Weather Conditions
To ask the Scottish Government what plans it has in place to help deal with the current weather conditions. (S4T-00814)
Conditions are generally improving and the Met Office amber and yellow warnings that have been in place have expired as the weather front moves south.
Yesterday I saw the work being carried out to open the A82 and this morning I attended the traffic Scotland control centre at South Queensferry to monitor the situation across the road network and ensure that the necessary actions were in place to reopen the roads when it was safe to do so. Both Paul Wheelhouse and I have participated in regular SGoRR—Scottish Government resilience room—meetings to co-ordinate the response and the Scottish Government and its partners continue to monitor the situation closely. The partnership approach to on-going incidents continues.
Nearly 230mm, or 9 inches, of rain has fallen in the north-west Highlands since Friday. The A83 remains closed and it is estimated that around 18,000 tonnes of material has come away from the hillside above the Rest and Be Thankful. The old military road diversion route is being set up for use in tandem with a clear-up operation, to allow people to continue to travel through Argyll and Bute, and we are confident that the OMR will be open in time for the evening peak.
I am aware that there have been other flooding issues on roads across the country and that rail travel has also been affected. We continue to work closely with stakeholders to provide the latest information on what is happening.
I urge the travelling public in the areas concerned to use the traffic Scotland website and the Twitter feed for updates. Our ready for winter campaign highlights how the public can be prepared for weather events. We encourage everyone to be as prepared as they can be, to be aware of where to get help, and to look out for those nearby who may not be as able to cope with some of the extreme weather that we expect.
I am well aware that the minister is not responsible for the weather, but can he elaborate a bit further on what the Scottish Government is doing to deal with the landslides that are affecting the A83 in the Rest and Be Thankful area, particularly the resilience road?
There is a landslip on the A83 at the Rest and Be Thankful, which is being dealt with. Much of it was caught in the netting that was put there, and that will be cleared. However, there were also landslips at either end of the Rest and Be Thankful—the old military road really operates as a diversion route only for the Rest and Be Thankful itself. The landslips at Ardgartan and Glen Kinglas are relatively small, at about 20 tonnes, and they are being removed. Once those areas of debris have been removed—we expect that to happen very shortly—we can, of course, open the old military road pending the full clearance on the Rest and Be Thankful itself.
How is the minister ensuring that drivers are prepared for such emergencies?
I have already mentioned the getting ready for winter campaign, which we launch every year. We launched this year’s campaign last week. We are putting out information through traffic Scotland and, as we do whenever there is an issue at the Rest and Be Thankful, we have contacted a substantial list of individuals and organisations in Argyll and Bute and they are also putting out information. As soon as we are able to open the old military road, which we expect to happen in the next hour or so and certainly before the evening peak, that information will go out to drivers as well.
The usual information obtains. People should get as much information as they can about the route that they intend to take, give themselves as much time as possible, and take the things in their car, such as a blanket and a mobile phone, that we have said every winter before now that people should take.
Is the minister aware of the reports in The Press and Journal this morning that tree-felling operations on a steep bank above the A82 a mile north of Corran contributed to one of the landslides? Will he speak to Forestry Commission Scotland to review the effects of tree felling, particularly near the A82 road network?
Yes. I spoke to the Forestry Commission yesterday when I visited the site where the incident took place. The work that the Forestry Commission has undertaken there is specifically designed to lessen the risk to the road, of course, but a huge amount of rainfall has brought down some tree cuttings, which were not piled and complete, from a substantial distance away. A great deal of work is going on with the Forestry Commission to minimise that risk. The idea was that the trees there, which go back to the 1930s and perhaps have not been managed as well as they have been in the past, must be taken away to reduce the risk to the road. The Forestry Commission has undertaken that. I spoke to it yesterday—my colleague Paul Wheelhouse was on both calls—and the matter is in hand.
I thank the minister, Transport Scotland and BEAR Scotland for their efforts in keeping our roads open. In particular, where are we with future improvements to the A82? How quickly are we moving on with the route action plan? How might that help in such situations?
We are making substantial progress and are committed to improving the A82. That is demonstrated by the Crianlarich bypass, which will shortly be complete, and the works at Pulpit Rock, which are extremely difficult to progress but have been scheduled for completion very soon. In addition, the work on the A82 Tarbet to Inverarnan scheme, which I visited last week, is progressing well. Ground investigations are currently taking place that will help to inform the on-going work to design a preferred route by next summer.
Audit Scotland Reports (NHS Orkney and NHS Highland)
To ask the Scottish Government what its response is to recent Audit Scotland reports on the financial management of NHS Orkney and NHS Highland in 2013-14. (S4T-00808)
The Scottish Government takes seriously the publication of section 22 reports by the Auditor General for Scotland and continues to work directly with NHS Highland and NHS Orkney on the progress that both boards are making towards addressing the issues raised. At no point has patient safety been compromised. All NHS health boards, including NHS Highland and NHS Orkney, met all their 2013-14 financial targets, including breaking even on their revenue and capital budgets for the sixth consecutive year. In addition, the Auditor General has issued an unqualified audit opinion on all health board accounts.
Audit Scotland’s report states that the overspend at NHS Highland and NHS Orkney was down to increased spending on agency and locum staff due to problems in filling vacant medical posts, which is a recurring theme. There has been a 73 per cent increase in long-term nursing and midwifery vacancies and a 103 per cent increase in long-term consultant vacancies just in the past two years. Does the cabinet secretary accept that there is a widespread problem across the country in retaining and recruiting staff and that that is at the root of boards’ struggle to break even and meet waiting time targets?
Although I agree that the number of vacancies has increased, a large part of that is because of the increase in the establishment figures for doctors and nurses.
I have on many occasions in the chamber mentioned recruitment challenges, particularly in remote, rural and island communities. I have implemented a series of initiatives, including recruiting overseas junior doctors and giving NHS Highland board £1.5 million to lead for Scotland on various rural medicine initiatives, particularly aimed at recruiting new people.
As the member will also know, in areas such as Ardnamurchan, which is part of the Highland board area, there is a particular problem in recruiting general practitioners. The issue is not money, because the money is available; rather, the issue in recruiting GPs and consultants in the rural hospitals is the effect on work-life balance of out-of-hours working, which is often a problem.
We are well aware of the challenges and we are rising to them in every possible way. However, the issue is not unique to Scotland; the problem is being faced by rural and island communities throughout the United Kingdom. Of course, the background to that is an overall shortage in many of the areas of expertise that the boards require.
I appreciate the minister’s views, but there is a cost to the problems. Figures that were released in April showed a 25 per cent increase in locum doctor costs, up to £51 million. It would be cheaper to have someone filling those posts permanently. It is clear that the boards’ problems are the intolerable pressures on their budgets.
While spending on the NHS has increased by 4.4 per cent in England since 2009, it has fallen by 1.2 per cent here. That is why posts are going unfilled, that is why nine boards cannot meet cancer targets, and that is why thousands of patients continue to have their legal right to be treated within 12 weeks breached. Does the cabinet secretary agree that the real mismanagement of the NHS is happening not at board level but in St Andrew’s house?
I have never heard as much rubbish in all my life—or not since I last listened to a Liberal Democrat speech.
As I said, the reality in rural and island communities is that there are major recruitment challenges. To ensure that the services that should be delivered are delivered safely, from time to time we recruit locum doctors. That is costly; in fact, the cost of the locum doctor is up to 180 per cent more than the cost of a full-time doctor.
We cannot get full-time doctors, because it is difficult to persuade enough of them to live in rural areas and for them to get the right work-life balance. Another problem is finding an occupation for their spouse. Indeed, it is very often the case that, when we think we have filled a position, it remains unfilled because the spouse cannot find a place to work. Therefore, to try to reduce such a complex challenge to silly point scoring does not do the member or the debate any good. Everyone knows the challenges that the health service north and south of the border faces in recruiting GPs, consultants and specialists. We must take an innovative approach and, in the longer term, we must increase substantially the number of doctors we train in the first place.
I am glad that the cabinet secretary recognises the specific recruitment challenges in rural areas. He will also be aware that NHS Highland does not receive its full NHS Scotland resource allocation committee funding allocation. He has made money available to the board temporarily, which it must repay. Would it be wise to include that money and thereby ensure that it gets its full allocation, so that it does not remain in the same financial position?
There are two separate issues in that regard. There is the issue of brokerage, when a health board will not have enough money to meet the cost of the services that it needs to deliver during a year and, in line with the precedent set by previous Administrations, we make money available to the health board, with an agreed repayment plan. That is brokerage, which is completely separate from the NRAC arrangement.
We are bringing all boards up to their NRAC allocation, and by 2016-17 every health board, including NHS Highland, will be within 1 per cent of its NRAC allocation. This year, NHS Highland’s baseline funding is £525.2 million, which is an uplift of 3 per cent on the previous year. The funding includes a £2.5 million NRAC parity uplift. NHS Highland is getting its annual NRAC uplift, and by financial year 2016-17 it will be within 1 per cent of its NRAC allocation.
We have followed the precedent of the previous Administration in relation to the Scottish health allocation revenue equalisation—SHARE—and Arbuthnott formulas, in that, rather than cut some boards’ allocations and take other boards straight to their NRAC allocation, we are giving everyone an uplift, with a disproportionate uplift for boards that are below their NRAC allocation.
I am glad that the cabinet secretary recognised that NHS Highland required brokerage of £2.5 million from the Scottish Government, so that it could break even.
Given that NHS Highland met only two of the nine targets that are set out on page 23 of the Audit Scotland report, including the target on urgent referral for cancer treatment, and given that the board must make cuts of a further £12.3 million if it is to break even next year, including cuts of £10 million at Raigmore hospital, how concerned is the cabinet secretary that patients in the NHS Highland area are treated less favourably than patients in the rest of Scotland?
Let me say to the member, first, that we are talking not about cuts but about efficiency savings. Efficiency savings north of the border are reinvested in their respective boards, unlike the situation south of the border. If NHS Highland makes efficiency savings, NHS Highland will be the beneficiary.
I accept that there are particular challenges in the NHS Highland area. Not just in Highland but throughout the north of Scotland there is a shortage of particular types of oncology consultant. There is a dire shortage of colorectal cancer consultants in the north of Scotland—indeed there is a shortage of such consultants across the United Kingdom. That is why some targets were not met when they should have been met. As the member knows, we are advertising vigorously to recruit people to positions, so that the board can manage its budget and, more important, achieve its outcomes and targets for the benefit of patients.
The cabinet secretary mentioned recruitment problems in remote and rural areas. There are recruitment problems across every region in Scotland.
Audit Scotland has highlighted the financial problems that face NHS Highland and NHS Orkney. As a result of a freedom of information request we have learned that NHS Highland’s use of agency staff has increased by 100 per cent and that bank staff posts have gone up by 400 in the past year. On top of that, the Scottish Ambulance Service is ready to go on strike for the first time in 25 years. All that is happening before winter pressures kick in. Does the cabinet secretary have any plan for the NHS in Scotland?
As usual, Mr Findlay is misinformed. On bank staff, the national health service, like many other public services and private industry, operates on the basis of bringing in additional staff as and when required—it is very similar to the use of supply teachers in education—
Zero-hours contracts.
No, not zero-hours contracts.
On average, across Scotland the proportion of nurse hours that are filled by bank nurses is of the order of 5 to 6 per cent. That is a reasonable figure in an organisation that performs more than a million operations and when more than 1.7 million people attend accident and emergency every year. The organisation employs a total of 157,000 people and it looks after its staff so that, when staff are off sick, there are still people on the wards doing the jobs that need to be done. That is what bank staff do.
Let me be frank. The agency budget has gone down dramatically since Mr Findlay’s party was in power. When Labour was in power, the agency budget was far higher than it is today. We have deliberately—under my predecessor and under me—had a policy of instructing NHS boards to substantially reduce the use of agency staff. The use of agency staff is a different issue from the use of bank staff. Very often, bank staff are nurses who are employed by the national health service.
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