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Chamber and committees

Meeting date: Thursday, February 27, 2020

Meeting of the Parliament 27 February 2020

Agenda: General Question Time, First Minister’s Question Time, War Memorials, Exam Results 2019 (Analysis), Portfolio Question Time, Budget (Scotland) (No 4) Bill: Stage 1, Decision Time


Portfolio Question Time

Health and Sport

Transvaginal Mesh Implants (Removal)

1. Neil Findlay (Lothian) (Lab)

To ask the Scottish Government whether it will provide an update on when Dr Veronikis will come to Scotland to carry out full mesh removal procedures. (S5O-04171)

The Cabinet Secretary for Health and Sport (Jeane Freeman)

This week, the chief medical officer wrote to Dr Veronikis to reiterate her invitation to him to come to Scotland for an observational visit. In their discussions, they have been looking at a provisional date of April or May. She also advised him of the offer of a contract of employment, subject to the detailed deliberations and agreement on processes and working in the NHS Scotland environment, which have previously been discussed with him and are standard for any visiting clinician.

We hope that Dr Veronikis will be able to accept that offer, subject to his availability. Today, the chief medical officer has written again to Dr Veronikis to get his response to her earlier letter, which contained the offer of a contract of employment.

Neil Findlay

Things are moving ahead very slowly, but I am pleased to hear that there is some progress at last.

In the meantime, women here are being told that they are having full mesh removal procedures, and those have been recorded on their medical records, only for them to then go to the US to be operated on by Dr Veronikis and find that he has removed 10cm, 15cm, 20cm or more of mesh from them.

This week, I got a response from the First Minister following the meeting that we had in November, which said that if women had such concerns, they should report the cases to the regulator. These women have gone through enough. They do not need the added stress of taking individual cases to the General Medical Council. I am asking whether the cabinet secretary—or, indeed, the First Minister—will now call in the GMC to look at what appears to be the systematic misleading of patients in the recording of procedures on patients’ notes.

Jeane Freeman

I have two points to make in response to that. On the point about matters moving slowly, I completely understand what Mr Findlay is saying. I share that frustration, but there are proper processes to go through to ensure that Dr Veronikis understands the environment in Scotland in which he would be operating, as he has acknowledged. Dr Veronikis has accepted that it is the right professional approach to come for an observational visit so that he understands what he needs by way of instruments and so on before he can come and operate. The offer of a contract of employment is a clear indication that that is where we want to be.

Mr Findlay has raised the point about cases before. We committed to having an independent clinician-led case note review, and that is under way. Professor Alison Britton has agreed to act as moderator for the review. It will involve independent clinicians who will be sourced by the Royal College of Obstetricians and Gynaecologists and who will look at the cases of each of the individual women and discuss them with them. That is the right next step to take before we see what evidence exists that could—if necessary—be referred to regulators. We need to do that in a way that involves, as it has done, the royal college, Professor Britton and the Health and Social Care Alliance Scotland, to ensure that patients’ views are fed into it. That work is well under way.

The specific reviews will begin in April. We will write to all the women whose information we hold, from the meetings that the First Minister and I have had with them, plus any others who have written to me. Others may want to come forward. We will write to those whom we know of at the moment to tell them exactly what will happen in their individual cases.

They will also be told how they can be involved and that we will take the lead in ensuring that their individual cases are looked at. It is a very serious situation, and I assure Neil Findlay that I will take further action if it is required.

The Deputy Presiding Officer (Christine Grahame)

That was, quite rightly, a very long and detailed answer, but I must ask for shorter supplementaries and shorter answers. That was a very full answer.

Miles Briggs (Lothian) (Con)

In a letter that I received from the cabinet secretary on 24 February, she said that work is currently on-going on drawing up the organisations, set-up criteria and validity for the new £1 million fund. Will women who are affected be involved in that, and what discussions have taken place?

Jeane Freeman

Yes. We are working with the Health and Social Care Alliance Scotland. We already have a lot of information, which has come from the women who have been in touch with us and with whom we have met, about the specific financial issues that have affected them. We will continue to involve them.

I hope to announce the exact details of the fund very shortly, including what the criteria are and how to apply.

Ruth Maguire (Cunninghame South) (SNP)

My constituent Julie is a full-time carer for her husband who has serious mobility issues. She is anxious and worried about her capacity to make the journey to Edinburgh, and the impact that it will have on her recovery. Will the cabinet secretary explore with me, perhaps at a later date, the issue of travel, recovery and rehabilitation for women from the west of Scotland who have to travel to Edinburgh?

Jeane Freeman

I am happy to tell Ms Maguire about the existing arrangements and how they might assist her constituent. I am also happy to look in more detail at the use of the fund, and whether there are aspects of care that can be delivered more locally.

Inflammatory Bowel Disease

2. Clare Adamson (Motherwell and Wishaw) (SNP)

To ask the Scottish Government what action it is taking to improve outcomes for people with inflammatory bowel disease. (S5O-04172)

The Minister for Mental Health (Clare Haughey)

Through its modernising patient pathways programme, the Scottish Government has been working closely with health boards and Crohn’s and Colitis UK in recent years to improve IBD services, pathways and patient outcomes across Scotland.

That includes the development of a series of self-management tools, care plans, a mobile app and supporting the pilot of a new specialist IBD community nurse model. In addition, we are currently trialling flare cards in NHS Lothian. Those provide people with quick and easy advice on the immediate steps that they can take to help manage unpredictable and fluctuating symptoms. The cards were co-developed with Crohn’s and Colitis UK and will shortly be extended to a further two health board areas: NHS Grampian and NHS Borders, with the intention of rolling their use out across the rest of Scotland, subject to further evaluation.

Clare Adamson

I thank the minister for the information regarding flare cards.

Based on discussions in the cross-party group on IBD, I understand that different health boards have different pathways for diagnosis and treatment of people; some are using primary care options and some are using secondary care options. In that context, what is the Government doing to ensure that there are clear pathways and protocols available to IBD sufferers across Scotland, and that those pathways are in line with best practice?

The Deputy Presiding Officer

Clare Adamson—[Interruption.] Oh, no. That would mean that you would be answering your own question. I call the minister.

Clare Haughey

First, I pay tribute to the work of the Parliament’s cross-party group on IBD and to Clare Adamson for the interest that she has shown in IBD over some years. The modernising patient pathways programme is leading on a series of national workshops with the gastroenterology community across Scotland, with a view to producing evidence-based standardised pathways for people who present with lower gastrointestinal symptoms, including those with an IBD diagnosis.

Mary Fee (West Scotland) (Lab)

Children and young people with inflammatory bowel disease are often misdiagnosed, which results in multiple hospital admissions and absences from school. An early diagnosis is a significant factor, given the huge rise in paediatric inflammatory bowel disease, which is mainly driven by Crohn’s disease. What steps will the Scottish Government and the NHS take to improve diagnosis for children and young people who have inflammatory bowel disease?

Clare Haughey

Mary Fee has raised an important issue. The Scottish Government has been investing in research by Cure Crohn’s Colitis and the Crohn’s and colitis in childhood research project, which is led by Professor Charlie Lees, a consultant gastroenterologist based at the Western general hospital.

The project will help to determine what causes disease flare-ups in some patients, and has the potential to lead to the development of personalised therapy for colitis. The project that I referred to is the PREdiCCT—prognostic effect of environmental factors in Crohn’s and colitis—study. There is investment in and research on this important issue in Scotland.

Scottish Ambulance Service (Investment)

3. Stuart McMillan (Greenock and Inverclyde) (SNP)

To ask the Scottish Government what investment it is making in the Scottish Ambulance Service ahead of the west of Scotland trauma network being launched. (S5O-04173)

The Cabinet Secretary for Health and Sport (Jeane Freeman)

By the end of 2019-20, we will have invested £33.4 million in the Scottish trauma network, which includes the Scottish Ambulance Service. Funding is planned to increase to £41.6 million annually by 2023-24.

Thanks to the investment to date, the SAS trauma desk, which is based at the Glasgow ambulance control centre, is operational 24/7 and plays a vital role in the co-ordination of the service’s response to trauma. There is additional investment in major trauma equipment across the service’s emergency vehicle fleet.

Stuart McMillan

At a recent community council meeting in my constituency, where senior staff from the Inverclyde royal hospital spoke about the west of Scotland trauma network, concerns were raised by constituents about the impact of the network on local ambulance provision. Will the cabinet secretary provide assurances to my constituents that the Scottish Ambulance Service will be able to meet the needs of the local community when the trauma network is launched, and that it will not result in slower response times in Inverclyde, particularly as ambulances have to take patients up to Paisley and Glasgow?

Jeane Freeman

I understand that such concerns have arisen in that instance, but the Ambulance Service is really clear about our expectation that it gives consideration to the impact of any changes where additional demands are placed on its capacity.

The SAS is undertaking a national review of demand and capacity, which will include the anticipated demand on it from the west of Scotland trauma network. It will use its experience from elsewhere in Scotland where there are trauma centres—Aberdeen and Dundee, currently. The review of demand and capacity will help it to ensure that it is able to meet demands and, from that, it will set out its requirements of the health service in terms of additional resources and where those resources need to be deployed.

We are committed to supporting the Ambulance Service in that work and to seriously considering the outcome of its national review of demand and capacity, taking account of all the factors that we have outlined.

Urology Appointments (NHS Tayside)

4. Murdo Fraser (Mid Scotland and Fife) (Con)

To ask the Scottish Government what the average waiting times are for a urology appointment at NHS Tayside. (S5O-04174)

The Cabinet Secretary for Health and Sport (Jeane Freeman)

The average wait for a new out-patient urology appointment in NHS Tayside was 32 days during the quarter that ended in December 2019.

More than £9.6 million has been made available to NHS Tayside in the current financial year to reduce waiting times across all specialties. In autumn 2019, NHS Tayside opened a treatment centre that is specifically focused on reducing urology waiting times. The focus is to enhance patient pathways and experience when accessing urology out-patient services.

Murdo Fraser

Despite the figures that the cabinet secretary quoted, I have been told by two constituents in just the past few weeks that they have been told that they have to wait 60 weeks to see a specialist urologist in NHS Tayside. I am sure that the cabinet secretary agrees that, for people with conditions that are sometimes painful and distressing, a wait of a year and two months is totally unacceptable. Will the cabinet secretary do more to help NHS Tayside to address that problem?

Jeane Freeman

I completely agree with Murdo Fraser and his constituents that that wait is too long. If he would care to send me the details of the specific cases that he referenced, I will pick them up directly with NHS Tayside.

All the boards have a trajectory from the waiting times improvement plan, and we have a weekly—in some instances, daily—focus with boards on the improvements that they are making against the investment that we have given them to improve waiting times.

I would like to see the information about the specific matter, have a detailed look at it with NHS Tayside and then get back to Mr Fraser.

Obesity Rates (School-age Children)

5. Willie Coffey (Kilmarnock and Irvine Valley) (SNP)

To ask the Scottish Government whether obesity rates in school-age children are reducing and what measures are being considered to make further progress. (S5O-04175)

The Minister for Mental Health (Clare Haughey)

The percentage of children who are at risk of being overweight has been fairly constant over the past decade at about 22 per cent, of which 10 per cent are at risk of obesity. However, there are increasing inequalities in child unhealthy weight between children who live in the most and least deprived areas. That is why our ambition to halve childhood obesity by 2030 and significantly reduce health inequalities sits at the heart of “A healthier future: Scotland’s diet and healthy weight delivery plan”, which was published in 2018.

We are taking action on many fronts. In the coming months, we will publish a plan to make it easier for people to eat well outside the home, and we will introduce legislation later this year to restrict the promotion of foods that are high in fat, sugar or salt. There is more to be done to strengthen support for children and families to eat well and have healthy weight in the early years.

Willie Coffey

According to Obesity Action Scotland, 16 per cent of children aged two to 15—that is about 130,000 children—are at risk of obesity. As the minister said, the problem seems to be widening between the most deprived and the most well-off communities. Can the minister give us some assurance that the Government’s commitment to halve child obesity by 2030 can get back on track? What more can we, our families and our schools do to encourage healthy eating in the home and at school?

Clare Haughey

I assure Willie Coffey that the Scottish Government is committed to reducing the number of obese people across Scotland, and particularly the number of obese children. The Scottish Government is doing many things, but the issue is fundamentally one for everyone in Scotland, including public bodies, industry and front-line practitioners, all of whom have a part to play in improving Scotland’s diet and supporting children to eat well.

We welcome the commitment of local partners in North Ayrshire, the east region and a number of other localities to work across the system to lead innovative action in their local communities. That includes exploring opportunities through a wide range of levers, such as planning and licensing, to tackle childhood obesity.

Drug and Alcohol Treatment Services (Punitive Sanction Regimes)

6. Ruth Maguire (Cunninghame South) (SNP)

To ask the Scottish Government what its position is on the use of punitive sanction regimes in drug and alcohol treatment services. (S5O-04176)

The Cabinet Secretary for Health and Sport (Jeane Freeman)

The Scottish Government does not advocate the use of punitive sanctions in drug and alcohol treatment and recovery services. In line with the approach in the rest of our national health service, a person-centred approach to treatment and recovery is a key focus of our “Rights, Respect and Recovery” strategy, and it is highlighted as part of our eight-point treatment plan.

Ruth Maguire

The cabinet secretary will share my concern that punitive sanction regimes do exist in drug and alcohol treatment services. What will the Scottish Government do to ensure that that ends and that all treatment services meet people where they are and offer them the best chance of support and recovery?

Jeane Freeman

As I think members across the chamber understand, in addition to the significant additional investment that the First Minister mentioned at First Minister’s question time, which my colleague Ms Forbes will make clear in the budget debate to come, all of the investment should be focused on ensuring that all our services, including mental health services, wrap around individuals rather than forcing them to fit into the nature of processes and services and how services want to run themselves. That was a clear signal and a clear recommendation that came to us from the Dundee drugs commission, and we are actively taking that approach in our plans for the coming financial year.

That significant investment, which is in addition to the £50 million-odd that sits with our health boards for this work, will be used proactively to ensure that we are listening, as Mr FitzPatrick was doing yesterday, to the voices of those with personal experience and service providers and users. We will ensure that the drug and alcohol treatment services are targeted at what individuals need and that they reach out beyond health into housing and other matters that are the responsibility of our local authority colleagues. In that way, we will put the services around the individuals and genuinely help them to move on with their lives.

The Deputy Presiding Officer

Question 7, which will be the last question, will have to be brief on all counts.

NHS Greater Glasgow and Clyde (Meetings)

7. Anas Sarwar (Glasgow) (Lab)

To ask the Scottish Government when it last met NHS Greater Glasgow and Clyde and what was discussed. (S5O-04177)

The Cabinet Secretary for Health and Sport (Jeane Freeman)

Ministers and Scottish Government officials regularly meet representatives of NHS Greater Glasgow and Clyde. As Mr Sarwar will know, we have two oversight boards running on that health board. I last met the chair of the health board on 7 February. The second performance oversight group that has been established, which is chaired by NHS Scotland’s chief performance officer, also met on 7 February and its second meeting will be held later today.

Anas Sarwar

The cabinet secretary knows my views on the leadership of the health board.

The matter of out-of-hours general practitioner services in Greater Glasgow and Clyde came up earlier, during First Minister’s questions. The problem is not just temporary closures; it is a systemic problem to do with GP shortages. In 2017, there were 54 closures of out-of-hours services across the health board because of GP shortages; in 2018, there were 258 closures; and, in 2019, there were 816 closures. What urgent action will the cabinet secretary take to ensure that we have continuity of care for the people across Greater Glasgow and Clyde?

Jeane Freeman

I am grateful for that question. I need to correct Mr Sarwar in as much as the problem with out-of-hours services in Greater Glasgow and Clyde is not about GP shortages. GPs are willing to be involved in those services. The problem is that NHS Greater Glasgow and Clyde has not paid attention to Sir Lewis Ritchie’s review and it has not enacted his very clear recommendations. That has resulted in the instances that you mentioned. One of the reasons why I escalated the full board to level 4 of the monitoring regime is so that we can direct and improve the service.

It is clear to me from visiting those out-of-hours services, from Sir Lewis Ritchie’s direct engagement with GPs and from my conversations with GPs, that GPs are very willing to work in those services. Many of them consider that to be a positive enhancement to their role. However, they need there to be a multidisciplinary team in those services, an appointment-based system and a location that is safe and offers them what they legitimately expect from working conditions.

The board has consolidated to four out-of-hours centres in order to ensure that it can deliver that service, under our direction. It will then expand from four to seven and then back to nine centres, in order to ensure that we have a robust, sustainable service. Out-of-hours services are critical to primary care, which is critical to integration. I could not agree more. That is the basis of the issue; that is why we are taking the action that we are.

The Deputy Presiding Officer

I apologise to Fulton MacGregor for failing to reach his question.