cabinet secretary’s recent official reply to CLAPA confirms, we have been in touch with NHS Lothian and we are advised that another speech and language therapist has been identified to support the service. She has started working with the two current specialist SLTs before they leave next month. In addition, the unit is advertising for a temporary SLT to cover for the maternity leave of the lead specialist SLT. However, I acknowledge that the number of specialist cleft SLTs is limited so there can be no guarantee that the Edinburgh unit will attract suitably experienced applicants. It is unfortunate that both of the specialist cleft SLTs at the hospital are leaving at the same time, but I am assured that NHS Lothian is taking all reasonable steps to rectify the issue in order to minimise the impact on the service. Finally, we have asked NHS Lothian to keep the situation under close review and to report back to the Scottish Government if any problems emerge that might have an adverse impact on the service.

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NHS Forth Valley

10. To ask the Scottish Government when the Cabinet Secretary for Health and Wellbeing last met the chair of NHS Forth Valley and what issues were discussed. (S3O-11457)

I chaired NHS Forth Valley’s annual review in the new Forth Valley Royal hospital on 16 August 2010. We discussed a wide range of matters affecting past and present performance and planning for the future with the board chair and his senior management team. I also met the chair on 30 August at the last regular meeting of NHS board chairs.

I draw to the cabinet secretary’s attention concerns that have been raised with me by NHS Forth Valley staff about the availability of parking for staff at the new Forth Valley Royal hospital. Will she outline what advice the Scottish Government gives to health boards when planning for such new facilities on what parking should be provided for staff? Will she also advise which public authority has the final say on what level of parking should be provided? Is it the local authority or the local health board?

Those are essentially local matters. The number of car-parking spaces in the new Forth Valley hospital was determined as part of the process that was undertaken by the health board in securing detailed planning permission from Falkirk Council. The planning permission that was granted by Falkirk Council focused on the board’s need to reduce the percentage of journeys to the hospital that are undertaken by car, with a target of 70 per cent or less having been set for 2010. Accordingly, given that planning permission, it would not be possible to provide additional car parking at the hospital. I hope that that answers Michael Matheson’s question.

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Housing Benefit (Reform)

11. To ask the Scottish Executive what its position is on the United Kingdom Government’s approach to the reform of housing benefit. (S3O-11417)

We have real concerns about the impact that the proposals might have and we are taking steps to ensure that the views of the people of Scotland are heard in Whitehall. It is essential that any changes do not affect the most vulnerable households, which simply cannot afford a reduction in their housing benefit. Officials are in regular contact with their counterparts in the Department for Work and Pensions. I have stressed to UK ministers, both in correspondence and in person, the importance of genuine and extensive consultation on their welfare reform proposals.

I thank the minister for that very clear statement. I share his concerns. It is worrying to listen to some of the comments being made by the Deputy Prime Minister, Nick Clegg, about people who live in poverty and people living on benefits. The more that all of us in this chamber can do to dissuade the UK Government from its approach, the better.

Many of my constituents are not council tenants but private tenants who rely on housing benefit to pay their rent. Do the minister and his colleagues see the provision of housing benefit to private tenants as merely a way of propping up landlords’ private income?

No, we certainly do not. We see it as an absolutely essential source of income for many tenants in the private rented sector, which makes up 8 per cent of the total housing stock in Scotland. Many of the people who live in the private rented sector are among the most vulnerable members of our community who have low levels of income. It is absolutely essential that those people continue to get access to a reasonable level of housing benefit that covers their housing costs while they rely on welfare benefits until they can get a job, if they are fit and able to work. Housing benefit is not a subsidy to private landlords; it is clearly a way of supporting some of our more vulnerable people who happen to be living in the private rented sector.

Does the minister agree that, rather than the private rented sector or the public rented sector, it is people who will suffer greatly because of these so-called welfare reforms? Does he share my fears that we will be creating ghettos in areas where rent is too high for people to afford, particularly in the private sector? Does he also agree that, instead of knocking people, we should say that some do a very good job? For example, the Glasgow Rent Deposit and Support Scheme helps people in these increasingly difficult times.

Sandra White has expressed some of my concerns, and I agree with her latter point.

This week, apparently, the DWP sent out a letter to 200,000 people across the UK who rely on mortgage interest payment support from the DWP. They were informed that, within two weeks, they will suffer up to a 40 per cent reduction in those mortgage interest payments. It is bad enough that they will suffer such a reduction, but to get only two weeks’ notice of it is totally inhumane and unacceptable.

In yesterday’s Evening Times, Councillor Matt Kerr said that proposed changes to housing benefit for temporary accommodation were

“nothing more than crude social vandalism”

that would lead to the return of huge, inappropriate hostels. What is the minister’s view?

I agree with the councillor.

Question 12 was withdrawn.

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Housing Strategy (Community Benefit Clauses)

13. To ask the Scottish Executive what consideration it is giving to the use of community benefit clauses in its housing strategy. (S3O-11434)

The Scottish Government includes community benefit clauses at the heart of a number of its policies. They feature in our economic recovery plan and in policies ranging from the energy assistance package to their use across public sector procurement, including social housing developments.

During the past few weeks I have been in dialogue with the construction industry and the concern has been raised that, even with the use of community benefit clauses, the lack of funding for those who are over 20 makes it more difficult for construction companies to employ people who, through no fault of their own, need to develop new skills to get on in the workplace. Will the minister have a look at some of the areas in which community benefit clauses can be used to provide opportunities for those adults? At the same time, will he make representations to his Cabinet colleagues about how there might be better support to ensure that community benefit clauses assist people who are over 20 to find apprenticeship opportunities?

We are conscious of the need to ensure maximum opportunities for everyone, irrespective of their age group. I draw the member’s attention to what will happen with the energy assistance package in the coming months, when we will ensure that people of all ages benefit from new training, apprenticeship and accreditation schemes for the installation of central heating systems and related skills.

I also draw the chamber’s attention to what is happening through the Cordale Housing Association, in Dunbartonshire. Not only has it developed a community benefit system relating to apprenticeships, it has developed a comprehensive local supply network and is making maximum use of the benefits of the substantial investment that it is making in social housing in that area, to the benefit of not only local businesses, but local people.

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Triage Services (Aberdeen)

14. To ask the Scottish Executive what measures are being put in place to minimise the impact of the closure of triage ward 6 at Woodend hospital in Aberdeen on health care in the region. (S3O-11397)

Ward 6 at Woodend hospital is not a triage ward; it is an intermediate care ward for older people. NHS Grampian’s introduction of patient triage in the hospital has helped to improve arrangements for assessing and diagnosing patients and has reduced their length of stay. It has also supported better and quicker planning for their discharge home or to more appropriate care. All of that means that fewer beds are required. Using resources efficiently while improving the quality of patients’ experience is something that we look to all national health service boards to do.

Has the triage system not been a significant success since it was developed and introduced in July 2009? I am told that ward 6 is not an intermediate care ward, but an intermediate assessment ward and very much part of the triage unit. Is it not the case that 2,000 patients have passed through the triage system and that that has helped to reduce the average length of stay in hospital, for those involved, from 21 days to between nine and 14 days and has also allowed 205 patients to be discharged directly home? Is it true that there were not enough staff to operate the unit safely due to a freeze on posts and appointments?

With the greatest of respect for Nicol Stephen, I think that there was a slight misunderstanding in his original question, which has flowed through into his supplementary question. The triage system, which was introduced in July 2009, has been an enormous success—what he claims for it is absolutely true. However, ward 6 is not a triage ward. The triage system is not being reduced. It is the success of the triage system that has led to patients having a shorter length of stay and being discharged more quickly. It is those successes that have led to a fall in the bed demand in the intermediate care ward—ward 6. Nicol Stephen is correct in saying that the triage system has been a success but he is wrong in suggesting that the closure of ward 6 is in any way putting that system at risk. The changes around ward 6 are a result of the successes of the triage system.

Does the cabinet secretary agree that this is, in fact, a good-news story in which social work colleagues, the discharge co-ordinator and health service staff have worked together to reduce the bed blocking that was prevalent under the previous Government? Will she confirm that the staff who currently work on the ward in question will all be redeployed within Woodend hospital?

Maureen Watt is absolutely correct in saying that all the staff who currently work in ward 6 will be fully redeployed elsewhere in the hospital. Also, the beds in ward 6 that are still required are being transferred to another ward. Maureen Watt is 100 per cent correct in saying that it is a good-news story. It is exactly what we want to see happening—patients having the correct triage, not having to spend longer than they should in intermediate care beds and being discharged quickly to the appropriate care. The changes that have taken place in triage have, in part, helped that to happen. It is an example of a health board looking to see how services can be delivered more efficiently—which is very important in the current economic climate—but in a way that also improves patients’ outcomes. It is exactly the kind of service redesign that we want.

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Emergency Care

15. To ask the Scottish Government what action it is taking to ensure that best use is made of emergency care resources and that accident and emergency departments are able to function effectively. (S3O-11395)

Over the past few years, NHS Scotland has made good progress in building a more integrated system of unscheduled care services, including services provided by emergency and accident departments, with the objective of delivering the right care in the right place at the right time. Through the pursuit of our ambitions in the quality strategy, we will continue to develop and improve all our unscheduled and planned care services and, in partnership with national health service boards, NHS 24, primary care and the Scottish Ambulance Service, the Scottish Government will build a genuinely integrated system of care for patients that responds to what people need and is safe, effective, sustainable and good value for money.

The cabinet secretary will of course be aware of difficulties in Fife at Victoria hospital’s A and E unit as a result of staff shortages and that in 2008-09 more than half of those treated in emergency departments had only minor injuries or illnesses. What is the Government doing to increase public awareness of the alternatives to emergency departments and blue-light ambulance services to ensure that genuine emergencies receive the attention that they deserve, where they deserve to receive it?

Iain Smith is absolutely right to highlight the importance of making people aware of the correct part of the NHS to go to in certain circumstances. That is the NHS’s responsibility. For example, NHS Grampian’s recent know who to turn to pilot project, which some of his colleagues might be aware of, seeks to tell people the right place to go in various circumstances. As he says, that plays an important part in reducing demand on A and E departments.

With regard to the specific issue that he raised about Fife, I know of the contingency arrangements that are in place for A and E services and that on some occasions they have had to be activated. However, NHS Fife is working hard to minimise the need to use such arrangements in future.

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National Health Service (Effects of European Working Time Directive)

16. To ask the Scottish Executive what assessment it has made of how the implementation of the working time directive on junior doctors’ hours is affecting the national health service. (S3O-11392)

NHS Scotland boards undertake their own on-going assessment of the effects of the implementation of the working time regulations and are supported in that by a Scottish Government working time regulations adviser who offers advice and help in designing compliant and safe medical rotas. Compliance with the regulations across NHS Scotland is currently running at around 99 per cent.

In light of the recent United Kingdom-wide survey of 980 NHS surgeons and surgical trainees that revealed that 80 per cent believe that care has worsened since the European working time directive came into effect last August, will the Scottish Government commit to carrying out an urgent review of the directive’s impact on the care provided by the Scottish NHS?

We monitor all these things closely. As I said in my initial answer, the Scottish Government has a working time regulations adviser who provides help and advice to boards on designing rotas that not only comply with the regulations but are safe and deliver safe patient care.

I know well the survey that the member refers to. It is right that the country has a system that ensures that doctors do not work too many hours or work to the point that they are tired and are perhaps unable to deliver a safe level of patient care. As a result, I support the working time regulations and, as Mike Pringle knows, even if I did not—which I do—the fact is that the issue is reserved. We do not have the ability simply to opt out.

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Capital Resource Allocation (NHS Grampian and NHS Tayside)

17. To ask the Scottish Executive, following its advice on capital allocations to national health service boards, what safeguards it has put in place to ensure that an equitable share of resources will be available to NHS Grampian and NHS Tayside. (S3O-11390)

The recommendations of the capital strategy group recognise the continued need for an equitable distribution of resources through a formula-based distribution of capital resources. Given the United Kingdom Government’s projections for reduced capital budgets, arrangements are being put in place to ensure that funding for larger capital projects is prioritised through a transparent process involving NHS Scotland representation.

The proposed removal of almost all delegated capital spending powers from health boards is an assault on decision making and the resulting bidding for resources from a central capital funding pot, which will pit health boards against one another, is unlikely to serve the north-east well. Will the cabinet secretary assure the chamber that she will consult on the criteria to be used to determine the project priorities? What steps will she take to ensure transparency? Finally, what will be the on-going role of the capital investment group?

Respond as quickly as you possibly can, please, cabinet secretary.

I think that I have answered the latter parts of Alison McInnes’s question already.

I will say that no final decisions on capital allocations will be made until we know about the comprehensive spending review, but we must responsibly make arrangements for dealing with capital budgets that are much reduced. Given that Alison McInnes is a member of a party that in the UK Government is presiding over these swingeing cuts in capital investment, it is a bit rich to hear her complain.