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Chamber and committees

Meeting date: Thursday, March 21, 2019

Meeting of the Parliament 21 March 2019

Agenda: General Question Time, First Minister’s Question Time, Men’s Sheds, Scottish Parliamentary Corporate Body Question Time, Portfolio Question Time, Land Reform, Decision Time


Portfolio Question Time

Health and Sport

The next item of business is portfolio question time. Today, the theme is health and sport. I make another plea for succinct questions and answers.

Specialist Endometriosis Unit (Glasgow)

To ask the Scottish Government whether it can confirm that the new accredited specialist endometriosis unit will open in Glasgow in April 2019. (S5O-03026)

I am delighted to confirm that the west of Scotland specialist accredited severe endometriosis service is expected to be operational from April this year.

I thank the cabinet secretary for that heartening answer.

Despite the fact that endometriosis affects one in 10 women, it still takes an average of 7.5 years for a woman to be diagnosed. Although there is no cure for endometriosis, having a diagnosis enables women to receive appropriate treatment; to stay in work, by having their condition understood and managed; and to make informed choices about fertility. Does the cabinet secretary agree that reducing diagnosis times should be a key priority for the new specialist unit?

I am grateful to Mr Gibson for that additional question. I agree that, for the new unit in Glasgow and for the two other units in Aberdeen and Edinburgh, reducing diagnosis times should be a key priority, and it is.

However, I also recognise that the length of the delay in diagnosis is due, in part, to the diverse nature of the symptoms, as well as a lack of reliable diagnostic tests. As yet, there is no solid evidence on what causes endometriosis to occur.

We have taken some additional steps to improve the situation. Last year, we invested £162,000 in a study by the University of Edinburgh to inform the design of a large, United Kingdom-wide clinical trial for the condition. Recently, we engaged with Endometriosis UK to discuss possible areas of mutual research interest.

I believe that research, coupled with the three specialist centres in Scotland, will go some way in raising awareness among the public and, importantly, among healthcare professionals to facilitate access to speedy diagnostics and the best treatment available.

In a recent written response, the cabinet secretary said that activity at the Glasgow endometriosis centre had been modelled on an expected demand of 20 cases a year. I am surprised at that low level of expected demand, given that one in 10 women have endometriosis. How was that figure reached? Will the cabinet secretary give an assurance that women in Glasgow and the surrounding area will not be forced to join long waiting lists for much-needed treatment?

Various factors are used to estimate the number of potential patients, including the use of the services in Aberdeen and Edinburgh and what clinicians in the west of Scotland—the area that the Glasgow centre will serve—anticipate the demand will be. That is the basis on which the centre has been designed. The centre can, in fact, accommodate up to 24 patients.

I mentioned research, improved diagnostic testing and so on. I expect that, over time, as the research proceeds and the diagnostic tests are, hopefully, developed through the clinical trials, we will see a significant increase in cases. We have that increase in mind for all three centres. We will look at how the centres progress and increase the capacity, if that is something that we need to do.

Health (Role of Sport and Leisure)

To ask the Scottish Government what role participation in sport and leisure plays in the health of the population. (S5O-03027)

Being physically active is one of the very best things that we can do for our physical and mental health, whether through sport, active forms of recreation such as walking or gardening, or active travel.

There is abundant evidence that physical activity helps to prevent heart disease, strokes, diabetes and a number of cancers. It plays an important part in helping us maintain a healthy weight and reduces the risk of developing depression. Sport and physical activity are also powerful means of addressing isolation, building community cohesion and developing confidence.

The minister may be aware of cuts to Edinburgh Leisure’s budget, which are symptomatic of the financial pressures that this Government has put on local authorities. Edinburgh Leisure has recently announced price increases and a 10 per cent reduction in the discount rate for over-65s. Does the minister agree that making sport and leisure facilities more expensive for elderly people in particular is a false economy, especially in Edinburgh, given the crisis in social care?

Obviously, all local authorities have to make decisions, in the same way that the Government has to, about how they prioritise those areas for which they are responsible—and those areas that are within the City of Edinburgh Council’s responsibilities are just that. I assume that the member does not support the idea of the Government telling councils how to go about their business.

My understanding is that, when the City of Edinburgh Council was deciding its budget, the Conservatives did not make a proposal to provide further funding to Edinburgh Leisure. Furthermore, had the Conservative Party’s proposals for the Scottish budget been agreed to in this chamber, £500 million less would be available across the whole budget, which would have impacted on all councils, including the City of Edinburgh Council.

Danestone medical practice in my constituency is one of more than 700 park run practices in the United Kingdom where patients and staff are encouraged to get active at their local park run, whether by walking, jogging or running. Does the minister agree that it was great to see more medical practices taking on the status of a park run practice? Will he join me in congratulating the volunteers who put on Aberdeen park run, which will celebrate its 400th event this weekend?

I agree with all the member’s points. Park runs are an amazing phenomenon that have taken off across Scotland. I might be signing myself up for something in saying this, but I encourage members to go along and experience the fun. I think that I have, indeed, just signed myself up to go to the one in Dundee. [Laughter.]

Infrastructure Improvements (NHS Lothian)

To ask the Scottish Government what plans it has to improve NHS Lothian’s infrastructure in order to cope with East Lothian’s rising population. (S5O-03028)

The £70 million East Lothian community hospital is due to be complete in August, with capacity for 132 in-patient beds, along with 14 day beds for minor surgery and endoscopy patients.

NHS Lothian is developing a business case for a £2.8 million project to refurbish Harbours medical practice in Cockenzie and build an extension.

East Lothian’s population is the second-fastest growing in Scotland, with population projections for 2026 predicting a surge of nearly 10,000 people from regional migration alone.

Can the cabinet secretary guarantee that the new hospital has been future proofed to meet the needs of East Lothian’s rapidly rising population? Has she commissioned an impact assessment of how the rising population will affect NHS Lothian’s overall provision of care?

Ms Ballantyne is correct: population figures show that East Lothian is one of the highest areas of growth, with growth of 23 per cent projected between 2012 and 2037. The highest growth in the population is projected to be among people aged over 65, whose numbers will increase by something like 72 per cent, and many of those people will be in single-occupant households.

All those are factors that boards—and health and social care partnerships, given the split in the rising population—are expected to take full account of as they plan their services. I understand that East Lothian Council and East Lothian health and social care partnership are fully cognisant of the figures—indeed, some of the figures came from those sources. With that knowledge, the board is actively engaged in the activity that I have announced and in considering what else it needs to do in relation to the provision of primary and intermediate care services.

“A Better Grief”

To ask the Scottish Government what its response is to the Sue Ryder report, “A Better Grief”. (S5O-03029)

The Scottish Government welcomes the helpful focus on bereavement that the report brings. My officials recently met Sue Ryder to discuss some of the themes in the report, and officials are exploring with the national health service and independent and third sector colleagues how the messages in the report can shape our bereavement work, to help to ensure that people with grief can access the care and support that is right for their individual circumstances.

The minister knows from this important report that 72 per cent of people have been bereaved at least once in the past five years but only 40 per cent know what kind of help and support to offer someone who is bereaved. Will he outline the Scottish Government’s plans to carry out research into the availability of bereavement support and the impact of different bereavement services, as proposed in the Sue Ryder “A Better Grief” report?

The Government is in discussion with a number of organisations, including the Scottish Partnership for Palliative Care, and we have met Sue Ryder, as I said, to understand how we can better provide support.

I recognise the member’s longstanding interest in supporting bereaved families. I will be happy to meet her if she wants to discuss how we can take that work forward.

We have time for a quick supplementary.

First, I thank Sue Ryder for the report and congratulate it and Hospice UK. There was an ask in the report about having local primary care teams identify support for people and signpost to it; that is important. Many members will have met constituents who are in the position—

Will you ask your question, please?

Will the Government support that approach and fund posts in general practitioners’ surgeries?

Access to support is important. Bereavement is unique to each individual and bereavement services have to be flexible and to connect with local networks that can provide support. As I said, officials have discussed with Sue Ryder—and are discussing with other partners, including Cruse Bereavement Care—how best to do that. Members across the Parliament can work to ensure that we provide the best possible support, which is right for individuals.

We have asked the Scottish Partnership for Palliative Care to work with NHS inform to improve the online content that is available in relation to palliative and end-of-life care and bereavement.

This is an on-going process and we need to continue to do what we can to make services better.

Out-of-hours General Practitioner Services (Glenrothes Hospital)

To ask the Scottish Government whether it will provide an update on GP out-of-hours closures at Glenrothes hospital. (S5O-03030)

The out-of-hours service at Glenrothes continues to be closed, often at short notice, because of on-going difficulties in securing staff for rotas. Patients who require to be seen during those periods are redirected to another centre or might be provided with a home visit, if that is more appropriate.

However, Fife health and social care partnership has made some progress. It has recruited an advanced nurse practitioner on the GP rota and an advanced paediatric nurse practitioner, who is now seeing patients. Additional advanced nurse practitioners were appointed in January and the out-of-hours centre is now a practice placement for student nurses.

Nonetheless, I continue to keep in touch with the health and social care partnership about how much more progress it can make in this area.

As the cabinet secretary will be aware, both Glenrothes Area Residents Federation, which submitted a participation request, and North Glenrothes community council have been assiduous in their commitment to ensure that we do not lose our out-of-hours GP service in Glenrothes. Although I appreciate that the decision is not ultimately in the cabinet secretary’s gift, will she agree to meet my constituents to discuss their concerns?

I am sure that Jenny Gilruth will be aware that NHS Fife met to discuss the Glenrothes Area Residents Federation participation request on 15 March. It also met St Andrews community council regarding its participation request on 14 March. Those discussions are on-going and it is important that we allow the board and the community to conclude them. I will be kept up to date and I am happy to speak further with Ms Gilruth, once we know the outcome of the discussions.

Glenrothes is not the only hospital that is affected by closures; St Andrews community hospital is facing similar difficulties. Will the cabinet secretary confirm what pressures are being placed on the Scottish Ambulance Service, given the concerns from the student population that the Victoria hospital in Kirkcaldy is just too inaccessible?

The ambulance service has not raised any specific issues with me in that regard. However, I have had discussions with one of the GPs from St Andrews and I have had an outline discussion with the principal of the University of St Andrews in respect of the additional steps that it is taking, in particular to look at whether there can be more co-operation between the university, our NHS and the health and social care partnership and how we can deliver an adequate service to that part of north-east Fife.

General Practitioner Services (Access)

To ask the Scottish Government what action it has taken to address patient access issues at GP practices. (S5O-03031)

The new GP contract will improve patient access to GP practices by increasing transparency on surgery times and making a wider range of healthcare professionals available to patients.

In addition, our commitment to increasing the number of GPs by 800 in the next decade will ensure that GPs can spend more time with patients who need to see them. The latest figures show that we now have a record number of GPs in Scotland—an additional 75 GPs and GP registrars. Targeted initiatives, such as the Scottish graduate entry medicine programme, an increase in undergraduate medical education places and increasing undergraduate training in primary care settings will, I believe, ensure a sustainable GP workforce in the future.

One of the welcome objectives in the new general medical services contract that the cabinet secretary mentioned is the redistribution of some of GPs’ workloads to other relevant staff. The problem is that patients do not know about it, and we have a lot of anecdotal evidence that GPs are spending quite a portion of their 10-minute appointments explaining the changes. Will the cabinet secretary outline what steps she is taking to fulfil the commitment that she has made to ensure greater patient awareness of the changes?

I would be very happy to hear from Ross Greer which particular practice areas the anecdotal evidence is coming from, because I have information that there are many patients across different parts of Scotland who are benefiting from the additional access to other professionals. There are many ways in which we can help independent contractors—and we need to remember that they are independent contractors, through our health service—to ensure that information is available to patients and through community pharmacies and so on. I would be happy to look at the particular issues that Mr Greer has raised, to see what more we can do.

Mortality Rates (Kilmarnock and Irvine Valley)

To ask the Scottish Government what the mortality rates for cancer, heart disease and stroke are in the Kilmarnock and Irvine Valley constituency, and how these compare with Scotland as a whole. (S5O-03032)

Information Services Division Scotland does not routinely publish data at the constituency level, but I can provide the member with data from Ayrshire and Arran health board. The latest mortality data show that in Scotland, over the last ten years, stroke mortality has reduced by around 42 per cent, heart disease mortality by 36 per cent and cancer mortality by 10 per cent. In relation to Ayrshire and Arran health board, ISDS figures show that over the same period cancer mortality has reduced by 2.1 per cent, stroke mortality by 43 per cent and heart disease mortality by 30 per cent. Those figures show that there is a continued downward trend in that health board area.

I thank the minister for that answer, in so far as it gives us the position across Ayrshire. At some stage, I hope that the Parliament can produce data on a constituency basis, given that most members represent constituencies.

Does the minister agree that there is a clear link between poverty and ill health, which has been a consistent problem in my part of Ayrshire for many years? Can he give some indication of what the Government is doing to address that and close the gap?

Scotland has seen significant improvements in public health, although there are deep-rooted, historical issues in population health that we are working hard to address through many of our strategies. We know that heart disease, stroke and certain cancers, like other lifestyle-related illnesses, are most pronounced in areas of deprivation. Tackling those inequalities can be done only by tackling their root causes, rather than their consequences. That involves ending poverty, paying fair wages, supporting families and improving our physical and social environment; and, across Government, we put an emphasis on all those areas. Such issues are made much more difficult to address by the United Kingdom Government’s continued welfare reform programme.

Pitlochry Community Hospital (Care and Treatment Hub)

To ask the Scottish Government how the provision of a care and treatment hub at Pitlochry community hospital will improve healthcare for highland Perthshire residents. (S5O-03033)

The care and treatment hub will bring together services such as phlebotomy, wound care, post-operative wound care management and suture and ulcer care and, by doing so, will increase access to appointments. The Perth and Kinross health and social care partnership intends the hub to be open from October 2019. The provision of those services through the hub will free up general practitioner time, allowing GPs to spend longer with patients who need their particular skills.

I thank the cabinet secretary for providing that information. There is a lot of interest in Pitlochry and highland Perthshire in what is being proposed. Will the cabinet secretary tell us how the community will be involved in designing the services that will be available? What information will be made available about exactly what will be on offer from October?

Mr Fraser asks a very good supplementary question about how the community will know what is being made available. I am happy to ask the local partnership for its detailed plan about the various outlets—pharmacies, GP practices and so on—through which it will make that information available to potential patients in the local community and to share that with Mr Fraser. Using social media is always a good idea and might be particularly useful in this instance.

My understanding is that the original thinking and design of the hub came from feedback from patients, but I will make sure that that is the case. I will ensure that patients are involved in the feel of the new hub, through the community council or other means, and, again, will see that Mr Fraser is made aware of that.