Meeting of the Parliament

Meeting date: Thursday, May 27, 2010

Official Report 966KB pdf

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Scottish Executive Question Time

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Health and Wellbeing

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Duchenne Muscular Dystrophy

1. To ask the Scottish Executive what progress has been made over the last year in the research, treatment and support of young people with Duchenne muscular dystrophy. (S3O-10716)

We welcome the priority that the Scottish muscle network has given during the past year to the development of care standards for the management of Duchenne, which are based on European standards.

The network has also developed a multidisciplinary care pathway for the management of Duchenne from the point of diagnosis onwards. That will incorporate the pathway that is being developed for the transition from child to adult services, which has an initial focus on Duchenne. A new transition clinic has been set up in Glasgow, along with young adult neuromuscular conditions clinics in Aberdeen and Dundee.

The network has also produced an information leaflet on Duchenne. One of the network’s main aims is to promote families’ participation in large-scale clinical trials in the United Kingdom and internationally.

Are measures under consideration that would further improve the practical situation of Duchenne sufferers and their families, for example the removal of bureaucratic obstacles to wheelchair access or improved co-ordination and consultation between support services, parents and decision makers in relation to school attendance and in-school support?

In addition to the information that I provided, I can tell Christopher Harvie that in children’s services the getting it right for every child approach puts the child at the centre. The Scottish muscle network wants to explore the role of a key worker in managing the complex care needs of boys and young men who have Duchenne and will discuss the approach with the people who are responsible for the development of GIRFEC.

The wheelchair assessment process now includes school and other educational settings, which makes it easier to introduce powered wheelchairs for the people who need them. We are revising our guidance to education authorities on accessibility, which will provide practical examples of how schools can improve provision for disabled children in all aspects of school life.

I welcome the minister’s response. It is important for people who have Duchenne to get as much exercise as possible, and an ideal and enjoyable way of getting exercise is through hydrotherapy. There does not seem to be provision for hydrotherapy in Lanarkshire. Are there plans to ensure that everyone in Scotland who has Duchenne can get access to hydrotherapy?

I am very much aware of the benefits of hydrotherapy and I am aware that in many locations access to hydrotherapy services has been arranged. I want to consider the specifics of the situation in Lanarkshire and I will write to the member with more detail.

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Medical Equipment Failure

2. To ask the Scottish Executive what action has been taken to reduce the failure rate of national health service medical equipment. (S3O-10685)

My officials work with NHS boards, through Health Facilities Scotland, to ensure that all adverse incidents that result from equipment failure are investigated appropriately, that the cause of the incident is identified, and that lessons that are learned are shared with the wider NHS.

We have given £90 million to boards since 2008, on top of their general allocations, for investment in new equipment.

It will come as no surprise to the cabinet secretary that my question was prompted by an investigation that was undertaken by the Sunday Post, the results of which were published some 10 days ago. The Sunday Post found that there were 1,131 recorded cases of medical equipment failure in Scottish hospitals in 2008 and that the number had increased to 1,156 cases in 2009, despite additional funding being made available by the Scottish Government, as the cabinet secretary said.

Audit Scotland said in its 2009 report, “Asset management in the NHS in Scotland”:

“Five NHS bodies did not know the condition of their medical equipment.”

Is the Scottish Government satisfied that enough is being done to ensure that patient safety is not compromised by equipment failure?

I am certainly grateful to David McLetchie for raising such an important issue, on which the Sunday Post is to be commended for its investigation. However, it is important to point out that, of the 1,000 or more cases of equipment failure that the Sunday Post identified, only 118 resulted in adverse incidents. That is 118 incidents too many, but it is important to give that context.

As David McLetchie said, Audit Scotland produced the report “Asset management in the NHS in Scotland”, which recommended that the Government should

“provide policies and guidance for all types of assets and update its current policies and guidance to reflect changes in the NHS”.

As a result of that, our asset management policy was revised to ensure that it specifically addresses the management of medical equipment.

NHS boards are also supported by Health Facilities Scotland’s incident reporting and investigation centre, which works closely with the Medicines and Healthcare products Regulatory Agency—the United Kingdom regulatory body—on the medical device alerts system. In addition, last year we issued to the NHS and local authorities guidance that, among other things, requires NHS boards and local authorities to appoint equipment co-ordinators, who are responsible for ensuring that all staff know about the process for reporting adverse incidents, monitoring adverse incidents within their own organisations, and distributing medical device alerts that are received from the IRIC and ensuring that they are acted on.

I take the issue of medical equipment failure very seriously indeed. I hope that David McLetchie is assured that we are taking action, but we will of course continue to monitor matters to ensure that we are doing everything possible.

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Huntington’s Disease

3. To ask the Scottish Executive how it is supporting people with Huntington’s disease. (S3O-10709)

Services for people with Huntington’s disease are primarily the responsibility of national health service boards. The clinical standards on neurological services produced by NHS Quality Improvement Scotland cover Huntington’s disease. The Scottish Government encourages and supports boards to use those standards to improve further the quality of services for everyone with Huntington’s disease.

We also welcome the valuable work of the Scottish Huntington’s Association for people living with the condition and for their families and carers. In recognition of its role, we provide the organisation with funding to help to underpin its core work. We also assist specific projects, such as the current development of an application for mobile phones.

I am glad that the minister recognises the good work that is undertaken by the Scottish Huntington’s Association. As she is probably aware, the organisation undertook an intensive consultation before publishing “‘Roon the Kitchen Table’—Outcome of the Consultation with Families Living with Huntington’s Disease in Scotland”. Indeed, I have a fantastic constituent who participated in the compilation of that report. How will the Scottish Government take forward the issues that the Scottish Huntington’s Association identified, namely the need for more specialist nurses and specialist respite and long-term care placements?

I, too, commend the work that was undertaken in the consultation with families. As the member recognises, the consultation report raises a number of important issues, which we will take forward in discussion. I am happy to write to the member with some detail on that as we take those matters forward.

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Hospital Consultant Bonus Scheme

4. To ask the Scottish Government, in view of the hospital consultant bonus scheme now costing over a quarter of a billion pounds of United Kingdom national health service expenditure per year and millions in pension consequentials, whether it will consider a further approach to the Secretary of State for Health with the aim of securing co-ordinated action to curb this expenditure. (S3O-10723)

I have made my position very clear on that issue. As members are aware, I have previously approached other UK health departments to seek their support on conducting a UK-wide review of current arrangements. Responses were mixed, but I intend to pursue the issue again with the new UK Government.

I agree that it is preferable for the four countries of the United Kingdom to co-ordinate action on the matter. However, does the cabinet secretary agree that Scottish public opinion is that the present situation of extra payments to hospital consultants is completely unsatisfactory? Will she agree not only to maintain the cap on the amount of money set aside for such payments in future years but to consider altering the regulations so that in future such bonuses are not pensionable?

I am happy to consider all suggestions on the issue. As Ian McKee knows, we took the decision this year to freeze both the level and the number of distinction awards. I will certainly consider whether similar action is appropriate next year in the light of the circumstances that prevail at the time.

However, I am also of the view—this is no secret to anybody—that much more fundamental reform of the system is needed. It is right that people in the NHS who work hard and contribute above and beyond their contractual obligations are rewarded for that, but we operate these days in a multidisciplinary national health service and, if that system is to apply, it should do so fairly and cost effectively.

As I said in my original answer, I asked other UK health departments to consider joining us in a review. Labour’s former health minister at Westminster said that he was happy with the current system and Wales supported the idea of a review, but I intend to raise the matter again with Andrew Lansley, the new Secretary of State for Health. I have already mentioned it to him informally and I intend to follow that up formally. I hope that we can get UK-wide agreement to review the system, which would be in the interests not just of Scotland but of the operation of the health service throughout the UK.

Although the cabinet secretary may indeed want to proceed on a UK basis, will she confirm that she can, in fact, do it alone? Will she also confirm that she recently signed off a review of the very scheme that we are discussing? She appears to be suggesting that we are going to have another one. Does she further agree that spending £30 million on consultant bonuses in a year is the wrong priority when we spend only £20 million on tackling hospital-acquired infections?

The HAI budget is considerably higher under this Government than it was under the previous Government, which is perhaps one of the reasons why rates of infection are now coming down in our hospitals. The position is not good enough, but there has been progress.

I did indeed sign off the review that Jackie Baillie mentioned, but that review was instigated by my predecessor, Andy Kerr. One of the problems with that review is that the remit explicitly ruled out fundamental reform of the system. If she has an issue with that, I suggest that she takes it up with him.

I also suggest that Jackie Baillie listens more carefully to what I say. I have never denied that we have the power to do what we choose to do on the matter, but I believe that, if we are to maintain a competitive position for our NHS within the UK and to be able to attract consultants, it is far preferable to have a system that operates throughout the UK.

I find it rather ironic, if not a touch hypocritical, that Jackie Baillie criticises me for our not having made more progress along the road of the review, given that it was a former Labour health minister in the Department of Health in England who blocked it. If Jackie Baillie now wants to join the consensus, I look forward to her arguing with her colleagues here and elsewhere that that is the right thing to do.

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Diabetes Action Plan

5. To ask the Scottish Executive when it will publish the Scottish diabetes action plan. (S3O-10674) [Interruption.]

Can we have one question at a time, please? We leave a question behind when we move to the next one.

We expect that the revised action plan will be published in the next few weeks. It will set out actions that will help to fulfil our ambition to provide world-class diabetes services in Scotland. The process of revising the 2006 diabetes action plan took longer than expected because of the efforts that were made to gather the views of people with diabetes.

Can the minister confirm whether the Scottish diabetes action plan will contain specific targets for each national health service board to increase insulin pump availability over the next three years? In particular, will there be increased access for children and young people? What plans does the minister have to apply the National Institute for Health and Clinical Excellence criteria to ensure that those who are considered to be eligible for an insulin pump have access to one?

Finally, can the minister advise me what systems and checks are in place to ensure that NHS boards are trying to achieve their targets for increased access to insulin pumps and get above the poor rates that boards such as NHS Highland and NHS Ayrshire and Arran have at present?

I am sure that the member will wait for the publication of the action plan and we will then be able to furnish him with the detail. As he knows, the availability of insulin pumps is a long-term problem.

We have taken action to address the situation. I wrote to NHS board chairs to remind them of their responsibility, through their diabetes managed clinical network, to develop a local insulin strategy, including for the use of pumps, in line with the latest clinical guidance to which the member referred. That was followed up by a request that each board provide details of its planned expenditure over the next three to five years on intensive insulin therapy and the structured education associated with it. Boards have now done that. An agreed table containing the information will be published in the revised diabetes action plan.

I hope that that gives the member a sense that we are making progress, that what has been a long-term issue is being addressed and that boards are working very hard indeed to ensure that they increase access to and the availability of intensive insulin therapy.

I ask the minister to ensure that optometrists throughout Scotland will all be given the opportunity to monitor regularly the eyesight of patients with diabetes, to reduce travel times to hospitals and enhance partnerships within the NHS.

Mary Scanlon raises a very important point. We have come a long way with the work that optometrists and ophthalmologists do around not just diabetes but a range of other conditions. Any steps that both help to pick up and diagnose issues and move as much work as possible out of hospitals into the wider primary care community are of course to be welcomed. Discussions are continuing about how much more progress can be made to build on the already good progress that I am sure that Mary Scanlon and others in the chamber would recognise.

Question 6 was not lodged.

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Budget Reductions (Workforce)

7. To ask the Scottish Government what assurances it can give to workers in the national health service in the wake of projected reductions to the Scottish budget. (S3O-10711)

Staff are at the heart of our national health service. Their contribution is crucial. I have made it clear to NHS boards that protecting the quality of front-line services and valuing those who work in the NHS are our priorities. I have given, and I am happy to repeat today, three important guarantees. First, the quality of care will be the guiding principle behind any service redesign. As I scrutinise NHS boards’ plans, I will seek to ensure that they, and the service changes that underpin them, protect the quality of care. Secondly, no one in the NHS will lose their job. The NHS has a policy of no compulsory redundancies and that will remain the case. Thirdly, there will be more people working in the NHS in Scotland at the end of this session of Parliament than there were at the start.

I particularly welcome the principle and guarantee of no compulsory redundancies, which I believe does not exist south of the border. How many more redundancies, voluntary redundancies or cutbacks would there have to be if this Government accepted Scottish Labour’s plans to cut a further £332 million from this year’s budget? I am very worried about the damage that that could inflict on the NHS and other front-line services.

Bob Doris will know that this Government has taken the decision not to impose the cuts announced by the chancellor earlier this week in this financial year. That was as a result of George Osborne’s offer. The reason for our decision, as the First Minister said at First Minister’s questions, is twofold. First, it is important in this financial year, when budgets have been set, not to force local authorities, NHS boards or any other organisation to rip up those budgets, because that would cause significant instability for those who work in and use those services. Secondly, it is really important that we support economic recovery at this time of fragile recovery. To take money out of public spending within this financial year would put that at risk. For those reasons, I think that we were right to take that decision. Unfortunately, from reading and hearing some of the conflicting comments made by those in the Labour Party, it seems that they cannot quite decide which side of that debate they are on.

Is it not the case that not one penny would require to be taken from the NHS budget? Far be it from me to defend the Conservatives, but none of the £6 billion of cuts was taken from the NHS.

I will say a bit about our commitment to the NHS. It is important that people hear this. We have ensured that there are real-terms increases in NHS budgets this year. We have given a very clear commitment to continue to protect NHS budgets as far as we can.







Let us also consider the reality, however. The economic mess that was created by the previous United Kingdom Labour Government means that budgets will be tight not just this year but for some time to come. Frankly, Labour’s desperate attempts to dodge responsibility for that simply will not wash with anyone in Scotland.

It is important that NHS boards look to deliver services as efficiently as they possibly can, that they redesign services and that they ensure the greatest possible productivity so that they can continue to deliver quality and ensure that Labour’s economic and financial incompetence does not impact on patient care in Scotland.

Will the cabinet secretary join me in congratulating the Conservative-Liberal Democrat Government in Westminster on scrapping Labour’s jobs tax and, therefore, saving the NHS in Scotland £20 million each year, which will help to protect jobs and front-line services?

I will certainly congratulate Murdo Fraser on his promotion to the position of his party’s health spokesman. I look forward to working with him in the same consensual and collegiate manner in which I work with all the other party health spokespeople in this chamber.

In the interests of consensus, I should say that it is important to recognise that the national insurance increase that was planned by Labour would have put an additional burden of £40 million on the NHS next year, at a time when budgets are already tight. I agree that it is good news that that burden has been removed, but I will wait a bit longer to see what the Conservative and Liberal Democrat coalition has in store for Scotland before I go much further than that in my congratulations.

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European Working Time Directive

8. To ask the Scottish Executive what advice has been given to national health service boards regarding potential staffing problems caused by the European working time directive and the shortages of locum cover. (S3O-10704)

NHS boards have had a considerable amount of guidance and support in implementing the working time regulations. On locum cover, a short life working group, comprising representatives of the Scottish Government, the British Medical Association and NHS Scotland employers, is working to identify solutions for managing the demand for temporary medical staff. The group is due to issue guidance to NHS boards setting out key issues and solutions in July 2010.

I am sure that the cabinet secretary is aware of the situation in Fife, which brought about the temporary overnight closure of the accident and emergency unit at the Victoria hospital in Kirkcaldy, with patients being transferred to the Queen Margaret hospital in Dunfermline.

According to a request earlier this year under the Freedom of Information (Scotland) Act 2002, there were, at that time, more than 140 junior doctor vacancies across Scotland, with 24.5 junior doctor vacancies in NHS Fife alone, six of those being in emergency medicine. Given that situation and the impact of the impending financial savings that must be made by health boards and which will result in a reduction in their workforces, what action will the minister take to ensure that vital NHS services are protected?

As the member will be aware, NHS Fife implemented its contingency plans in the interests of patient safety, and I am sure that no one in this chamber would argue that it should have done anything other than that. The situation in Kirkcaldy arose because of the unexpected absence of a number of junior doctors and the difficulty in securing locum cover. It was not a finance-driven move; in fact, the board incurred additional costs during that period. It is also not about cutting staff. The board has appointed two new A and E consultants in recent months.

I am pleased to say that the situation has reverted to normal and that the A and E unit in Kirkcaldy is operating as normal. Of course, it is right that NHS Fife should continue to hold those contingency plans, in case a similar situation arises in future.

On the broader issue, the final stages of implementing the working time regulations have come at a time when the NHS is experiencing some shortages of training-grade medical staff in some specialties. That situation has arisen for a variety of reasons, including changes to the immigration rules. Those shortages are not caused by the working time regulations, they are coincidental with them.

There has been an expansion in the medical workforce in recent years. That has meant that the overall demand has marginally outstripped the supply of doctors who are available to fill posts, which has resulted in a shortage in some areas. However, the supply of junior doctors is continuing to grow and current shortages of staff for locum posts are likely to reverse in the near future.

The Scottish Government, in partnership with boards, has been taking a number of short-term actions to support boards in mitigating the immediate impacts of medical staffing difficulties. However, as members are aware, the longer-term solutions lie in the expansion of the number of trained doctors to reduce the reliance on trainees for service delivery.

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Oesophageal Cancer

9. To ask the Scottish Executive what discussions it is having with medical professionals and patient groups to improve early detection rates of oesophageal cancer. (S3O-10640)

Through the Scottish cancer task force, the Scottish Government is working to improve awareness of possible symptoms of all cancers among the public and medical staff. That activity includes working with the voluntary sector to identify effective approaches to developing health promotion opportunities.

Awareness of oesophageal cancer is raised among medical professionals through a number of different routes at national, regional and local levels, including through the dissemination of relevant clinical guidelines. Work is under way to support wider sharing of general practitioner data and best practice on cancer diagnosis, as that will contribute to more effective and efficient primary care pathways, increasing the possibility for earlier detection and, ultimately, improving outcomes for people who have cancer.

The cabinet secretary will be aware that we have both met representatives of Ochre, the oesophageal cancer charity. Ochre recently informed me that Professor Sir Mike Richards, the national cancer director for the Department of Health, has written to it and a number of other main stakeholders involved in upper gastrointestinal cancer symptom awareness with the aim of creating a forum to guide future work. That will result in patients in England being able to benefit from an increased awareness of symptoms among medics and clinicians.

Will the cabinet secretary inform members in the chamber whether her officials have given thought to establishing a similar forum in Scotland? That could offer similar benefits to Scottish patients alongside all the work that the Government is taking forward.

I acknowledge Bill Butler’s on-going interest in the issue. As he mentioned, I met Ochre last year, and I am grateful to him for facilitating that meeting. He makes a useful suggestion. I am not aware of any interaction between Sir Mike Richards and my officials, but I will certainly investigate whether there has been any. If there has not, I am happy to consider the possibility of encouraging the creation of a similar forum in Scotland.

We should do anything that we can to raise awareness of the causes and symptoms of cancer—whether upper GI cancers or any other cancers—and to encourage the earliest possible detection and diagnosis. I am happy to keep Bill Butler informed of any progress that we make in that regard.

The cabinet secretary will be aware that although the incidence of stomach cancer is decreasing, the incidence of oesophageal cancer is on the increase, with the incidence of tumours at the junction of the stomach and the oesophagus increasing particularly rapidly.

What action is the Scottish Government taking to develop new and emerging technologies and techniques such as intensity-modulated radiotherapy? I understand that that technique is not yet in clinical use anywhere in Scotland and that only a few places are implementing it in England. What plans does the Government have to develop such radiotherapy services for the future in Scotland?

I thank Nanette Milne for her question and welcome her to her post. She is right to mention the increasing incidence of oesophageal cancer. The latest figures I have before me show that for men, the incidence is continuing to rise. Better news suggests that between 1997 and 2007, the incidence among women was falling, which is encouraging. While not underplaying the seriousness of the issue, I say that it is also encouraging that mortality rates for men and women are beginning to fall. We must ensure that that progress continues.

Nanette Milne will be aware that we invest heavily in the most up-to-date and state-of-the-art forms of radiotherapy equipment. I am happy to write to her to set out the details of our recent planned investment in that area. She may be interested to know that the chief scientist office is currently funding two projects in the area of oesophageal cancer. As in all such areas, the chief scientist office always welcomes further research proposals, because the more we know about how to prevent and treat diseases like this, the more progress we will make in cutting the numbers of people who get such diseases and die from them.

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NHS Lothian (Meetings)

10. To ask the Scottish Executive when it last met senior management of NHS Lothian and what issues were discussed. (S3O-10639)

I met the chair of NHS Lothian on 24 May—Monday this week—at the most recent regular meeting of national health service board chairs. We discussed a wide range of matters that are affecting the delivery of patient services.

Officials from the Scottish Government health directorates meet representatives of NHS Lothian regularly to discuss matters of current interest that are affecting health services in the area.

In her recent meetings with NHS Lothian, how did the cabinet secretary justify requiring the health board to make staff cuts of more than 700 this year and nearly double that figure next year? Can she tell the chamber which hospitals and clinics the 333 nursing posts will disappear from? If she is so convinced that she can cut hundreds of nursing jobs in the NHS and the Lothians without affecting patient care, will she offer to resign if front-line services for my constituents get worse as a result of her cuts?

Unlike members of the previous Government, I have never shirked from saying that, in all NHS matters, the buck stops with me. It is important that ministers face up to that responsibility. Right now, part of that responsibility involves dealing with the impact of the economic and financial mess that Labour has made of this country. Labour members might not like to be reminded of that, but I am afraid that it is a sad fact of reality.

It is incredibly important that, as we face up to the situation, NHS boards look at how they can deliver services efficiently and cost-effectively; how they can take advantage of service redesign, new technology and, for example, the increase in day-case rates; how they can ensure better productivity of staff and reduce sickness absence; and how they can take advantage of the lean technology that boards such as NHS Lothian are using to great effect. It is right for boards to carry out that work and, frankly, I think that it ill behoves any member to scaremonger in the way that Rhona Brankin has just done.

I have said and will continue to say that, as the NHS faces up to these extremely difficult times, quality of care is of the utmost importance and will be our guiding principle. I hope that all members accept that and will back us as we seek to steer the NHS through difficult times, but in a way that safeguards for patients the quality of front-line services.

When I last raised the issue of NHS Lothian not getting the share of health money to which it is entitled, the cabinet secretary said that she recognised the problem and was taking action. However, how can such action be effective when each year the gap between what Lothian gets and what it is entitled to gets bigger rather than smaller? Surely, given the big challenges that the cabinet secretary rightly emphasised in her previous answer, it is more critical than ever that boards get their full entitlement as quickly as possible. Will the cabinet secretary start to narrow the gap for Lothian instead of seeing it increase year by year?

Malcolm Chisholm knows that I have huge respect for him and it is right that as an MSP from Edinburgh he comes to the chamber and raises these very important issues. I have to say that I believe that I have been very frank in recognising the position that NHS Lothian is in.

That said, I gently remind Mr Chisholm that the issue of some health boards in Scotland receiving less than their parity share has not just arisen under this Government; it was also an issue under the previous allocation formula and when he was Minister for Health and Community Care. Like him and my predecessor Andy Kerr, I am trying to close that gap and take boards that are below parity up to parity; I note, for example, that this year NHS Lothian received a higher increase than other boards to help it along the path. However, we have to do that gradually because any other approach would involve taking money away from other health boards. If members are asking me to do that, I really think that they should also tell me which health boards I should take the money from.

I think that that is the right way to go. In times of tight finances, it will take us longer to do it than it would have done when finances were not tight. Nevertheless, we will continue to make as much progress as possible and I will ensure that members who have an understandable and justifiable interest in the issue are kept fully informed of that progress.

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Coeliac Disease

11. To ask the Scottish Government whether it will review policies and procedures to ensure that people with coeliac disease have appropriate and consistent access to gluten-free products on prescription. (S3O-10727)

The Scottish Government is committed to ensuring that people living with long-term conditions such as coeliac disease receive the care and support that they need. A range of gluten-free food products is offered on prescription and our commitment to abolishing prescription charges in April 2011 will benefit everyone who pays for those prescriptions.

First of all, I note a personal interest in this issue, as my daughter has coeliac disease. I stress, though, that my question concerns a very much unrelated constituent case.

The constituent in question has faced a number of challenges when she has tried to obtain her new gluten-free products on prescription due to the discrepancies in what general practitioners are willing or able to prescribe. That has led to some sufferers being able to access products that are denied to others. Will the minister ensure that all health professionals utilise the same guidelines when they supply gluten-free products in order to eradicate the health inequalities that exist in health board areas and across the country? Will she also look into the introduction of pharmacy-led provision to free GPs’ time and improve the efficiency of the national health service in general?

The Advisory Committee on Borderline Substances, which is a United Kingdom-wide body that was set up to advise on the prescription of certain foodstuffs, including gluten-free foods, decides what can be prescribed. Its list is published in the British national formulary, to which we expect GPs to adhere.

Obviously, the member is concerned about discrepancies in prescribing and the products that are available. If she has not done so already, I advise her to write to me with details of the case. I will look into whether we can do more to ensure that there is consistency in adhering to the guidelines, and will write to the member once I have done that.

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Disabled Young Adults

12. To ask the Scottish Executive what action it is taking to support young adult disabled people in care homes. (S3O-10691)

Due to the success of care in the community, only a relatively small number of young adults with disabilities are in care homes. The national care standards require care providers to ensure that the support for young people in care homes is based on their individual care plan, taking into account their individual needs. It is the responsibility of the Scottish Commission for the Regulation of Care to ensure through regular inspections of care homes that the requirements of the national care standards are met.

I think that there are 48 homes with 728 places and some places in more elderly homes as well.

Does the minister agree that younger adults in residential care require the company of people of their own age, things to stimulate their brains, activities to enhance the quality of their life, and opportunities to go outside the confines of the home? Does she agree that the standards are all very well, but there is sometimes a bit of a gap between the standards that have been set and the reality in a number of individual homes? Do things point to a situation that could be described as dire for some younger disabled adults, who are often left to hibernate without such support? Will she engage with the care commission and others on that? Will the Scottish Government commit to an action plan to guarantee that our citizens who are in that situation have proper standards of care in practice and the opportunities in life—so far as they can be provided—that the rest of us take for granted?

I will put in context the total number of young adults who are resident in care homes. According to the last published statistics in the 2007 care home census, which included age breakdowns, of the total number of 36,428 long-stay care home residents, 230 were adults aged from 18 to 24. Some of those young adults were placed in care homes for people with physical disabilities and others were placed in care homes with a specialism for people with learning disabilities. The numbers are quite small, but Robert Brown has made the point that it is important for those individuals that the right standards and packages of care are provided.

I am happy to look into Robert Brown’s suggestion. I meet the care commission regularly, and am happy to discuss such matters with it. However, I point out that we have an agenda on and an interest in pursuing self-directed support and making it easier for young adults with disabilities in particular to access the care packages that they want, whether they want to remain in their own home or build a care package with a range of services that is based in supported accommodation, and we want people to have more options. I hope that the member will support us in our endeavours to achieve that.

We will move on to the next item. We are very tight for time for the rest of the afternoon’s business.