Chamber and committees

The Scottish Government has already acted to put in place changes to the way that medicines are assessed in Scotland, to ensure that there will be increased access to medicines for treatment at end of life.

SMC had made the pharmaceutical company aware that the timing of their submission meant that it would not be considered under the new, more flexible process but the company wished to proceed on that basis. The new process for these medicines allows a further opportunity for a company to submit a patient access scheme to improve the cost effectiveness of the medicine. This submission did not include a patient access scheme.

The Scottish Government would welcome a resubmission to SMC and encourage that the pharmaceutical company considers a patient access scheme.

Scotland’s Digital Future – Infrastructure Action Plan sets out plans for delivering a world-class and future-proofed digital infrastructure by 2020, facilitated by the Step Change 2015 programme. The Scottish Government and the Convention of Scottish Local Authorities recognises, in our National Telehealth and Telecare Delivery Plan for Scotland to 2015, the importance of ensuring there is a wide range of solutions for the delivery of telehealthcare services to people who live in areas with limited or no mobile or broadband connectivity.

This has included exploring the use of low-cost satellite broadband, which is currently being successfully utilised in areas of the west of Scotland, and, given their ubiquity, the greater use of digital television to deliver services. Increasingly, digital telehealth devices are being equipped with dual-SIM capability, allowing the device to ‘lock-on’ to the strongest mobile signal in the area in recognition of the variation in mobile connectivity across not just remote and rural communities but also within urban areas.

There are also a range of, for example, environmental and lifestyle monitoring sensors/devices in use which are analogue, meaning data is transmitted through the user’s telephone line thus reducing the dependency on mobile/broadband capacity and availability.

Whilst the Scottish Government recognises that there is still a degree of work to be completed to ensure adequate infrastructure is in place, in the interim period investigation is underway into the efficacy of more simple telehealth solutions, including text-based and (landline) phone-based options.

Ultimately, connectivity should be part of the initial assessment of the individual, and appropriate technology put in place only if it is both suitable for the individual and suitable for the location.

Sections 34 (interpretation), 35 (ancillary provision), 36 (commencement) and 37 (short title) of the Marriage and Civil Partnership (Scotland) Act 2014 came into force on the day after Royal Assent which was on 12 March 2014.

In addition, sections 7 (reset: abolition of defence), 19 (marriage outside Scotland: evidence of dissolution of former civil partnership), 20 (religious marriages: solemnisation by Church of Scotland deacons), 22 (second marriage ceremony: form of endorsement), 23 (sheriff court jurisdiction in relation to declarator of marriage), 27 (dissolution of civil partnership: evidence) and 32 (provision of certain information to district registrars) came into force on 21 May 2014. The relevant commencement order is at: http://www.legislation.gov.uk/en/ssi/2014/121/made

Further commencement orders are planned. Our intention is that the Act will be in force generally by the end of 2014.

There are a number of initiatives that will deliver improved broadband connectivity, including superfast broadband, to the final 5%.

Community Broadband Scotland has a £5 million budget to work with remote communities to deliver local broadband projects in the final 5% of areas that will not be served by the Superfast Broadband programme. Scotland is also one of the pilot areas for the £10 million competitive fund across the UK. These initiatives will explore innovative technical and investment solutions to deliver broadband services in some of the hardest to reach areas.

Scotland has been allocated a further £21 million to extend superfast broadband beyond the current predicted coverage levels. This money will be matched in Scotland, which will mean a further £42 million will be available to increase the number of premises with access to superfast broadband. Work is ongoing at the moment to determine the best way to invest this money to deliver improved connectivity and maximum benefits for Scotland.

We have committed to ensuring that premises that are unable to receive superfast broadband through these projects will have access to a minimum of basic broadband connectivity.

In terms of mobile coverage, the commercial market is still investing in the roll-out of 4G coverage across Scotland. We expect this to provide widespread coverage over the next few years and therefore further intervention would be premature at this stage. We will review this when the impact of the commercial roll-out of 4G is clearer and the UK Government’s Mobile Infrastructure Project has been completed.

The following table details primary medical service (PMS) expenditure over the last 10 years.

Primary Medical Service Expenditure (2003-04 to 2012-13)

Information on primary medical services obtained from the published Scottish Health Service Costs Book.

The table reflects that since 2003-04 there has been a cash increase of around £237 million (46%) in PMS expenditure and a real terms increase of around 17% over the period.

Despite the challenging financial climate over the last five years, boards’ expenditure on PMS has remained broadly static – representing on average around 7.6% of total operating expenditure.

General practice has an invaluable contribution to make in improving outcomes through more effective integrated care and management of patients and Scotland already leads the world in patient safety. It is vitally important that the individual needs of patients are at the centre of all that is being and will be done. The Scottish Government is pleased that the Royal College of General Practitioners', through its ‘Put Patients First’ campaign, is in full agreement with this government’s 20:20 vision for health and social care, putting primary care firmly at the heart of its ambition to ensure that people are able to live longer and healthier lives.

General practice, by means of their clinical decisions, affect such services as prescribing, direct investigations and unplanned admissions and in this way commit about 52% of total NHS expenditure.

For the first time this year, health boards were required to complete a ‘Strategic Assessment of Primary Care’ as part of the annual local delivery plan process that will inform the measurable resource shift necessary to innovate in and strengthen primary care, recognising that across Scotland, health boards have different priorities, reflecting their geographic situation, current infrastructure and health needs.

Currently, lungs are allocated to the designated UK transplant centres on a zonal basis and the centres are responsible for selecting the patient. Organs such as the heart and lungs are very vulnerable to time spent in the cold (required for transport of organs) without a blood supply. This fact has to be taken into account in any allocation policy and, in general, encourages transplantation in the centre nearest to where the donation took place.

The allocation of organs is a highly complex clinical issue where we have to rely on expert advice. The current lung allocation policy was developed by the Cardiothoracic Organs Advisory Group within NHS Blood and Transplant (NHSBT). A sub-group of this is presently looking at reviewing the current approach to ensure it delivers the best patient outcomes.

NHSBT monitors the current allocation systems closely to ensure there is equity for all patients across the UK and zones are adjusted to help ensure equity of access. The most recent analysis showed no statistically significant differences in outcomes across the UK lung transplant centres.

The allocation of organs is a highly complex clinical issue where we have to rely on expert advice. The Scottish Government contracts with NHS Blood and Transplant (NHSBT) to develop organ allocation policies and NHSBT draws on the necessary expert advice to do this. It would not be appropriate for the Scottish Government to comment on such an issue.

A sub-group of the Cardiothoracic Organs Advisory Group within NHSBT is currently reviewing the lung allocation policy to ensure that it delivers the best outcomes for all patients awaiting a transplant and I am assured that Scotland’s interests are appropriately represented by clinicians involved in that work.

We welcome the publication of the recent report from the Cystic Fibrosis Trust and sympathise with cystic fibrosis patients and indeed everyone who is waiting for a transplant. I recently met with members of the trust to discuss the report and services for cystic fibrosis patients in Scotland.

Of course, one of the most important factors in reducing the number of people who die while waiting for an organ to become available for transplant, is to increase the number of organs available. Over the last six years we have increased by 96% the number of organ donors in Scotland, and our Donation and Transplantation Plan for Scotland 2013-2020 sets out the ways in which we hope to continue to improve donation and transplantation in Scotland over the next few years.