Health and Wellbeing
NHS Lanarkshire (Capital Funding)
NHS Lanarkshire is given an annual formula capital allocation. It is for the board to identify its capital spending requirements and prioritise them in line with the available resources.
Will the cabinet secretary bring pressure to bear on Lanarkshire NHS Board to carry through the commitment that it has given to people in Cumbernauld and Kilsyth to provide a new health centre in Kilsyth? The board is not meeting the community’s needs. It promised to provide a primary care function in Cumbernauld, which it has not yet provided for. Will she intervene to encourage the board to meet the commitments that it has made to my community?
I hope that I can reassure Cathie Craigie that Kilsyth health centre remains a development priority for NHS Lanarkshire. She and other members might be interested to know that eight of the 16 capital projects included in “A Picture of Health: A Framework for Health Service Provision in Lanarkshire” were due to be completed by 2013. Seven of those projects definitely will be completed by 2013. Planning for the eighth project, which is the north mental health in-patient unit, is on-going. The board envisages that it will also be completed within that timescale.
The minister will be aware that, as a result of Tuesday’s budget, NHS Lanarkshire will have to pay its share of NHS Scotland’s £26 million extra costs in VAT from next year. That will remove potential national health service capital funding for Cumbernauld and Kilsyth and beyond. Does she share my disappointment that one reason for that was the Labour Party’s refusal to countenance the formation of an anti-Tory coalition in London and the subsequent infliction of a Tory Government on the people of Scotland?
Yes, I do. People throughout Scotland will be absolutely dismayed that Labour has ushered in another Conservative Government, which nobody in Scotland wanted.
Not nobody; 17 per cent of people wanted it.
I leave it to Murdo Fraser to point out how few people in Scotland wanted a Conservative Government.
Caithness General Hospital (Maternity Services)
NHS Highland has confirmed that it has no plans to change the maternity services that are delivered from Caithness general hospital in Wick.
It is clear that the challenges—dangers, even—that are presented by, for example, the distance to Raigmore hospital and severe winter weather render any notion of increasing the number of mothers who have to travel to Inverness, which is a journey of more than 100 miles each way, quite unthinkable. Several proposals have been made in the past to downgrade the consultant-led maternity services that are based in Caithness general hospital, but in each case, people pressure and the highlighting of the dangers to mothers and babies that would be presented by any such downgrading have won the day. I need an assurance that the minister understands where we are coming from in the far north, that the consultant-led services that we have now are the most appropriate for such a remote area, and that if the downgrading proposal were ever resurrected, she would make it clear that it would be entirely unacceptable.
There may well have been proposals to downgrade the maternity services that are delivered from Caithness general hospital in Wick, but there are no such proposals under this Scottish National Party Government. I hope that that gives the member the clear answer and reassurance that he asked for.
Can the minister help us in relation to issues of consultant recruitment at Caithness general hospital? The hospital does not have the full complement of consultants, and the use of locums is expensive. Is any attempt being made to help rural general hospitals get permanent, full-time staff?
Yes. Rob Gibson highlights a challenge that many hospitals face in trying to recruit, particularly where they are trying to recruit specialists from a small pool of people who are in short supply. As I am sure he is aware, a lot of work is under way to make rural general hospitals more attractive to consultants. As part of the action that we are taking, we are ensuring that people are supported and linked to some of the bigger hospitals. That gives them experience and keeps their skills up to date. We believe that our action has led to health boards being better able to recruit consultants to hospitals, no matter whether the hospital is in Wick or another part of rural Scotland. We are not complacent about the issue; we need to keep it under constant review.
NHS Greater Glasgow and Clyde (Meetings)
Both ministers and Scottish Government officials meet regularly senior officials from NHS Greater Glasgow and Clyde to discuss issues of importance to local people.
I welcome the target that the minister has set of a 50 per cent reduction in hospital-acquired infection rates among the over-65s. In her discussions with Mr Calderwood, did she say how she expects NHS Greater Glasgow and Clyde to implement the new initiative to reduce infection rates, given the planned loss of some 1,200 staff across the board area and the loss of 500 cleaning hours at Glasgow royal infirmary alone?
Members who are familiar with my position on tackling heath care associated infection in hospitals will know that I prefer to keep the issue clear of party politics. Frankly, it is too important for that. In her question, Patricia Ferguson betrays a lack of understanding of the real progress that NHS Greater Glasgow and Clyde—and, indeed, every health board across Scotland—is making in reducing infection rates and of the measures that are already under way. It is clear that she also misses the fact that this Government has substantially increased the resources that are available for fighting infection in comparison with the resources that the previous Government committed. That is simply a fact.
National Health Service Board Elections (Pilot)
The key criteria that will be used to assess the pilot elections are set out in the Health Boards (Membership and Elections) (Scotland) Act 2009. The criteria are: the level of public participation in the health board elections; whether having elected members on health boards will lead to increased engagement with patients and other members of the public and improved local accountability; the cost of holding the pilot elections; and the estimated cost of holding future elections in all health board areas. The act requires that the assessment be carried out as part of an independent evaluation, the results of which we expect to lay before Parliament in the autumn of 2012.
Does the cabinet secretary share my disappointment that only 22 per cent of the electorate of Dumfries and Galloway voted on 10 June, despite its being an all-postal ballot? One of the points that my constituents have made to me is that having to read through the biographies of 70 candidates for 10 places was rather off-putting. Should the pilots be rolled out elsewhere, I wonder whether consideration might be given to voting on a ward basis, particularly in rural areas, or to requiring candidates to have a certain number of supporting nominations.
Those are perfectly valid suggestions. The reason for piloting health board elections was to examine the experience and see whether there are ways of doing them differently or better in the future. I am sure that Elaine Murray’s suggestions will be fully taken into account by Parliament before it makes a decision on whether to roll out the elections.
The cabinet secretary will recall that during the passage of the Health Boards (Membership and Elections) (Scotland) Bill, she indicated that she might be prepared to consider other forms of structure and experiment. Can she indicate to Parliament today when she might undertake those other experiments and, indeed, whether she will do so at such a time that they can be assessed alongside the elections to which Elaine Murray referred?
Ross Finnie may be interested to know that the non-statutory pilots, as we call them—rather than experiments—are already under way. One of the new, non-executive members appointed to the board of NHS Lothian was drawn from a local patient-public forum. I am more than happy to give members a full progress report on where the non-statutory pilots have got to. However, members who paid close attention to the passage of the bill will know that the non-statutory pilots will be fully evaluated in parallel with the elected boards.
Front-line Health Workers (Protection)
Violence or abuse against any health care worker is unacceptable and should not be tolerated. That is why we extended the Emergency Workers (Scotland) Act 2005 in 2008 to ensure that doctors, nurses, midwives and ambulance workers are protected from obstruction, abuse or hindrance whenever they are on duty. The applicable penalty is up to 12 months’ imprisonment or a £10,000 fine, or both.
I welcome the cabinet secretary’s response and concur with her view that it is a very serious problem that needs to be dealt with. While I welcome the measures to which she referred, I am concerned that, out of the 65 incidents at Inverclyde royal hospital last year, just 25 resulted in a court appearance, and there were only 17 convictions. Does she agree that those depressing facts send out the wrong message to those who see health workers as a soft target? Will she discuss this unacceptable situation with her colleague the Cabinet Secretary for Justice to ensure that those who abuse and use violence against our nurses and doctors will, indeed, face the full consequences of their actions before our courts?
I agree with Duncan McNeil that anybody who perpetrates violence against, or abuses, health care workers deserves to suffer the full consequences of their actions. It is behaviour that I am sure nobody in the Parliament and the vast majority of people outside it can even begin to understand. To abuse or commit violent acts against those who are there to help people and, in some cases, save lives is just beyond comprehension.
Does the cabinet secretary believe that we get 100 per cent reporting? I suspect that many professional people will not report other than very serious incidents and that a vast number of such acts may go unreported, which we should be getting to the bottom of.
I suspect that, in this category of crime—as, unfortunately, in many other categories of crime—there is a degree of underreporting because people, for a variety of reasons, decide not to report such behaviour. We are, however, starting to see an increase in the reporting of such behaviour in the national health service, as there has been an increase in the number of reported violent and abusive attacks. I encourage anybody who suffers such unacceptable behaviour to report it in the appropriate way. All of us want to see those who are responsible suffering the consequences of their behaviour.
Private Letting Agencies (Regulation)
Our recent consultation on a proposed private housing bill outlined new powers for local authorities to require letting agents to provide a list of the properties that they manage. That measure could help to put an end to unscrupulous agents acting on behalf of unregistered, rogue landlords. The consultation also described legislative provisions that will clarify prohibited charges, which will prevent agents from charging unacceptable administration fees. I am well aware of the impact that rogue landlords and private letting agents can have on communities such as Govanhill and those in Mr Gordon’s constituency, and I am determined to tackle the growing problem. That is why, last week, the cabinet secretary announced £1.8 million in funding to tackle problems in Govanhill.
The minister will recall that, in yesterday’s debate on stage 1 of the Housing (Scotland) Bill, I drew attention to the actions of private letting agencies that have placed antisocial tenants of rogue landlords in parts of my constituency, thereby ruining the quality of life of hundreds of my constituents. Will he act, in this parliamentary session, to force such agencies to vet both tenants and landlords? If so, when will he act?
As Mr Gordon knows, we are considering all such issues in the drafting of the proposed private housing bill. We are specifically considering the definition of who constitutes a fit and proper person to be a landlord and how that relates to their allowing tenants to engage regularly in antisocial behaviour. The bill will place the responsibility on landlords as well as introducing additional measures for controlling and regulating letting agents. We hope that the combination of those measures will have the desired impact. I share Mr Gordon’s objective in that area of policy.
The minister will know that it was because of the antisocial behaviour that was carried out by many tenants of private landlords in my constituency that I pushed for the amendments to the Antisocial Behaviour etc (Scotland) Act 2004 that introduced licensing. The point was made yesterday that that was perhaps not the right legislation in which to have that provision. Nevertheless, it is a growing problem, and it was a problem then.
At my regular meetings with the Convention of Scottish Local Authorities, I have raised a number of times the need for all local authorities to implement the landlord registration scheme more robustly and to take action against rogue landlords. We will include additional powers in the proposed private housing bill, which will be published after the summer recess. I entirely share the member’s objective of taking a more robust overall approach to dealing with the problem of rogue landlords.
Sight Loss (Early Intervention)
There are a number of measures in place in Scotland to tackle sight loss, including free national health service eye examinations for all, vision screening in children and diabetic retinopathy screening.
I welcome the minister’s mention of free eye tests, which were brought in by the Liberal Democrats, of course.
We have invested record sums—about £92.9 million last year—in general ophthalmic services. Scottish eye care is widely recognised as being among the best in the world. Demographic challenges throw up a range of issues for us to be aware of, and sight loss is one of them. We need and intend to keep our eye services as robust as they are at the moment.
There is concern that some younger diabetic patients—possibly those who need screening most—are missing out on screening for diabetic retinopathy and macular oedema. What actions is the Scottish Government taking to improve the screening of young people in particular, thereby meeting its as yet unmet targets? What is being done to promote patient responsibility in actively seeking such screening?
The Scottish diabetic retinopathy screening programme is widely recognised as a world-class service, and it has robust processes in place to ensure that everyone who is eligible for it is offered regular screening. Nanette Milne raises some valid questions about how we ensure that sections of the population who might be less likely to come forward for screening are reached. We will continue to consider that point, possibly using different communication channels to raise awareness, among young people in particular, of the importance of coming forward at an early stage to get any concerns checked out. I will perhaps write to the member with some more detailed information.
I concur with the minister that, with our optometrists and general ophthalmic services, Scotland’s eye programme is a world leader. Can she indicate whether the innovative link between optometrists and ophthalmology that has been developed at Queen Margaret hospital in Fife, which the Cabinet Secretary for Health and Wellbeing has visited, will be rolled out? Will the Government support the setting up of a robust information technology link to increase the efficiency of that highly innovative and productive programme by replacing the workaround method that is currently being used to support it?
I am certainly aware of NHS Fife’s very successful work in that area. Officials have been considering a draft outline business case, which includes proposals for electronic referrals from optometrists to secondary care. The project team has been asked to undertake further work on the business case, and we will be looking at it in due course.
National Health Service Dentists (Orkney)
Responsibility for the overall provision of NHS dental services in the area rests with NHS Orkney. Progress has been made in adult and child registrations, with an additional 1,713 new patients being registered with an NHS dentist in Orkney between December 2008 and December 2009. Plans to increase capacity further are well advanced. In addition, Orkney NHS Board has advised that a dental review will be undertaken to consider demand, activity, waiting list management and how best to use current capacity. The review will report in early August, and a timescale for addressing the outstanding registration waiting list will be available following that review.
I thank the minister for that detailed response. She will recall that I had an exchange with the Cabinet Secretary for Health and Wellbeing in November 2008 on the same subject. Although there has been progress on registrations in some respects, they have simply mopped up an additional 3,000 to 4,000 patients who were added to the waiting list as a result of the departure of two or three dentists.
Further to my first answer, an outline business case for improved provision of dental facilities to increase capacity is in development. In the meantime, as I alluded to, current capacity is being examined for efficiencies. NHS Orkney was allocated £1.35 million of primary and community care premises modernisation programme funding to be used for dental provision.
Low-cost Initiative for First-time Buyers
The Scottish Government wants to help as many people as possible, within the resources that are available, to access home ownership if it is affordable for them. We keep all five schemes in our low-cost initiative for first-time buyers under review. We have made a number of adjustments to enable more first-time buyers to achieve their aspiration of home ownership, particularly in the current economic climate. An evaluation of the main LIFT schemes is being carried out this year to help to inform how our support for first-time buyers should best be targeted.
What is the minister doing for first-time buyers who qualified for the Government-backed interest-free equity loan but cannot take advantage of it because the banks are demanding a contribution on top of it, thus undermining their prospects of buying a property? Has he thought about meeting the banks to discuss their obligations? What is the point of a Government scheme to help first-time buyers on low incomes if the banks ask for a contribution on top of it that a low earner simply cannot provide?
I have already raised the issue with the Council of Mortgage Lenders and individual banks. I share Pauline McNeill’s concern about the fact that, for a shared-equity scheme under which the Government was providing up to 40 per cent, banks were still demanding deposits averaging about 5 per cent. We need to persuade them that that is not a fair proposition. They reply that there is a lower default rate among those who put in some money of their own, but I believe that the deposits that they are asking for are far too high—in many cases, they are excessive. However, many banks do not require a deposit when a property is purchased under a shared-equity scheme.
What impact have the Government’s shared-equity schemes had on housing provision?
Last year, we spent £60 million on our LIFT schemes, which helped 1,500 families. We are helping up to another 1,000 this year. Two thirds of the money is in the open market shared-equity scheme; another third last year was in the new supply shared-equity programme. However, we have recently launched an innovative pilot with five developers, in co-operation with Homes for Scotland, the umbrella organisation for developers in Scotland, which will involve them sharing the shared-equity contribution 50:50 with the Scottish Government. We are considering every way possible to increase the numbers against a background of reducing public sector budgets.
National Health Service Boards (Expenditure Reduction)
Obviously, I expect all health boards to ensure that services are as efficient as possible in order to deliver best value for taxpayers’ investment, but boards must also be fully aware of their obligation to engage with appropriately and to involve the public, staff and other local stakeholders when any proposals for service change are being made. Comprehensive guidance on that was issued to all boards in February, and I expect all boards to follow it.
I am grateful to the cabinet secretary for that response, but let me press her on it slightly. As I understand it, the need to consult those who will be directly affected by proposals is understood, but some cuts might have an indirect effect on people such as carers. How is the requirement to consult groups of such people—carers are not the sole example—embodied in the guidance that she issued?
In fairness, Ross Finnie raises an important point. Much of the guidance that I am talking about—like many of the changes that we have introduced over the past three years, such as the need for independent scrutiny—deals with proposals for major service change. It is right that we lay out clear and comprehensive guidance to boards on dealing with those circumstances.
As the cabinet secretary will be aware, workforce projections suggest that the NHS will have 4,000 fewer staff, including 1,500 fewer nurses. The Royal College of Nursing and others do not believe that that number of nurses can be taken out of the NHS without there being an impact on patient care. Therefore, will the cabinet secretary have a final say on those service changes? If so, will she mirror the current practice by ensuring that local communities are engaged in those decisions, too?
I know and respect the RCN’s views on those projections, but, unlike Jackie Baillie, the RCN also recognises the need to engage constructively in this process, because, unlike Jackie Baillie, the RCN recognises the financial climate that we live in. I find it absolutely staggering that Labour, which created the economic meltdown that led to the financial crisis, continues to deny any responsibility for the crisis and continues to pretend that we do not need to deal with it. I think that people in Scotland will also be staggered by that hypocrisy.
Will she sign off on those?
I hear Jackie Baillie say, from a sedentary position, that we will sack NHS staff. That is the height of irresponsibility—
That is not what I said.
I apologise if that is not what she said, but that is how it sounded to me.
National Health Service Staff (Disabled Employees)
The Scottish Government has established the mutuality, equality and human rights board to provide a forum for key stakeholders to discuss issues relating to all strands of equality, including disability. In addition, the Scottish workforce and staff governance committee has had discussions on disability leave policies. Both those bodies include representation from trade unions and professional bodies.
I cannot think of any member who is not sympathetic to the needs and wishes of disabled people in Scotland. That includes the minister. Having said that, we must translate that empathy, sympathy, support or whatever we might call it into practical action.
I have every sympathy for Helen Eadie’s position. No one wants sheltered workshops to be closed. A lot of work has been done in different localities across Scotland to support sheltered workshops, but that must be balanced against the procurement rules and the requirement for us, in these difficult financial times, to get the best value for money in the procurement policies that the public sector pursues. That is difficult to do, given the difficult financial situation that we are in.
Patient Care
The national scrutiny group that I announced on 3 June will subject board workforce plans to on-going scrutiny to ensure that they do not impact adversely on the quality of patient care. The group will liaise closely with local area partnership forums and will raise any issues of concern with the Scottish partnership forum and directly with me.
I welcome the setting up of the national scrutiny group. Will the cabinet secretary commit to publishing full workforce plan information to allow stakeholders to engage effectively with that group? How will she ensure that service design is not undermined by tactics such as
We have already published workforce projections, but Marlyn Glen might be interested to know that boards will publish workforce plans, just as they do in every other year. All the information that the national scrutiny group requires to do its job will be shared with it.
Will the cabinet secretary ensure that any member of staff who raises concerns relating to patient care is protected from disciplinary procedures or any other form of reprisal from the NHS?
Every single member of NHS staff has a right to raise any concerns about patient safety or any aspect of patient care in the appropriate way, and all health boards have policies in place to make it clear that that is the case. Those policies also state that anybody who seeks to bring about reprisals against any member of staff for raising such concerns will themselves be subject to disciplinary action. That is an important message to send to everybody in the NHS.