Meeting of the Parliament

Meeting date: Tuesday, June 4, 2019

Official Report 985KB pdf

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Topical Question Time

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Out-of-hours General Practitioner Services

To ask the Scottish Government what action it is taking to improve out-of-hours GP services in the NHS Greater Glasgow and Clyde area, in light of reports that only one in five centres was open on Sunday. (S5T-01686)

I expect all integration authorities to take every measure possible to ensure that safe and sustainable out-of-hours services are provided. However, arrangements are in place for Sir Lewis Ritchie and senior Scottish Government officials to meet the management team in Glasgow regarding their review of out-of-hours care and the difficulties that are being experienced by the service.

Since 2016-17, the Government has provided an additional £6.6 million to the Glasgow integration authorities to support implementation of Sir Lewis Ritchie’s review of out-of-hours services.

The reality is that, this weekend, only one centre was open across the whole of the city of Glasgow. I pay tribute to the staff at Vale of Leven hospital, who had to deal with the huge amount of people coming in to see them.

When people in the south side or east end of Glasgow phone NHS 24 and are directed to an out-of-hours service, it is virtually impossible out of hours to get to that location because it requires a taxi or a lengthy car journey. Most people will turn up at an accident and emergency unit, which puts more pressure on our emergency centres on busy Saturday nights.

What I did not hear in the first answer is what action the minister—or, indeed, the Scottish Government—is taking to address the issue of GPs who are not contracted to do out-of-hours shifts choosing not to do them. What are the reasons behind GPs choosing not to do those shifts? Why is it becoming a systemic problem in Glasgow?

Last year, more than 211 shifts in the NHS Greater Glasgow and Clyde area were not filled because of staff shortages. In her second answer, perhaps the minister can go into more detail about what action she is taking to address the problem.

My understanding is that arrangements were put in place between NHS Greater Glasgow and Clyde and NHS 24 over the weekend to deal with the closures. Home visits by GPs were available to people who had clinical need for that.

I am not happy with the level of service, and I expect NHS Greater Glasgow and Clyde and the health and social care partnerships to take every possible step to stop that happening again.

As I said in my first answer, Sir Lewis Ritchie and the out-of-hours policy team have a planned meeting with NHS Greater Glasgow and Clyde to discuss progress on the review of its out-of-hours services. That meeting will be on Monday 10 June; this weekend’s issues will form part of the discussion. We expect to receive an update in due course following that meeting.

I also pay tribute to the staff at the Vale of Leven centre, who were under pressure at the weekend because their centre was open.

I thank the minister for that further update.

However, the reality is, as we learned last week, that across Scotland, more than 100,000 patients have had to find new GP services because their local practice has closed due to excessive shortages of GPs. Every member will have constituents who are struggling to get an appointment—who are queuing on a Monday morning or who cannot get through on the telephone to get an appointment. This is not just an out-of-hours problem; it is an in-hours problem.

I would like to hear what action the Government is taking to address the systemic problem of GP shortages right across Scotland. Can the minister assure us and the wider public that what happened at the weekend in Glasgow was just a blip—that it was just a one-off—and that there is not a systemic problem that is facing us right across the country on a continuous basis, because that would simply not be good enough?

I assure Jamie Greene that I share his concerns. I want to ensure that the people of Glasgow—and, indeed, the people of Scotland—get the NHS that they need. Jamie Greene will be aware that we have recently rolled out the new GP contract, which helps to reduce GPs’ workloads so that they can spend more time dealing with the more complex cases and patients in their case load. We are considering expansion of the primary care team, which encompasses advanced nurse practitioners and other allied health professionals, in order to free up GP time so that they have smaller workloads and can use their skills more effectively. We have also been investing in primary care pharmacy and the minor ailments service. I assure the member that we are looking at GPs’ workload.

We are also looking to expand the number of GPs. We have increased the number of medicine places in Scottish universities, which will increase by 22 per cent—an extra 190 places—between 2015 and 2021.

I am delighted that the Vale of Leven hospital’s out-of-hours service was open, and join other members in praising the staff. Of course, the irony is that it is normally the Vale’s out-of-hours service that is closed. Last year alone, there were more than 80 shutdowns of the out-of-hours service, and there have been more than 40 so far this year. Will the minister consider use of salaried GPs, or even allowing local GPs who cover the Vale of Leven catchment area to arrange out-of-hours care at the hospital?

I expect that that will be discussed in Lewis Ritchie’s review, in looking at what NHS Greater Glasgow and Clyde is doing to ensure that it has GPs to cover out-of-hours services. My understanding is that there are some salaried GPs in the out-of-hours GP service as a whole, but most of the GPs who work in the service are not salaried.

As the minister will be aware, staff can be deployed throughout the system to ensure that adequate cover is maintained across the health board area. Given that, is the minister aware of whether there is a preference as to which out-of-hours centres will be open on any given weekend?

I do not have that information to hand for Stuart McMillan, but I make a commitment to request that he gets it as soon as I have it.

Obviously, Saturday night is a peak time for accident and emergency services across the west of Scotland and the whole of Scotland. There are two impacts. One is on patients who perhaps have to wait longer to access NHS 24, or who show up in A and E departments when they would not normally do so, which increases their waiting time.

There is also an impact on the NHS staff, who are already overworked and who face more pressures because there are fewer staff and more requirements on them. I understand the point about the review, but if the minister recognises those two pressures, what urgent steps will she take to reassure patients across Glasgow and the west of Scotland that they can have a wraparound out-of-hours service?

As I said in answer to Jamie Greene, I am not happy with the level of out-of-hours service that was provided at the weekend. We expect NHS Greater Glasgow and Clyde and the health and social care partnership to look at the service to ensure that we do not end up in the same situation again. Mr Sarwar has raised valid points. I again pay tribute to the staff who were on duty on Saturday night and Sunday night and who provided a service to the people of Glasgow.

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Prisoner Transport (Family Vehicles)

To ask the Scottish Government what its response is to reports that prisoners are being transported in family vehicles. (S5T-01687)

The prisoner escort and court custody services contract is with GEOAmey. The services that are provided under the contract include the movement of those arrested from police custody to court and the movement of those held in prison to court or to any other location, including hospitals and other prisons.

GEOAmey has a range of vehicles in its fleet. The contractor carries out robust risk assessment and makes a decision about the most suitable vehicle in which to escort the individual. The type of vehicle is only one factor in ensuring the security of an escort. For example, the type of vehicle to which Daniel Johnson refers is used to transport sentenced children and young people as well as pregnant women in custody. Non-cellular vehicles are used where it is appropriate to do so. The safety and wellbeing of the staff, those being transported and the general public are of paramount importance to the Scottish Prison Service and the Scottish Government.

The reality is that, according to press reports at the weekend, a convicted murderer who was being transported in such a family vehicle went on to strike prison staff while it was doing 60mph on the A90. Surely, the question is whether those kinds of vehicles can ever be considered suitable for transporting violent individuals such as the one who was featured in those reports.

I checked with the SPS this morning. As the member will no doubt be aware, a new prisoner escort service contract was recently awarded and started in January this year. To date, no incidents have been reported to the SPS under that contract.

A dynamic risk assessment is carried out before deciding the most appropriate vehicle in which to escort an individual. If someone is considered to present a high risk, it is unlikely that a non-cellular vehicle would be used. At appropriate stages of their sentences, individuals who have committed serious offences such as murder, which Daniel Johnson mentioned in his example, are escorted in non-cellular vehicles. Although their offences might have been serious and of a high-profile nature, individuals who are escorted by that means of escort will have been subject to risk assessment to determine that they are suitable for it. Such individuals are most likely to be accessing the community while they are on licence and therefore are not considered to present a high risk at that time.

I thank the minister for her response, but does such an occurrence not at least hint at the possibility that the risk assessments are inadequate? Does she not feel that, at the very least, a partition should be installed in such vehicles to protect hard-working prison staff from the risks that prisoners might pose? Will she agree to meet the GMB union, which represents those staff, to discuss the safety concerns that they continue to have?

On Mr Johnson’s point about safety in cars, in April 2019, GEOAmey tested new bulkheads, which are now being installed throughout the fleet to improve driver safety. I have been advised that that roll-out will be complete at the end of this month. That additional measure has the support of the Community trade union, which is the recognised union that represents staff who work in the area. The member has requested that a meeting be held with the trade union that he mentioned. I am sure that the cabinet secretary would be happy to take part in such a meeting.

Up to five members wish to ask supplementary questions, so I ask all members to keep their questions brief.

Will the minister confirm whether non-cellular vehicles have been used routinely to transfer high-risk offenders, including those who have been convicted of serious crimes such as murder?

About 180,000 prisoner movements are undertaken every year, the vast majority of which are in cellular vehicles. There are occasions on which non-cellular vehicles are used and will be appropriate—for instance, when children and young people, or pregnant women who are going to hospital appointments and so on, are being transported. I am sure that the member will recognise that in such instances non-cellular vehicles will be the most appropriate form of transport.

Still on the subject of appropriate equipment and staff safety, I stress that prison officers have to deal with an increasingly high-risk environment. Those who work south of the border have been equipped with body-worn cameras, but the Scottish National Party has refused to give such cameras to our officers in Scotland. Why does the SNP think that their safety is less important?

We absolutely do not think that. The Scottish Prison Service does not have a record of staff raising such concerns, but if any instances were to be raised with the contractor they would be passed on to the SPS, which would investigate every single incident to see whether lessons needed to be learned in such cases. I assure the member that a robust process is in place to monitor and investigate all incidents that are reported by the contractor. However, I reiterate that, as I said in my previous reply to Daniel Johnson, under the current contract, which began in January, no incidents have so far been reported.

Is the issue here not that there was only one bidder for a contract that is worth £238 million? The minister talked “robust risk assessment”, but then qualified that by saying that it is carried out where it is “appropriate”, and she used the word “unlikely”. Is it not time that the Scottish Government reviewed the provision of prisoner escort and court custody services and took them back in-house?

I thank the member for that question. I take on board the concerns that he has raised. The escorting contract has, of course, freed up front-line staff in both the Scottish Prison Service and Police Scotland and allowed them to undertake their core duties. Prior to the inception of the contract, staff were required to be diverted from key tasks to escort prisoners to and from prisons, police stations, hospital appointments and so on.

The Scottish Government and its agencies set the standards of the service and they assess bidders on a number of criteria, including their organisational values. That allows us to ensure that the terms of how they operate are well aligned with what the Scottish ministers want to see from the service in Scotland. The contracts are then rigorously monitored to ensure that they provide the taxpayer with the best possible service delivery.

As John Finnie said, GEOAmey was awarded the £238 million contract after alternative providers dropped out and despite a track record that includes multiple violent escapes and critical equipment failures. Does the minister believe that in such circumstances, companies must be held accountable? Does she agree that that could be achieved by extending the remit of the freedom of information legislation to include private companies that operate public contracts?

The member has raised an important point. I believe that contractors should be held accountable for their level of service. I do not have any further information on the point that the member has raised, so I undertake to write to him with a fuller answer to his question.

Following on from the answer to Rona Mackay’s question, will the minister clarify which vehicles children and young people travel in?

Children and young people are transported in non-cellular escort vehicles that have a range of securing measures. For example, each vehicle must be fitted with a locking system such that the child or young person cannot operate the windows and doors. The vehicle must not in any way identify the purpose for which it is being used. It must be of a size such that it is capable of accommodating a minimum of three adults in the rear seats in order to ensure sufficient comfort on a long journey.