Plenary,

Meeting date: Thursday, May 25, 2006

Official Report 708KB pdf

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Question Time

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SCOTTISH EXECUTIVE

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General Questions

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Acute Hospital Services

To ask the Scottish Executive what steps it is taking to ensure that planned changes to acute hospital services are carried out in a strategic manner. (S2O-9961)

We made clear in "Delivering for Health" that changes to acute hospital services delivery must be consistent with the principles of the national framework for service change as laid out in the Kerr report. Any proposals for change that come to ministers for approval will be judged on that basis.

Does the minister accept my serious concerns about the potentially damaging impact that downgrading Monklands hospital's accident and emergency unit could have on the ability of Glasgow royal infirmary and Wishaw general to provide high-quality accident and emergency services? Will he examine whether, as is my belief, Lanarkshire NHS Board is wrong to state that it will be able to prevent large numbers of patients who currently go to Monklands from going to Glasgow royal infirmary despite the fact that, even at rush hour, the journey time to GRI is substantially less than the journey time to Wishaw general or Hairmyres hospital?

I am certainly aware of Karen Whitefield's views and concerns on the matter. A consultation on the particular issues relating to cross-boundary flows was part of the wider consultation that was recently completed in Lanarkshire. Karen Whitefield can rest assured that, when the board's proposals finally come to me, I will consider the extent to which the consultation on those matters met the requirements that we laid out, which are monitored on our behalf by the Scottish health council.

Is the minister satisfied that Ayrshire and Arran NHS Board has adequately assessed the strategic needs of accident and emergency patients in south-west Scotland in its proposal to downgrade the accident and emergency unit at Ayr hospital, which would leave no accident and emergency unit between Dumfries and Crosshouse hospital in Kilmarnock?

As John Scott will be aware, Ayrshire and Arran NHS Board has decided to consider those matters further in conjunction with its consideration of provision for planned care. Clearly, that is the basis on which its report will come to ministers and the decision will be made on the basis of that joint consideration.

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Partnership Agreement (Education)

To ask the Scottish Executive which of its partnership agreement targets relating to education will not be met by 2007. (S2O-9924)

None.

That is, I am sure, good news.

The partnership agreement refers to improving attainment. How does the minister reconcile what he has just said with the statement in "The Futures Project: Trend Analysis Papers 2006", which was published this week,

"That the attainment of the poorest performers … has not improved at all"?

The attainment figures overall have risen substantially and they have risen significantly since the Tories left office. For example, the score for reading at secondary 2 is up by 20 percentage points and the average increase in five-to-14 test results is 9 percentage points. We have seen a gradual improvement in highers results and a continuing improvement in standard grades. The education system is performing well overall.

However, I readily acknowledge—in fact, the Executive has drawn attention to the problem—that the performance of the group of pupils at the bottom of the system who are performing least well has not improved at the rate that we would like but has remained static. That is exactly why we are radically reforming our curriculum and producing new skills for work courses. We are doing a range of things to better engage and motivate those young people in our schools so that they join the rest of our pupils in the rising trends to which I referred.

Head teachers have said that they will not be able to achieve the reduction in class sizes to 20 pupils in English and maths. Is the minister listening to the head teachers or is he ignoring them?

I listen to head teachers all the time and I reassure them that we will provide all the staff whom we said we would make available. Recruitment into our programme to train maths teachers is up by 116 per cent and recruitment into our programme to train English teachers is up by 145 per cent, which will help to achieve class size reductions. That does not take into account all the external recruitment that we are doing. People want to come to teach in Scotland, because they recognise that we have a strong education system and that we are committed to teacher development. We are absolutely confident that we will meet our targets.

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National Health Service (Costs for Treatment Abroad)

To ask the Scottish Executive what the implications are for the national health service in Scotland of the European Court of Justice ruling in the case of Mrs Yvonne Watts and how many persons resident in Scotland have since 1999 requested reimbursement of costs incurred in respect of operations undertaken in other member states of the European Union. (S2O-9977)

I apologise in advance for what will be a fairly long answer.

The ruling of the European Court of Justice in the Watts case will affect the NHS throughout the United Kingdom. We are therefore working with the other UK health departments to develop systems to manage requests for elective hospital treatment overseas in a way that is consistent with EU law. We will issue guidance to NHS boards as soon as possible.

I welcome the court's clarification that no one should consider going abroad for treatment without discussing it with their NHS board, as they cannot assume that their costs will be met. Critically, they need to establish whether the treatment that they want is available on the NHS; if it is not, the court's ruling will not apply. People cannot argue undue delay in accessing a service that the NHS does not provide. People should also be clear about how much the NHS will refund. It may meet only the equivalent cost of the UK NHS treatment, and it might not always meet travel costs.

People also need to be aware that the local regulators will be responsible for care, hygiene and safety standards, not the UK regulators. Perhaps most important of all, they need to agree with their local board the arrangements for when they come back to Scotland and the arrangements for what will happen if anything goes wrong.

Finally, to our knowledge no one who is resident in Scotland has sought reimbursement of costs from an NHS board in circumstances similar to those of Mrs Watts.

I thank the minister for his full and comprehensive answer. As referred to in the exchanges last week between the First Minister and Miss Goldie, perhaps treatment abroad is no longer

"one of the best-kept secrets".—[Official Report, 18 May 2006; c 25807.]

Does the minister agree that it is a national disgrace that we are unable to treat patients in our NHS within a reasonable time, which leads some of them to go abroad for operations to relieve their pain and suffering? Has it occurred to the minister that, if the health service in France can provide hip operations for all the French men and women who need them, as well as for refugees from our own NHS, such as Mrs Watts, we might have some lessons to learn on how to organise and provide our health services?

That is a typically right-wing view, which I am sure is not shared by many in this chamber. The Conservative party consistently talks down our NHS, and it is doing so on the day we have announced that no in-patient is waiting more than six months, no out-patient is waiting more than six months, waiting for heart treatment investigations is down, waiting lists are down and we have the lowest ever number of in-patients and out-patients who are waiting more than 18 weeks. We are on track to deliver more in the near future.

Mr McLetchie's question concerned hip operations. Hip replacements are up by 25 per cent and knee replacements are up by 77 per cent. Those statistics should reassure Scottish patients that our health service is delivering. They should not listen to the Tories.

If a person is self-employed, they can get tax relief when they purchase a computer or a motor car, but if they cannot continue their work because they need a double hip operation—which costs £10,000—they do not get tax relief. Will the minister approach the Westminster Government on that issue?

With due respect to the member, no, I will not. We have to address any long-term waits in the health service and deliver on them. Yesterday, I met a patient from Edinburgh who was over at the Golden Jubilee national hospital and whose wait was three and a half months for a complete knee replacement. That is an example of the actual experiences of people in Scotland. We are delivering, but I acknowledge that we must do more. This is all about clinicians' judgments on how people are treated in the health service. Fifty-three per cent of people do not wait at all and 70 per cent of people do not wait longer than three months. Our health service is delivering. However, I am not complacent. More needs to be done.

The case that Mr McLetchie raised relates to 2003, but our health service has been transformed since 1997 and it is delivering for Scottish patients.

The minister mentions clinicians' judgments. Is he concerned about the comments made by ear, nose and throat surgeon Clive Davis, who said that clinicians have been asked to defer cancer cases so that patients who need to have their wisdom teeth removed can have the operation done on time? If he is concerned, will he institute an inquiry into whether such practices are common within the health service? What will he do to ensure that such practices never happen again?

I was reassured by the clinician's comment that the clinicians involved said that their clinical judgment was superior to any requests made by managers—if the suggestions of such requests are true. Members can rest assured that immediately after the press interview we spoke to the clinician involved to get clarification on what I consider to be the unsubstantiated claim made on the radio today. We will seek clarification and I will investigate. It is not acceptable that clinicians' judgment should be overruled by any manager in the health service. To my knowledge, that has not been the case. At the moment, the claim is unsubstantiated. An investigation began at 8.16 this morning.

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Alcohol

To ask the Scottish Executive what progress it is making in changing attitudes towards alcohol. (S2O-9940)

The findings from independent social research show that there is some positive movement in attitudes towards binge drinking and greater recognition that excessive consumption can have negative consequences. We are clear, however, that if we are to achieve a fundamental shift in attitudes towards alcohol, there is a good deal still to do.

I know that the Executive is conducting a pilot project on test purchasing of alcohol. How will that work be evaluated? Within what timescale does he envisage that the scheme will be extended, should it prove to be successful?

The pilot will be conducted over a 12-month period from this summer until the summer of next year. It will then be evaluated independently to assess the extent to which the procedures proved to be fit for purpose. If they prove to be fit for purpose, there will be nothing to prevent us rolling them out. However, we must wait for the results of the evaluation before we determine when and where we want to extend the use of the procedures to other police force areas.

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Long-acting Reversible Contraception

To ask the Scottish Executive what steps it is taking to extend the provision of, and enable women to make an informed choice about, long-acting reversible contraception in accordance with the National Institute for Health and Clinical Excellence guideline published in October 2005. (S2O-9934)

The national sexual health strategy makes it clear that the Executive expects the full range of contraceptive methods, including long-acting reversible contraception, to be made available to women, who will be facilitated to make an informed choice.

Does the minister share my concern that too many women in Scotland are not being offered the choice of long-acting contraception, such as three-monthly injections or three-yearly implants, which offer many women safer, more convenient and more reliable methods of contraception than, for example, the daily combined contraceptive pill? Does he agree that extending access to long-acting contraception could help to greatly reduce the number of terminations that take place in Scotland, of which there are currently 12,500 each year? Will he take steps to ensure that women throughout Scotland have a wider choice of contraception sooner rather than later?

I am sure that the member is aware that the national sexual health advisory committee was set up to tackle some of the issues that she raises. Its work is continuing and I look forward to receiving a response from the professionals involved about the advice that they will give to ministers. As part of that process, the NICE guidelines will continue to be reviewed.

I understand the point that the member makes. We face big challenges, especially in relation to the statistics on abortion that she mentioned. The provision of long-acting reversible contraception is part of our strategy. I am waiting for the response from the national sexual health advisory committee's working group so that I can ensure that we do better in the advice and treatment that we give to women on the NHS.

Given what the minister said about long-acting reversible contraception, will he confirm whether the Executive is committed to the principle that contraceptive services must be centred around women's right to choose whether and how to control their fertility?

That is the approach that we continue to adopt. The whole point of the national sexual health advisory committee—which is highly inclusive, in that there are many voices round the table—is to ensure that that approach continues to be adopted.

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Glasgow Housing Association (Stock Transfer)

To ask the Scottish Executive what recent discussions have taken place with Glasgow Housing Association regarding the second-stage transfer of its housing stock. (S2O-9976)

We are clear that our commitment to second-stage transfer is absolute and the setting up of a ministerial progress group is a reflection of our commitment and of the importance that we attach to that process. We continue to work closely with GHA to find a way through the process of delivering second-stage transfer. In addition, I have regularly been meeting other key partners—including Glasgow City Council and the local housing organisations—to ensure that they are fully involved in progressing second-stage transfer.

The GHA claims that a financial black hole is preventing second-stage transfer. Has the minister seen any evidence to support that claim or does she believe that GHA is stalling for its own reasons? Does the minister share the frustration and anger of tenants that the promises that were made to them before the ballot have not been kept? Will she indicate when she expects the first transfer to take place?

We have invested £1.6 billion in Glasgow for its housing stock transfer. Whatever the issue, it is not one of a financial black hole. Stock transfer is a huge opportunity for the people of Glasgow, and it is one that people accepted. Indeed, the challenge for all of us who are involved in the process is to ensure that the financial commitment that we have made translates into the very best deal possible for GHA tenants. All the members of the ministerial progress group on second-stage transfers and all those whom I have met in Glasgow and who are involved in the issue are determined that the needs of tenants should be at the centre of all of this. We will work on the financial issues to ensure that second-stage transfer is delivered.

I am clear that there is a commitment to second-stage transfer. There is an issue about the way in which the process is taken forward, but the issue is not one of finance. Obviously, we are developing the pilots. We are keen to see them progress quickly. Once we have learned the lessons that are to be learned from the pilots, we can go forward with further transfers. We do not have an exact timetable for the pilots because we are determined to get them right. That will ensure that the process goes forward as speedily as possible.

Further to the considerable progress and investment that has been made, does the minister acknowledge that the GHA, in moving forward on second-stage transfers and other matters such as the modernisation of its factoring policies and practices, must avoid the pitfall of taking the approach that nothing can be done until everything can be done?

Absolutely. In our dialogue with the GHA, Glasgow City Council and those who have given a lifetime commitment to making housing work at the local level, we are keen to ensure that second-stage transfer is taken forward. Huge amounts of investment should not lead to paralysis; investment is not a barrier. Stock transfer is a huge challenge, but I am sure that the GHA is up to the challenge. The Executive is also up to the challenge of supporting the GHA in taking forward this work.

Question 7 has been withdrawn.

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Glasgow Housing Association (Evaluation)

To ask the Scottish Executive what its evaluation is of the progress that Glasgow Housing Association has made to date in meeting its stated objectives. (S2O-9932)

I am delighted that tenants are now beginning to feel the benefit of the step change in investment that was promised at transfer, with £291 million having been spent to date. Tenants are clearly at the heart of the decision-making process through the local management arrangements that have been put in place, but we are determined to see quick progress on second-stage transfer, which remains an absolute commitment and a key part of the solution for Glasgow's housing. We will continue to work closely with all the key partners to ensure that it is delivered.

I accept the Executive's good intentions and commitment. However, does the minister agree that the GHA needs to make much swifter progress towards second-stage transfer and community ownership? Does he also agree that its present approach conveys a worrying impression of drift and inaction? Furthermore, will he take the appropriate action to ensure that the GHA takes the necessary measures and that it does so speedily? Will he investigate whether Communities Scotland, which monitors the effectiveness of GHA's spend, is satisfied—or not—with that spend?

I assure Bill Butler that the issue is right at the top of Johann Lamont and my agendas. As Johann Lamont described in her answer to the previous question, we have regular meetings with Communities Scotland and many of the partners in Glasgow. Clearly, we take a very close interest in the matter. We are determined to drive forward second-stage transfer and to do so as quickly as possible.

We are as disappointed as Bill Butler is that second-stage transfer has not taken place as quickly as it was originally envisaged. We are determined to make up for that. At the same time, we should acknowledge the considerable investment that has been made in Glasgow. In my initial answer I indicated the figure involved—I am sure that Bill Butler and others know the many details. I mentioned the £291 million that has been spent over the past three years, which compares well with the £65 million and £75 million respectively that were spent in the two years before transfer. A further £150 million will be invested this year.

Will the minister admit that the GHA transfer has been an absolute shambles? Apart from second-stage transfer not going ahead, people are being asked for £6,000 or £7,000 to pay for repairs—elderly people in the Knightswood area have been given 12 months to pay that. The GHA has built no new houses for rented accommodation and some houses—particularly the Winget houses in Carntyne—still await a pilot scheme that was supposed to start two years ago. Will the minister admit that it is a shambles and do something about it?

It is outrageous that £291 million of investment should be called an "absolute shambles". Sandra White would be better served by maintaining a sense of balance. Much has been achieved, but there is a lot more to do. Nobody is more determined to press ahead with that than Johann Lamont and me.

Of course, it is partly a matter of investment. Johann Lamont mentioned the £1.6 billion, which includes resources to deliver 6,000 new homes for tenants who will lose their houses through the GHA demolitions. Second-stage transfer is the immediate priority this year. An enormous amount of work is going on: a financial team was established and a short-term working group is trying to resolve some issues. I expect and we are determined to see early progress on that most important issue.