Plenary, 25 Jan 2007

Meeting date: Thursday, January 25, 2007

Official Report 719KB pdf

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Question Time

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SCOTTISH EXECUTIVE

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General Questions

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MSSA Infection

To ask the Scottish Executive what action is being taken to reduce MSSA infection rates in hospitals. (S2O-11795)

An overall target has been set for Scotland to reduce bloodstream infections caused by staphylococcus aureus as a result of health care-associated infection by 30 per cent by March 2010. Recently published figures show that MRSA and MSSA rates in Scotland have been stable, and the increase in numbers reported in the quarter from July to September 2006 is almost certainly due to the introduction of mandatory reporting.

The HAI task force has set in place wide-ranging measures such as a media campaign to raise awareness amongst national health service staff, patients, visitors and the public of the benefits to public health of improved hand hygiene. Local health board co-ordinators are being appointed to help to implement and monitor compliance. Moreover, the task force's delivery plan includes additional training courses for NHS staff and robust monitoring of cleaning standards in Scotland's hospitals.

I thank the minister for his helpful and detailed answer and welcome a number of the measures that are being taken. However, does he think that measures specifically to combat MSSA need to be introduced? If so, should further guidance in that regard be issued to health boards?

First, I should reassure the member that, as the World Health Organization and others have recognised, we are probably one of the leading nations in the world with regard to measures that have been introduced to tackle health care-associated infections. Secondly, to reassure the member further, I point out that we can separate out MSSA from MRSA, which allows us to track that particular difficulty.

Our overall strategy remains consistent in its focus on hand hygiene, with the availability of alcohol hand gel at every front-line bed in our health service; in the involvement and work of NHS staff, particularly the cleanliness champions; and in the measures that we are taking in relation to hospital visitors and the public. That is how we will defeat this particular cause of infection. We are also taking other measures, particularly in relation to the prescribing of antibiotics by general practitioners, to deal with the problem comprehensively throughout Scotland.

What are the reasons for cases of MSSA being up by 100 in the past three months? Does the minister believe that the extended use of pre-admission screening in elective cases has a major role to play in combating hospital-acquired infections? Will he give the chamber an indication of whether the use of pre-admission screening has gone up in each health board area? If he cannot give us that information today, will he provide it at a later stage?

I repeat what I said in my answer to Euan Robson. I am absolutely sure that the reason for the increased number of cases being detected is that our health service in Scotland has probably the best and most internationally verified detection measures. In the identification of, and ways of dealing with, health care-acquired infection, we sit well in relation to other world nations. Our situation is unlike that in other parts of the world. The increase over the quarter—the 100 cases to which the member referred—shows Scotland's success in monitoring and tracking these infections. We have to understand the rationale that lies behind the numbers.

The Golden Jubilee national hospital continues to maintain its rate of zero in terms of health care-acquired infection. In addition to using pre-admission screening, the hospital is able to separate planned elective care from accident and emergency admissions. Those are significant factors in reducing health care-acquired infection. The use of pre-admission screening offers lessons that the rest of the health service can learn with regard to the reduction in health care-acquired infection.

I will come back to the member on the specifics of each NHS health board. I do not have the detail at this time.

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Post Office Network (UK Consultation)

To ask the Scottish Executive whether it plans to make a submission to the United Kingdom Government's consultation on the post office network and, if so, when. (S2O-11749)

We are considering carefully the terms of the UK Government's proposals for the future of the post office network, and how best to respond. We will make that submission prior to the closing date of 8 March 2007.

On Monday evening, in Elgin, I met representatives from nearly 20 post offices from across Moray. I was told that many of those who run post offices continue to fear for their future. That said, all of us welcome the reprieve that the Secretary of State for Trade and Industry offered last night. It would seem that some rural post offices in Scotland will come under that reprieve; they will not have to close under the Government plans.

Does the minister accept that the big challenge for all the post offices in Scotland that are under threat lies in generating new business? What assistance will the Scottish Government offer in that regard? Post offices are mooting ideas such as bringing together tourist information services under the post office network and issuing local authority bus passes through post offices—a development that is already happening in some local authority areas. Is the minister looking at such proposals?

Yes, certainly. First, we are looking at the precise detail of the provisions that the Department for Trade and Industry announced, one of which included the prospect or possibility of the sort of new business to which the member refers. When the First Minister responded to a question in Parliament on the subject, he said that one of the key criteria that the Executive wanted to establish was the extent to which the Post Office and the United Kingdom Government would make efforts to promote innovative means of service delivery that could be used to augment and enhance the business of the Post Office. In the assessment that we are making, that is a key criterion against which we will test the matter.

However, the first and fundamental issue is for the UK Government, which has responsibility for such matters, to set out its financial support. We will assess that before reaching our decision.

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Prisons (Private Sector)

To ask the Scottish Executive what estimate it has made of the percentage of prisoners who will be detained in private prisons if both Addiewell and Low Moss are operated by the private sector. (S2O-11753)

The estimated figure is approximately 24 per cent.

Does the minister realise that that figure is more than three times that of the United States of America? If the Executive goes ahead in that way, Scotland will be the world leader in the use of private prisons, ahead of not only the US but countries such as Australia and South Africa. Should not Scotland be ashamed of doing that? Surely some matters, including the safety of our communities, are too fundamental to be put into the hands of those whose first priority is private profit?

I want Scotland's criminal justice system, and our prison system, to be at the forefront of developments in reducing reoffending. The plans that we have put in place will do that. However, the public expect value for money. I strongly believe that we need to see a 21st century prison estate with the right prison buildings and the right programmes to reduce reoffending.

The question that the SNP has to answer—which it has not answered as yet—is whether it will decide not to use the private sector anywhere in the criminal justice system. Would the SNP put the public at risk by not having the right facilities in our prison system? The SNP has threatened to do that with our schools and our health service. The SNP's sums simply do not add up.

Will the minister join me in paying tribute to the staff and all those who are associated with Kilmarnock prison for the excellent service that the prison gives to the prison estate? [Interruption.] Will she take account of the situation whereby the thieves and felons who are incarcerated at Kilmarnock could well benefit from the fact that they will miss voting in the Scottish Parliament elections? Will she give us an assurance that not one penny of taxpayer's money will go into their pockets?

As I am sure Mr Gallie is aware, the Scotland Office Minister, David Cairns, was robust on the issue of prisoners and voting when he spoke about it this morning.

There has perhaps been a first in the chamber today: Margaret Jamieson, the MSP for Kilmarnock and Loudoun, was cheering on Phil Gallie in the background. That may never be repeated.

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GP Partnerships (Dissolution)

To ask the Scottish Executive, in circumstances where a general practitioner partnership is dissolved, whether there is a statutory requirement for the national health service board to seek to tender the services provided openly to non-general practitioners. (S2O-11742)

NHS boards have a statutory duty to ensure that all patients have access to GPs and primary medical services.

Again, we do not get a straight answer from the minister. Perhaps I can help him. The minister was responsible for introducing the Primary Medical Services (Scotland) Act 2004, which the Scottish Socialist Party was the only party to oppose. Section 4 of the act inserted new section 17L into the National Health Service (Scotland) Act 1978, under which

"A Health Board may, subject to such conditions as may be prescribed, enter into a general medical services contract with … a medical practitioner … a partnership, where"

at least one partner is a GP, or

"a company limited by shares,"

where the only condition is that

"at least one share in the company is … owned by a medical practitioner".

That is the crucial difference—

And your question?

My question is: will the minister finally refute the statements that his department made to the media that NHS Lanarkshire had no option other than to tender openly, including to non-GPs? Will he confirm that, according to the legislation, the board may not have had to do that?

The actions of NHS Lanarkshire are entirely appropriate in terms of the provisions in the legislation. A very rare set of circumstances are involved, which is that two GPs cannot agree on the future of their practice. We offered a partnership split that would have allowed them to work as single-handed GPs, but they would not agree even on that proposal. We therefore find ourselves in this situation.

What is important in all this is that the people of Harthill who are patients of that practice are given access to GP services. That is exactly what the board will do. As I have said many times, there is no reason why the traditional model of GP provision should not continue. The circumstances in which we find ourselves are very rare. I understand that the board is looking at the matter today and that it will shortly make known its views on the future of the practice.

Does the minister agree that it is vital that patients of the Harthill medical practice should be represented on the decision-making panel? Does he also agree that the approach that NHS Lanarkshire has taken in this regard has not been as inclusive as it should have been? Does the minister further agree that the primary focus in the process must be on providing the best possible GP services, in which the health care needs of the people of Harthill, Greenrigg and Blackridge are recognised?

Of course, patient need is at the heart of what we do in the NHS in Scotland. The work of GPs in our communities is absolutely vital.

With regard to the consultation process, I understand that all people in the area were lettered, public meetings were held and patients are represented on the panel. Nonetheless, if the member has specific concerns on the way in which the process was conducted, I am happy to look at them. The matter is the responsibility of NHS Lanarkshire, but I want to learn any lessons that should be learned from the process that was undertaken.

I repeat that we are dealing with a very rare set of circumstances. I see no reason why the traditional model of GP provision should not continue in Lanarkshire. It comes down to the fact that two independent GPs—who are not employees of the national health service—could not continue to agree on the way in which the partnership should operate in the future. They could not even agree on the proposal to run the practice as a two single-handed GP set-up. We therefore find ourselves in this very rare situation. The board is doing the right thing: it is ensuring that the community gets access to good-quality GP provision.

Will the minister confirm on the record that NHS Lanarkshire could have chosen not to invite a tender from a non-GP company limited by shares? The 2004 act says that such tenders "may" be invited, not that they must be invited. If it is difficult for the minister to answer that question now, will he send a letter to interested members that provides an interpretation of the law?

The member has chosen to ignore what I have said. Given the circumstances at Harthill, NHS Lanarkshire has acted entirely appropriately. The provisions of the legislation in question and the National Health Service (Scotland) Act 1978 ensure that boards have sufficient flexibility to discharge their duties to provide primary medical services. How they do so in accordance with the needs of local populations and local circumstances is a matter for each NHS board. I repeat: what the board has done is entirely appropriate and in accordance with the legislation.

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Ministerial Attendance at Constituency Events (Guidelines)

To ask the Scottish Executive which ministers plan in their official capacities to attend constituency events organised by MSPs from their own parties in the period up to dissolution and what guidelines apply to such visits in a pre-election period. (S2O-11745)

The requested information is not held in such a format. Ministerial diaries retain a record of engagements that have been carried out. However, I assure the member that ministers will give due consideration to all invitations from members of the Scottish Parliament to visit their constituencies.

I thank the minister for his interesting answer.

Recently, I asked the Minister for Justice to attend a public meeting in Milton. I am still waiting for a reply to my request. She was able to attend a public meeting in Kelvin; prior to that, she attended a Labour Party election campaign meeting in Kelvin. Will Mr Lyon allay the fears of Scottish people who do not want ministers to be used as electioneering tools? Will the relevant minister accept an invitation from a member of the Scottish National Party to come to a public meeting to allay the concerns and fears of the many people in Glasgow who are affected by the operations of Glasgow Housing Association? I assure him that there will be a full house at that meeting.

Sandra White's allegation is inaccurate. Ms Jamieson attended the Labour Party meeting that she mentioned in her capacity as a Labour representative, and not as a minister.

I repeat: ministers will give due consideration to all invitations from members to visit their constituencies.

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Aberdeen Dental School (Consultation)

To ask the Scottish Executive when it will consult on the need for a full dental school for Aberdeen in line with its commitment to do so in the partnership agreement. (S2O-11801)

In the partnership agreement, we committed to establishing an outreach dental training centre in Aberdeen and to consulting on the need for its development to a full dental school.

On 6 November, I opened the Aberdeen dental institute, which will bring together on one site an outreach training centre for dental students, postgraduate education for practising dentists and a general dental practice that will register up to 6,000 national health service patients over the next two years. We will consult on further development early next year, once the institute has been in operation for sufficient time to inform the consultation process.

The partnership agreement is clear. It states:

"We will expand the capacity of dental training facilities in Scotland by establishing an outreach training centre in Aberdeen. We will consult further on the need for its development to a full dental school."

The agreement will last until May. Why is the minister so reluctant to implement a Liberal Democrat manifesto pledge, which the Labour Party agreed with in the 2003 coalition negotiations and which would directly benefit people in his own constituency of Aberdeen Central?

I am delighted that in opening the Aberdeen dental institute, we have gone beyond the commitment that was made in the partnership agreement and put in place a centre for dental education, training and treatment. I look forward to being in a position in Government from which we can consult on the further development of that institute once it has been proven that it has made a significant contribution to dental education and to access to NHS treatment for dental patients in north-east Scotland. I have no doubt that that will be proven.

Does the minister agree that not only the new dental institute's training role should be considered in such consultation, but that its treatment role for thousands of patients who have been deregistered by dental practices that went private and who are now receiving NHS services again should be considered? Does he expect that treatment role to develop as we encourage more dental practices to provide more NHS treatment?

Absolutely. That is an important part of going beyond the partnership agreement. The dental institutes and outreach centres in other parts of Scotland are scheduled to come on stream in the next year or two. It is important that we are addressing not only the numbers of dentists, but access to NHS dentistry, which is a critical matter for patients. I expect that in future consultation on how we develop the dental estate further, the success that we have had in improving access to dentistry through salaried services, such as the Aberdeen institute, will be a key part of that consultation.

Before questions to the First Minister, members will want to welcome a delegation from the Government of Tanzania, led by Dr Hussein Ali Mwinyi. [Applause.]