Meeting of the Parliament

Meeting date: Thursday, June 30, 2011

Official Report 1081KB pdf

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Scottish Executive Question Time

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Health, Wellbeing and Cities Strategy

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Social Care and Social Work Improvement Scotland (Capacity)

1. To ask the Scottish Executive what its position is on the capacity of Social Care and Social Work Improvement Scotland to carry out its duties in light of recent budget changes. (S4O-00092)

The change from the combined budgets of Social Care and Social Work Improvement Scotland’s predecessor bodies in 2010-11 to its budget for 2011-12 is from £35,894 million to £35,444 million, which is a reduction of just over 1 per cent. The care inspectorate maintains the required skill mix and experience to provide the necessary assurance as to the quality and standards of regulated care services. The budget for future years will be set in the context of the spending review and will be driven by the need to ensure a robust system of inspection.

Is the cabinet secretary aware of the worrying data that SCSWIS has released in response to Labour’s freedom of information request? Does she know, for example, that in North Lanarkshire four privately owned care homes were revealed to be weak on quality of care and support and that eight privately owned care homes are either weak or unsatisfactory in at least one inspection area? That means that 23 per cent of North Lanarkshire stock is falling short of the required standard. I am sure that the cabinet secretary will agree that that is unacceptable.

Can we get to the question?

Does the cabinet secretary agree that cutting the budget for SCSWIS, the organisation that is tasked with supporting improvement and signposting good practice, will not improve matters, will inhibit the organisation’s capacity to carry out the duty and will lead to further deterioration in standards?

I say to the member seriously and genuinely that that is a serious issue and I appreciate any member who comes to the chamber to raise it. We should all be aware of our responsibilities on the issue and pledge to do what we can to ensure that older people have the standards that they have a right to expect. However, the press release that Siobhan McMahon issued yesterday had inaccuracies in it. For example, it said that there were eight care homes in North Lanarkshire, when in fact there are 36 care homes there. The situation is that four services had grades of 1 or 2 for care and support out of a total of 35 assessed care homes for older people in North Lanarkshire. That is 11 per cent of those care homes, not 100 per cent, as was implied in the press release that Labour issued yesterday. Fifty-six per cent are graded good or very good.

I repeat the comments that the First Minister made at First Minister’s question time. We want to ensure the highest standards for every older person in care homes. However, it does nobody in Scotland, including older people and their families, any service to use information that is not factually accurate. The Government will continue to take the necessary action, including on the budget of the care inspectorate, to ensure that older people know that there is a robust inspection regime in place to ensure that we have the standards that all of us want older people to have.

I call Derek Mackay.

To ask the Scottish Executive whether procedures are in place to ensure that national health service medical staff seek a full employment history for all new mesothelioma cases.

That is question 6, Presiding Officer.

Sorry.

I call Mary Scanlon to ask a supplementary to question 1.

Given the lack of commitment in the past by the Scottish Commission for the Regulation of Care to following up problems that were identified in care home inspections, I ask the health secretary whether all reports and follow-up reports by SCSWIS can be reported electronically to constituency and regional members within seven days to ensure that all members of the Parliament have the same information on care homes as we currently receive for school inspections.

I absolutely agree with Mary Scanlon on the importance of transparency and appropriate follow-up, which are vital components of the inspection regime. If weaknesses are identified, that is a sign of the success of the regime, but we should expect those weaknesses to be followed up and rectified. I am more than happy to relay Mary Scanlon’s specific suggestion to SCSWIS to discuss its practicality. If appropriate, and if it is acceptable to Mary Scanlon, I will get back to her on that point in writing.

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Measles Outbreak (Mainland Europe)

2. To ask the Scottish Government what steps it is taking to warn parents about the measles outbreak on mainland Europe and the dangers of taking abroad children who have not had two doses of the measles, mumps and rubella vaccine. (S4O-00093)

Health Protection Scotland has undertaken a range of activities to raise awareness of the measles outbreak in mainland Europe. Travax, the travel health advice website for national health service professionals that Health Protection Scotland maintains, has been updated to reflect the current situation.

Health Protection Scotland has written to professionals across the NHS several times—it wrote as recently as last week—to provide updated advice. In May, it wrote to directors of education to provide advice that was to be passed on to all parents on the importance of ensuring that children are protected against measles before any travel or school trips to Europe. Similar advice was also provided to universities and further education colleges. Health Protection Scotland continues to monitor the situation and will update its advice as required.

I thank the minister for his detailed answer. I welcome the fact that the latest quarterly figures published by ISD Scotland—for the quarter that ended on 31 March 2011—show that uptake at five years of age of one dose of the MMR vaccine is 96.2 per cent, which once again exceeds the 95 per cent target. However, uptake at five years of age of the second dose of the MMR vaccine is only 89 per cent. Given the public health concerns that could result from a low uptake of the MMR vaccine, what does the Government intend to do to encourage parents to ensure that their children receive the vital second dose?

Stewart Maxwell raises a worthwhile point. For children to have the proper protection from measles, it is extremely important that they complete the two doses of the MMR vaccine.

Practice nurses and general practitioners have done a considerable amount of work to recall parents and their children for the second dose. As a result of such initiatives, uptake of the second dose is 93 per cent at the age of six.

It is clear that there is more progress to make, but I assure Stewart Maxwell that uptake of the first and second doses of the MMR vaccine is higher in Scotland than in any other part of the United Kingdom. It is important that parents recognise that their children need to complete both doses of the MMR vaccine to be properly protected from measles.

The minister will be aware that I raised the issue more than once in the previous parliamentary session and that I have done so in recent parliamentary questions. I welcome the fact that uptake levels have always been higher in Scotland than in the rest of the UK and that the figures are approaching a satisfactory level, but I ask the minister to reconsider a written answer that I was given in the previous session to a question about England’s catch-up campaign. I admit that the situation there started from a lower base, but we have not had such a public campaign to encourage parents to vaccinate children whom they did not get vaccinated—partly because of the approach of Opposition parties during our time in power of attacking the combined MMR vaccine. Will he reconsider the approach, which led to low uptake? Significant numbers of older children are unvaccinated.

I would have thought that the MMR vaccine was a matter of importance that went beyond party politics. It is clear that significant progress has been made to meet the 95 per cent target at which we aim. Uptake among six-year-old children is 93 per cent, and our level is still significantly higher than that in other parts of the UK.

We are making progress. GPs and practice nurses have done considerable good work to encourage parents to return. I am confident that that work will continue and that we can continue to make progress. I hope that we can continue to make progress on a cross-party basis, too.

I remind all members that supplementary questions should be brief. I would appreciate ministers’ co-operation in making their answers brief, too. In that way, we will get through most of the questions in the Business Bulletin.

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NHS Dumfries and Galloway (Meetings)

3. To ask the Scottish Executive when the Cabinet Secretary for Health, Wellbeing and Cities Strategy last met officials from NHS Dumfries and Galloway and what issues were discussed. (S4O-00094)

I last met health board chairs in Edinburgh on 27 June. A range of issues of importance to the people of Scotland were discussed. My officials meet regularly with officials from all health boards, including NHS Dumfries and Galloway.

In 2009, 39 men in the NHS Dumfries and Galloway health board area died of prostate cancer, which is almost double the number 10 years previously. That is a worrying trend, especially as only one in three men over the age of 50 has ever heard of the prostate-specific antigen test that can detect prostate cancer.

Is the cabinet secretary aware of the Prostate Cancer Charity tour ride that will come to Dumfries in early September? Perhaps more important, what assurances can she give that the charity’s efforts in raising funds for and awareness of prostate cancer are matched by the Scottish Government’s efforts to ensure that the male population is made aware of the PSA test and given sufficient information to enable men to decide whether to take it?

The Government is always keen to work with charities to do everything that we can to improve the general population’s awareness of cancer symptoms and understanding of the actions that can and should be taken to prevent cancer and ensure its earliest possible detection.

I am aware of PSA testing. We take advice on general population screening programmes from the national screening committee, and we will continue to follow any advice that it gives on PSA testing. I am happy to write to Alex Fergusson in more detail about the benefits of and issues surrounding the test. I am sure, given his interest in the subject, that he would find that information useful and interesting.

More generally, our detect cancer early initiative—details of which will be announced soon—is about doing everything that we can to improve earlier detection of cancer. It will focus initially on the three big cancers in Scotland—lung, breast and colorectal—but it has great potential to ensure the earlier detection of all cancers in due course. I am happy to correspond with Alex Fergusson on the specifics of his question and keep him fully up to date with progress.

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Detect Cancer Early

4. To ask the Scottish Government what is being done to implement the detect cancer early initiative and how it will work in practice. (S4O-00095)

That is a very topical question given the previous exchange.

Cancer waiting times targets are being met ahead of schedule, and in our view the time is now right to launch an ambitious new programme to save more lives. We are developing a draft implementation plan for the detect cancer early initiative and will engage with key stakeholders from this week. We expect to launch the full, detailed plan by September.

To achieve earlier diagnosis of cancer, the initiative will encourage improved participation in screening programmes and increased awareness of symptoms and suspicious signs of cancer. It will also encourage referral at an earlier stage.

Can the cabinet secretary elaborate on which social groups might benefit from the earlier detection of cancer? It is my understanding that the lower socioeconomic groups will benefit most.

Joan McAlpine is absolutely right. We know from looking at the screening programmes in Scotland that those from lower socioeconomic groups and those who live in deprived areas are less likely to access those programmes and are therefore less likely to have their cancer diagnosed at an earlier stage. The detect cancer early initiative will focus on ensuring not only that we improve early detection rates in general, but that we seek to address the health inequality that often exists between different groups in Scotland.

I referred in my answer to Alex Fergusson to the meeting of health board chairs that was held earlier this week. One of the key issues under discussion was the detect cancer early initiative, and a number of chairs emphasised the importance of ensuring that we get the messages across firmly and effectively to people in those groups.

I am grateful to Joan McAlpine for raising that important issue, and—as I offered to do for Alex Fergusson—I am happy to keep her up to date with progress.

The cabinet secretary will be aware of the work of the Rarer Cancers Foundation. Does she agree that one of the detect cancer early initiative’s key pillars should be that it addresses the obstacles to treatment that patients diagnosed with rarer cancers, such as osteosarcoma, still face because they are diagnosed late? In the case of osteosarcoma, that is often due to difficulties in identifying the symptoms in young adults; indeed, the initial symptoms can be similar to those for a sprain. Will she make identifying rarer cancers much earlier a priority?

Absolutely. Given her background, Nanette Milne probably knows better than I do of difficulties in diagnosing all very rare illnesses, not just cancer. By definition, general practitioners and other medical and health professionals do not come into contact with those illnesses regularly, and part of the detect cancer early initiative is to raise awareness of common early signs of cancer among not just the public but GPs and other health professionals. The importance of that with regard to cancer in general is well understood, but Nanette Milne is right to highlight its importance with regard to rarer cancers and I assure her that we will keep the matter firmly in mind.

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Health Budget 2011-12 (VAT Increase)

5. To ask the Scottish Government what impact the increase in VAT has had on the health budget for 2011-12. (S4O-00096)

The estimated implication of a VAT rise from 17.5 per cent to 20 per cent for national health service boards in Scotland is £26 million.

Given that that additional burden is being placed on a fixed budget, should the increase not be termed a cut? Will the Scottish Government be seeking dialogue with the United Kingdom Government to address the matter?

Gil Paterson has raised a very important issue. The Scottish Government and I have highlighted in the past the impact on the NHS of changes in taxation that we in this Parliament do not control. I have responded to the question about the increase in VAT, but I point out that changes to national insurance contributions are also impacting on the pressures bearing down just now on our NHS. I assure Gil Paterson that we will always seek to ensure that our NHS’s interests are fully articulated to the UK Government.

Of course, this all serves as a reminder that the pressures on our health service and other parts of the public sector that people are experiencing are down to the £1.3 billion cut that has been imposed on Scotland by the Westminster Government. I am sure that people will be reflecting on that matter given that, at the moment, Scotland’s resources contribute greatly to the UK Treasury.

The cabinet secretary will be aware that, due to distances that have to be travelled in the Highlands and Islands, health boards in those areas will incur further costs with the increase in VAT on fuel. Will she join us in calling on the Westminster Government to reduce VAT on fuel?

The Scottish Government has made its position on these matters very clear indeed. Rhoda Grant and Gil Paterson are right to raise the issue. Notwithstanding the protection of the health budget that the Government has assured by passing on consequentials, increases in VAT, national insurance contributions and the cost of energy are all putting pressure on health boards and are outwith this Parliament’s control. I think that that provides a very powerful, real and tangible reason for increasing the Parliament’s powers—indeed, for making this Parliament independent.

Would Derek Mackay now like to ask question 6?

He would, Presiding Officer.

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Mesothelioma Cases (Employment History)

6. To ask the Scottish Executive whether procedures are in place to ensure that national health service medical staff seek a full employment history for all new mesothelioma cases. (S4O-00097)

Although there is no specific guidance on or recommended procedures for mesothelioma in general or taking an occupational history from patients with mesothelioma in particular, medical practitioners’ awareness of the condition is now much greater, and it is considered good practice to undertake this procedure with any patient suspected of having the condition.

Recent reports have highlighted a 20 per cent increase in the number of women who have contracted mesothelioma, which is cancer caused by asbestos. However, the fact is that, all too often, women are not asked about their full employment history to find out where the exposure to asbestos took place. Asking all new cases specifically about their employment history not only ensures better outcomes for compensation cases but provides a better picture of asbestos exposure across Scotland. Is the minister able to comment on the legislation that the Supreme Court is considering in relation to compensation cases?

Although the increase in the instances of cancer is relatively small, it remains a matter of concern, which is why cancer remains a top priority for the Scottish Government. The cabinet secretary outlined the initiative we are taking with the detect cancer early initiative, which will be backed by an additional £30 million to help to ensure that we get early diagnosis of conditions. That type of approach will help to improve the outcomes for those who are diagnosed with the condition.

Although I mentioned to the member that there is no specific guidance in relation to taking down someone’s occupational history, I understand that clinical practice for dealing with individuals who may have a lung condition is often to consider their occupational history as a matter of course. However, if the member believes he has evidence of cases in which that has not been properly carried out, I would be more than happy to consider that.

With regard to the member’s final point about the case that is before the Supreme Court, it would obviously not be appropriate to comment on a matter that is live before the court. However, the Scottish Government continues to believe that the legislation is right in both principle and law. I hope that the Supreme Court comes to a judgment soon on that matter.

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Dementia (Care Home Places)

7. To ask the Scottish Government what discussions it has had with national health service boards and local authorities regarding care home places for people with dementia. (S4O-00098)

We are working nationally with all key stakeholders through the national development group for older people’s care to enhance the quality and consistency of care for older people.

Most people with dementia wish to remain in their own home. The national dementia strategy aims to help people to stay living independently for as long as possible by improving both post-diagnostic support and care in acute general hospital settings so that they are not unnecessarily discharged into a care home.

The national care home contract between the Convention of Scottish Local Authorities and Scottish Care is being strengthened to enhance the quality, consistency and stability of the commissioning of care from the independent sector.

Would the cabinet secretary care to meet me to discuss what appears to be a particular problem regarding the treatment of individuals who attempt to leave hospital and their placement in appropriate residential care provision by the local authority? I refer to, in particular, the delays and apparent obstructions to finding appropriate residential care accommodation.

On the first part of John Wilson’s question, I would be happy to meet him to discuss any particular constituency concerns he has on that issue. I am always concerned, as I am sure everyone in the chamber is, when I hear about any older person facing delays in receiving appropriate care. People should not have to spend a day longer in hospital than they need to, and they should not find themselves discharged from hospital into an inappropriate care setting.

I am sure that members will acknowledge the huge progress that we have made over the past four years in reducing the level of delayed discharges. However, we are not complacent. One person delayed too long is one too many, and one person discharged into the wrong care setting is also one too many. We are determined to take further action on that. This year, we introduced the change fund, giving £70 million to help partnerships to redesign services so that older people can be helped to remain independent in their own homes, focusing on reducing unnecessary hospital admission and speeding up discharge after a crisis. We continue to work with partners as we look ahead to the integration of health and social care to ensure that we have continued improvement in that area of care.

What assurances can the minister give members and families throughout Scotland who are concerned about recent evidence that care homes are struggling to cope and have been found to be drugging patients—as happened in the case of Mrs V, for example—and that one in 10 care homes are providing weak or unsatisfactory care? What steps are in place to integrate health and social care for the elderly, particularly those with dementia, to prevent events such as those at Elsie Inglis nursing home and Ninewells hospital?

There were a lot of different aspects to that question, so I will try to be as brief as possible. I am more than happy to follow up any particular aspect in writing if I do not do it justice in my answer.

Mary Fee referred to drugging patients, and the use of antipsychotic medication is a sensitive issue. The national dementia standards that I published a few weeks ago set out standards for the use of such medication. It is essential that it is not used with any older person just because it is the easiest way to control someone who is displaying difficult behaviour. It should be used only when it is the best and most appropriate form of treatment for an older person.

On the other aspects of Mary Fee’s question, the Government has made clear its commitment—I detect cross-party support for this—that health and social care should be integrated. We are looking carefully at the best way of achieving that objective, and we will come forward with our further thinking and our plans in due course. I genuinely hope to build consensus in this Parliament not only on what we are trying to achieve but on the route to achieving it.

Mary Fee referred to the Mental Welfare Commission’s report on the elderly patient in Ninewells hospital. That is one of the events that have taken place in recent weeks that have helped to have create often understandable concerns about the standard of care for older people, whether in hospitals or care homes. That is the main reason why the Government has said clearly that the issue is a priority for us. As Parliament would expect, it is one that I intend to give my personal attention to, to ensure that we are addressing all the issues effectively.

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Young Carers

8. To ask the Scottish Executive what role it considers specialist young carers services have in implementing the young carers strategy. (S4O-00099)

Dedicated young carers services have an important role. They can help to implement the young carers strategy by providing a range of support to young carers across Scotland, including short breaks, emotional support, counselling and leisure activities. Our commitment to young carers is demonstrated by the range of funding that we provide in support of those services.

Through the strategy, we have encouraged local authorities to continue the core funding of young carers services. Health boards have also provided support to young carers services by using some of the £4.9 million that we have allocated to them for such work in this financial year.

Research from the Princess Royal Trust for Carers shows that for every pound spent on specialist carer services, more than £6 can be saved. Can the minister confirm what support the Scottish Government is providing to local authorities to support such services, many of which I understand face frozen or falling budgets and rising costs and which are creating waiting lists for young carers? Can he also please reassure us that a specific classification of young carer will be introduced as part of the 2011 school census, so that schools will be supported to look at their policies and practices to support young carers?

On the member’s final point, I confirm that we intend to include that classification in the school census. Later this year, we will bring forward a carers charter, which will look to provide further support.

On the specific support that we are providing to young carers services, we are supporting a range of initiatives, from the young carers festival to a programme that I recently launched, called the Eryc and Trayc toolkit, which is for primary school children and is intended to help identify young carers who are at primary school.

It is important that there is greater awareness among education staff of the pressures that young children who are carers may be under. For example, if they are late in arriving for school or late with their homework, it may be because of that caring responsibility. Therefore, it is important that we continue to raise awareness of the number of young people who are involved in caring.

We continue to encourage local authorities to prioritise the need to support young carers. It is clearly for each individual local authority to determine how it utilises its budget but, as a Government, we have made it clear that young carers and carers in general remain a priority, given the important role that they play in our society. I encourage all local authorities to recognise that they need to support young carers in the best way that they can.

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Commonwealth Games 2014 (Multiculturalism)

9. To ask the Scottish Executive whether it considers that the 2014 Commonwealth games in Glasgow offers an opportunity to promote multiculturalism in Scotland. (S4O-00100)

The Scottish Government is committed to creating a vibrant, multicultural one Scotland and to using the 2014 games to bring communities together and make stronger links across the Commonwealth. As part of the curriculum for excellence, we are already using the games to provide an excellent context for learning and to enable young people to develop as responsible global citizens.

I work with many communities from various ethnic origins in Glasgow as part of my constituency casework. Recently, I worked with the African and Caribbean community in Glasgow. I should declare an interest, as I am a referee for a live funding application for the African and Caribbean Network. I would be delighted if the minister would come along and visit its centre in Glasgow to see what worthwhile role it could play in promoting multiculturalism and getting a legacy for the diaspora from the 2014 Commonwealth games.

I am certainly keen that all communities in Glasgow—and, of course, throughout Scotland—are as involved as possible with all aspects of the Commonwealth games. I am keen that the African and Caribbean community is also involved in that, and I would be delighted to visit the centre in Glasgow to hear more about the African and Caribbean Network’s work.

What action is the Scottish Government taking following the resignation of the well-regarded chief executive of the Commonwealth games organisation?

I am not sure that that has any relevance to multiculturalism.

I was about to get to the point, Presiding Officer, if you will bear with me just for a second. How are we going to find a replacement chief executive for the Commonwealth games organisation of a suitable calibre in order that the planning for the games, including planning for multiculturalism, can continue on track?

Minister, would you like to answer?

The priority for the organising committee will be to find a replacement chief executive as soon as possible because of the importance of delivering the games. That is what the organising committee is all about, and it is doing a very good job in that regard.

I make members aware—if they are not already aware—that we announced today that the BBC has been appointed as the domestic rights holder for the 2014 Commonwealth games. That brings a welcome contribution to the games budget. I hope that that is something that Murdo Fraser and members from all parties will welcome.

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Sports Development

10. To ask the Scottish Executive what steps it is taking to support sports development across Scotland. (S4O-00101)

The key steps towards supporting sports development and increasing physical activity levels were set out in our manifesto, and we are working with our stakeholders to deliver them during the current session of Parliament.

Does the minister share my concern that gross expenditure on sports development by Aberdeenshire Council is due to fall from nearly £1 million in 2009-10 to zero from 2012-13? Does she agree that investment in sports development throughout Scotland is vital as we look ahead to the Commonwealth games, and that Aberdeenshire Council’s decision is concerning, as such activities will apparently need to be self-funded in future? Will she discuss the matter with Aberdeenshire Council to ensure that there is appropriate investment in sports development in the future?

I will certainly look at Aberdeenshire Council’s support for sports development. I am aware that sportscotland has put in a lot of effort in speaking to all local authorities about their sports development plans. It is important that there is a good relationship between sportscotland and local authorities, because the active schools network is delivered in partnership between them. The active schools network is performing well in all local authorities. However, I will look into the issue that the member raises and write to him.

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Preventative Health Messages

11. To ask the Scottish Government what measures are being taken to ensure that local communities are involved in the delivery of preventative health messages. (S4O-00102)

Since 2007, the Scottish Government has demonstrated a strong commitment to engaging, supporting and working in partnership with local communities to deliver improved health and wellbeing outcomes for Scotland’s citizens. We have supported a co-ordinated and strategic approach to building community capacity and enhancing local practice and solutions in the delivery of community-led health improvement. We provide financial support to a range of third sector health organisations with a view to supporting and developing the community-led approach to health improvement.

The minister has already kind of answered my supplementary question, but I will go on anyway.

You do not have to.

It is important. Does the minister agree that delivery of the service should be more outcome led and that local authorities and community groups can be much more actively involved in the preventative aspects of wellbeing in communities, alongside health boards and community health partnerships? A local example of that involvement is the work of Reaching Older Adults in Renfrewshire, which keeps older people active and healthy within the community for longer.

All the partners who have a role to play in improving outcomes for older people or for anyone who requires adult care or childcare are important. That means that, in trying to meet people’s needs in the most appropriate way, there must be a partnership among local authorities, the health boards, the third sector and independent sector.

The member referred to a specific initiative in his constituency. It is one that—I must be honest—I am not entirely familiar with, but I would be happy to learn more about it from him. As we go forward, it is extremely important that a greater focus is given to the need to ensure that we prioritise outcomes. Part of our approach to the integration of health and social care is about trying to ensure a joined-up approach across different agencies that focuses on improving the outcomes for people within the community.

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Cancer Drugs

12. To ask the Scottish Executive whether it is satisfied with the availability and provision of drugs to treat cancer. (S4O-00103)

We have robust, independent arrangements for the appraisal of newly licensed cancer medicines. They focus on patients in all parts of Scotland having access to clinically and cost-effective medicines to treat all conditions, including cancer, on an equitable basis in accordance with clinical need.

National health service boards in Scotland are responsible for providing NHS services in accordance with national and local priorities and in line with the health needs of the populations that they serve.

The cabinet secretary will have noted the United Kingdom Government’s response to its consultation on a cancer drugs fund and, in particular, the number of cancer charities that have welcomed the fund and the commitment to improve access to cancer drugs that underpins it. Given that and the fact that there are now 20 medicines routinely available to patients in England that are not available to patients in Scotland, is it not now time that we set up a cancer drugs fund here in Scotland and followed that excellent example?

This is a serious issue, and I have always said that I am open minded and will consider any way in which we can genuinely improve access to drugs. In the last parliamentary session I worked very closely with the Public Petitions Committee, and that work has had some tangible outcomes that have improved the processes in place.

I am more than happy to write to David McLetchie on his point about 20 medicines that are not available in Scotland but are available elsewhere, because behind the headlines we often find a picture that is not quite as stark as is presented. In fact, we often find that medicines, although not approved by the Scottish Medicines Consortium here, are still available to patients through exceptional prescribing routes and that medicines that are said to be routinely available in England may not be—they may be available in one part of England but not in all parts. I am happy to enter into correspondence on some of the detail.

I proffer to David McLetchie two serious issues of equity in the cancer drugs fund approach—I have discussed them openly with cancer charities in Scotland. One relates to cancer itself. Drugs are of course very important in the treatment of cancer but, increasingly, surgery, radiotherapy and other ways of treating cancer are involved. We need to be careful that we do not skew resources towards one method to the detriment of others.

Secondly, I get a lot of letters—as I am sure that other members do—about people wanting access to cancer drugs, and I understand absolutely the position that those patients and their families are in. I also get a lot of letters from people who suffer from Alzheimer’s or other serious illnesses and who want access to drugs. It is important that, whatever processes we have in place, we ensure equity for patients regardless of their diagnosis or condition.

I will always consider those issues, and I will never close my mind to different approaches to improve the processes that we have in place, but I will also do everything that I can to ensure equity across Scotland and between different patient groups.

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NHS Greater Glasgow and Clyde (Meetings)

13. To ask the Scottish Executive when it last met representatives of NHS Greater Glasgow and Clyde and what issues were discussed. (S4O-00104)

Ministers and Government officials regularly meet representatives of NHS Greater Glasgow and Clyde, and we discuss a range of issues of importance to local people.

Has the minister discussed with national health service Greater Glasgow and Clyde the future of Lightburn hospital and its proposed closure? When will she take a decision in respect of the report that the health board will provide to her by the end of August? Did she also receive the 10,000-signature petition on the hospital’s closure? Finally, does she share my concerns that the hospital provides a valuable service and that we should take every opportunity to ensure that those services are protected?

I have said before and will no doubt say again that I always appreciate the efforts of people who campaign for their local health services. Health services do not stand still. The way that we provide them changes so that we continue to improve the services that people receive.

On Lightburn hospital, I am aware—not only as Cabinet Secretary for Health, Wellbeing and Cities Strategy but as a member representing a constituency in the city of Glasgow—of the strength of feeling on the issue. However, as Paul Martin knows, NHS Greater Glasgow and Clyde has been conducting a formal public consultation on the future of the hospital and the board has yet to respond formally to that consultation or agree any final proposals. It would be inappropriate for me to say anything further on the issue at this moment because any final proposals will ultimately be subject to my approval or otherwise. However, I am happy to assure members and local people that I will take full account—as I always do—of all the available information and representations in considering the final proposals when they come to me.

Members will wish to note that the next debate is heavily undersubscribed, so I intend to take a further few questions on the health theme.

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Diabetes Action Plan 2010

14. To ask the Scottish Government what progress has been made on the actions set out in the diabetes action plan 2010. (S4O-00105)

Our “Diabetes Action Plan 2010: Quality Care for Diabetes in Scotland”, which was published in August last year, includes more than 50 actions that are designed to support our ambition for a world-class diabetes service.

The National Health Service boards’ diabetes managed clinical networks have all provided comprehensive reports to the Scottish diabetes group. They show that, overall, good progress has been made and that the MCNs are on track to achieve the vast majority of actions for which they are responsible. The reports have been published on the diabetes in Scotland website.

A couple of weeks ago, people across the country took part in diabetes week. I am sure that the minister wants to put on record the good work that is done by many organisations that work hard to raise awareness of diabetes in Scotland, including Diabetes UK Scotland, which has an exhibition in the Parliament today.

I am pleased to note from recently published data that the Greater Glasgow and Clyde NHS Board area has one of the lowest rates of undisclosed diabetes in Scotland. What more can we do to take that figure down to zero?

I am happy to agree with Humza Yousaf on the important work that Diabetes UK plays in raising awareness of diabetes. I visited its stand earlier this afternoon and had a go on what could only be described as the biggest game of Operation that I have ever come across. It is a good initiative that is being used for children from primary 6 to secondary 2 as part of the Diabetes UK live for it initiative, which is embedded in the health aspect of curriculum for excellence.

The diabetes action plan highlights the need for people who may have diabetes to be diagnosed early and then access treatment and care as appropriate. It is also run in partnership with the keep well programme, through which some 90,000 people have had health checks carried out since 2008.

In March 2010, we announced that the keep well programme would be mainstreamed across all health board areas. That will help to address some of the inequalities that need to be targeted and to ensure that primary prevention activity becomes normal practice within the national health service.

Question 15 was not lodged.

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Smokers

16. To ask the Scottish Government what progress is being made in reducing the number of smokers. (S4O-00107)

Smoking prevalence has dropped from 30.7 per cent in 1999-2000, to 24.3 per cent in 2009-10. In 2010, we supported 31,456 smokers to quit with the help of NHS Scotland smoking cessation services, which is up almost 12 per cent on the 2009 figure.

I thank the minister for his encouraging response. Could he give me an understanding of what NHS Tayside and NHS Grampian will do for my constituents in Angus North and Mearns? The area is between the big cities of Aberdeen and Dundee but the services there are still, of course, important.

All health boards have a responsibility to ensure that they provide smoking cessation programmes in their individual areas. For example, in NHS Tayside, the give it up for a baby initiative targets in particular women who are pregnant and continue to smoke. Some of the initial outcomes from that initiative are encouraging, but we must wait to see its final outcome.

Other initiatives are being undertaken by a range of health boards in Scotland, but the Government remains committed to reducing the number of people in Scotland who smoke. We also give priority to matters relating to pregnancy, trying to encourage young mothers not to start smoking again should they have been able to quit during their pregnancy. Progress has been made on reducing smoking in Scotland, but there is more to be done and the Government is committed to ensuring that more action is taken on that.

Is the minister aware of the latest campaign to prevent smoking in cars, in order to protect vulnerable children travelling in the back of those cars from the dangers of second-hand smoke? Has he yet had a chance to look at that campaign and form a view on whether the Government is likely to support it?

I am aware of the campaign and the debate that took place at the British Medical Association earlier this week. We are trying to add to our initial strategy on reducing smoking in Scotland and, as part of that work, we will consider a range of initiatives to address the level of smoking in Scotland. No doubt, the debate on the issue will continue over the weeks and months ahead.

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NHS Highland (Cowal Hospice)

17. To ask the Scottish Executive what discussions it has had with NHS Highland regarding the future of Cowal hospice in Dunoon. (S4O-00108)

The planning and provision of local services are for national health service boards, in line with Government policy. I assure Jamie McGrigor, however, that I am fully aware of the strength of local feeling in support of the Cowal hospice.

NHS Highland and its planning partners are actively considering how best to provide local palliative care and end-of-life services. It is important to note that that consideration is on-going and that no decisions have been made. The board has assured me that all local stakeholders will continue to be fully engaged and involved with the work as it moves forward.

The minister is right that there is an enormous amount of high feeling about the issue. Does she agree that it is not surprising that people want local accessibility to high-quality palliative care services and that those are a key factor in a place such as Dunoon?

I absolutely endorse the concept of full access to good-quality palliative care services. That is at the heart of living and dying well, our palliative care strategy, which is being successfully implemented.

As I said, in answer to a question a few moments ago, the delivery of healthcare does not stand still. If we compare the situation today with the situation some years ago, we see that many more people are choosing to—and are able to—receive palliative care and die at home than are opting to do so in a hospice. As a result, many hospices are now delivering day care services as well as in-patient services.

Services do not stand still, but I absolutely understand the strength of local feeling. I assure Jamie McGrigor that the constituency MSP, Michael Russell, is ensuring that his constituents’ views are well represented on the issue. No decisions have been taken. As I have previously said in the chamber in response to Jamie McGrigor, it is vital that the health board consults with stakeholders and, most important, local people before producing any firm proposals.