Skin Disease
The final item of business this evening is a members' business debate on motion S2M-2553, in the name of Kenneth Macintosh, on action on skin disease. The debate will be concluded without any question being put.
Motion debated,
That the Parliament recognises the stigma, frustration and desperation felt by many people with skin disease, including residents in East Renfrewshire; points out that conditions such as psoriasis are lifelong and incurable but are eminently treatable; highlights the benefit of having skin disease classified as a chronic condition; raises concern that skin disease is not a priority under the new GP contract; welcomes the new provision of specialist retraining in skin disease for nurses but points to the need for similar training for other health professionals such as pharmacists and GPs, given that 20% of GP consultations include skin disease, including an emphasis on skin conditions in the undergraduate education and training of health professionals; approves the Skin Action Scotland service redesign programme as an opportunity for clinicians to test new ways of accessing and delivering dermatology out-patient services and to better demonstrate and define the current relationship between demand and capacity, and looks to see greater availability to patients of new treatments with strong evidence of effectiveness such as the new biological treatments for psoriasis and the complications of arthritis.
Skin disease is one of the most common chronic diseases in Scotland. Its effects can range from the unsightly and uncomfortable to the unbearable or unendurable, but public ignorance of skin disease can leave patients with little or inadequate support and it can leave them ashamed of and embarrassed by their condition. The failure of our national health service to prioritise skin conditions has led to insufficient training for many health professionals and to a constant struggle for under resourced specialists.
This debate is about recognition, support and fairness: recognition of diseases that damage too many lives; support for patients and the doctors and nurses who do what they can to help; and fairness in giving patients who have skin diseases the right to the same expectation of care as others.
If ignorance is part of the problem, what is skin disease? It includes psoriasis, alopecia and eczema, to name but a few skin conditions. I have learned from Janice Johnson, the founder of the psoriasis charity PSALV—Psoriasis Scotland Arthritis Link Volunteers—and one of our many welcome visitors in the public gallery today, that the word psoriasis comes from the Greek, meaning to itch. She says:
"yes it itches, it also bleeds, it weeps, it is painful and it scales … Many people have to spend hours each day waiting for their skin to be in a reasonable state so they can go to work … and it requires a strong personality to stand up to the jibes and cruel remarks, especially when young."
Skin disease covers a range of conditions that bring in their wake stigma, depression and desperation as well as anger and frustration. I suspect that there is a tendency among uninformed people to dismiss a condition such as psoriasis as being a bad rash; however, it is an acute condition that is often linked to very painful arthritis. It is crippling and disfiguring, and the drugs that are used to treat it can have toxic side effects. Skin disease generally is estimated to afflict one in four people in Scotland. One in five visits to the local general practitioner involves a skin complaint, and skin disease is one of the most common reasons why people take time off work.
My interest in the subject came through inquiries into skin cancer and the work of dermatologists and others in the national health service in that area. I discovered a world of misery and pain, of damaged lives and of lowered expectations. Here were diseases that affect confidence and self-esteem as much as they physically drain and disable sufferers.
I knew a little bit about childhood eczema and had some understanding of its impact on families through disrupted sleep, and I learned more about its effects on children as a result of increased irritability and, sometimes, consequent disruptive behaviour. However, until I came across the work of the Skin Care Campaign Scotland, I did not know that 130,000 people in Scotland are affected by psoriasis, 30,000 of whom have severe psoriasis and a quarter of whom have associated arthritis. I discovered that, although psoriasis is incurable, it is treatable; that it is often, mistakenly, regarded as contagious, although it is not; and that patients have been and are being laughed at, teased and sometimes humiliated and discriminated against.
I congratulate the members of the Skin Care Campaign Scotland who are in the public gallery today, including Barbara Page, Ann Smith and Colin Munro—I cannot name them all—and people such as Rosemary Gierthy, Stewart Douglas, Jimmy Ferguson and others, who are not. Those people need our help and support. They have turned to us and are relying on us here at the Scottish Parliament.
I also thank all the MSPs who are present and all those who signed the motion for their support. In particular, I thank my colleague, Helen Eadie, who has done much in recent months to raise the parliamentary profile of skin care issues. I hope that we can build on the momentum that she and Skin Care Campaign Scotland have generated.
I mentioned that I came to this subject through my interest in cancer. The epidemic of skin cancer from which we are now suffering in Scotland has, as well as leading to an increase in what can be a devastating diagnosis, had a second deleterious effect: hospital dermatology departments are in effect being turned into cancer screening centres, and unfunded ones at that. The decline in recent years in expertise in skin disease in primary care and a marked increase in common skin diseases combine to put a huge strain on specialist dermatology services. Clinicians have switched from treating chronic disease to screening for skin cancer. Dermatologists can still deal with patients with skin diseases who are suffering from emergency flare-ups, but they are finding it difficult to provide the on-going expert help that is needed to cope with a wide range of pressing and demanding skin conditions.
Consultants are worried both at the number of unnecessary referrals and at the lack of training and expertise among medical students. Currently, only one in 20 general practitioners is trained in skin disease, and only 1 per cent specialise in it. Compared to European figures, we have between a fifth and a tenth of the amount of specialist services of other countries.
On top of all that, the new GP contracts have failed to prioritise skin disease. The anxiety that is already apparent is that treatment of skin disease will be abandoned as doctors meet other targets. It is unacceptable for a patient who has alopecia to wait a year for a wig. It is unfair on a young man who has severe acne to make him wait a year to benefit from Roaccutane. If part of the problem is caused by unnecessary referrals, it manifests itself in what can only be described as unnecessary suffering.
What can we do? First and foremost, skin disease can be reclassified as a chronic disease under the national health service. Skin disease is not just disabling—it is a financial burden and it can involve among the highest prescription charges of any chronic conditions. Many people need multiple prescriptions to treat different parts of their skin and their scalp. To give skin disease official recognition as a chronic disease would help to lift that physical, mental and financial burden.
Patients also want access to the new biological treatments, which are not curative but which hold out hope of stopping and treating conditions such as arthritic psoriasis. Some of the new drugs have proved to be effective, but they are expensive and funding for them has proved difficult in Scotland, making availability variable around the country. The most recent advice from the Scottish medicines consortium added a further anomaly: if a person has psoriasis with arthritis, they may qualify for one of the new treatments, but if they have just psoriasis, no matter how severe, they do not.
Improved education is essential. I have already highlighted the potential benefits of GPs having greater expertise, and the new provision of specialist retraining in skin disease for nurses is more than welcome. A survey of nurse prescribing habits this year revealed that 75 per cent of all prescriptions are for skin conditions, but 91 per cent of primary care nurses have no specialist knowledge of skin conditions. When I had the opportunity to visit Professor Munro's clinic at the Victoria infirmary in Glasgow, the benefit to patients of having experienced nurse specialists was immediately apparent. We need more psoriasis and alopecia management clinics, and nurse training needs to be extended to pharmacists, medical students and other health professionals. GP contracts and targets need to reflect the importance of treating common skin diseases such as psoriasis and eczema. Skin disease is underrecognised and undertreated. We must address the underlying deficit in service capacity through investment and improvement.
I end with a specific plea for alopecia patients. Alopecia is sudden hair loss, often starting as patches, but in severe cases it can lead to complete hair loss. As I am sure we can all imagine, that can have a dramatic effect on an individual. Most cancer patients are provided with wigs easily, as they should be. Alopecia patients do not always have the same experience. There is no effective treatment for alopecia and wigs are prescribed because of psychological need. That psychological need is no different from that of the cancer patient, but there is a great difference in the provision of wigs. Further unfairness occurs when patients reach pensionable age. For most patients of that age, prescription charges are dropped, but not charges for wigs or, for that matter, for the hosiery that is used to treat or prevent leg ulcers. The abolition of charges for both acrylic and real-hair wigs would be a step in the right direction. I ask the minister to actively consider reviewing prescription practices for wigs and hair-pieces, including the number of items that can be prescribed each year.
We need recognition, support and fairness, we need to tackle the stigma that attaches to skin disease and we need to make the treatments that are already available accessible to patients. We need action on skin disease.
I congratulate Ken Macintosh on securing a debate on this important subject. I apologise on behalf of Shona Robison, who unfortunately is unable to be with us owing to a conflict in her diary. It is not lack of interest but logistics that mean that she is not here today.
I have a very personal interest in skin disease. If I explain that as a child my heroes were Pete Murray and Hank Marvin, members might get a faint clue as to what I am talking about. Both those media stars suffered from quite disfiguring post-acne scarring on their faces.
I suffered from the most horrific acne as an adolescent and continue to do so. Fortunately, in my case it is on my torso rather than on my face. Some of the treatments that I experienced over a period of approximately 10 years have left their effects on me today: I am infertile and have very short legs and small feet. That is fine, because my small feet are the smallest size so I can always get shoes in the sales—it is not all bad news. One has sometimes to be philosophical about the deal that life gives one, but other people are not always so well equipped to respond and adapt to what skin disease deals them.
Consider some of the social history of the human race: we always admired milk maids historically because they had clear and perfect complexions because they were exposed to cowpox so they did not get the disfiguring pustules and scarring that many other people in our community got through exposure to smallpox. That illustrates our instinctive response, over a long period of time, to people who have skin conditions. That is why it is so important, for their psychological and physical health and for society as a whole, that we provide for people with a variety of disfigurements that arise from skin conditions.
As Ken Macintosh said, skin cancer is an important issue for one of the body's major organs: the skin. We do not think of it as an organ, yet we would be lost without it. It is not an organ that we can cut off or amputate: we have to have it.
I have recently, in later life, become episodically subject to another skin condition: urticaria. In becoming exposed once again to the medical profession in relation to a skin condition, I have had reinforced what Ken Macintosh and some of the briefing papers that we have received said: there is no great in-depth understanding in the primary health care service of skin conditions and their identification. I was lucky because my GP has a particular interest, but he shared with me his thought that that situation is quite exceptional. I visited my GP after I had had that rather irritating condition for several months. He had a student with him, so I suspect that we spent more time than we might have done on what would otherwise have been dismissed as a relatively trivial condition.
The effects of urticaria are widespread, but I will close by referring to one fact that I uncovered in relation to the condition from which I suffered for many years, which is that people who have acne, or who had acne and have scarring from it, are far more likely to be unemployed as adults. Therefore, it is not simply a trivial adolescent condition. Skin conditions can affect people for their whole lives. I hope that the minister will be able to tell us that she will crank up the support for people who suffer from a range of skin conditions. I look forward to hearing what she has to say on this important topic.
I begin, as did Stewart Stevenson, by congratulating Ken Macintosh on securing the debate. The plight of skin disease sufferers and the number of sufferers is an important topic that is worthy of our attention. As a signatory to the motion, I will concentrate on one aspect of it, which Ken Macintosh highlighted: the lifelong nature of what the motion describes as "eminently treatable" conditions.
Before I continue, I offer Ken Macintosh and other members my apologies. I will not be able to stay for the whole debate, because I have to go to a constituency surgery, but I look forward to reading the other speeches in the Official Report.
Psoriasis and other skin diseases should be classified as chronic conditions, as Ken Macintosh said. People who suffer from such conditions do not qualify for exemption from national health service prescription charges. I hope that the minister will consider that. Some 130,000 people in Scotland suffer from skin conditions, so it is clear that some people will not qualify for free prescriptions on the ground either of their condition or of their age. I wonder how many of those people find it difficult to pay for prescriptions for drugs that they need to treat their condition throughout their lives.
I acknowledge the help that I have received from Skin Care Campaign Scotland and in particular from Janice Johnson, from PSALV, in bringing the plight of skin condition sufferers to my attention. As members know, I introduced the Abolition of NHS Prescription Charges (Scotland) Bill; I am grateful for the support that Skin Care Campaign Scotland has given me. The substantial number of skin condition sufferers who are not exempt from the £6.50 prescription charge, which they must pay repeatedly, have been let down by the NHS, which promises to protect people who have difficulty paying the charge.
The exemption criteria have been described by the British Medical Association as illogical, irrational, inconsistent and against the founding principles of the NHS. There are exemptions on the grounds of age, income and chronic condition, but unfortunately skin diseases are not included in the latter category. Stewart Stevenson was right to highlight the problem. Many skin disease sufferers who are on disability living allowance or incapacity benefit must pay for their prescriptions in full. Although discounts are available through pre-payment certificates, the annual upfront payment of about £100 is difficult for many low-paid workers to find. Skin disease sufferers are often in the miserable position of having to ask their community pharmacist which of the two or three creams or lotions that they have been prescribed they can afford to do without for a fortnight. None of us would want to be in that position and I do not think that any of us wants that situation to continue.
I hope that Parliament will in due course accept the case for complete abolition of prescription charges for all patients in Scotland and follow the welcome approach of the National Assembly for Wales. I also hope that in the more consensual spirit of a members' business debate, we can all agree that we can do something to relieve chronic treatable skin diseases, by ending sufferers' worry about their ability to afford the medical treatment that their GP recommends.
I am pleased that Janice Johnson is here. I am reminded of the launch of PSALV, at which Shona Robison and I spoke. I support the work of that charity and of Skin Care Campaign Scotland.
It is important that there is public recognition of all aspects of skin conditions, including the effect of those conditions on people's lives—Stewart Stevenson told us a little about his experience. When I was a young pharmacist, in the days when we used to have to make messy concoctions to ladle on to people, a GP came into the pharmacy and said, "Do you know, most of us can recognise only four or five skin conditions?" I think that training has improved since then, but the area has been sadly neglected. Like Ken Macintosh, I would like better training to be provided. He mentioned the number of nurses in the community who can prescribe but do not have the right training, which is a matter of general concern to the General Medical Council. Some of my pharmacist colleagues are specialists; others do not have a lot of knowledge but know what the medication does.
After diagnosis, the most important issue is access to consultant services. The waits that have occurred are scandalous. In my area, which is covered by Grampian NHS Board, a shortage of consultant dermatologists resulted in waiting lists of much more than a year for preliminary screening, which meant there was no chance to get on top of particular conditions.
Colin Fox mentioned prescription charges, which I had already scribbled on my notes. On many occasions I have been in a pharmacy when patients have said, "I can't afford that range." I ran a trial to sell what are now called season tickets. If patients could afford it, we encouraged them to buy them. The Conservatives in this Parliament have been pushing for reform of prescription charges for treatments for chronic conditions, so we are pleased that ministers have accepted that that should happen. I hope that a full consultation on that will be open to all members of Parliament and to the outside world.
Stigma and depression are serious issues. There is also a learning difficulty aspect to skin disease, because young children can be distracted and sleepless, which can halt some of their development. What support do the parents and carers who look after those children get? They do not receive enough education. The charity sector does well, but we have to provide far more education, whether through the parenting classes on Wednesday afternoons that Tommy Sheridan has spoken about or, for children, through their schools. It is important that people have the knowledge to be able to cope with skin disease and to recognise when their child needs extra help or support.
We are getting more and more sensitive; more and more allergic reactions are being seen in society. As Ken Macintosh rightly said, we have almost a skin cancer epidemic, partly because people do not look after themselves properly and protect their skin, but also because people are becoming more sensitive. I would like more research to be done on how to control such conditions.
There are treatment anomalies and there is a bit of a postcode lottery. I hope that the minister will be able to assure us that, following the Kerr report that was announced today, we will see a decent roll-out of dermatology services that are accessible in all parts of Scotland, with correctly trained people helping people who suffer and their carers.
I thank Ken Macintosh for securing this debate on such an important subject. I fully support the motion, and I will try to address many of the points that it raises. I echo Ken Macintosh's thanks to Helen Eadie for hosting a successful series of briefings on dermatology issues over the past few months. The briefings that I was able to attend were immensely interesting and informative.
When I was a medical student about 30 years ago, we used to say that dermatology was the best specialty for private practice, because the patients did not die but they never got better. It was recognised 30 years ago that skin diseases are chronic conditions, so it is ironic that we have not recognised that officially in the way that they are treated now.
Was not another important aspect of private practice's enthusiasm the fact that, almost without exception, the conditions are not infectious?
That is a valid point, which relates to what I will say on stigma and the way in which people with skin diseases are treated.
The motion takes psoriasis as an example of a chronic skin disease, and rightly so, as it can be a severe condition with effects that go far beyond the skin. At a briefing, we heard about psoriatic arthritis, which can be extremely severe and difficult to treat. We heard that psoriasis is a chronic condition that is generally lifelong and affects 2 per cent of the population. We heard that a quarter of people with psoriasis have some sort of arthritic problem. We heard about the stigma and discrimination that are experienced by psoriasis sufferers. For example, they are banned from the armed forces for no good reason that I can determine. We heard stories about women being refused treatment by beauty therapists because of the appearance of fingernails that are affected by psoriasis. We heard that existing treatments are effective for less than 50 per cent of patients.
Although there is hope for at least some patients in the new biological treatments, the treatments are expensive and severely rationed to the extent that they are sometimes introduced to the patient too late. If they were to be introduced earlier, they could prevent progression to disability. We need to fund those treatments properly and remove some of the bureaucratic hoops that clinicians and patients have to go through to get those treatments for people. The skin action Scotland service redesign programme, which is mentioned in the motion, should be supported. I fully support the programme, but it will not address underfunding. The treatments have to be funded.
Psoriasis is a chronic condition, but it can have acute flare-ups. Those of us who remember the television programme that was first broadcast some years ago called "The Singing Detective" will remember Michael Gambon's excellent portrayal of someone in the acute stages of psoriasis. His portrayal was of someone who was practically immobile from the arthritis effects, with a skin that was acutely red and inflamed and who was delirious and hallucinating as a result of a high temperature. During the series, we saw how he gradually got better. The programme was very well done; I have never forgotten it.
At present, only half of the mere 100 in-patient dermatology beds across the whole of Scotland are used for the intensive treatment of severe psoriasis. We heard in the briefing that 80 per cent of psoriasis patients find their treatment frustrating: about a third of patients feel that their treatment is not aggressive enough and would welcome access to new treatments.
On a separate occasion, we heard about eczema and skin allergy, another chronic condition. Atopic eczema is becoming more common, with a five-fold increase in its incidence in children over the past 40 years. Up to one fifth of children in the United Kingdom are now affected. When eczema is severe—which happens in about one fifth of all cases—it can have a huge effect on a child and their family. Sixty to 80 per cent of children lose sleep because of their eczema. Parents can lose two to three hours of sleep a night—all of us can imagine the effect of that on family life. Parents report that, on a day-to-day basis, having a child with severe eczema is worse for the family than having a child with cystic fibrosis. Furthermore, there is no network of specialist nurses to support them. I understand that there are only 15 specialist dermatology nurses in Scotland.
Eleven per cent of families with a child with severe eczema experience financial difficulties. Huge costs can result from skin conditions outwith the prescription costs that we have heard about this evening. I am thinking of laundry costs, time off work and so on—the costs are never-ending. Skin disease seems to be a poor relation in our health care system, or at least one that is not resourced in proportion to the misery that it can cause to sufferers and the profound affect that it can have on their lives.
We heard about instances of good innovative practice. For example, we heard about the experience of teledermatology in the Western Isles. A specialist nurse on the islands can link with a doctor in Inverness, which has enabled waiting times to be reduced from seven months to two or three weeks.
There is no doubt that we need more specialist nurses. There is also no doubt that skin conditions can be every bit as chronic as the conditions that are recognised at present for prescription charge exemption. I hope that the minister will consider that.
I, too, congratulate Ken Macintosh on securing the debate. I also congratulate Helen Eadie and Skin Care Campaign Scotland on their tremendous efforts and success in recent months in raising the profile of chronic skin disease, not only in the Parliament but outside it as well.
Only last Saturday, I came across an excellent two-page article, "Getting under the skin of an agonising problem", in my local paper, the Press and Journal. The author, Nicola Barry, vividly describes her experience of contact dermatitis and graphically portrays the commonest irritants that cause it. The article even includes a photograph of Helen Eadie. It is quite a coup for the member for Dunfermline East to feature in the Aberdeen Press and Journal.
The article highlighted what many people in Scotland experience on a daily basis. I will quote directly from the introductory part of the article. Nicola Barry says:
"Which part of your body would you least like to lose? Probably your hands. If you think about it, you use your hands for everything – washing, dressing, going to the loo, cooking, eating, typing, reading, writing, sewing. The list goes on and on. The fact is life without the use of your hands doesn't bear thinking about. I know. I've tried it.
At first the skin on my hands was just dry, a few cracks. I slathered on the moisturiser but the cracks still didn't go away. They felt itchy, raw, the skin broken and weepy … I carried on using moisturiser, to no avail.
There were other remedies, none very successful … Every night I sat with plastic or cotton gloves filled with an assortment of moisturisers. It was distressing to say the least. To confound the problem, the cream went everywhere: on the sofa, all over the chairs, on every door handle, all over my clothes … I started having trouble carrying things. It hurt … I mean really hurt."
When out shopping,
"I'd go into a dressing room to try on something, only to notice blood on the clothing. I felt like a freak."
That is a vivid description of one individual's personal experience of a problem that took months of GP visits and eventual specialist dermatological care to solve. The problem is multiplied throughout the country. Scotland has 80,000 new dermatology out-patients per year.
The common chronic skin diseases such as contact dermatitis, eczema, psoriasis and alopecia cause many thousands of people untold stress and misery. Skin Care Campaign Scotland has highlighted many of the problems that face those patients. Because skin disease is not classified as a chronic or long-term condition, it is not a priority in the new GP contract. GPs are concentrating on meeting targets on other diseases, to the relative neglect of skin conditions. Their training in dermatology is minimal—I remember that from when I was a medical student—and only 1 per cent develops a special interest in the subject.
Prescription costs are prohibitive and the campaign is pushing for patients with chronic skin disease to be exempt from prescription charges. The long-promised review of prescription charging will have to consider many legitimate claims from chronic disease groups, but I hope that a system of exemptions will be devised that does not disadvantage such people, who require lifelong medication.
Patients with chronic skin disease need support and accessible services to help them to manage their disease. Trained specialist dermatology nurses are ideally suited to that role. At present, not enough of those nurses are available—indeed, many fields of medicine do not have enough specialist nurses. I fully support the Royal College of Nursing Scotland's right for nurses, right for patients campaign, which highlights the need for more specialist nurses to provide the service standards that patients deserve.
NHS funding has many competing demands, but chronic skin disease is so common that it deserves much more than the Cinderella status that it has had until now. I commend all those who are working to raise the profile of skin disease in the Parliament and I have no doubt that the campaign will continue until a better deal is struck for the many patients who struggle with this widespread problem.
I, too, add my congratulations and thanks to Ken Macintosh, my friend and colleague, on securing a members' business debate that highlights some of the key political issues that we as parliamentarians can progress. The debate will make a real difference to the legions of skin disease sufferers throughout Scotland.
Before I focus on what we as politicians can do, I, too, warmly welcome the Skin Care Campaign Scotland members who have joined us in the public galley. I pay tribute to Rosemary Gierthy, Colin, Pam, Nicola, Professor Jimmy Ferguson, Alison, Janice, Barbara and all the other executive committee members who have campaigned energetically and tirelessly to put skin care firmly on the political agenda. I have been privileged to work closely with them and have found the team to be immensely informative and to have enriched my work by setting an agenda for action in the Parliament.
When patients and clinicians met in the Parliament, they described the misery, suffering and often stigmatising effect of skin disease. The conditions are socially and occupationally disabling. As we have heard, some skin diseases are incredibly painful. At the patient and clinician seminars that I organised here in the Parliament, we shared knowledge and experience on a range of skin diseases, including eczema, psoriasis, skin cancers, leg ulcers and alopecia. From those sessions, we learned much. I thank especially Eleanor Scott, Ken Macintosh, Karen Gillon, Nanette Milne, Jean Turner and David Davidson, who were among the members who turned up, which Skin Care Campaign Scotland and I greatly appreciated. It is important for campaigners to see parliamentarians taking an interest and they are grateful for that.
The skin is the largest organ of the body. Twenty-five per cent of the population have skin disease that would benefit from medical care. Of all GP consultations, 15 to 20 per cent have a dermatological component, and that figure increased by 50 per cent from 1981 to 1991. Skin disease also relates to 35 per cent of the disorders and 30 per cent of the medicines that are under consideration for nurse prescribing. In December 2003, there were 14,985 on the waiting list, and the current target is to reduce waiting time to less than 26 weeks by the end of 2005. The University of Reading's Courtenay survey of 2005 found that 75 per cent of all prescriptions are for skin conditions—we need to think about the implications of that. Moreover, 91 per cent of primary care nurse prescribers have no specialist knowledge of skin conditions.
The centre for change and innovation is striving to increase capacity and develop nurse specialists in primary care. That work involves patient pathway review, the key objective of which is to reduce pressure on secondary care and treat patients as locally as possible. We heard about that earlier today. Fife NHS Board, which covers my constituency, is one of the key project areas and is undertaking pioneering work. I am pleased about that.
Most important, at the seminars, we learned about key political issues that need responses from all politicians and civil servants. Crucially, we learned that, as Ken Macintosh's motion highlights, skin disease must be treated as a chronic condition, which would relieve the many sufferers throughout Scotland of the related prescription charges.
One such patient is Margaret McLaughlin, a constituent of mine who is in the public gallery and who has suffered from psoriasis for many years. I have seen Margaret at her worst; I have seen the nail conditions, her hair falling out as a consequence of the psoriasis and the arthritis that comes with it. She tells me that a visit to the chemist can cost as much as £60 for her prescriptions, which places an intolerable strain on the family budget of someone who has four children. I plead with the minister to hold an urgent review for those who are in the same situation as Margaret.
We also have in the public gallery Pam Thomson, who is an alopecia sufferer. She is a brave person among the hundreds of other women and children in Scotland who suffer from total or partial hair loss. She has to wear a wig. Prescription charges for her wig are not £6.50; they can range from £50 to £208. That cost does not stop when a sufferer is 60; it goes on and on. On the same day that we listened to Pam, we also heard about Jack, whose father described the experience that alopecia was for Jack and his family. Jack was in his early teenage years, so members can imagine the enormous embarrassment that alopecia was for him.
Several of the actions for which alopecia sufferers are asking are applicable to many other skin conditions. Alopecia is a chronic condition and there is no effective treatment for it, so funds must be identified for psychological and practical support. We need to provide counselling and/or psychiatric support. We need to increase the availability of eyebrow tattooing, as total hair loss with alopecia means that a sufferer loses their eyebrows and all their body hair. We need to review urgently the prescription charges for wigs and hairpieces and allow GPs to prescribe wigs, which would ease the pressures on secondary care. We need to review the restrictions on the number of items that can be prescribed per annum and consider free wig prescriptions for affected individuals, as alopecia is a chronic disease like all other skin diseases. We also need to encourage funding for research on the causes of and treatments for alopecia.
Although 20 per cent of GP consultations concern skin disease, medical schools have no plans to increase their teaching of dermatology. Only 5 per cent of GPs receive training in basic dermatological skills, but modernising medical careers contains no plans to increase posts in dermatology for GP trainees. Dermatology training for medical students and GPs should be restored, as outlined in the report of the Westminster all-party parliamentary group on skin.
I urge all members to support those who campaign about and those who suffer from the skin diseases about which we have spoken today.
I thank Ken Macintosh for the effective way in which he has presented to the Parliament the needs of those with some form of skin disease. I also place on record my thanks to Helen Eadie for her work and for her sheer, dogged determination to highlight issues related to skin disease. I also thank those members who have stayed to take part in an important debate. The debate is timely, given that last week was psoriasis awareness week.
I recently had a very helpful meeting with Professors James Ferguson and Colin Munro of the Scottish Dermatological Society, at which we discussed some of the key issues that are contained in the motion. I have also had various discussions with Helen Eadie and I look forward to working closely with members on the issue in future.
As the debate has made clear, we are dealing with a wide range of skin conditions, which, taken together, affect a large percentage of the Scottish population. It is also clear that, no matter whether the condition is common or rare, mild or severe, the basic fact about long-term skin conditions is that the disease is visible. As we have heard, that can have profound implications for patients in many aspects of their lives, such as employment, personal relationships and leisure activities. Indeed, one of my daughters suffered from severe acne for many years.
Although there is no cure for many skin conditions, they can be treated, and we would expect treatment to be made available according to the clinical judgment of the prescriber and in line with the existing evidence base. We must also be able to take advantage of effective new treatments as they become available, such as the biological treatments for psoriasis that are mentioned in the motion.
Prescription charges have been discussed. I would point out that, at present, around 50 per cent of the population do not have to pay for their prescriptions, and that around 92 per cent of dispensed items are supplied free of charge. We are committed under the partnership agreement to a review of prescription charges for people with chronic health conditions and for young people in full-time education and training. That review began in October 2004. Those who are concerned about prescription charges for people with skin conditions will have a chance to respond to the consultation, which forms the second phase of the review. It will begin later in the year.
I am aware of the recent report commissioned by the Skin Care Campaign Scotland on the treatment of those suffering from alopecia. It highlights variations in the way in which NHS boards treat patients with the condition. The Executive will be replying to Helen Eadie, who submitted that report to us, in the near future. I am also aware of concerns about the policy on charging for wigs for those suffering from alopecia. I can well understand the distress that is caused by hair loss as a result of that condition and the psychological importance of wearing a wig. It is an issue that I very much want to explore. I have listened carefully to what members have said on the matter, and I give a commitment that I will go away and think very carefully about it, having heard about some of the somewhat anachronistic arrangements that are still in place and some of the discrepancies around wig prescription, which can be in hospital, outwith hospital, for cancer patients or for other patients. I am keen to explore that issue and I undertake to work with members and organisations to develop some sort of rational approach for the future.
The terms of the motion suggest that skin conditions are not a priority under the new general medical services contract. However, the GMS contract includes minor surgery, including the excision of skin lesions, as a directed enhanced service, and it enables early diagnosis and treatment of relevant skin conditions. In its quality and outcomes framework, the contract also recommends the management of medicines for people on repeat prescriptions, which can include regular reviews. That covers medication that is provided for long-term skin conditions.
Members will be aware that the quality and outcomes framework of the contract is under review, and those who wish greater priority to be given to skin conditions can make representations to the expert panel that has been set up to carry out the review. There is some urgency to that. The outcome will take the form of recommendations as to what could be included in the quality and outcomes framework from April 2006. The expert panel's call for evidence runs until 30 May. There is still time to make representations and I am sure that members will do so. If any members wish to contribute to the review, I am more than happy for them to send an e-mail to my ministerial mailbox and I can give them details about how to contact the panel.
Dermatology is largely an out-patient service, with a pattern of long waiting. As part of its drive to tackle the five specialties with the longest waiting times, the centre for change and innovation launched a £3.5 million redesign project in February 2004 to improve access. We have heard about the skin action Scotland project, which is mentioned in the motion and which has been mentioned by members in the debate. We expect the project to deliver sustainable reductions in waiting times by December 2005.
Skin action Scotland covers 11 NHS boards. The improvements that it is introducing include the development of nurse-led services in primary and secondary care for conditions such as paediatric eczema, acne and psoriasis. It is also developing education in primary care to enhance the current level of dermatology input to GP training, which members quite rightly mentioned. It is encouraging the development of GPs with a special interest in skin conditions and, taken together, those developments will allow an additional 7,000 new patients a year to be seen by nurses and 1,800 new patients a year to be seen by general practitioners with a special interest in dermatology.
The first programme for training GPs with a special interest in dermatology is based in NHS Greater Glasgow. That board has also been allocated capital funding of £450,000 to establish an ambulatory dermatology centre at the Western infirmary and a skin cancer and laser unit at the Southern general.
Helen Eadie mentioned Fife, where a nurse-led service based in primary care has been developed. That provides local access and treatment for patients with chronic skin conditions, which until now had been managed by hospital clinicians. Care is therefore provided locally on a personalised basis.
As part of the centre for change and innovation's out-patients programme, evidence-based patient pathways have been developed for 16 dermatological conditions, including the chronic conditions of alopecia, eczema, psoriasis and acne. Those pathways provide information for GPs and health services on possible management and referral routes. Dermatology pathways are being piloted in nine NHS boards, including Greater Glasgow NHS Board.
We have heard concerns that long-term skin conditions have been left out of future planning of the management of long-term conditions. There is no foundation for those concerns. Earlier, the Minister for Health and Community Care made a statement on the Executive's immediate response to the publication of the Kerr report on the national framework for service change in the NHS in Scotland. A hugely important element of that statement was about new approaches to the management of long-term conditions in Scotland.
The definition of "long-term conditions" that is used in the report is wide enough to encompass any persistent and incurable skin condition. There is absolutely no intention to exclude skin conditions from the new approach; on the contrary, the new approach seeks to address all an individual's needs, and the impact that conditions have on the person's quality of life. Given what we have heard today about the impact of skin conditions, the new approach should have particular benefits for those suffering from such conditions.
The Executive will also work with patients with long-term conditions by enabling self-care, which is an important aspect of the Kerr report. Following the report, the Executive intends to fund and develop a Scottish long-term conditions alliance to articulate patients' views and pilot self-management approaches. It acknowledges that for the bulk of the time patients with long-term conditions in effect monitor and maintain their own health. Of course we already have an effective group in the Skin Care Campaign Scotland, which is articulating ably the views of patients with skin conditions. Such groups will benefit and be engaged in the new approach that is set out in the Kerr report.
I thank Ken Macintosh for bringing the debate and members for taking the time to engage with the issue. I very much look forward to working with MSPs and organisations such as the Skin Care Campaign Scotland. There is a big agenda out there, but I believe that we are at a time when there are exciting opportunities to make a real difference to the lives of people with chronic skin disease.
Meeting closed at 17:59.