Meeting of the Parliament

Meeting date: Thursday, February 27, 2014

Official Report 843KB pdf

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General Question Time

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Junior Doctors’ Hours

1. To ask the Scottish Government how junior doctors’ hours are regulated. (S4O-02947)

Junior doctors’ working hours are set and controlled by the new deal contract and the working-time regulations, both of which set limits on the number of hours that a doctor can work and ensure that minimum periods of rest and time off are adhered to. The working-time regulations limit hours of work to an average of 48 per week, and all junior doctor rotas in Scotland comply fully with the limits in the regulations.

Under the new deal contract, NHS boards are required to monitor junior doctors’ hours of work twice a year. In that exercise, junior doctors self-monitor by recording the hours that they work and the rest breaks that they achieve over a minimum period of two weeks. That information is then analysed by NHS boards to assess their compliance with the new deal contract and the working-time regulations. The results from the monitoring are reported to the Scottish Government’s medical workforce adviser and to the junior doctors involved.

I thank the cabinet secretary for his answer, but the practice in workplaces is often very different from the theory. I know that there are concerns about the culture in which junior doctors work, and those are currently being discussed with the British Medical Association and others.

Does the cabinet secretary have a view on what can be done to ensure that what is documented is actually happening on the ground?

I met last month—at my request—with the BMA’s junior doctors committee in Scotland, and we have agreed to work together on the issue. I want to be completely assured that we are meeting not only the spirit of the working-time regulations and the new deal contract, but the letter of the law. I want us to look at ways in which we can ensure that junior doctors are not overburdened as a result of the total hours that they work or the rota system in which they work.

I will discuss the matter further when I meet the BMA next week, and we will look at any additional action that needs to be taken to ensure that we meet the requirements of the regulations and the contract.

I thank the cabinet secretary for his fairly full answers and evident concern on the matter. I share the concerns of Ian Ritchie, the president of the Royal College of Surgeons of Edinburgh, who recently announced publicly that while the letter of the law on rotas is being fulfilled, the spirit is not.

In addition, the correspondence that I have received demonstrates that the diaries to which the cabinet secretary referred, which are part of the self-monitoring procedure, are often being filled in incorrectly, as junior doctors are being strongly urged not to include hours beyond the hours that they should serve.

Too many junior doctors are still having to work for 100 consecutive hours over a brief period before driving home very late at night, which resulted in the recent death of Dr Connelly, which was a distressing event for her family.

Has not the time come for an independent review of how the rotas are handled internally by health boards to ensure that, as the cabinet secretary said, the spirit as well as the letter of the law is followed?

There has certainly been no demand for an internal review. It is important to act as quickly as possible on any issues that need to be addressed, and I am addressing jointly with the BMA junior doctors committee the issue of recording hours to which Dr Simpson referred. We will work out the way forward together, and I will take whatever appropriate action I need to take to ensure that we are not putting an unfair or undue burden on junior doctors, not only with regard to the regulations and the contract but in terms of ensuring that the rules are being followed in spirit and are not being bypassed in any way that could threaten the livelihoods or indeed the lives of junior doctors.

Before I call question 2, I remind members that I would appreciate succinct questions and answers. In that way, we will make progress through the list.

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New Psychoactive Substances

2. To ask the Scottish Government what it is doing to tackle the supply and use of new psychoactive substances. (S4O-02948)

The member will be aware of course that our actions are restricted by the fact that new psychoactive substances are not classified under the Misuse of Drugs Act 1971. We had our first Scottish Parliament debate on new psychoactive substances on 6 February 2014, during which I summarised the work that has been done to date and announced my plans to work with partners in Scotland and at the United Kingdom level to combat the supply and use of new psychoactive substances, including plans for a summit in the near future.

In 2013, I made new psychoactive substances a priority for Scotland’s alcohol and drug partnerships. Mr Scott will be interested to hear about the proactive approach to addressing new psychoactive substances in his constituency that has been undertaken by NHS Ayrshire and Arran and associated ADPs. It includes the establishment of a pan-Ayrshire drug trend monitoring group; work to determine the prevalence of new psychoactive substance use locally; and training to raise awareness for staff, service users and people at risk.

The minister will know that a recent freedom of information request revealed that NHS Ayrshire and Arran had the highest number of accident and emergency admissions due to new psychoactive substances, although only six out of the 14 health boards were able to provide figures. What is the Scottish Government doing to address the issue, specifically in light of the particular health risks from new psychoactive substances? Will the Government take steps to ensure that all health boards are recording information on hospital admissions and treatment due to new psychoactive substance use in order to better inform efforts to reduce the use of those harmful substances?

Hospitals in Scotland record information using the international classification of disease codes, but unlike for other substances there is no specific international code for new psychoactive substances. That means that there is no agreed central recording system, so figures produced by NHS boards locally are not sufficiently robust to be comparable by year and by NHS board. The codes are used internationally, so there is a similar difficulty worldwide of hospital recording of new psychoactive substance use. The World Health Organization is consulting on a revised version of the coding system, but that is not due until 2017. However, we will continue to work with partners locally and nationally, including in the national health service, to look at how data can be better collected in drug services and in hospitals to help us understand the full extent of new psychoactive substance use and the health impacts, and how, collectively, services in Scotland can best respond.

Is the minister aware of a recent case involving new psychoactive substances in Belfast in which a judge ruled that under the General Product Safety Regulations 2005 so-called legal-high products seized from a shop could be destroyed on the ground of inadequate labelling and safety information? Will the Scottish Government consider whether similar use of those regulations might be made here in Scotland to help reduce ready access to new psychoactive substances?

I am aware of the recent case in Belfast. I can advise the member that I have already asked my officials to look at it very closely indeed. I would be astonished if Police Scotland was not looking at the case and considering whether it pointed to a potential way forward in Scotland. I hope that we can discuss the issue at the summit to which I referred in my response to John Scott.

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Care Home Inspections (Standards)

3. To ask the Scottish Government what measures it is taking to ensure the highest standards of inspections in care homes. (S4O-02949)

The Government is absolutely committed to ensuring the highest possible standards of care and has strengthened the inspection regime to allow the Care Inspectorate to direct its resources where they are most needed. As part of that new regime we require the Care Inspectorate to inspect every care home in Scotland on an unannounced basis at least once a year. Additional inspections are carried out on services that are at the greatest risk, and that means that high-risk services are inspected several times during the year to ensure that improvements are being made. We have tasked the Care Inspectorate and Healthcare Improvement Scotland with developing a new inspection model that focuses on improving outcomes for people who receive care.

The cabinet secretary may be aware of the case of Jimmy Gallacher, who died in hospital in Kirkcaldy in September a week after his care home was given a six-star rating. Hospital staff identified failings in his care, including severe bedsores, lack of nutrition and dehydration. It was an extremely distressing situation for his family, who believed that he was being well looked after in the care home because the inspection reports suggested that he was. However, the Care Inspectorate subsequently upheld nine complaints against the care home and downgraded its rating to “weak”.

I acknowledge the proposed changes that the cabinet secretary has outlined, but does he agree that there are serious failings in the system when a care home is given top marks by the inspectorate, only for an elderly resident to die days later in hospital, with dehydration and signs of neglect being contributory factors? Does he agree that we now need to move towards having an independent inspection regime in which residents, their families and staff in the sector can have confidence?

Obviously, I cannot comment on individual cases.

I point out that the Care Inspectorate is entirely independent of Government. The Care Inspectorate reviews cases in which something appears to have gone wrong, but I would be cautious and careful about saying that something going wrong in one particular case is a prima facie indication of systemic failure across the entire care inspection regime. I do not think that that is necessarily the case.

The Care Inspectorate is looking at that case and at a number of other cases to ensure that its inspection regime is as robust as it needs to be—and should be—and is in line with the overall policy that I outlined in my first reply.

Question 4 in the name of Duncan McNeil has been withdrawn. The member has provided an explanation.

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NHS Ayrshire and Arran (Meetings)

5. To ask the Scottish Government when it last met NHS Ayrshire and Arran and what matters were discussed. (S4O-02951)

Ministers and officials regularly meet representatives of NHS Ayrshire and Arran to discuss matters of importance to local people.

In relation to delayed discharges in Ayrshire and Arran, which are significantly under the Scottish average, can the cabinet secretary assure me that everything is being done to improve the position, particularly in assessing whether admissions are necessary and, of course, ensuring that discharge plans are put in place as early as possible and that such arrangements coincide with planned discharge dates?

Health boards and local authorities must work together to ensure that the discharge planning process is started as early as possible in the patient’s journey. That will ensure that any carer support that is needed on discharge is put in place for the discharge date.

Partnerships across Scotland are making good progress in developing intermediate care services, and such step-up, step-down services are helping to reduce unnecessary admissions to hospital as well as ensuring timely discharges. Although many of those services are at the early development stage, positive results are already being seen, including—as I am sure you will be glad to learn, Presiding Officer—in Fife.

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Slipper Farming (Abolition)

6. To ask the Scottish Government what progress it has made on abolishing so-called slipper farming. (S4O-02952)

Tackling what is called slipper farming was one of our top priorities in negotiating the new common agricultural policy. I was pleased to meet Commissioner Ciolos recently to discuss the issue further, and he indicated that one of our proposed options for implementing the rules would comply with the European regulation and World Trade Organization rules. We are now proceeding on that basis.

What that means is that in order to meet the minimum activity requirement farmers will have to either graze domestic livestock or carry out annual management activities on land. That is in contrast to the current CAP rules, which do not include any active management requirements. I hope that the measure will go a long way towards tackling a very unacceptable practice.

Slipper farmers often buy subsidy entitlement through brokers from estates with naked acres. Is the cabinet secretary able to reveal how many millions of pounds of public money are made by all parties in a legal but despicable trade that has caused a loss in active farm support for new entrants, crofters and family farms across Scotland?

Given the current regulatory quagmire of the common agricultural policy with regard to the matter, it is always difficult to work out exact figures. However, in his report of a few years ago, Brian Pack estimated that up to €30 million of farm payments was going to slipper farmers each and every year. That equates to around 4 per cent of the budget and roughly 4.4 per cent of the claimed area.

As I have already indicated, there will be more restrictions in place under the new CAP, including on the trading of entitlements across payment regions. That should cut down on the use of the practice and help us as a Government ensure that farming support is directed at genuine farming activity.

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Bus Service Operators (Discussions)

7. To ask the Scottish Government what recent discussions it has had with bus service operators. (S4O-02953)

My officials, ministerial colleagues and I frequently meet bus service operators and their representatives to discuss a range of issues.

In a recent letter to the local MP, Glasgow Citybus cites the continued erosion of reimbursement levels in the national concessionary fare scheme as being a major contributing factor to its decision to withdraw three services in West Dunbartonshire. Can the minister tell me how many bus services have been withdrawn across Scotland since the concessionary fare reimbursement rate was reduced?

As the member will know, the removal of services is the responsibility of the traffic commissioner, but I can say that there were 423 million journeys by bus in 2012, which equates to around 80 per cent of all public transport journeys.

In relation to the reimbursement rate, the alternative was to keep it at the previous rate. We considered the evidence for that, and came to an agreement with the industry on the new reimbursement rate. From what the member has said, I assume that he wants to keep the old rate. If that is the case, perhaps we should have seen that in Labour’s budget proposals, but we did not.

We have taken an evidence-based approach that gives operators a proper rate of return, based on evidence, and they have accepted that. That is the right way to do this.

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River Dredging (Powers)

8. To ask the Scottish Government what powers it has to ensure the dredging of rivers where it is appropriate. (S4O-02954)

The Scottish Government has empowered the Scottish Environment Protection Agency to regulate dredging under the Water Environment (Controlled Activities) (Scotland) Regulations 2011. Local authorities and other land managers can apply to SEPA for a licence to dredge where dredging is clearly the best way to solve a problem such as flood risk, in accordance with guidelines that were updated in July 2013.

However, dredging is not always effective in reducing flood water levels and can cause other problems such as increased erosion and higher flood risk downstream. SEPA assesses licence applications for dredging on a case-by-case basis, and encourages applications to be part of sustainable, long-term catchment solutions to sediment management issues.

Low-risk activities, such as debris and vegetation removal, do not normally require an authorisation from SEPA.

I realise that the issue is complex and controversial, but the build-up of silt at the Water of Leith basin has been a matter of concern to local residents for some time. Would it be possible for an official from SEPA to meet the friends of the Water of Leith basin, which is a Leith group with a large membership, in order to discuss the problem and advise on what action, if any, may be appropriate?

I am happy to agree to arrange a meeting between SEPA officials and Mr Chisholm’s constituents to discuss those matters.

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Scottish Housing Regulator (Discussions)

9. To ask the Scottish Government what recent discussions it has had with the Scottish Housing Regulator. (S4O-02955)

I last met Kay Blair, the chairperson of the board, on 3 December 2013. We discussed a number of topics related to the regulator’s work.

Is the minister aware that the regulator is imposing a staff code of conduct over the heads of local housing associations? Does she share my concern that the regulator is operating outwith its remit? Will she agree to meet me and staff representatives to discuss their concerns?

As the member knows, the regulator is independent of Government and is answerable to the Scottish Parliament. I suggest that any specific concerns that the member has should be taken up in the first instance with the chairperson of the regulator’s board. If, after that, he is still unsatisfied, he should raise the matter with the Parliament’s Infrastructure and Capital Investment Committee, because the regulator is independent of Government.

As the minister obviously knows, and as James Kelly should know, the Housing (Scotland) Bill, which the Infrastructure and Capital Investment Committee is scrutinising, contains proposals relating to the Scottish Housing Regulator. Does the minister agree that we should wait until all the evidence is taken before any judgment is made?

I acknowledge that there are issues around the Housing (Scotland) Bill. However, I reiterate that, rightly, the regulator is independent of Government and is accountable to Parliament. That is the way that it should be, because we all know that good governance in housing associations is extremely important.

I say again that anyone who has concerns can raise them with the regulator or, through the Infrastructure and Capital Investment Committee, with the Parliament.