Public Petitions Committee
Meeting date: Tuesday, January 8, 2013
Agenda: New Petitions, Current Petitions, Decision on Taking Business in Private
Chronic Pain Services (PE1460)
Agenda item 1 is consideration of new petitions, of which there are four. The committee will hear evidence from the petitioners in respect of two of them.
The first new petition is PE1460, in the name of Susan Archibald, on behalf of the Scottish Parliament cross-party group on chronic pain, on the improvement of services and resources to tackle chronic pain. Members have a note by the clerk, the Scottish Parliament information centre’s briefing and the petition.
I welcome Jackie Baillie, who has a particular interest in the petition. I also welcome the witnesses, Susan Archibald and Dorothy-Grace Elder who, of course, is a well-kent face and a former member of Parliament. I ask that Susan Archibald makes a short statement of about five minutes, after which I will invite Jackie Baillie to speak. I will then kick off with a couple of questions and invite my colleagues to ask a few more.
There are so many people across the country who suffer frae chronic pain. It is something that you cannae see, and naebody understands what it is like. It is the maist debilitating thing that could ever happen to you. When I went intae hospital for minor surgery years ago, I ended up disabled, but my problem was not the fact that my leg was paralysed but the fact that the chronic pain that I was left with was mair debilitating than anything else.
I am here for tae fight for better services for all, and I feel guilty that it has taken me 13 or 14 years for tae come back and fight for change and better services for people.
I remember deeply that, after the surgery, I was sent first to my doctor and health visitor. At that time, I had a three-month-auld baby and I struggled to cope with becoming disabled overnight. I experienced a whole load of emotions and I struggled with depression and everything else. I probably even had post-natal depression when I think about it, but I was never diagnosed with that. I had to go through so much.
It is really important to the petition that people understand that there are millions of folk across the country who struggle in the same way. Loads of people dinnae understand how chronic pain affects those people’s everyday life. Maist important is the lack of provision. How can anyone talk about people in one part of Scotland having access tae a service when people in another part dinnae? I dinnae get that.
At the time all this happened to me, I had to stop working—I couldnae work. I had worked all my life but, because I had been at college beforehand, somewhere along the line I hadnae paid enough national insurance for tae get benefits. I was therefore hit and penalised again because I couldnae afford the prescriptions.
So many times, I lived in a dark corner of my bedroom, struggling with the pain. Doctors and nurses hivnae helped—no for the want of trying, but so many folk across society have never had access to specialist pain services or chronic pain management. God, if I have tae tell my ain story and put ma heart out there the day for tae help everybody else, I am here to do it—but I didnae think that it would be as hard as this.
I now invite Jackie Baillie to make a brief contribution.
Susan Archibald quite rightly described chronic pain as a debilitating condition that crosses all sorts of other conditions. Because chronic pain is not something in and of itself, I suspect that services have not grown organically to meet the need, but it is very real. Some people need to deal with chronic pain a lot of the time or all of the time, so it has fairly profound consequences for them and their families.
Frankly, what the petition calls for is common sense: treatment should be as local as possible, so it should be centred in primary care; self-management is important, because we believe in a social model that allows people to manage their own condition as they know best; and, yes, people sometimes need access to specialist services that are centred in acute care. However, all too often access to such services is different in different parts of Scotland, and it really comes down to where people live, with some areas providing services for adults and some areas providing services for children. Frankly, in a country the size of Scotland, we should not see such a huge variation across the board.
The Scottish Government has made attempts to rectify matters. I am grateful to the current cabinet secretary for his intervention, which has shed some light on the emerging statistics on patterns of service provision across the country, but it has been a long time in coming.
I know that Dorothy-Grace Elder championed the issue in the first session of the Parliament; I hope that the committee will champion the cause, too. If we can, we must create some space for change and movement that will make a real difference to people on the ground. I hope that, through the committee’s good offices, we can even debate the issue on the floor of the chamber.
My first question is to Susan Archibald and Dorothy-Grace Elder. Their excellent petition mentions the importance of the Bath centre for pain services, to which many Scottish patients travel. Jackie Baillie made the point that you want services to be as local as possible, so my simplistic question is: why is there not a Scottish equivalent of the Bath pain centre? Perhaps we can start with Dorothy-Grace Elder.
Wales has long had a residential service, whereas Scotland still sends patients to the Bath centre for pain services, at a cost of £1.1 million over the past three years for just 119 patients. It is screamingly clear that we should have an in-patient service here. The new health secretary has already made a good intervention regarding some of the secrecy about chronic pain, so I hope that we might deal with that ridiculous situation. Such punishment of people cannot go on. One patient was sent from Shetland to Bath, a 1,600 mile return trip, when they were already in pain—people are sent to Bath because they are at the worst end of pain.
That said, the issue is the day services. If our day services were anything like up to scratch, which they are not—I am not talking about the staff, who are great—we would be able to cope with many more in the day service and people would not need to get into the dreadful state that many get into.
The health boards are also not co-operating. SPICe rightly referred the committee to a new report on chronic pain, the “Update report on Scottish Pain Management Services”, which is already under fire even from Alex Neil because of what it conceals. Even if you can find the hidden statistics that are tucked away on a little-known website, they will not help you. Those statistics are what the public are given to inform them about their health. Obviously, Healthcare Improvement Scotland does not want you to read them—they are bad news—but I read through those awful statistics and they show that 10 out of 14 health boards do not supply any funding for chronic pain services.
That lack of funding is in defiance of the Scottish Government’s recognition of chronic pain as a condition in its own right—not that the Government gave any money for it, because it does not give any money to other services. The services are therefore in a double bind: there is no money from many of the health boards so they have to beg and borrow from other departments, and there is no money from the Government.
It is a preposterous situation. We have up to 700,000 in the community, including up to 70,000 children, suffering from chronic pain. Services for children are deplorable, with low staff numbers. They are called multidisciplinary teams but they are not. In Aberdeen, there is not even a doctor being funded for children in pain.
The picture that you and Susan Archibald have painted is of a lot of Scots who are suffering in silence because they are not getting the correct treatment. Do you agree with that statement, Susan?
What has been set up in Bath might look like an alternative because at least somebody is getting something—people with the best knowledge maybe thought that they were doing good. However, if you take someone who is suffering from chronic pain and expect them for tae travel for that long, where are the risk assessments and the impact assessments? Where is the equality? How much does that journey breach people’s human rights? You are not even allowed to send an animal to slaughter for as long as people are being sent for tae get help.
I emphasise that I am no trying tae stop anybody who is suffering pain getting a service; I am trying tae help them to get services in their ain local communities, where they should be getting them. I thought that the Scottish Government’s policies were aligned with that view.
People in Bath that I speak to on the internet every day of my life arenae getting sent to that service in Bath. They are not even getting the service that people from Scotland are being sent to. Scottish money is being used for tae support English services.
We have a lot of buildings in the health service in Scotland that need to be renovated or updated a wee bit. They could be looked at and adapted for tae provide services—I dinnae care if the services are in Aberdeen, Glasgow or Fife, as long as they are in Scotland and it saves people from having to travel. It is no just the travelling but the fact that they are away frae their families for the amount of time that they have to be away—it isnae right. I am sorry but it really isnae right.
Perhaps Dorothy-Grace Elder could address this point because she mentioned the issue of health boards. The SPICe briefing says that one of the report findings is that
“All NHS boards reported they have pain management services”
and yet Dorothy said that not all NHS boards have those services.
Healthcare Improvement Scotland is trusted to report on all problems and dangers in the health service. With this report, it has slipped up so badly that we must ask what trust we can have in it. The term “multidisciplinary pain services” does not relate to the actual figures. Healthcare Improvement Scotland refuses—
The idea of psychosomatic pain, which is especially applied to women—young women have told me that they have been brushed off in that way, even though something was wrong with them—has been punted by health department civil servants behind the scenes for a long time. However, if you look into the issue, you will see that chronic pain affects people who are suffering from everything and anything—cancer, spinal damage, accidents—and they just want their pain cured. They are brave enough to face up to the fact that they are not going to get the condition cured.
How do you define the difference between moderate and severe pain?
The 35,275 patients that I mentioned are people who have gone to chronic pain clinics in Scotland. Presumably, they know that something is seriously wrong with them. They are the people who are suffering. The point that I am making is that there are too few medical staff, psychologists and physical therapists to deal with them, and hardly any occupational therapists.
I should start by declaring that I am in what some might call a dangerous liaison with Jackie Baillie, as I am a co-convener of the cross-party group on chronic pain—in fact, it is a dangerous liaison à trois, as John Wilson is also a co-convener.
I do not have a substantial question about Bath, but I want to pursue Mr Brodie’s point about trying to drill down to the numbers. Are there sufficient numbers of chronic pain sufferers to populate a Scottish centre? Would sufficient numbers be regarded by clinicians as being at a stage at which that sort of therapy would be beneficial?
With regard to trying to overcome that, I hear what you say about the new cabinet secretary. What does the key initiative have to be to generate the leadership that will lead to an acknowledgement of the issue and to overcoming the obstacle of what I heard a Government minister say recently: “There is no pot of money available to direct towards any of this problem”?
As for leadership on the issue, there needs to be direct political leadership—that is what this Parliament is for. Ten years ago, 130,000 people emailed the Parliament, which is a record to this day, pleading for help on chronic pain. What happened? Very little except spin, and we have got very little since. If 130,000 people can be let down, any issue coming before the Parliament can be let down.
The leadership on the ground is the lead pain clinician, who is assigned only two days a week. He is the co-author of the “Update report on Scottish Pain Management Services”, which has been widely attacked. Need I say more? He is in a virtual civil service position. We need strong political leadership.
My questions relate directly to the petition and what the petitioner, Susan Archibald, is calling for. My first question is on the focus on the social model of care rather than the clinical model. Would either Susan Archibald or Dorothy Grace-Elder like to expand on that? There is still a lot of confusion about what the two models are and why there is demand for a social model of care rather than the clinical model.
The social model of care involves looking at alternative therapies. I am no saying that that is no happening across Scotland, because in a lot of hospitals there is a lot of good work going on. I am no knocking what is already being done, but you have to improve on it. You might have to spend money in the first place for tae help folk to be treated and to get their conditions under control, or as far as possible, but that is preventative spend. Millions of pounds is spent on medications, but people will tell you—I can tell you—that if people are on certain medications for a long time, they become immune to them. It disnae dae as much as it did in the first place, so the person has to try something else. I used to smoke, years ago, and I suppose that it is like reaching for a cigarette, or maybe for some folk it is like reaching for drugs.
I took more medication than I was meant tae take for tae try to relieve the pain. You have nae idea what it is like. I got masel tae a state yin night wi everything that was happening at that point in my life—there was so much going on wi ma family and ma work and just so much pressure—that I took a cocktail of drugs and tried tae end ma life. I am so glad that my wee bairn at three months auld gret, or I wouldnae be here the day. I thank Christ that I am here the day—no that I am religious, sorry, but I really thank God that I am here the day and I can go oot and shout and try to fight for people like myself.
There have to be other ways of working. Just handing oot medical prescriptions definitely isnae the answer. It is not curing people.
I try to go oot there and help everybody else like me the day to cope with their condition and move on wi their life. It is really hard, but somebody has tae stand up and take account for that. They are throwing money at anything and everything, but there are so many people suffering from chronic pain. It goes on amongst hundreds of conditions and naebody is daein anything about it. In the next few months, people will be even worse affected because they will all get stripped of their benefits because they have conditions that naebody will say actually exist. It is so hard for tae sit back and watch. Sorry.
That leads me on to the other part of the petition in which you call for a residential unit to be established in Scotland rather than sending people to Bath. Would it not be more advisable to establish several pain management centres, throughout Scotland, that people could attend regularly to look at how they deal with pain issues, how they get treatment and the models of support that can be provided for those individuals so that they can better manage their conditions as they wish?
We have fantastic doctors and nurses oot there who can provide those services, but they need the money and the resources and the bloody staff to dae it. Sorry.
“UK is bottom of the list of 15 European countries in terms of the negative impact that chronic pain has on people’s lives.”
Are there lessons to be learned from other countries about how to deal with these issues?
I have forgotten what you asked me—sorry, I blew it.
We could stay near home and look at Wales. Why has it managed to have a residential service since the mid-1990s? With all respect to Susan, I think that we will always need a residential service for a small number of people. We should certainly not be sending them as far away as Somerset. Wales has done much better than Scotland, but we could show the world what we can do. We can control chronic pain in Scotland. I am sure that members will remember that, in the next 10 years, we will see a 25 per cent increase in the number of over-75s. Of course, chronic pain is by no means confined to older people; it can go right down to child level.
I respectfully ask the committee to look at what is being done with the SIGN guidelines on chronic pain. They seem to completely ignore children’s services and adult services and to look at only primary care. Who made such a disgraceful decision to ignore children?
The committee should have a look at this quango—Healthcare Improvement Scotland—if it can. The bosses at HIS have just had a 21-day Christmas break. They came back yesterday after failing to answer questions. I hope that the health secretary gets some of the truth, but I also ask the committee to question HIS. I am sure that Ms Baillie will agree that the “Update Report on Scottish Pain Management Services” is just a spin effort and that it does not give patients the truth.
My view is that we should continue the petition and ask the Scottish Government for its views. Dorothy-Grace Elder has suggested some other groups that we should write to, such as Healthcare Improvement Scotland, and we could also consider contacting the Pain Association Scotland.
Do colleagues have suggestions for any other groups that we should write to?
I note that we might also write to Dr Steve Gilbert. If we do, I would like that to be done with regard to those statistics that were not highlighted in the report, and to ask for comments arising from that information.
Are members happy with those suggestions for our next steps, or have I missed anything that members wish to raise?
10:37 Meeting suspended.
10:39 On resuming—
Scotland’s National Tree (PE1457)
2013 has been declared the year of natural Scotland, and we should all want to make the year of natural Scotland a winner. However, there is a concern that the whole idea may somehow be kicked into the long grass. I got a message from a spokesperson for Stewart Stevenson, who was the Minister for Environment and Climate Change at the time, which said that there is no real mechanism to formalise this request. I hope that the committee and Parliament are not ruled by Sir Humphrey and that it is possible to do something active about it. I suggest that a timetable be established, in line with the year of natural Scotland, and that John Muir day—which is celebrated on 21 April—should this year be marked by the declaration of Scotland’s national tree. For the rest of the year of natural Scotland, our national tree could then be celebrated, with the year of natural Scotland being a year of celebration. After 2013, our having a national tree would be a permanent contribution by this year of natural Scotland.
I am very grateful—I hope that you are as well—to have with us today Alan Watson Featherstone, the founder and executive director of Trees for Life. His expertise on trees generally is probably second to none in the nation. I invite him to make further comments on the petition and on the Scots pine.
The Scots pine is one of the most widely distributed trees in the world. It is also the only tree that is named after our country, and is already considered unofficially by some people to be the national tree. It has a lot of qualities that are relevant to Scotland at this time when we are, as a nation, seeking to enhance our national identity and to strengthen Scottishness.
The Scots pine is a long-lived tree. The oldest known Scots pine in Scotland is more than 520 years old and is in Glen Loyne. The Scots pine also has great character. Some trees grow tall and straight while some are called “granny” pines and are celebrated for their beautiful shape, their age and the quality that they bring; there is great variety. When we think about trees, we think about strength and wisdom—qualities to which we aspire and which would make a positive statement about our Scottish nationality. If we are looking to celebrate natural Scotland, trees are the longest-lived things that we have here.
We have a history of deforestation in our country, of which committee members will be well aware, but I am pleased to say that there has, in the past 20 years or so and in parallel with the movement that has led to the Scottish Parliament, been a tremendous upsurge of interest in and support for reversal of the process of deforestation.
The Scots pine is the iconic tree of our country. It is the tree that forms the pinewoods that differentiate us from other parts of the United Kingdom and it forms the habitat for most of our charismatic wildlife species, ranging from the ospreys at Abernethy, to the capercaillie, the pine marten and the red squirrel, whose stronghold in the UK is now in Scotland. I believe that having a national tree would enhance people’s sense of pride in Scotland. It would be something that people everywhere could relate to and which would unite the Scottish population in this year of natural Scotland.
The Scots pine also has an interesting relationship with Scotland’s impact on the world. We are a small country—there are only about 5 million of us—but I put it to you all that we have, globally, a disproportionately positive effect. If we look at Scottish people who have gone out elsewhere and at their successes, historically and more recently—such as the successes of athletes at the Olympic games and so forth—we see that we have a big impact. The Scots pine ranges from Scotland to Siberia and from north of the Arctic circle to the Mediterranean, but our pine woods in Scotland are unique. That says something that reflects our national character.
There might not be a clear mechanism for establishing what is a national tree, but a mechanism was found to declare this year to be the year of natural Scotland, so it could be done.
The petition is interesting. Like many members, I followed carefully the media coverage about it on the radio and television yesterday. If your petition came to fruition, what would be the practical effect for ordinary Scots?
I corresponded with one of your colleagues about trees and, somehow or other, we got bogged down in a long discussion about the 2006 forestry strategy and its amendment last year. Can we imagine that resonating with the public? No. The issue is how to communicate with the public; the idea of a national tree would do that.
The notion of our having a national tree is excellent. My question is whether the Scots pine is the right tree. You have just answered that question. My concern is that SPICe has advised us that
“The Scots pine is ... grown widely as a commercial species for its timber.”
I do not know about you, but I would find it difficult to cut down our national tree to benefit biomass production, to build wardrobes or what have you. How big is the commercial requirement for Scots pine in comparison with that for other trees?
Why not have a debate as to which is the best national tree? I think that the Scots pine would come out on top, but participation in a debate would be useful.
In the commercial forestry sector, there is uncertainty because of a disease called red band or Dothistroma needle blight, which has come into the country on non-native pines, and which affects lodgepole and Corsican pines. It has now been found on some Scots pines in nurseries.
Perhaps I can couple my next two questions. If we were to designate a national tree of Scotland, would not it be frankly undemocratic for politicians to determine the species? I notice that the John Muir Trust thinks that, in the event that there were to be a national tree, it should be for the people of Scotland, and not politicians, to determine the species.
I am slightly led by your previous answer to ask whether, in the event that we adopted a national tree, a consequential financial cost would arise. Would we find all manner of organisations springing up that felt that the Government should deploy considerable financial resource in sustaining, managing and expanding the national tree? Thereby, a symbol could, in fact, become something with a financial consequence attached.
The symbol would be there to be used. The decision to use the symbol would be made by different bodies and agencies. For example, does the saltire, which is the most obvious symbol of Scotland, by itself cost the Scottish Parliament and Government anything? I do not think so.
Are you not being slightly naive when you say that there is nothing inevitable about this? I think that that is exactly what there is. Surely an environmental and financial campaign will arise as a consequence of our embracing the Scots pine; indeed, in his question Chic Brodie seemed to hint at his sympathies in that regard when he expressed concern about people being allowed to cut down a pine if it were adopted as a national tree. That is where I start to get slightly alarmed, because I have met such people.
Finally, I wonder whether you can touch on the question that I began with, which was whether warranting a national tree rather than having something more widely agreed on by politicians and Government is undemocratic.
I welcome the petition, because it allows us to have this debate and perhaps to get away from the more serious side of politics. However, returning to Jackson Carlaw’s comments about the disease affecting the Scots pine, I recall that the United Kingdom Conservative Party took the oak tree as its symbol; perhaps it should have taken the ash instead, given what is happening with ash dieback.
The question is whether it is useful for Parliament to consider such issues. Over the recess, I visited the Fortingall yew, which is reputed to be 5,000 years old and stands as a symbol of tree longevity; Mr Featherstone mentioned a 540-year-old Scots pine, so there is a clearly an issue in that respect.
However, defining a national symbol on the basis of its commercial viability, as Jackson Carlaw suggested, is worrying to me. We have all seen the pine plantations that were planted in the 1970s and 1980s for tax purposes, and I would hate to think that in adopting the Scots pine as the national tree we might revert to a situation in which it became the subject of massive plantations across the north or central belt of Scotland. Do you think that there is a danger that, because of its commercial value, the Scots pine might suddenly become popular again as a crop and that those who do not have the same feelings about the pine as a symbol or about its iconic value might be encouraged to make commercial gain from its planting?
Secondly, commercial plantations are planted primarily for the economic benefit from timber production. To declare a tree a national tree would not make much difference in that respect in economic terms. People consider the quality of the timber and how trees would grow with a site’s particular soil conditions. That is what determines commercial planting.
It is much more likely that there would be an expansion of native woodland cover in Scotland, which the Scottish Government has already called for in response to climate change and so on; that is already Government policy. A national tree could be a flagship and spearhead that would enable that side of things to grow, and that would go in parallel with timber production. We need more native forest and we also need plantations. They do not need to be in conflict, and I do not see that having the Scots pine as the national tree would force the commercial forestry industry to use it, because its mandate is determined by site characteristics and the quality of the timber that is produced.
It is a question of where we look. I live in the Highlands, where the Scots pine is widely planted; it is the principal tree that is planted in native woodland schemes in the Highlands. Again, it comes down to site selection. The Scots pine’s natural range is more in the elevated parts of the country. In low-lying areas such as the central belt, broad-leaf trees were the original native trees, so it is more appropriate to plant them there. It is a question of getting the site right. Large numbers of Scots pines have been planted in the Highlands. I can show them to members if they would like to come up to the Highlands.
Please excuse me for having to depart at this point. I will miss my train, otherwise.
Again, the petition is very interesting, and we should continue it. Obviously, we can write to a number of organisations, such as the Forestry Commission Scotland, SNH and the Woodland Trust. I am sure that there are other organisations to which members will want us to write.
Members indicated agreement.
11:05 Meeting suspended.
11:06 On resuming—
Tobacco Products (Individual Purchase Licence) (PE1456)
Over a number of years, the Scottish Executive and the Scottish Government have put in place various schemes to try to restrict the purchase and distribution of cigarettes. It might be worth asking the Scottish Government what its position on the petition is, but I think that, because of the potential costs, it is highly unlikely that it would introduce an individual licensing process.
Members indicated agreement.
Judiciary (Register of Interests) (PE1458)
I ask for members’ views on the petition.
Members indicated agreement.