Meeting of the Parliament

Meeting date: Tuesday, January 17, 2017

Official Report 898KB pdf

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Topical Question Time

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Air Pollution

I declare an interest as a councillor in Stirling.

To ask the Scottish Government how it plans to support local authority action to reduce air pollution. (S5T-00323)

The Scottish Government is already working closely with local authorities as they implement their air quality action plans, providing both practical and financial assistance. An additional £1 million to support this important work is being provided in 2017-18.

Clearly, finance is important. This is a public health crisis, as 3,500 people in Scotland are dying every single year because of these air quality problems. Will the Government commit to providing funding specifically for low emission zones?

I am sure that the member does not want me, as the cabinet secretary, to tie the hands of local government when we give it funding. He will be well aware that there is a considerable debate about that. The funding that currently exists allows local government £1 million for action plan measures, £0.5 million for monitoring, £0.5 million for roadside emissions testing, and £1 million to support wider air quality resources. A further £1 million has been added to that in the 2017-18 budget.

The development of low emission zones is already a matter for discussion in the Government and will require local authorities to come forward with their own ideas about it. At that point, I will consider what might or might not be required at what stage in order to deliver a low emission zone. There are a number of components of any financing of that, as the member is probably well aware.

I hope that we can get some clarity on the exact package of low emission zones.

In addition to the 38 areas that breached air quality limits, there are many areas where, in particular, nitrogen oxides emissions and particulate emissions are creeping up. There is good evidence that 20 miles per hour speed limits can significantly reduce air pollution from diesel vehicles, so will the Government also consider a default 20mph speed limit for Scotland’s residential areas, which would be significantly cheaper for councils to roll out than the current piecemeal approach to 20mph zones?

First, we expect an initial low emission zone to be in place by the end of 2018. That is what we are working towards. A great deal of water has to go under that particular bridge before it is in place and it will be interesting to see how many of the campaign commitments that are made in the coming April to May campaign relate to potential bids to be the location for a low emission zone.

On the secondary question of the specifics of 20mph zones, I am sure that the member is perfectly well aware that I would not be within my portfolio remit if I started indicating what detailed policies someone else should introduce in their portfolio. It may be that the member will wish to raise the question again on Thursday after the statement on the climate change plan.

My constituents in Johnstone and Renfrew will have been alarmed to read that their town is one of the worst places in Scotland for air pollution, according to Friends of the Earth Scotland. Parents especially will be worried about the harm that that may cause their children. Unfortunately only 10 air quality monitors—half of which are broken—are available to share between every school in Scotland. Will the cabinet secretary consider extending access to air quality monitors for Scotland’s schools?

I will have a look at that specific point and get back to the member on it. I know that there are monitoring units in a number of different places and I will check where we are with schools specifically. Local authorities are doing a great deal to help the situation, and it is local authorities that have the statutory obligation to review air quality in their areas regularly and produce plans to deal with it. I hope that, as well as raising the issue in the chamber, Maurice Golden is raising it directly with the local authority concerned.

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Scottish Ambulance Service (Targets)

To ask the Scottish Government whether the Scottish Ambulance Service is meeting its response-time targets in rural areas. (S5T-00313)

I know that provision of ambulance services in the Highlands and Islands is a matter of concern to Edward Mountain and his constituents, and I understand that the member will meet senior Scottish Ambulance Service managers soon to discuss those concerns.

In 2015-16, the Scottish Ambulance Service reached 65.5 per cent of its category A calls within the eight-minute target, against steadily increasing patient demand. That does not mean that the other patients faced long and extensive delays, however. Despite the increased demand, Scottish Ambulance Service crews are saving the lives of more patients than ever before, and the average response time to calls regarding potentially life-threatening situations remains at around 7.4 minutes.

Although time targets are clearly important, they do not in themselves measure the quality of patient care or patient outcomes, neither do they take account of advances that have been made in clinical developments in pre-hospital care in recent years. That is why the Scottish Ambulance Service is piloting a new response model that was announced in November. The model has been developed following the most extensive clinical review of its type that has ever been undertaken in the United Kingdom, with nearly 500,000 call-outs examined. That will benefit patients in urban, rural and remote communities in Scotland.

The Scottish Government and the Scottish Ambulance Service are both committed to ensuring that patients across Scotland receive the best possible care. That is why we have invested an extra £11.4 million in the Scottish Ambulance Service for 2016-17, which will include recruitment of 200 more paramedics as part of our commitment to training 1,000 more paramedics over the next five years. The funding will help to improve care across Scotland, including in some of our most remote and rural communities.

I thank the cabinet secretary for her answer, although it does not solve all the problems. I remind her that, on 24 November, I raised with the First Minster the issue of the mum who went through labour in an ambulance on the way from Caithness general hospital to Raigmore hospital. Eilidh McIntosh and I were both promised a report on that, but we still await it. On Christmas eve, I raised with the cabinet secretary the issue of Thomas—a young child who waited over 10 hours for an ambulance to take him from Caithness general hospital to Raigmore hospital. I have received an acknowledgement, but no detailed response.

Today, on 17 January, I raise the issue of two mums who had to travel to Raigmore hospital while in labour and in horrendous weather conditions. In one case, the snow gates were closed, which meant that two attempts were needed to get the woman to Raigmore hospital in a private four-by-four before she got through.

It is clear to me and the people of Caithness that NHS Highland’s management model for Caithness general hospital is not working. Will the cabinet secretary join me and the latest convert whom I am delighted to welcome to the cause—Gail Ross MSP—in asking for a full management review of hospital provision in Caithness and the ambulance provision to support it before the situation spirals further out of control?

I ask Edward Mountain to ensure that the details of any individual patients whom he has mentioned are sent to my office. The senior managers he will meet will be keen to discuss with him individual patients’ cases, because it is important to get to the bottom of the issues that have been raised.

I am very aware of the fact that NHS Highland has taken the difficult decision to make changes to obstetric maternity services at the hospital in Caithness, and the chief medical officer has kept closely in touch with the progress that is being made. As Edward Mountain knows, the decision was made on the ground of patient safety. Although there was no consultation on the issue because of that, I have made it clear that it is very important that we keep local people in touch and allow them to contribute to discussions on the need to strengthen services not just in the Scottish Ambulance Service, but in Raigmore hospital, as the receiving hospital for those cases.

It is very important that we deliver safe and high-quality services to pregnant women and newborn babies, and that when adverse events happen, we reflect on them and learn lessons to ensure that they are never repeated. We want to make sure that all women receive the best services, which is why we initiated a review of maternity and neonatal services across Scotland. The review has now reported to me and the report will be published shortly. I expect managers in NHS Highland to ensure that the services that they deliver for women and newborn babies in any part of the Highlands are in line with the outcomes and recommendations of that report, and I will make sure that NHS Highland follows up on the recommendations under the guidance of the chief medical officer.

There is time for additional brief supplementaries. Mr Mountain, do you want to ask another supplementary?

Thank you. How can services in Caithness ever equate to those in the rest of Scotland, given that it is necessary for mums who are in labour to make a 100-mile trip under blue lights to get to Raigmore, especially when snow gates are closed and helicopters are unable to get there? I do not understand how the cabinet secretary believes services can be the same as they are in the rest of Scotland when Caithness is different by its very nature, given its remoteness.

I am sure that the member will appreciate that, if a report after an adverse incident says that a service is not safe, no one—not me, as Cabinet Secretary for Health and Sport, nor managers in NHS Highland—can ignore that. It would be extremely irresponsible of managers to ignore a report that said that a service was not safe.

Across the Highlands, many midwife-led services are being delivered in remote and rural areas. It is important that the infrastructure and protocols are in place to ensure that the Scottish Ambulance Service responds as it needs to respond in order to ensure that women are transferred safely, at the right time and early enough. It is important that the receiving hospital—in this case, Raigmore—has the facilities to ensure that women and their families are catered for in a comfortable and welcoming environment. I am sure that Edward Mountain will be aware, as he will have had a great number of local briefings on the subject, that there is a lot of work under way to ensure that that happens. I assure him that I am keeping a very close eye on the situation—as is the chief medical officer—in the Highlands and Caithness.

Cabinet secretary, there are three more questions to get through.

What is the range of options that are available to the Scottish Ambulance Service when it is faced with adverse weather conditions?

Adverse incident calls are assessed. If a need for access to a remote patient is identified, the SAS assesses its capability to respond, either through its special operations response team—SORT—which is led by people who have undertaken specialist training to drive off-road, or through the air ambulance services. If that is not possible due to availability of resource or severe weather conditions, the SAS would seek assistance from partner organisations including the Ministry of Defence and HM Coastguard to supply aircraft. In certain circumstances, a Polaris all-terrain vehicle may be requested through a partner organisation—for example, Police Scotland.

It is very difficult to argue with the need for patient safety as the reason for changing how a service is delivered. However, I have asked NHS Highland the question that I will ask the cabinet secretary: what risk assessment has been undertaken of alternatives for taking women in labour down to Inverness when appropriate vehicles are not available? NHS Highland has no locus over the Scottish Ambulance Service, but the cabinet secretary does. Will she take steps today to make sure that there is adequate provision in Caithness to take women in labour down to Inverness in an ambulance or by helicopter, but certainly not in the back of a vehicle when the snow gates are closed?

I welcome Rhoda Grant’s recognition of the patient safety issues that have been raised in relation to the service at Caithness general hospital, which left senior managers in NHS Highland with a difficult decision to make. I assure her that that decision was not taken lightly.

I have made it clear that the expectations around the service for pregnant women and their newborn babies in NHS Highland rely as much on the Scottish Ambulance Service’s response as they do on NHS Highland. I assure Rhoda Grant that there has been close working and collaboration between the Scottish Ambulance Service and NHS Highland. I have asked for regular updates from both organisations to make sure that they are working together to ensure not just the safe transfer of women and other patients, but that Raigmore—the receiving hospital—has high-quality facilities available for the patients and their families, too. I am happy to keep Rhoda Grant—and any other member—updated on that. I assure her that the role of the SAS is critical.

Please make your question as succinct as possible, Mr Lochhead.

The cabinet secretary may be aware that one factor that influenced response times in Moray was the use of emergency vehicles for inter-hospital transfers between Dr Gray’s hospital in Elgin and the Aberdeen royal infirmary. Thankfully, that is now being addressed through a new post to co-ordinate better use of emergency and non-emergency vehicles, so that emergency vehicles are available to answer 999 calls. Will the cabinet secretary be willing to ensure that her officials closely monitor the progress of that change to make sure that it is effective and to check whether further intervention is required?

I am happy to agree to do that. The Scottish Ambulance Service has an urgent-tier vehicle based in Elgin, which can be used to transfer safely patients who do not need an accident and emergency ambulance. As Richard Lochhead has suggested, the service has recently invested in deploying two specialist paramedics to cover Elgin and the surrounding area to provide an enhanced response for patients. The service is now able to manage a range of clinical needs in the area, including treating patients at home, referring patients or conveying patients to hospital. I am happy to keep Richard Lochhead informed of the development of that service.

Thank you, cabinet secretary.