Health and Wellbeing
Good afternoon. The first item of business this afternoon is portfolio questions. I would appreciate short and succinct questions and answers, in order to get in as many members as possible.
National Health Service (Senior Managers)
To ask the Scottish Government what progress has been made in reducing the number of senior managers in the national health service. (S4O-03511)
NHS Scotland was set a demanding target of reducing senior management posts by 25 per cent between April 2010 and April 2015. That target was exceeded one year early. By 31 March 2014, senior management posts had been reduced by 29.3 per cent. The savings from the reduction will continue to be reinvested in services in the national health service in Scotland.
Furthermore, unlike with trusts in England, the savings of more than £1 billion that NHS boards have made over the past five years through increasing efficiency, while also improving quality, have been retained and reinvested, and not returned to central Government.
Does the cabinet secretary believe that NHS Scotland would have made such substantial progress in reducing bureaucracy if we had followed the example of the Tories at Westminster, with their disastrous reorganisation and privatisation?
No, I do not. The role of non-NHS providers in delivering NHS-funded care in England has increased markedly since 2006. In Scotland, we ensure high-quality healthcare provision by other means, including efficiency and productivity initiatives.
Consultants
To ask the Scottish Government how many consultants work in NHS Scotland. (S4O-03512)
There is currently a record number of consultants working in Scotland’s national health service, with NHS boards looking to recruit even more staff to increase capacity further. There were 5,037 whole-time-equivalent consultants working within the national health service in Scotland at June 2014, which represents an increase of 1,140 full-time equivalents, or 29.3 per cent, within the lifetime of this Government.
The rise in the number of consultants under this SNP Government is welcome, although I have some concerns about recruitment of consultants at Aberdeen’s accident and emergency services, which I hope can be resolved. Can the cabinet secretary offer any specific information about the number of junior doctors in the health service?
Doctors in training within NHS Scotland have increased by 254.8 whole-time equivalents—from 5,361 to 5,591—during the lifetime of this Government, which equates to an increase of 4.8 per cent. It should be noted that the funded establishment of emergency medicine consultants in NHS Grampian has risen by 125.4 per cent during the period, with 80.3 per cent more consultants working in that specialty in NHS Grampian.
The leaked minute of the meeting of NHS chief executives that was held on 6 August highlighted a number of issues requiring “immediate and transformational change”, including consultant and other recruitment challenges. How is the cabinet secretary going to close the additional £450 million gap in his budget, much of which was apparently caused by the pursuit of initiatives that run contrary to his own 2020 policy?
If Neil Findlay looks at the published information of the NHS territorial boards in Scotland in particular, he will see that the targets for savings for this year have already been exceeded, and that there is not a reduction of £450 million in the NHS budget in Scotland.
However, I do take the point that we need additional resources. Of course, had we been able to remove Trident from the Clyde, we would have had substantial additional resources available for the health service. [Interruption.]
Order, please.
I note that Neil Findlay voted to keep Trident on the Clyde.
Given the national and international shortage of consultants in certain specialties, can the cabinet secretary outline what research has been undertaken to assess how many potential future consultants are currently in training, particularly in those specialties, and when they may enter the workforce?
We are in constant contact with the board for academic medicine in Scotland under Sir David Carter, with the education secretary, with the universities and medical schools, as well as with the Academy of Medical Royal Colleges and the individual royal colleges themselves. We are continually looking at vacancies—in particular, at those that have not been filled within a three-month period. There are certain specialties—paediatrics and general practice, for example—in which there is a United Kingdom and, in some cases, world-wide shortage of available qualified staff. As Nanette Milne knows, in some cases we are advertising overseas to recruit staff when we find it impossible to recruit in the UK. The situation is very challenging for some specialties.
NHS Lanarkshire (Staffing)
To ask the Scottish Government how it is addressing medical staffing issues in NHS Lanarkshire. (S4O-03513)
The Scottish Government is supporting NHS Lanarkshire in aligning its staff to meet patient demand and the implementation of a number of site-specific actions.
The number of consultants in post in NHS Lanarkshire has increased by 59.8 per cent—or 159.1 whole-time equivalents—between September 2006 and June 2014. We have also seen a rise in the numbers of qualified nurses and midwives by 9.8 per cent, or 329 whole-time equivalents, during the same period.
A recent international recruitment exercise for accident and emergency and acute medicine trainee doctors has led to NHS Lanarkshire successfully recruiting to a specialty training 4—ST4—emergency medicine post.
NHS Lanarkshire board papers from last month say that medical staffing across all “front door” emergency services is fragile, and that models of care will require further review if vacant posts are not filled. What does the health board mean by “further review” and what contingencies are in place to maintain patient safety if the staffing situation deteriorates further?
Unlike Labour, we will not be planning to close any accident and emergency departments.
We are recruiting people. When we took over, there were a total of eight whole-time-equivalent accident and emergency consultants in Lanarkshire; there are now 32 full-time-equivalent accident and emergency consultants in Lanarkshire. Of course, because of the number of elderly people who have complex conditions, we cannot just look at the number of patients; we have also to consider the increasing complexity and co-morbidities of the patients who are presenting.
I do not want to underestimate the challenges that every modern health service and society faces in the face of an ageing population, but we have multiplied by a huge factor the number of accident and emergency consultants in Lanarkshire, compared to the pathetic record of the previous Labour Administration.
NHS Lanarkshire (Meetings)
To ask the Scottish Government when it last met NHS Lanarkshire. (S4O-03514)
Ministers and Government officials regularly meet representatives of NHS Lanarkshire.
I know that the cabinet secretary is aware of the situation at Bellshill clinic, where a local general practice has had to co-locate because its facility burned down some years ago. It is now more than five years since that co-location took place. I know that the cabinet secretary is not responsible for the reasons behind that, and questions have to be asked about why the situation occurred, but the fact is that services that should be delivered at Bellshill clinic cannot be delivered because the GP practice is co-located in the facility. Staff tell me that that creates pressure on services at Monklands hospital in particular, because those services have to be delivered there. Does the cabinet secretary have contingency plans to address the problem? It cannot be allowed to continue for much longer.
Michael McMahon makes a valid constituency point. I am aware of, and fully understand, the concerns in Bellshill. I would be happy to meet him to look at the current situation and the plans to deal with it. I accept that speedier action is required to deal with it, so I would be happy to convene a tripartite meeting between NHS Lanarkshire, Michael McMahon as the local member, and me, to see whether we can agree on a way forward.
The cabinet secretary is aware that we have issues at Hairmyres hospital in East Kilbride, with beds being occupied for longer than necessary because the local authority has not put home-care packages in place timeously. I know that action has been taken in that regard, but can the cabinet secretary update me on progress?
Delayed discharges have become more of an issue in recent months, although the scale of delayed discharges in Scotland is nothing like it used to be. In areas including Fife, Glasgow and South Lanarkshire in particular, delayed discharges have not been dealt with by the local authority as quickly as they should have been. As a result, we have put in an additional £5 million to deal with delayed discharges. Some of that money has gone to NHS Lanarkshire, specifically to help to deal with the situation in Hairmyres.
Based on the latest management information that I have available, Hairmyres has shown a degree of improvement, but there is still a major challenge because of the local authority’s failure to provide the required level of care, whether it be residential care or assessments for care at home.
The cabinet secretary is living in cloud-cuckoo-land if he does not think that this is the biggest issue in health and social care at the moment. It does him no service just to lay the blame at local authorities, when the Scottish Government is slashing local authority budgets every year. Can we start to get some reality into the proceedings? I would happily meet the cabinet secretary to discuss how we deal with delayed discharges, because it is the biggest issue in health and social care at the moment.
I presume that that was a question.
I am always happy to meet members, particularly if they have solutions to offer to any problems. I have never found that in Neil Findlay’s case.
The fact is that the scale of delayed discharges is nothing like it was five, six or seven years ago, when his party was in power. There has been a substantial reduction in the number of delayed discharges.
However, in certain areas we have not achieved the final reduction that I want to see for this year and projecting into next year. I merely stated that that is because of the time that local authorities are taking either to place people in residential care or to arrange home care—or, indeed, to undertake assessment. It is not a question of blame. It is a question of fact—but I know that Mr Findlay always gets confused with the facts.
Delayed Discharges
To ask the Scottish Government what additional resources it is providing to address delayed discharges. (S4O-03515)
I probably answered that in my answer to the previous question.
On 7 August 2014, I announced an additional £5 million for financial year 2014-15 to help health boards to improve the flow of patients through health and social care services. The funding has been carefully targeted to seven health board areas that face the most significant pressures from delayed discharge. The investment will enable them to accelerate progress towards sustainable change, drive down delays and release hospital capacity over the long term.
Our legislation to integrate health and social care will also ensure that health and social care is provided in the right place, at the right time, making the best use of available money, facilities and people.
In his written response to a question from me in the recent purdah period, the cabinet secretary suggested that by next year he will have developed a methodology to assess the cost to individual health boards of delayed discharge. However, the upward trend in delayed discharge in the Lothians is a problem for us now.
We have heard that tackling delayed discharge could release between £100 million and £125 million for reinvestment elsewhere. Will the cabinet secretary clarify whether that resource will go to local authorities to address the issues that he has just identified of the lack of care packages and home care support by councils? Will he clarify what impact the £400 million to £450 million funding gap that Neil Findlay identified a few minutes ago will have on his efforts to transfer that resource from the national health service to our local authorities?
That was a good question until the myth of the £450 million funding gap was mentioned.
Edinburgh has got more than £1 million—more than 20 per cent—of the £5 million. As Sarah Boyack knows, there is a strategic challenge in Edinburgh, which mainly arises because of the lack of social care capacity—residential care as well as care at home. Some of that is due to the fact that 25 per cent of people in residential care in Edinburgh are self-funders and the private sector tends to take them in rather than take in people referred by the local authority.
Sarah Boyack will also be aware that there are now regular meetings between the senior leadership—councillors and the chief executive and her team—in the City of Edinburgh Council and the senior team in the health board, including the chair and the chief executive. They have got together a plan to deal with the particular challenges in Edinburgh around delayed discharges and associated issues. I believe that the plan that has been put in place is the right one. We need to think about how we can fund that. I recognise that Edinburgh is one of those areas with special challenges that have been building up for a number of years but which need to be tackled at the earliest possible opportunity.
I must ask for more succinct questions and answers, or we will not make much progress.
Homeopathy and Complementary Medicine (South Scotland)
To ask the Scottish Government whether it will provide an update on national health service homeopathic and complementary medicine arrangements in South Scotland. (S4O-03516)
The Scottish Government position is as set out in my answer to the oral parliamentary question that was asked by the member on 12 March 2014.
The Scottish Government recognises that complementary and alternative medicines may offer relief to some people living with a wide variety of conditions. It is for individual NHS boards to decide what therapies they make available, based on the needs of their resident populations, in line with national guidance.
I thank the cabinet secretary for that answer, but I would like to progress the issue beyond what was the case in March.
In the NHS Lanarkshire area, significant numbers of people have responded to the consultation, and a report about the services is imminent. I note that point in order to highlight the interests of my constituents in that area. More specifically, in the NHS Lothian area—which covers part of the region that I represent—I have heard constituents’ concerns about conflicting advice from healthcare professionals and barriers to access to homeopathic care, often, as I understand it, in contradiction to NHS Lothian’s statements.
I must ask for a question.
What guidance is available to practitioners when making those decisions?
If the member has evidence of contradictory or wrong advice, she should let me know, and we will take up the matter with the health board. I am happy to send her details of the guidance that we offer on these matters.
Scottish Ambulance Service
To ask the Scottish Government what additional support it is providing to the Scottish Ambulance Service in light of it not meeting a range of targets. (S4O-03517)
The Scottish Government funds the Scottish Ambulance Service to provide a high-quality, safe and sustained emergency ambulance service to Scotland’s population when they need it most. Setting and agreeing performance measures is part of that. It is encouraging to note that, nationally, performance this year continues to show improvement. Despite seeing a 10 per cent rise in the number of calls, the Scottish Ambulance Service’s average response time is just 6.5 minutes across the whole of Scotland. However, we are not complacent—neither is the service—and we will continue to monitor and support the service.
The cabinet secretary will be aware of reports of ambulances being sent significant distances to cover shortages in neighbouring areas and of issues to do with staff numbers and available funding. There are thousands of cases of ambulances taking more than 20 minutes to reach patients, and it is clear that, despite the efforts of front-line staff, the Scottish Ambulance Service is struggling to deliver the level of service that the public would expect. In light of that failure to meet a wide range of vital targets, will he provide further information on steps that are being taken to address the issues and the timeframe in which significant improvement is expected?
I recognise that there are challenges, particularly in rural areas. I know that the area that the member represents faces specific challenges, not least because, in some areas, the road infrastructure does not always make it easy for the Scottish Ambulance Service to meet the targets that it sets itself.
Having said that, I should say that the service has achieved its target 74 per cent of the time. However, we recognise the need for further improvement. I am happy to send the member details of the improvements that the service is putting in place to improve performance and the quality of service that it provides.
In considering areas where improvements might be made, will the cabinet secretary examine concerns that some of my constituents have raised with me about possible capacity issues with the road ambulance fleet in Aberdeen that appear to be delaying the transfer on to Aberdeen royal infirmary of patients who arrive by air ambulance from Orkney and the other island groups? I am in correspondence with the Ambulance Service directly about that, but I would welcome any intervention that he might be able to make on the issue.
If Liam McArthur writes to me with details of the issue, I will be happy to take it up with the Ambulance Service and see whether we can make substantial progress.
Unpaid Carers
To ask the Scottish Government what steps it will take to improve support for unpaid carers. (S4O-03518)
We intend to introduce a carers bill that will extend and strengthen the rights of adult carers and young carers to help to ensure that they are much better supported.
We will continue to provide support to carers and young carers, investing nearly £114 million between 2007 and 2015 in a range of programmes and initiatives. That includes funding for carers initiatives through the reshaping care for older people change fund, providing funding to national health service boards for their carer information strategies and funding the voluntary sector short breaks fund.
Subject to parliamentary approval, we will invest a further £5 million in NHS boards’ carer information strategies and a further £3 million in the short breaks fund in 2015-16.
I welcome the minister’s comprehensive response. He will be aware that the carers allowance is the lowest income-replacement benefit in the United Kingdom. Does he agree that the UK Government should increase it to at least the level of jobseekers allowance as a matter of urgency?
I am aware that, as James Dornan highlights, the carers allowance is one of the lowest income-based benefits in the UK welfare system. Of course, during the referendum campaign, we set out clearly the need to tackle that and for an increase in the allowance. I add my voice to call on the UK Government to consider reviewing the overall level of carers allowance, which at times has felt as though it is the forgotten benefit for carers.
We should recognise the significant contribution that carers make to our society and acknowledge the fact that, if they did not provide that support, the cost to the taxpayer would be significantly more. They deserve not only practical support but financial support.
Will the minister consider improving support to young carers through the education maintenance allowance? The EMA requires excellent attendance, which is difficult for young carers to achieve because of their caring responsibilities. Under current legislation and guidance, individual circumstances are to be taken into account for young carers, but will the minister consider putting them on the same footing as care leavers so that their education maintenance allowance cannot be withdrawn from them?
Rhoda Grant will be aware that the Scottish Youth Parliament has made a number of recommendations on support for young carers, particularly in relation to the education maintenance allowance. My colleague Angela Constance made some changes to the guidance to reflect how the EMA should be provided to reflect the issues that the Scottish Youth Parliament raised. My colleague Mike Russell is due to meet representatives from the Scottish Youth Parliament to discuss those issues in more detail.
We are taking forward a range of measures under the carers policy to help to support young people in schools and in further and higher education. My colleagues on the education side are also considering what measures they can introduce, including whether they can take further actions under the EMA to provide further support to young carers in education.
Type 2 Diabetes (Research)
To ask the Scottish Government what research has been undertaken to determine if there is a link between the intake of sugar and an increased risk of type 2 diabetes. (S4O-03519)
The Scientific Advisory Committee on Nutrition published its draft report for consultation on the links between intakes of carbohydrates, including sugars, and health on 26 June 2014.
The advisory committee report referred to evidence suggesting that sugary drinks are associated with increased risk of type 2 diabetes in adults. The report shows that diets that are high in sugar can contribute to excess calorie intake, which, if sustained, leads to weight gain and obesity. If an individual is overweight or obese, they are more prone to a range of serious health problems, including type 2 diabetes.
The Food Standards Agency in Scotland will review Scottish dietary advice, based on the report’s final recommendations early in 2015.
Does the minister share my concern that we are facing a ticking time bomb with the explosion of type 2 diabetes in Scotland? The minister will know that diabetes is the main cause of blindness among those of working age and contributes half the non-traumatic leg amputations.
A variety of studies such as the Stanford Medical School study have linked sugar intake with diabetes. Will the minister agree to meet me and Diabetes Scotland to work up new proposals to tackle and prevent Scotland’s silent killer?
I am sure that the member will recognise that tackling obesity is a complex issue. It needs to be attacked and taken forward on a number of fronts. One involves improving individuals’ health through participation in physical activity. However, importantly, this is also about changing people’s dietary habits, which is not an easy challenge in the short term. That is why we have taken forward a range of measures with the food sector, from the reformulation programme right through to the supporting healthy choices framework, which we launched a few months ago. There is also our work on improving labelling so that when people purchase goods, they have a much greater understanding of the content of those products.
Of course, I am more than happy to meet the member and his colleagues to discuss whether there are specific measures that they feel that we could take forward together in order to help tackle what is a growing problem in western society that we need to ensure we tackle head on.
Jackson Carlaw—very briefly.
Does the minister agree that many people who purchase low-fat products, particularly dairy products, are unaware that those products often contain much higher levels of sugar than they might anticipate and that they are unwittingly potentially exposing themselves to diabetes?
We are doing a range of work with the Food Standards Agency Scotland to drill down into the issue so that the public understand much more clearly the choices that they are making.
The member has highlighted an area where individuals can often be confused in relation to the products that they are purchasing, which is why we pushed for front-of-label packaging. The traffic light system allows people to see products’ contents much more clearly. We need to make further progress in that area and the FSA is doing some very interesting work in that field to ensure that we move forward.
National Health Service Boards (Meetings)
To ask the Scottish Government what issues it discussed when it last met national health service boards. (S4O-03520)
The Scottish Government last met NHS boards on 22 September 2014. The outcome of the referendum, seven-day services and the performance of NHS boards were the matters discussed.
I wonder whether delayed discharge was discussed, given the many questions on that topic today. Each quarter, 150,000 bed days are occupied by delayed discharge patients, and one patient in NHS Highland had to wait for more than a year from the date of medical discharge to go home. What is the Scottish Government doing to support NHS Highland, which has responsibility for home carers, to recruit and retain staff in order to ensure that patients get care and support when and where they need it?
The member will be aware of the report that we published jointly with the Convention of Scottish Local Authorities earlier this year as a result of a review of residential care services. We are following up that report with a joint review of home care services.
I believe that the social care sector faces a number of challenges. For example, we are committed in principle to the need to introduce the living wage; we need a proper career structure for people working in the social care sector; and we recognise that the funding of independent providers is below what it needs to be to provide the level, standard and quality of care that is required. There is a whole range of other things as well.
We are looking at the implementation of the recommendations in the reports across the whole of Scotland because the description that Mary Scanlon outlined of the social care sector and NHS Highland could be applied to many other parts of the country. For example, in Aberdeen at the moment, people can very often earn more filling shelves in a supermarket than they can working in the social care sector.
We have to tackle the underlying strategic issues so that we get the social care sector in Scotland—including in the Highlands—into far better shape, and we need to deal with the very specific challenges in rural, remote rural and island communities.
I am afraid that I must once again ask for shorter questions and answers or some members will be disappointed.
Cochlear Implant Processors
To ask the Scottish Government what the average waiting time is for children who require an upgraded cochlear implant processor. (S4O-03521)
If, on clinical assessment by the cochlear implant specialist team at Crosshouse hospital, it is considered that a cochlear implant processor needs upgrading, and there is a suitable processor in stock, there is no waiting time and it will be provided to the patient at the time of assessment. If a processor has to be ordered, it will normally take two to three weeks to be delivered. If, on clinical assessment, a patient is found to have a processor that is faulty but can be repaired, the patient will be provided with a like-for-like processor from stock while their processor is sent for repair. There is no waiting time for that process.
The minister will be aware that young people who have profound hearing difficulties and use cochlear implants face a very challenging environment—not least in the classroom, which can affect their ability to learn. As new technology becomes available, their parents are obviously anxious to secure the best possible opportunity for them.
Does the minister sympathise with the parents of one of my constituents who has been told that there are some 200 young children in the queue ahead of her before she is likely to have an upgraded cochlear implant processor? Does he believe that, in line with the rest of the country, processors should automatically be replaced after an interval of five years?
On Patricia Ferguson’s final point about changing the cochlear implant processor every five years, NHS Scotland is in the process of implementing that policy. She will be aware that the national cochlear implant service that is provided at Crosshouse hospital in Kilmarnock is delivered nationally. As I have outlined, if a processor needs to be changed or repaired there is a process in place to enable that to happen within the specified waiting time if the processor is in stock.
If Patricia Ferguson wants to write to me with specific details on a particular type of cochlear implant that is not currently available through our national service, I will be happy to get the clinicians who are responsible for deciding on the approach in Scotland to respond to the specific issues affecting her constituent.
“The Sexual Health and Blood Borne Virus Framework 2011-15”
To ask the Scottish Government what evaluation it is undertaking of “The Sexual Health and Blood Borne Virus Framework 2011-15” and when it will publish the framework for work beyond 2015. (S4O-03522)
“The Sexual Health and Blood Borne Virus Framework 2011-15” comes to an end in 2015, and we have already commenced work to evaluate the progress that has been made. National health service boards and their partners in local authorities and the third sector are preparing reports on progress, which will be collated to present a national report on progress overall. Officials will visit each NHS board before the end of 2014 to hold detailed discussions on achievements, challenges and progress.
Our national monitoring and assurance group is carrying out an analysis of data to establish progress against each of the framework outcome indicators and a report of that work will be produced soon. A refreshed framework that sets out the future strategic direction in that area will be published in summer 2015.
A study in Glasgow found a prevalence rate for hepatitis C among south Asian communities in Glasgow of up to 3.1 per cent, in comparison with approximately 0.6 per cent or less in the rest of the population. However, the current strategy makes only passing mention of awareness raising in ethnic minority communities. Can the minister assure members that the review framework will adopt a more thorough approach to tackling the virus in south Asian communities in Scotland, particularly in Glasgow?
Answer as briefly as possible, please, minister.
Our boards, which are broadly responsible for delivering the framework on the ground, are already doing that work. For example, NHS Greater Glasgow and Clyde undertakes a range of work with minority ethnic groups in Glasgow on blood-borne viruses.
We will of course consider, in reviewing the progress that has been made, what further steps must be taken, and that should be reflected in the new framework in 2015.
NHS Fife (Funding Shortfall)
To ask the Scottish Government what the impact on NHS Fife would be of the reported shortfall of up to £450 million in national health service funding. (S4O-03523)
Let me be clear: there are no planned cuts to NHS funding. Read my lips: there are no planned cuts to NHS funding.
I would prefer not to, cabinet secretary.
The Scottish Government has a record of protecting and increasing the NHS budget. NHS Fife, like all other territorial boards, will receive above-inflation resource increases in 2014-15 and 2015-16.
Despite that response, it is absolutely clear that, at the moment, there are problems facing patients and staff across NHS Fife, with up to 40 vacant consultant posts needing to be filled and reports of the health board’s increasing use of private firms such as Medinet. In August, patients awaiting surgery were sent home at the last minute as operations were cancelled because wards were full. Will the cabinet secretary join me in supporting calls for an independent inquiry into whether the model that NHS Fife is currently following is fit for purpose in meeting the needs of the people of Fife?
Although I accept that NHS Fife, like every other health board in the civilised world, is facing particular challenges, its performance has improved dramatically in recent years, as has the quality of provision across a range of services. However, if the member has any specific concerns, I am happy to listen to those so that we can address them with NHS Fife.
National Health Service Funding
To ask the Scottish Government how front-line services would be affected if the reported £400 million reduction in national health service funding is implemented. (S4O-03524)
Let me make it absolutely clear: there are no planned cuts to NHS funding. The Scottish Government has a record of protecting and increasing the NHS budget, and our latest £12.1 billion resource budget—the first time that the budget has ever gone over £12 billion—reflects a funding increase in real terms for both this year and next.
The leaked memo from NHS health board chiefs that was previously referred to said that boards would have to consider centralising hospitals and closing services. Can the cabinet secretary give us a cast-iron guarantee that, across Fife, Tayside and Forth valley, there will be no such centralising or closing of services? Specifically, can he give us that guarantee in relation to services at Perth royal infirmary?
The memo that was leaked contained some thoughts of a number of chief executives and does not represent Government policy. The member knows perfectly well that any proposals for service redesign go through a very intense process, including a major process of public engagement. I certainly have no intention of redesigning services in a way that leads to any retrograde steps in the quality of provision. We will certainly always ensure that any proposals for change have to go through a comprehensive exercise of public engagement, as we have always done. The biggest threat to the national health service in Scotland is the £25 billion-worth of cuts that is being promised by George Osborne and Ed Balls. That is the real threat to the national health service in Scotland.
Will the cabinet secretary confirm how the Scottish budget has been impacted since George Osborne became chancellor and by how much the NHS front-line budget in Fife has changed over the same period?
A brief response, please, cabinet secretary.
We have passed on every penny of the funding that has been allocated to us for health in Scotland. Just for the record, I point out that the Institute for Fiscal Studies report that tried to allege otherwise was factually incorrect, and I think that I am right in saying that the IFS has admitted its mistake—it got it wrong.
Accessible General Practitioner Services (Remote and Rural Areas)
To ask the Scottish Government how it supports the provision of accessible general practitioner services for people in remote and rural areas. (S4O-03525)
We know that some health boards in Scotland face significant difficulties with recruiting in remote and rural areas. Some communities in the Highlands and Islands have been without a permanent GP for a while, and I completely understand how frustrating that is for residents. One key element of the recently agreed GP contract agreement is the change to golden hello payments for remote and rural areas from 1 January 2015, which will mean that health boards have more flexibility to specifically incentivise GPs to work in areas that are more difficult to recruit to. That will, we hope, make it easier for boards to meet the challenge of recruiting to remote, rural and deprived areas and help those communities that have faced a long wait for a permanent GP.
Is the minister aware of plans to reduce the number of GP consulting hours in Dalmally, which is one of the most geographically remote GP practices in the United Kingdom? The plans are apparently due to a lack of uplift in additional payments from the health board to support Dalmally surgery since 2004. Is he also aware of concerns in Inverary, nearby, where people have had to rely on locum GP cover for three years?
Will the minister raise those concerns with NHS Highland and work to ensure that communities in rural areas are not receiving a poorer level of GP cover than areas in the central belt receive? Does he agree that devolution was meant to improve living standards for everyone in Scotland?
Briefly, please, cabinet secretary.
I am already doing everything that the member asked. I am going to Oban in October and I will be glad to meet him there, so that we can report on progress.
That concludes portfolio questions.
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Referendum Debate