Meeting of the Parliament

Meeting date: Thursday, April 4, 2019

Official Report 1029KB pdf

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General Question Time

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Fife Health and Social Care Partnership (Deficit)

To ask the Scottish Government what progress it has made in addressing the deficit that was built into the Fife health and social care partnership when it was established. (S5O-03110)

The opening budget deficit dating from the establishment of the integration joint board in 2016-17 is now reduced to just under £9 million. Further progress will be made on that over the coming year.

The deficit needs to be addressed by NHS Fife and Fife Council. Together with the Convention of Scottish Local Authorities, we are engaging with NHS Fife, Fife Council and the IJB to support their plans to systematically reduce the deficit without reducing capacity by redesigning services and delivery and by investing in quality sustainable care.

That is not an acceptable position for us to be in. The chief executive of NHS Fife wrote to me last week and said:

“As we move into 2019/20, the budget position remains challenging with an estimated £15m ... budget gap.”

NHS Fife and the council have had to bail out the IJB for the current year, which is on top of the deficit that it started with.

The only answer from the Scottish Government seems to be that NHS Fife and Fife Council instruct the IJB to cut services. Does the cabinet secretary not realise that it is struggling to deliver services? Will she commit to meeting the co-leaders of Fife Council, who confirmed that to be the case when I spoke to them this morning?

That is a bit ironic. The deficit was bequeathed by Fife Council and NHS Fife to the IJB before it even started. I agree—absolutely—that it is not acceptable, but if Mr Rowley really wants to start changing it, he needs to talk to Fife Council and get it to come on board with the work that COSLA and I are trying to do with the council and NHS Fife to address the deficit that they gave the IJB. They are not bailing out the IJB; they are being forced, in a really perverse way, to address a deficit that they bequeathed in the first place.

We are trying to get them to stop telling the IJB to cut services; to recognise that the IJB has the statutory responsibility and, therefore, the decision-making power for commissioning and planning services; to use the funding that both NHS Fife and Fife Council have, including the additional funding for integrated joint services, to plan systematically to reduce what remains of the legacy deficit over a period of years—let us say the three years that I have given health boards to plan their finances—and to allow the IJB to work within its budget without having to try to repay a debt that belongs to NHS Fife and Fife Council in the first place.

With Fife health and social care partnership looking to tackle the budget gap, day care services and care home closures are being considered. How will the cabinet secretary ensure that vital care for the elderly in the area will not be seriously affected?

We are having a bit of an irony bypass this morning. I remind Alexander Stewart that the additional funds to NHS Scotland and our local authorities, including an additional £160 million for integrated health and social care, are funds that he and his party voted against. Nonetheless, we, on the SNP benches, take our responsibility seriously, even if our Scottish Conservative colleagues do not.

My officials and COSLA officials are directly engaging with the council, the health board and the IJB to resolve the legacy debt that was bequeathed to the IJB without reducing capacity or cutting services. It would be helpful to have members across the chamber engage with us in supporting that in whatever manner they might wish rather than trying to score cheap political points on the back of it.

The cabinet secretary will be aware of the redesign of general practitioner out-of-hours services that is currently under way in the Fife health and social care partnership. A new multidisciplinary model is emerging that could save the services that we have all been fighting for, but it will require additional resources. Will the cabinet secretary commit to providing additional funding for training prescribing pharmacists and advanced nurse practitioners to deliver that new, modern model for out-of-hours delivery across Fife?

I am aware of the proposals that are in hand. We have additional funds available to help both prescribing nurses and pharmacists in those matters. We will look at the proposal when it comes to me specifically.

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Pension Age (Women Born in the 1950s)

To ask the Scottish Government what discussions it has had with the Department for Work and Pensions regarding progress with changing the state pension age for women in Scotland born in the 1950s. (S5O-03111)

We have raised that issue with the United Kingdom Government on numerous occasions and have made clear our position that it should take responsibility for the mishandling of the policy and provide transitional protection for those who have been affected.

Those women have been badly let down by the UK Government, and it is disappointing that, despite the overwhelming evidence of the devastating impact that the changes have had, nothing has changed at the UK Government level. It is time for the UK Government to accept responsibility for the hardship that it has created.

Changes have obviously been made. In the light of the UK Government’s punitive changes to pension credit, with the WASPI women—the women against state pension inequality—again being penalised, I ask the minister to call on the UK Government to put in place fair transitional state pension arrangements and halt the reforms to pension credit, which will hit those who are most in need.

In February, I wrote to the pensions minister about the recent changes to pension credit eligibility, and I urged him to consider the impact of those changes, particularly on those WASPI women who are part of a mixed-age couple and who will now find themselves doubly disadvantaged because of the UK Government’s policies. He did not address my points regarding the plight of the WASPI women in his reply, so we will continue to raise those issues with the UK Government.

The strength of support from all parties, with the exception of the Scottish Tories, was evident in last night’s members’ business debate, which was led by Sandra White. I commend Sandra White and others who are involved in the cross-party group on WASPI for their continued support of the WASPI women in their fight for justice.

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Mental Health Waiting Times (NHS Ayrshire and Arran)

To ask the Scottish Government what it can do to help NHS Ayrshire and Arran reduce waiting times for treatment for mental health problems. (S5O-03112)

Since 2016, the Scottish Government has invested £1.8 million in NHS Ayrshire and Arran for capacity building and workforce development to improve mental health waiting times, with over £770,000 to come. That funding is currently paying for 8.8 whole-time-equivalent staff, with another in recruitment. Alongside that, the board is receiving support from the mental health access improvement team to deliver front-line improvement projects to improve access to treatment.

The Scottish Government is also investing an additional £4 million in child and adolescent mental health services staff across Scotland, who will be instrumental in supporting new services and reducing pressure on the system.

The minister will be aware of the difficulties in accessing CAMHS, particularly in south Ayrshire, and the long waiting time for an appointment with a consultant psychiatrist. She will know that suicide numbers are rising—particularly among young men, but regrettably across all age groups—with loneliness and isolation on the increase. What additional measures can the Scottish Government take to address those growing problems?

Mr Scott might be interested to know that the latest figures show that, in NHS Ayrshire and Arran, 95 per cent of CAMHS and 82 per cent of psychological therapies patients were seen within 18 weeks, with an average wait of seven and five weeks, respectively.

However, the Scottish Government recognises that some people are still waiting too long and we are determined to meet the waiting times standards across Scotland. That is why we set up a new mental health delivery board, which I chair and which had its second meeting this week. The board will oversee improvement activity and will track performance. Boards have been asked to put in place improvement plans by April, setting out clear milestones over the next two years.

The minister will be aware that Labour-led North Ayrshire Council is the first local authority in Scotland to have a dedicated mental health counsellor in each of its secondary schools. However, the leader of the council, Councillor Joe Cullinane, has told me that demand for the service is so high that some schools already have waiting lists, and he has raised the issue of support outwith the school day. What action will the minister take to ensure that every secondary school in Scotland, like those in North Ayrshire, has a dedicated mental health counsellor? What resources are available to ensure that the service is sufficiently resourced and that support does not end at the end of the school day?

Monica Lennon will be aware that we have committed to having school counsellors in every high school in Scotland. As I said in my previous answer, we have also invested £4 million in CAMHS to deliver 80 additional staff, which will ease pressure on the system across the country. We have also committed to having 250 additional school nurses and to rolling out mental health first aid training for teachers across all local authorities. I believe that those measures will help to address some of the issues that Ms Lennon has raised, not just in Ayrshire but across Scotland.

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Silverline Care Caledonia (Unions)

To ask the Scottish Government what its response is to Silverline Care Caledonia derecognising GMB Scotland as the trade union representing the staff in six of its care homes. (S5O-03113)

The Scottish Government’s fair work action plan recognises the important role of trade unions and we are committed to supporting strong trade unions for the benefit of workers and our economy. It is therefore regrettable when an employer chooses to derecognise a union. I strongly urge both parties in this case to come together to reach an agreement.

Does the minister consider that the decision is a concerning development at a time when care home staff across Scotland may feel undervalued, despite providing some of the most valuable services in society?

I agree with Stuart McMillan. Our care home workers, and our social care workers more generally, provide an essential service. The strong message from this place should be that we recognise their great value to our economy and society.

In relation to the specific circumstances, the Cabinet Secretary for Health and Sport is aware of and closely monitoring the situation, and we will be willing to offer any support that is required. However, the matter is being dealt with by the Advisory, Conciliation and Arbitration Service, and I reiterate my message that we strongly urge both parties in this situation to come together, through ACAS if necessary, to reach an agreement.

The derecognition of the GMB at Silverline comes on the back of the derecognition of Unison at Cornerstone. A deliberate anti-union stance appears to be emerging in the care sector. What is the Government doing to stop that from becoming a growing phenomenon? Has the minister met the companies and the trade union concerned to try to end that derecognition movement?

I have not, at this stage. I will be willing to do so, as is necessary. As I said, the Cabinet Secretary for Health and Sport is monitoring the situation. Clearly, it would be preferable if the parties could come together to resolve the situation. If it requires our further involvement, we will consider that. ACAS is actively involved and I hope that both parties can come to an agreement and an arrangement.

I reiterate that we greatly value the work of, and are working with, the trade unions, and I consider it a matter of the utmost regret when, in any circumstances, an employer actively derecognises a trade union.

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Rural GP Association of Scotland

To ask the Scottish Government what steps it plans to take to re-engage the Rural GP Association of Scotland with its remote and rural general practice working group. (S5O-03114)

The rural group chair, Sir Lewis Ritchie, met the new chair of the Remote and Rural GP Association of Scotland on 3 April. I understand that the meeting was productive for all involved. Sir Lewis has acknowledged the concerns raised by RGPAS members and has agreed to hold further discussions in due course towards their continuing involvement in implementing the contract in our remote and rural communities.

I have had discussions with Sir Lewis as recently as last week and will continue to keep in touch with him as the matter progresses.

The cabinet secretary’s answer is very welcome, but there is a perception that tangible progress is not being made in the short-life working group. Will the Scottish Government commit to taking that feedback into account and refreshing the aims and objectives of the group with a view to reflecting the desire for the group to be more proactive?

I am grateful to Ms Ross for that additional question. I am aware of that perception. I do not think that it is entirely fair; nonetheless, it needs to be taken seriously and that was part of the discussion that I had with Sir Lewis. We will now take that feedback very seriously indeed, continue those discussions and look to see what more can be done, so that the group can become more proactive in the work that we need it to take forward.

I agree with Gail Ross’s sentiments, because, as much as the cabinet secretary tries to dress it up, the Rural GP Association of Scotland resigned from the group because of the lack of progress that was being made to take on board rural GPs’ concerns. Will the cabinet secretary agree to meet a cross-party delegation to take forward those real concerns and ensure that we get the GP contract right for every community in Scotland?

It would be helpful if we could wait to see how Sir Lewis’s discussions progress with the new chair of that group. That should be within a short timescale, because I am keen that we make progress on it and engage that particular association in this work. Once we understand how that progress has been made, I am content to meet members to see what more might be done.

I am sure that the Rural GP Association of Scotland will re-engage if it is clear that its concerns are being heard and acted on, because there is real concern about the contract. It flies in the face of addressing health inequalities and it certainly does not value the work of rural GPs. It also lacks oversight by the technical advisory group on resource allocation. Will the cabinet secretary make sure that oversight is in place, so that the contract is in keeping with other health services?

I am grateful to Ms Grant for that question. Of course, we continue to have oversight, but it is worth noting for the record and for members’ information that the Scottish Government did not impose that contract on GPs; the contract was negotiated and agreed with the British Medical Association GP group. Therefore, a significant number—in fact, a majority—of GPs across the country voted for that contract and are already working to it and seeing the benefit of it, including GPs in remote and rural practices. Nonetheless, there are additional concerns, which we are attempting to address. I am happy to keep members up to date with the progress that we make in that regard.

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Falling Birth Rate

To ask the Scottish Government, in light of the birth rate falling to its lowest level since records began in 1855, whether it will provide details of the steps that it will take to support people to have children, including supporting existing families to have more children. (S5O-03115)

Deciding when, and if, to have children is a matter of personal choice. The Scottish Government is working hard to create a country that is the best place in the world to grow up, through a variety of initiatives that are aimed at supporting pregnant women, children and families.

Our targeted support that is provided to families includes our best start pregnancy and baby payments—which have already awarded more than £2.7 million—the provision of universal free school meals for every child in primary 1 to primary 3 and a school clothing grant that supports approximately 120,000 children.

We have funded 600 hours of early learning entitlement for all three and four-year-olds and eligible two-year-olds, which will rise to 1,140 hours from August 2020, and more than 80,000 baby boxes have been given to new parents across Scotland.

I thank the cabinet secretary for that answer.

In the 20th century, Scotland’s population growth was the lowest on earth. Last year, our birth rate was a feeble 9.2 per 1,000 people—well below replacement level. By contrast, our northern neighbour, the Faroe Islands, had a fertility rate of 2.4 children born to each woman—one of the healthiest in Europe.

Does the cabinet secretary agree with the Scottish Government’s expert advisory group on migration and population that immigration alone cannot address regional or local depopulation or sustain communities? What will the Scottish Government do to research the barriers to Scots having children?

The decreasing birth rate is not new and it is not unique to Scotland. A recent report from the National Records of Scotland suggested that some of the reasons behind that are that women might be postponing childbearing until later ages and that economic uncertainty might be influencing decisions around childbearing. That is why the Government is doing what it can to help overcome some of those uncertainties and has introduced a raft of new financial supports, some of which I outlined in my earlier answer.

We are also taking wide-ranging action across Government portfolios to tackle poverty, by increasing income for work and earning, reducing household costs and maximising income from social security and benefits in kind. That will ensure that Scotland is not only the best place to grow up, but the best place to have children.

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General Practitioners in Rural Areas

To ask the Scottish Government what action it is taking to support GP practices in rural areas. (S5O-03116)

General practitioners in rural communities face distinct challenges, so the 2018-19 package of support that we put in place included financial support for recruitment incentives; financial support for relocation costs for GPs moving to rural posts; support for the Scottish rural medicine collaborative to develop recruitment and sustainability measures, including the £20,000 for GPs scheme; support for GP recruitment and resilience schemes in the Highlands and Islands; additional support of £0.5 million to support rural dispensing practices; and £150,000 to support information technology improvements to rural health boards.

A recent survey of rural GPs showed that 82 per cent of members of the Rural GP Association of Scotland believe that the outlook for rural healthcare is worse under the new contract and that 92 per cent of its members would reject the contract if they were given an opportunity to vote on it now. What reassurance can the cabinet secretary give rural GPs, who are clearly desperate and feel that their voices are being ignored by her Government?

That contract was negotiated with the British Medical Association and was passed by GPs, including GPs in rural communities. It is always worth making the point that this Government did not impose the contract on GPs. Nonetheless, we are continuing to work with the BMA, which also needs to take account of some of these concerns. In fact, I met the BMA only yesterday to discuss what more we might do in phase 2 of the contract. We are also, as I said to my colleague Gail Ross, taking forward work with Sir Lewis Ritchie to take account of and address those concerns specifically, in addition to the substantive package of comprehensive support that I outlined.