SCOTTISH EXECUTIVE
Health and Community Care
Health Service (Centralisation)
To ask the Scottish Executive what plans it has to prevent further centralisation of the health service, in light of the paper by the Academy of Medical Royal Colleges "Centralisation and Specialisation of Hospital Services—bigger is not necessarily better for rural and remote communities." (S2O-10849)
The paper in question is an unpublished document, which I understand has been sent by the United Kingdom Academy of Medical Royal Colleges to the authors for redrafting. I understand that, in its draft state, the report does not take full account of the work on remote and rural health care that is under way in Scotland. Nevertheless, it welcomes the Kerr report's remote and rural health care recommendations, which we have adopted in Scotland through "Delivering for Health". The national health service in Scotland will, of course, continue to consider any relevant published reports as it seeks to improve patient care.
Can the minister reassure Parliament that he will take every step to re-examine the published paper and that, if it contains any clinical arguments that people who live in more remote areas are being put at risk, he will take action to ensure that the centralisation that is proceeding across Scotland—including the centralisation by stealth at St John's hospital—is tackled and stopped immediately?
That is the usual outrageous misinformation from the Scottish National Party. It is inappropriate to base health policy on an unpublished draft that has been sent back to the authors for more work. However, the draft report actually states:
Is the minister aware that the SNP in West Lothian continues to peddle rumours about service centralisation away from St John's hospital, which Fiona Hyslop mentioned? Such rumours are sapping the confidence of staff and patients. Will the minister follow Lothian NHS Board's lead by reaffirming his confidence in the services that are provided at St John's? Will he also confirm that services are actually being decentralised to that hospital?
That is exactly the case. I remind members—in particular, Fiona Hyslop—of some of the facts of the case. We are now treating more in-patient and day cases at St John's than we did in the previous year. We have moved Lothian's ear, nose and throat surgery out to St John's and the phototherapy unit there is now dealing with psoriasis patients. St John's is a vibrant and busy acute hospital that has been part of NHS Scotland's overall success recently in drastically reducing waiting times for both in-patients and day cases.
The minister will be aware that Greater Glasgow and Clyde NHS Board recently announced the closure of the integrated care pilot at Vale of Leven hospital in June next year once alternatives can be put in place. Is that decision in line with the recommendations of the Kerr report? Is it also in line with the duty that all health boards now have under the National Health Service Reform (Scotland) Act 2004 to implement regional planning through managed clinical networks to sustain the delivery of services in rural areas?
The member is wrong, as ever. However, I seek the guidance of the Presiding Officer on the question, as question 6 was appropriately lodged by another member.
The member has asked a supplementary question that is relevant to question 1—specifically, whether the approach corresponds to the Kerr report. The minister could answer that. His response to the later question will doubtless cover the other aspects.
Before answering the question, I must correct the member's assertion. The Vale of Leven pilot has not ended, but there are concerns about the next stage of the project. The clinical safety issues are not about the pilot as it currently stands but relate more to implementing the next phase of the operation. Any strategy by any health board in Scotland must fit exactly with "Delivering for Health". I will ensure that that is the case in the Vale of Leven and everywhere else in Scotland.
Cancer Patients (Treatment Delays)
To ask the Scottish Executive whether it has concerns about delays being experienced by cancer patients in receiving their treatment. (S2O-10800)
Yes, we have. I am always concerned to hear about delays in cancer treatment. The possibility of cancer and the worry that it causes for patients, their families and friends is of concern to me. As I have said many times, it is unacceptable for people with cancer to wait longer for treatment than is absolutely necessary.
I draw the minister's attention to the recently published data on the "Cancer in Scotland: Action for Change" targets, in particular the target that by 2005 the maximum wait from urgent referral to treatment for people who suffer from cancer will be two months. Is the minister aware that the data that were published indicate that in the Forth valley fewer than 65 per cent of patients who are referred urgently are receiving the treatment that they require? That is the third-lowest compliance level for any health board in Scotland.
We are taking significant action and I say again that I am deeply unhappy with the performance to date on the matter. However, the context is important. First, 14 per cent more patients are living through and surviving cancer. That is because of the work of our national health service. In the last quarter, performance has improved on bowel cancer, lung cancer, breast cancer, ovarian cancer and melanoma.
Has the minister received information from Lanarkshire NHS Board about its recent decision to site the new Lanarkshire cancer care centre at Monklands hospital? I am sure that the minister will agree that that will provide an opportunity for better access and better services for my constituents in Cumbernauld and Kilsyth. Will the minister make a speedy announcement on the issue and endorse the decision that has been taken by NHS Lanarkshire to provide this much-needed service at the Monklands site?
My colleague Lewis Macdonald will be in receipt of that document as soon as it comes from NHS Lanarkshire.
Residential Care
To ask the Scottish Executive what assessment it has made of local authority requirements for residential care places for elderly people between now and 2014. (S2O-10842)
The report of the Executive's range and capacity review group, published in May this year, considered the available evidence on the balance of needs over the next 20 years. It recommended that local partners do further work to assess future needs in individual local authority areas and come to conclusions at local level as to what future provision of services will be required to meet those needs.
I am sure that the minister is aware, from correspondence with me and with the convener of Orkney Islands Council in recent months, that the percentage of the population that is elderly is set to rise much faster in Orkney than in Scotland as a whole, and that there are already concerns about the possibility of residents having to be sent across the Pentland firth for residential care places. Will he respond positively to my request for a meeting at ministerial level to discuss the issue and to consider a report, a copy of which he has been sent, that indicates that the allocation of grant-aided expenditure for social services in Orkney falls well short of the amount that the council spends on social services, and that community care services for older people, and children and family services, are among the areas that have been most acutely hit by the underallocation?
I am grateful to Orkney Islands Council for sending me a copy of that report, and my officials have had a constructive meeting with officials from the authority. Jim Wallace knows that, as the allocation of resources forms part of the wider local government settlement, it will be considered as part of that wider process, and we would not wish to negotiate on the settlement within individual councils. However, we are happy to have a meeting to discuss and fully address the issues that are particular to Orkney. The report covers issues that relate to a number of different ministerial portfolios. I would like to take a little more time to consider which minister will be best placed to respond to the issues, but we will certainly accept Mr Wallace's request for a meeting.
Is the minister aware of a report that was submitted to Dundee City Council's social work committee on Monday night, which shows that the number of people who are waiting for funding for a care home place in Dundee almost doubled between May and September, from 63 to 118, and that, in the same period, the number of people waiting for free personal care rose from 17 to 30? What advice can he give my constituents who are caught up in those waiting lists? Who does he hold responsible for those waiting lists? Is it the Labour-Lib Dem coalition that runs Dundee City Council, or his own Executive?
Shona Robison knows very well that there are, in some circumstances, perfectly legitimate reasons why a person will wait for the delivery of full services. Responsibility for delivering those services at local level lies with the local authority. Where discharge from hospital is a factor, responsibility lies with the local authority in partnership with the local health board or with other partners. The allocation of funding for delivery of those services fully meets the earlier request that was made by the Convention of Scottish Local Authorities, and further consideration will be given to that in the spending review next year. Ms Robison is also aware of the fact that we are currently reviewing the implementation of the free personal care policy across Scotland, in order to ensure that we can learn any lessons that need to be learned and can improve the delivery of those services.
Will the minister give a progress report on the situation regarding the excellent proposals to make pensioners' homes, where applicable, safer for residents, to enable them to remain in their own homes, as was recommended by the Kerr report? The main benefit of such an initiative would obviously be that it would do away with the need to sell people's homes to pay for their care.
Good progress is being made in addressing the issue of making people's homes safer. We are keen to enable people to stay in their own homes as long as they can, because that is what most older people want. I commend the example of West Lothian Council, which is in many respects leading the way in adaptations to housing to enable that. That is the sort of example that we would like to see being followed throughout Scotland.
National Health Service Employees<br />(Monklands Hospital)
To ask the Scottish Executive what its estimate is of the number of NHS employees in Monklands hospital in each of the next three years. (S2O-10832)
The staffing establishment at Monklands hospital in March of this year was just over 1,500 whole-time equivalents. Lanarkshire NHS Board expects the staffing establishment at Monklands hospital to remain at much the same level in each of the next three years.
Will the minister guarantee that there will be no rundown in the number of people who are employed in the accident and emergency department at Monklands, particularly while that department is still having to cope every other weekend with the overspill from the other A and E departments in Lanarkshire? Given his last-minute—though welcome—decision to retain the intensive care and renal units at Monklands, will he explain how that impacts on the effective use of consultants when he is stupidly proposing to close the A and E unit?
Mr Neil has slightly missed the point about the clarification that I provided on renal services and high-dependency care. We have confirmed that the changes that are to be introduced in the next five years will permit continued delivery of dialysis and level 1 high-dependency support at Monklands hospital.
Dental Students
To ask the Scottish Executive how many dental students graduated from Scottish dental schools in each year from 2004 to 2006 but did not take up dental vocational training posts in Scotland. (S2O-10814)
The number of dental students who graduated from Scottish dental schools was 116 in 2004, 109 in 2005 and increased to 133 this year. The number who did not take up vocational training posts in Scotland fell from 25 in 2004 to 14 of the 109 graduates in 2005 and 14 of the 133 graduates this year.
Does the minister agree that the loss to Scotland and to the national health service dentistry services of about 50 dental students is an absolute scandal? Does he agree that the situation resulted directly from the fact that, although we welcome trained students from England into the country, there were simply not enough vocational training posts in Scotland to keep about 50 dental graduates here? Given the acute shortage of NHS dentistry services, is not that an absolute scandal and a sign that the Executive simply maladministered a system that could easily have worked to the benefit of all those who are throughout Scotland languishing on waiting lists for NHS dentistry services?
Mr Ewing, you are now debating the point. I ask the minister to answer.
The scandal is the misinformation from Mr Ewing—the facts are contrary to what he says. The dental action plan made it clear that the number of vocational training places that we would provide would be in excess of the number of students who graduate from Scotland's dental schools. We have done that, so Mr Ewing's information is clearly wrong.
Vale of Leven Hospital (Integrated Care Pilot)
To ask the Scottish Executive why the integrated care pilot at Vale of Leven hospital has ended and what implications this has for the integrated care model in other areas. (S2O-10804)
The integrated care pilot at the Vale of Leven hospital has not ended, but concerns about clinical safety mean that the implementation of the next phase of the pilot, which requires the removal of on-site anaesthetic support, cannot proceed. The clinical safety issues are not about the pilot as it currently operates but about implementing the next phase. The current arrangements will remain in place until alternative service proposals for the area north of the river have been planned properly.
I am afraid that the minister speaks with forked tongue.
You are not allowed to accuse somebody of lying.
He is saying two things at one time.
You are allowed to say that.
The minister is facing in two directions—that would be a surprise—because "cannot proceed" means that it will not go ahead, which is what the health board has said. Why does the minister not just admit that the proposal for an integrated care model at the Vale of Leven hospital was nothing more than a cynical political manoeuvre to derail protests on the street against the closure of the hospital? People have been duped into thinking that the hospital would be kept open using that model, but the intention is to close it.
The member is coming late to this game. I look back at her ministerial correspondence system cases for the Scottish Executive. She has written 26 letters, three of which relate to health: one on stoma; one on national health service dispensary; and one on chronic obstructive pulmonary disease. She has never written to, scratched a pen to or phoned NHS Greater Glasgow and Clyde about the matter. Nonetheless, we find ourselves in the chamber discussing it. What I said clearly was that the integrated care pilot at the Vale of Leven has not ended, because it has not ended. The decision of the team involved was that we could not proceed to the next stage of the integrated care pilot due to very sound clinical risks with regard to the pilot. What I have asked the NHS in Glasgow to do—and what it will do because I have told it to—is to go back and review all current services at the Vale, including anaesthetic cover, to ensure that we have a satisfactory way forward for the community north of the river. That is what we will do.
On a point of order, Presiding Officer. I want to raise a point under the Data Protection Act 1998 about how the minister gets access to the letters that I have written to the health board and under what premise he did that.
That is an interesting question, which I cannot answer now, but I am sure that we will endeavour to find an answer. I cannot quite put my finger on a point of order, but to be honest I was not awfully comfortable with the nature of the response. Any member is entitled to ask any question about any matter within the remit of the Scottish Executive.
I welcome the minister's confirmation that the integrated pilot will remain in its current form and thank him for his letter setting out the next steps. I am sure that he will agree with me that the provision of anaesthetics is key to the future provision of services at the Vale of Leven hospital. Will he therefore make two things abundantly clear to NHS Greater Glasgow and Clyde and, indeed, to Parliament? First, will he make it clear that the starting point for any review of services is that all options must be considered to sustain anaesthetics at the Vale? Secondly, will he make it clear that a north-of-the-river solution will underpin the review, with the majority of health care for my constituents delivered at the Vale of Leven hospital?
There is little I can add to the correspondence with the member. The review will consider sustaining the provision of anaesthetics and NHS Greater Glasgow and Clyde will examine all possible models of delivery. I hope that that satisfies the member's request. As I said in the letter, the Health Department and NHS Greater Glasgow and Clyde agrees that while the work is being undertaken, there will be no changes to the services that are currently provided at the Vale.
Environment and Rural Development
Waste Management (Glasgow)
To ask the Scottish Executive whether it will consider funding the upgrading of waste management facilities in the city of Glasgow. (S2O-10863)
We have provided Glasgow City Council with more than £37 million to improve recycling facilities and we expect a further application from the council shortly to enhance those facilities. In addition, we are considering the strategic outline case from groups of local authorities, one of which includes Glasgow, for residual waste treatment.
I acknowledge the recent generous treatment of Glasgow in respect of new facilities for recycling. It is my understanding that Glasgow and the seven other local authorities in the Clyde valley have submitted an outline business case to the minister's department in respect of three proposed new waste treatment plants in the period up to 2020. Can the minister tell us more about the current status of the evaluation of that outline business case?
We have received the strategic outline cases. They are extremely complex and involve allocations of substantial amounts of public money. The on-going discussions between my department and the local authorities have been designed to ensure that not only do we meet the environmental targets of our policy but we achieve best value. The Glasgow case is currently under consideration, as are others, and I expect to be in a position to make announcements relatively shortly. However, we still have a number of technical issues to resolve.
Crofting Counties Agricultural Grants Scheme
To ask the Scottish Executive what the future is of the crofting counties agricultural grants scheme. (S2O-10869)
The crofting counties agricultural grants scheme came into operation on 1 April and it has state aid clearance that would allow it to continue in operation until 2009. The future of the scheme is under consideration in the context of the rural development programme for Scotland and land management contracts.
Is the minister aware of the anxiety among small crofters and farmers about the possible loss of these ring-fenced grants? Those anxieties, together with the expense of the bull scheme, the uncertainty over payments from the less favoured areas support scheme and the imposition of inappropriate animal welfare transport regulations next year, are putting additional pressure on crofters at a time when they most need our support. Will the minister consider what the Executive can do to relieve their anxieties?
I am well aware of some of the anxieties that Maureen Macmillan describes. I have already met her, and Ross Finnie and I will meet the Scottish Crofting Foundation next week to discuss some of those concerns.
Will the minister acknowledge that one concern that crofters have about the possible change is that they will find that they have to bid for grants, rather than the grants being ring-fenced in the way that Maureen Macmillan mentioned? The experience of many crofters and small farmers in relation to the rural stewardship scheme was that they spent substantial amounts of money on bids that did not come anywhere near the threshold. People are concerned that the crofting counties agricultural grants scheme will go down the same route.
I reiterate that we are well aware of the concerns about the schemes. As I said, we will meet the Scottish Crofting Foundation next week. Jim Wallace and Maureen Macmillan can be assured that we will take the concerns into consideration and we are more than happy to keep in touch with the members who represent the affected constituencies.
Waste Water Treatment Plant (Dalmuir)
To ask the Scottish Executive whether it will consider the introduction of a new legal obligation to remedy long-running odour problems from the waste water treatment plant at Dalmuir experienced by the people of Clydebank. (S2O-10876)
The Sewerage Nuisance (Code of Practice) (Scotland) Order 2006 came into effect on 22 April. It introduced the first statutory code of practice on the assessment and control of odour from waste water treatment works, which applies to all such works in Scotland including the one at Dalmuir.
The people of my constituency have been blighted by a failed public-private partnership project since 1998. The smell is disgusting and the catalogue of incompetence and disorganisation by the PPP company and Scottish Water beggars belief. We need the problem to be sorted out now. Does the minister recognise that the Executive cannot fail to deal with PPP projects? The smell from a PPP project needs to be treated in the same way as a smell that comes from a non-PPP project. Will the minister meet me and perhaps some of my constituents to discuss the way forward?
Yes. As I said, the first code of practice on the matter came into force only in April this year, but it applies to all waste water treatment works including the 21 works that are operated under the private finance initiative, so it applies to the works at Dalmuir as well. I recognise the difficulties that have been experienced by Des McNulty's constituents and I am more than happy to meet them to discuss the matter.
Does the minister share my growing anger and frustration that, despite substantial action, investment and indeed legislative change to tackle sewage odour, there are still no plans or funding in place to provide a lasting solution to odour emissions from the Seafield waste water treatment works? Can she give a firm assurance that the Executive will do all in its power to resolve that unsatisfactory situation so that Edinburgh can be rid of the Seafield stench once and for all?
Yes. I am well aware of the problems associated with Seafield and the continuing work that Susan Deacon undertakes on behalf of her constituents to try to get a resolution to the problem. I am also aware that there is an on-going legal position on Seafield, but let me state that the new code of practice applies to the works operated by private finance initiative. I share Susan Deacon's frustration, and I am more than happy to meet her to consider ways that we can help to speed up the process of dealing with the problem.
Nuclear Power Stations (Leaks)
To ask the Scottish Executive what assessment has been made of the environmental impact of leaks from Scottish nuclear power stations. (S2O-10840)
That is essentially a matter for the Scottish Environment Protection Agency, which works closely with the independent regulator responsible for nuclear safety—HM nuclear installations inspectorate of the Health and Safety Executive.
I thank the minister for his answer, and I am heartened by his reassurances. However, given the effect that Chernobyl had on Scottish agriculture and the particles that are still being found at Dounreay, does he agree that there is a risk to the Scottish environment from any new generation of nuclear power stations?
The usual leap of logic and faith. There are two things that I want to say about that. First, anyone listening to the question and answer should not draw the inference that the current leak reported by the authority was nuclear related. It is important for the public to understand that the authority reported a crack in the pipeworks relating to the conduction of water and steam. It was not nuclear related, and I would not want anyone listening to the exchange to draw that unfortunate inference.
The minister will be aware of the John Large report published this summer, which reported significant uncertainties over the structural integrity and residual strength of the moderator cores in all advanced gas-cooled reactor plants, including Hunterston and Torness. Is he also aware that the nuclear installations inspectorate yesterday reported that most of the graphite bricks in the core of Hunterston are expected to crack in the near future, "jeopardising the safe running" of the station? If so, what action does he intend to take?
Yes, I am aware of the report; Mr Ballance would have been surprised if I had not been. Again, there are two points. First, we have regulation, which is why we are aware of the information. We have inspectorates in place to examine the sites, so we should not try to inflame unnecessary public concern when the regulator is clearly doing its job and drawing the public's attention to the problems that exist. Secondly, it will be for the operator to take action; otherwise it will fall foul of the regulations and will be required to cease operating the plants until they have been repaired. That is what the system is about, and we should not use inflammatory language when a regulator is doing its job properly.
Given that the minister speaks for the Executive, is it not patently obvious that, regardless of the source of the current leak, the best way to minimise the danger of any future leaks from nuclear power stations is not to build any more nuclear power stations?
That would depend on what happened to new nuclear power stations. We are currently dealing with the leaks from existing power stations, and I do not think that even Mr Morgan is suggesting that we should necessarily close them down.
Scottish Environment Protection Agency (Licences)
To ask the Scottish Executive whether it intends to review the fees for licences issued by the Scottish Environment Protection Agency and, if so, when. (S2O-10836)
The Scottish Executive will review any proposal by SEPA to increase its charges by more than the retail price index. A benchmarking report comparing SEPA's charging schemes with those in England and Wales has recently been published. We will study the report carefully to decide whether any action is needed. A major review of the pollution prevention and control charging scheme is also due to begin shortly.
I am interested that comparisons are to be made with England and Wales. The minister might be aware of the issue of the use of road planings from the Berwick bypass. Scottish farmers are being asked to contribute £200 to get a licence to use planings, whereas English farmers in Northumberland do not have to do so. Would the minister agree that the regulation system has almost become an industry in itself and that, if an organisation requires to raise fees to contribute towards its budget, there might be a temptation for it to be overzealous in so doing?
I am aware of that concern. Euan Robson has written previously on the particular issue of planings. He will understand from the letter that he got back that there is potential concern about the unregulated use of road planings as, in some circumstances, they could pose a risk to the environment. I am also aware of concerns that have been expressed about the regulatory framework and charges. We are already comparing the charging scheme here with that of England and Wales, and we are looking to review the system of regulation in Scotland.
I call John Swinney. A question about fees, Mr Swinney.
I cannot imagine what you mean by that, Presiding Officer.
I am enjoining you to be skilful in your supplementary.
You should have no requirement to suggest that.
That is obviously a serious issue for the management of that plant, rather than for SEPA, but I am more than happy to enter into correspondence on the issue if there is a continuing problem with the plant.
Loch Lomond (Byelaws)
To ask the Scottish Executive when it will announce the outcome of the consultation on byelaws for Loch Lomond. (S2O-10854)
The consultation on the byelaws was followed by a 12-week period during which objections could be sent to the Scottish Executive. That period ended in the summer. The Executive has asked the Loch Lomond and the Trossachs National Park Authority to provide additional information on some of the matters that were raised in the objections. That information will help inform my decision on the byelaws. I understand that the park authority expects to provide the additional information by the end of November.
I know that the minister will be considering the submissions carefully. She will, however, be aware of two issues that unite all the campaigners, irrespective of where they stand on the question of the need for byelaws. First, there is a deeply held desire to ban jet-skis. Secondly, there is a need to enforce the existing byelaws, never mind create new ones. Will the minister act on those remarkably united views?
The Executive has asked for information on the proposals for the effective supervision and enforcement of the byelaws, including dealing with the antisocial use of jet-skis. The Executive has asked for information on arrangements to monitor and review the effectiveness of the proposed increase in speed reduction zoning in Milarrochy bay. We have also asked for economic impact work and information on commercial operations on the loch. I am happy to provide Jackie Baillie with a copy of the letter that I sent to the chief executive of the national park authority. We are very much aware of concerns about jet-skis, and we recently met several commercial operators and people living in the national park. I am more than happy to keep Jackie Baillie up to speed with developments. To reiterate, we are seeking additional information from the park authority specifically on jet-skis.
By an incredibly narrow margin, question 7 can be called.
Energy (Security of Supply)
To ask the Scottish Executive what analysis it has undertaken of the impact on the environment if security of energy supply from indigenous sources cannot be guaranteed in the foreseeable future. (S2O-10873)
We have commissioned the Scottish Executive energy study to examine energy supply and demand in Scotland and associated carbon dioxide emissions. Volume 5 of the study will consider how Scotland's energy use could change in the medium term to 2020 and will use projections of demand and supply that are informed by different scenarios that could influence energy use in the future. Volume 5 will be published at the beginning of 2007.
Does the minister agree that it is foolish to believe that we can replace all our power-generating plants with hundreds of windmills? If we tried that, the lights would go out when the wind chose not to blow. Does he agree that our future energy generation must have a nuclear component if we wish to reduce carbon emissions and to have security of supply? Does he agree that although renewables are all well and good, if we are serious about the environment, we must look beyond the green spin to identify carbon reduction policies that include nuclear power as not only a carbon-free solution, but an ideal solution?
My only dispute with Michael McMahon is that to describe renewables as wind power only is wholly to misunderstand the range of renewable sources that is available to us. That range is why the Scottish Executive has invested considerable sums of money in the research centre in Orkney to test wave and tidal power. As Michael McMahon knows, although the wind may cease, the tide—strangely enough—keeps coming in and going out, so it is a much more reliable source of energy that is more attuned to meeting the problem that he raises.