Good afternoon. The first item of business is portfolio questions. Question 1, in the name of John Park, has not been lodged. The member has provided no explanation or apology and therefore we are displeased. Question 2 was withdrawn for understandable reasons. Question 3 was not lodged for understandable reasons.
Obesity and Mental Health
There is a well-established association between obesity and mental health problems that is supported by a body of research. Although the Scottish Government has not added directly to that work, we have acknowledged the importance of the link, most recently in the new mental health strategy, which was published in August. In the strategy we gave a commitment to work with national health service boards and other partners to support a range of measures to help people with severe and enduring mental illness to improve their physical ability levels.
The minister seems to be aware of the Scottish Association for Mental Health’s research, which shows that people with mental health problems are more likely to be less active and to be concerned about being judged when going out of their home. Does the minister agree that Renfrewshire mental health arts and film festival, which is being held in the first three weeks of October, is one way of engaging those with mental health issues and of not only helping them to get involved in the community, but giving them confidence—if needed—to attend public events.
Yes, I agree with George Adam. Engaging in the arts, whether through participation or appreciation, is a positive way of helping to support someone’s recovery from mental illness. The Scottish Government provides funding to the Mental Health Foundation to help to support the Scottish mental health arts and film festival, which is one of Scotland’s most diverse cultural events and covers everything from music, film and the visual arts to theatre, dance and literature. The annual festival is about to start in October and will take place at venues throughout the country. I encourage members to consider participating in and attending some of the events.
Epilepsy
The Scottish Government is committed to ensuring that people with neurological conditions such as epilepsy can access safe, effective and person-centred care. We are therefore working with national health service boards, the third sector and patients to make sure that clinical standards for neurological conditions are implemented.
I draw the minister’s attention to an initiative in Glasgow that I have helped to secure to raise awareness of epilepsy among those working in the licensed trade. Epilepsy Scotland will now deliver training to all staff in Òran Mór licensed premises in Glasgow and other outlets that are run by the proprietor, Colin Beattie. Will the minister meet me and Epilepsy Scotland to discuss how this innovative approach to epilepsy awareness and training can be rolled out not just to licensed premises across Scotland, but in other areas such as justice and education, so that those who deal with people who may suffer from epileptic episodes can make informed choices and support those people in the best way possible?
That sounds like a worthwhile initiative and I will be more than happy to meet Bob Doris, Epilepsy Scotland and any other parties who would like to explore that particular project.
Emergency Surgery (Rural Areas)
It is a matter for national health service boards to plan and provide such services to meet the assessed needs of their resident populations.
The cabinet secretary will be aware that Perth royal infirmary has seen a loss of emergency service provision over the weekends, with no operations now taking place between 6 pm on a Friday and 8 am on a Monday. Given that Perth royal infirmary serves a large rural area, there is growing concern that more and more services are being centralised at Ninewells in Dundee, with the associated travel that is involved.
I have not received any proposals for any reduction in services at Perth royal infirmary. I am acutely aware of the particular needs of all our rural areas in respect of all aspects of the health service.
Care Homes (Psychotropic Medication)
Mr Campbell, as your microphone did not come on immediately, Mr Neil might not have heard the full question. I ask you to repeat it.
To ask the Scottish Government what steps it is taking to promote the safe and effective prescription of psychotropic medication to care home residents.
Thank you, Presiding Officer. I actually read the question in the Business Bulletin this morning.
Thank you, cabinet secretary. Of course, you will know that it is important for members of the public and the official report to hear the question as well.
Has the cabinet secretary also considered the recommendation by researchers at the University of Dundee and NHS Fife of systematic medication reviews? That is particularly important as the study found that the majority of psychotropic drugs that are used by nursing home residents were started before the patient was admitted.
All those recommendations will be considered as part of the review that I mentioned in my answer to the first question.
I thank the cabinet secretary for the information that he has provided. Given that it remains the fact that people in care homes with dementia are significantly more likely to be on a psychoactive substance, will he consider, even before he receives the report that he mentioned, allowing those citizens to register with a pharmacist for chronic condition prescribing? Up to now, they have been barred from doing so. It is a right for every other citizen and it appears to me that residents in care homes should have that right as well.
I am always willing to listen to constructive suggestions, whichever part of the chamber they come from. I will certainly take that matter into consideration in deciding policy for the future.
I endorse what Dr Simpson has just said. I suggest to the health secretary that a prior step that could be taken to ensure the comfort and safety of such people in old people’s homes is the training and registration of people who will work with them.
Margo MacDonald has made another valid suggestion that I am prepared to take back and consider.
Monklands Hospital
Both this Government and NHS Lanarkshire remain totally committed to the maintenance and development of Monklands hospital. NHS Lanarkshire is progressing an initial agreement to develop options for what will be very complex work—with a construction and capital value of £400 million—to upgrade the hospital to meet current standards. The £15 million that has made available in the board’s capital plan for expenditure on Monklands over the three-year period from 2010-11 to 2012-13 is being spent on projects that prioritise backlog maintenance and statutory compliance to ensure not only that the building remains safe and functional but that investment is aligned to the site’s clinical requirements.
I thank the cabinet secretary for his answer and, as his former constituency chairman, I wish him well in his new job. Does he agree that mental health services at Monklands hospital should be improved?
First of all, I thank Dick Lyle for welcoming me to my new job—it is much appreciated.
The much-needed investment in Monklands hospital will be welcomed across the chamber but what plans are or have been in place to renovate the towers, which are in an extremely poor condition? Are they covered in the plans that the cabinet secretary mentioned?
I am very much aware of the towers and, indeed, other physical problems at Monklands hospital, which, of course, was opened in the late 1970s. The £400 million capital spend that I have just mentioned will include modernisation—although I make it clear that I am not familiar with the final plans as they have not been finally decided. They might well involve the towers’ removal, but that is still to be confirmed.
Question 9 has not been lodged for understandable reasons.
Cancer (Early Detection)
The detect cancer early programme, which was launched in February with an initial focus on breast, lung and colorectal cancers, aims to improve cancer survival rates for people in Scotland to become among the best in Europe. The social marketing priming campaign ran through February and March, with the aim of tackling fear and negative attitudes towards cancer, and the first of the tumour-specific campaigns was launched on 4 September to increase awareness of breast cancer symptoms.
As the cabinet secretary said, the on-going advertising campaign fronted by Elaine C Smith gives women information and advice on how to check for early symptoms of breast cancer. Given that the expected upsurge in the number of women recognising and acting on early signs and symptoms will inevitably lead to more consultations at general practitioner surgeries, are there any plans to offer a renewal or review of GP training to reinforce the importance of early detection of breast cancer and to assist GPs in working with other health professionals such as practice nurses on detecting early signs of breast cancer as soon as possible?
Every GP in Scotland has received supporting breast campaign literature and specific information on the current Scottish referral guidelines for breast cancer that will raise awareness of the campaign and the symptoms and signs of breast cancer on which they should act.
At a conference organised by Bowel Cancer UK two weeks ago, we heard about the bowel cancer screening programme’s great success. Will the cabinet secretary tell us whether there are any plans to develop that programme? Will he also tell us about any action that the Scottish Government is taking to reduce some of the unacceptably long waits for colonoscopy?
I am examining in particular how quick the patient’s journey is from the point at which there is a suspicion of bowel cancer to establishing whether cancer is present and how quickly it can be treated.
Given our ever-ageing population in Scotland and the importance of early detection, will the cabinet secretary tell us what steps he intends to take to raise awareness of the continuing risk of breast cancer among women over the age of 70, as routine breast screening stops at 70 and, with increasing life expectancy, more cases of breast cancer in older women are likely to occur?
As Nanette Milne will be aware, we already have a range of programmes to make all women aware of the possibility of breast cancer. However, I take the point that she makes about women over 70. We are considering what additional work can be done to make that group particularly aware of breast cancer.
Accident and Emergency (Treatment Times)
The Scottish Government continues to view the four-hour accident and emergency standard as an important measure of the quality of care provided to patients. It is the only Government in the United Kingdom that maintains a commitment to delivering and sustaining the challenging standard that 98 per cent of patients should be admitted, discharged or transferred within four hours of their arrival at an accident and emergency department.
Will the cabinet secretary congratulate NHS Fife on its dramatic improvements on waiting times for emergency treatment? Newly released figures show that, during July and August 2012, it went from being one of the worst-performing health boards in Scotland in the past year to achieving a performance level in which 98 per cent of people waiting for treatment were seen in less than four hours.
Even although those figures have not been officially released, I believe that they have appeared in a local newspaper. Therefore, I feel free to comment on them and to congratulate Fife NHS Board on that excellent performance.
Hear, hear.
I welcome the progress on the four-hour waiting times targets in accident and emergency and join in congratulating the staff on their achievements. However, does the cabinet secretary share my concern that the number of patients waiting more than eight and more than 12 hours for admission and treatment has doubled? Will he advise members what he intends to do to address that?
Although the numbers and percentage in that category are—to put the matter in context—extremely small, we are taking action across the board to ensure that it does not happen in future.
Two weeks ago, the cabinet secretary suggested that the rise in the longest waits in accident and emergency was simply due to circumstances in particular hospitals. I will ask him about the situation at one of those hospitals. Why does he seem so sure that the persistence of a 12-hour wait at Hairmyres has nothing to do with the staffing situation in NHS Lanarkshire that the previous health secretary left unresolved?
We have undertaken a detailed analysis in every case in which the situation arises. I have been advised that staffing shortages are not the reason for the delays and that there are other reasons. I am happy to write to the member to give some more details of our analysis.
Community Medical Services (Older People)
Providing high-quality care and support for older people is a fundamental principle of social justice and an important hallmark of a caring and compassionate society. Supporting and caring for older people is not only a health or social work responsibility. We all have a role to play: families; neighbours; communities; providers of services such as housing, transport, leisure and community safety; and others.
Does the cabinet secretary agree that it is vital that the elderly and housebound have full and continued access not only to assessment and clinical medical services but to dental services, podiatry and a full range of routine checks and screening services? Such services ensure that appropriate prevention and early intervention can be planned for that group of patients. What is the cabinet secretary doing to ensure that appropriate transport arrangements and information about the arrangements are in place for that group of patients?
I expect NHS boards to work with the Scottish Ambulance Service and a range of local private, public and voluntary transport providers to ensure that all patients have the support and information that they need to access transport.
Drug Prescriptions (NHS Ayrshire and Arran)
The cost to NHS Ayrshire and Arran of dispensing prescriptions in the community in 2011-12 was approximately £74.4 million. The cost of secondary and tertiary prescriptions in the same year was approximately £28.6 million.
A major contributor to the expenditure is repeat prescriptions, which in many cases result in the non-use of the drugs so prescribed. It is estimated that that may cost a particular health board a sum in excess of £1.5 million per year, which might be better spent elsewhere in the service. The same applies to health boards across Scotland.
We are already tackling the issue under our improving efficiency programmes. Our estimate is that, if every health board in the country adopts the best practice of the best health board in relation to prescriptions, there is the potential to save at least £30 million a year from the drugs bill. Repeat prescriptions are a significant element of that potential saving.
I associate myself with Chic Brodie’s comments, which were absolutely valid.
NHS Lothian is probably the most proficient health board in its ability to dispense drugs efficiently. I would like NHS Greater Glasgow and Clyde and all the other health boards to follow that example and to use Lothian as the benchmark. If we do that, we can make the savings that I described and ensure that everybody gets the drugs that they require while minimising wastage and freeing up resource for investment elsewhere.
Individual Patient Treatment Requests (Consistency)
NHS boards are expected to maintain an overview of the effectiveness of their local arrangements for the introduction of new medicines, including NHS board management of IPTRs. NHS boards were reminded of their responsibilities on that in additional guidance that was published on 13 February this year under the cover of SGHD/CMO(2012)1, which recognised the benefits of NHS boards meeting at least annually to share good practice on IPTR management.
I recognise that the cabinet secretary inherited the problem from his predecessor, but the Scottish Government seems to be disengaged from the process. I have received written answers that show that health board policies are not monitored or compared, that decisions are not monitored, that panels and procedures for dealing with requests are not standardised, and that training for panel members is not standardised. Boards are supposed to have annual meetings, but none has occurred yet and no date is set for one. No details are available about contact between staff of different health boards. That is a recipe for a postcode lottery. How does the minister expect to ensure consistency when the Scottish Government is not even looking at those issues?
We are looking at the issues. Once the Scottish Medicines Consortium has approved a drug for use, each health board has three months to submit its strategy in terms of the criteria for using that medicine. It is the case that a number of health boards have not submitted and agreed their strategies within those three months.
My questions are in that spirit. As many potentially life-saving and spectacular new treatments are becoming available almost monthly by routine, does the cabinet secretary agree that patients’ expectations for IPTRs probably cannot be realised? In those circumstances, will he agree to consider the Health and Sport Committee’s examination of access to new medicines?
First, I will take into consideration reports from the Health and Sport Committee not just on this subject but on every subject that it reports on that impacts on my portfolio. Secondly, I look forward to receiving more detailed observations from Jackson Carlaw, which I will take seriously. Thirdly, if there are areas of health policy in Scotland in which we can get greater consensus across the chamber, I am more than willing to work with other parties to ensure that that happens.
In seeking to avoid a postcode lottery and to ensure a much more level playing field of policy among the health boards, has the cabinet secretary considered that we may have too many health boards in Scotland and that we could do with fewer?
There are 22 health boards in Scotland, plus many other bodies such as the Mental Welfare Commission for Scotland, Social Care and Social Work Improvement Scotland, the Scottish health council and others. Given the scarcity of resources that we all face because of the budget cuts, which will continue for a number of years yet, plus the increasing demands that the health service faces, we should find opportunities where we can to streamline the organisation of the health service to release resources that could be better spent on the front line. That is an area on which I will focus some attention in my time as the new health secretary, however short or long that may be.
World Health Organization
A representative of the Scottish Government met Dr Shekhar Saxena, director, mental health and substance abuse, and Dr Matt Muijen, programme manager, mental health, of the World Health Organization, from 3 to 5 September 2012. That meeting was part of the WHO consultation on the European mental health strategy and the global mental health action plan. The Scottish Government has provided expert support to the development of the European mental health strategy.
The cabinet secretary may be aware that the World Health Organization’s international agency for research on cancer has, in the past few months, classified diesel exhaust emissions as carcinogenic to humans, causing lung cancer and increased risk of bladder cancer. Dr Christopher Portier, the chairman of the IARC, has stated that the scientific evidence is “compelling”. How does the Scottish Government view those findings and what steps is it taking to measure the impact of diesel emissions on the health and wellbeing of Scotland’s people?
Right across Government, whether in the transport function, in climate change or in health, we measure all the emissions because we must reach our climate change targets. We will and do take into consideration all the primary and secondary research that is produced by the World Health Organization, which is a first-class international body.
The cabinet secretary was doing so well until that last comment. When his representatives met the WHO individuals, did they discuss the issue of drug deaths, which is a major problem for Scotland? The number of drug deaths in Scotland is increasing, whereas the number in England is decreasing. Indeed, in France the number has been reduced by a considerable measure. Was there any discussion of what best practice might be of assistance to us in tackling that difficult problem, which has been growing for the past eight or nine years?
I will make two points: first, my understanding is that the discussions with the WHO officials were wide ranging across a range of issues; secondly, I recognise that particular problem of the relatively higher rate of deaths.
Psychological Therapies (Waiting Times)
The Scottish Government has established the health improvement, efficiency, access and treatment target to deliver faster access to mental health services by delivering 18 weeks referral to treatment for psychological therapies from December 2014. We have already made improvements in service performance across Scotland since the HEAT target was set.
Will the minister take specific action to target areas in which waiting times for psychological therapies are longer, such as in the Highlands, where an estimated 75,000 people suffer from mental illness? Health boards that cover large geographical areas with a sparse population need more staff time per patient to deliver those therapies. Will the minister take that into account when setting health board budgets?
In order to improve access to psychological therapies, the HEAT target is there to drive all boards—including NHS Highland—to ensure that they have processes, systems and data collection mechanisms in place to meet that HEAT standard. It is for local boards to respond with regard to how they can best effect that within their local areas.
Commonwealth Games 2014
Progress with our preparations for the 2014 games continues to be excellent. The great success of Scottish athletes in the Olympics and Paralympics has enthused our nation and raised the profile of the games. It is now just 665 days until the Glasgow games get under way.
I thank the minister for that full response.
I am aware of the concerns that many members have about Atos; indeed, as a constituency member, I have also raised concerns about its work assessment programme. It is important that we recognise that, to a large extent, such matters are for the organising committee in Glasgow. I have no doubt that members will seek to make representations to that committee on areas about which they have concerns, but we should not distract ourselves from the fact that we are making very good progress in ensuring that the arrangements for the 2014 games are in place. More than anything, I think that the games will be remembered for the friendly welcome that they are assured from the people of Glasgow and the people of Scotland.
Dave Thompson’s question should be brief and relevant.
Will the minister support proposals to have a 2014 Commonwealth highland games linked with the Commonwealth games? That will not only boost highland games, but will promote all of Scotland as a great place to visit.
It is my understanding that the Commonwealth Games Federation does not permit the staging of exhibit sports as part of the Commonwealth games. However, we have a long highland games tradition and given that 2014 is also the year of homecoming, I have no doubt that various organisations will wish to look at the possibility of hosting a major highland games event in that year. I encourage Dave Thompson and parties that are interested in taking that initiative forward to work with all the agencies that can offer support and assistance in making that a success in 2014.
That pushed things to the limit, but that concludes question time.
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