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Chamber and committees

Meeting of the Parliament

Meeting date: Wednesday, November 30, 2016


Contents


Portfolio Question Time


Health and Sport


Waiting Times (Out-patients)

To ask the Scottish Government what action it is taking to lower out-patient waiting times. (S5O-00396)

The Cabinet Secretary for Health and Sport (Shona Robison)

There has been significant growth in out-patient numbers: more than 140,000 extra patients are now being seen annually, in comparison with the situation in 2009. Last week, I announced that £10 million has been made available to health boards to reduce long waits for first out-patient appointments. That funding will provide an additional 40,000 out-patient appointments between now and the end of March.

Yesterday, I announced the publication of a consultative document, “The Modern Outpatient: A Collaborative Approach 2017-2020”, which aims to transform out-patient care and deliver a major shift in the way that it is delivered. The document sets out a new strategy for managing the rising demand in out-patient appointments and aims to free up approximately 400,000 hospital appointments. It will enable people to be seen by the most appropriate health professional and often closer to home, thereby ending many repeated and unnecessary trips to hospital.

Dean Lockhart

Further funding is, of course, welcome. However, as we on the Conservative side of the chamber have said a number of times, it is not just about the money that is spent, but about the availability of the necessary staff resources to deliver satisfactory outcomes for patients.

Throughout Scotland, there are high vacancy rates in cardiology—especially in NHS Forth Valley, where the vacancy rate for cardiology consultants currently stands at 16.7 per cent, which is above the national average. That is having a direct effect on patient outcomes. In NHS Forth Valley, despite the hard work of local staff, the longest reported wait to see a cardiologist is 202 days, which is nearly 29 weeks. That is more than double the Scottish Government’s target of 12 weeks. What is the cabinet secretary doing to resolve urgently the problem of high vacancy rates for cardiology consultants throughout Scotland and in NHS Forth Valley, and to address the unacceptable waiting times for patients?

Shona Robison

In taking forward the out-patient plan, we will need to ensure that a range of health professionals, especially those who work in the community, are involved. The £500 million investment in primary care will help to ensure that we have the right professionals in the right places to enable us to manage the out-patient process much more effectively. The consultant, as a specialist, will remain very important in that process.

I can tell Dean Lockhart that the number of medical and dental consultants went up by 40 per cent between September 2006 and June 2016, so there are more consultants and specialists. However, there are shortages in particular specialties, including cardiology, which presents a challenge. Dean Lockhart has raised specific local issues relating to cardiologists in NHS Forth Valley, so I will write to him with more specific information about the action that is being taken to address those issues.

Maree Todd (Highlands and Islands) (SNP)

I welcome the Scottish Government’s investment in reducing out-patient waiting times. Over the winter period, demand for national health service provision is expected to increase. What support is being given to NHS boards over the winter to ensure that the required capacity is in place to manage the expected increase in demand?

Shona Robison

Last week, I announced the allocation of an additional £3 million to NHS boards to support them in their preparations for winter. The funding is for increasing winter resilience in each area and is in addition to previously announced sums, including £9 million to support accident and emergency departments over the winter and £30 million specifically to reduce delayed discharges this year.

John Scott (Ayr) (Con)

Patient treatment following general practitioner referrals in NHS Ayrshire and Arran is now the worst in Scotland, and has been falling from acceptable levels to unacceptable levels for the past 18 months. I am aware of the issue because a growing number of my constituents have contacted me because they are unable to get hospital appointments, with winter pressures still to come.

I have raised the issue of unmet demand in different ways with the cabinet secretary over several years. She has reasonably acknowledged the growing problem and I welcome her promise of extra funding. However, hand wringing over statistics of misery and disappointment that have a bearing on outcomes is no longer enough—notwithstanding the daily more-frantic efforts of front-line staff to get through the work. What instructions or funding will the cabinet secretary give directly to NHS Ayrshire and Arran to encourage it, or force it, to raise its game?

Shona Robison

I acknowledge that John Scott has regularly raised issues to do with NHS Ayrshire and Arran’s performance. Of course, NHS Ayrshire and Arran will get a share of the £10 million to improve out-patient performance. That is important for the short term because it will create 40,000 additional out-patient appointments across Scotland between now and March.

However, there is a more fundamental issue. The way our out-patient system works means that everybody ends up in the same queue to see a specialist, even if it would be better that they were treated by someone else. A lot of work has been done to make sure that many of those who would, for example, have been in the traditional queue to see an orthopaedic consultant are now being seen by a physiotherapist because the physiotherapist is the best health professional to see them.

Through reform of out-patient services—whether in Ayrshire and Arran or anywhere else—we need to make sure that we get people to the right professional, so that the people who need to see specialists can see them far sooner. I am happy to write to John Scott with more detail about the proportion of the £10 million that will be allocated to NHS Ayrshire and Arran.

Thank you. I encourage members to ask shorter questions and ministers to give shortish answers. We will get through more.


Lightburn Hospital

To ask the Scottish Government how long it would take to make a decision on the future of Lightburn hospital if this was to come to ministers. (S5O-00397)

The Cabinet Secretary for Health and Sport (Shona Robison)

As Pauline McNeill knows, NHS Greater Glasgow and Clyde’s proposals for Lightburn hospital might well change, or not be taken forward at all, as a result of the public engagement process that is under way. That is part of the well-established process on service change in the NHS and why I cannot, and will not, prejudge the outcome.

The time that needs to be taken to consider carefully any major service change proposals largely depends on the nature, context and complexity of the proposals. If the proposals are designated as major and they come to me, I will take sufficient time to consider carefully all the available evidence and representations.

Pauline McNeill

In January this year, former MSP Paul Martin highlighted that there was a plan to close Lightburn hospital by referring to a health board minute that stated that Lightburn hospital was up for closure. He was called a liar for that.

In April, local MP Anne McLaughlin wrote to constituents to say that she had received an unequivocal assurance that Lightburn hospital would not close. I do not think that anyone can give such an assurance given that the minister said that she is deliberating on the matter. I would like to know where Anne McLaughlin got that assurance. Is the minister concerned that the service is clearly being run down while the decision is being taken? Will she accept an appeal from me that the people of north-east Glasgow need a third hospital to serve older people? If the minister is considering an option to reduce the service by closing Lightburn hospital and transferring beds to Stobhill hospital and Glasgow royal infirmary, that will not be an adequate solution for the people of north-east Glasgow.

Shona Robison

I stress that nothing has come to me. I will have to wait until NHS Greater Glasgow and Clyde has gone through a proper public engagement process, which might or might not result in a formal proposal.

If anything did come to me and I was considering it as a major service change proposal, I would need to be convinced that the change would address concerns that Pauline McNeill and others have raised, that it would be fully consistent with national policy, and that it would improve the patient experience. I would expect any proposal that came to me to address all those issues. I hope that Pauline McNeill and others will take part in any consultation around those issues.

Ivan McKee (Glasgow Provan) (SNP)

The Scottish Government’s national clinical strategy calls for a shift to community-based services and to person-centred care in homely settings—for example, a local community-based hospital and familiar surroundings—and calls for health inequalities to be addressed by moving resources into areas of high deprivation, not away from them. Will the cabinet secretary reiterate her support for those principles and does she agree that proposals for changes to health services in the east end of Glasgow—including local community hospitals such as Lightburn—would have to be consistent with those principles?

Shona Robison

I can say that in 2011 Nicola Sturgeon, when she was Deputy First Minister and Cabinet Secretary for Health and Wellbeing, rejected proposals to close Lightburn hospital because she had consistently heard from patients and clinicians that the hospital provided greatly valued high-quality services. As I said to Pauline McNeill, I would need to be convinced that final proposals—if any emerge—would effectively address the concerns that have been raised by Ivan McKee and others, that they would be fully consistent with national policy and, importantly, that they would improve the patient experience. That is the challenge to NHS Greater Glasgow and Clyde when it considers the future of Lightburn hospital. I stress that no proposal has come to me. We are at a very early stage of the process: I expect NHS Greater Glasgow and Clyde to take on board the need for it to address all those issues.

Anas Sarwar (Glasgow) (Lab)

Let us be clear. Days before the election, Paul Martin was called a liar for suggesting that there were plans to close Lightburn hospital. An SNP MP used parliamentary resources to write to every constituent to say that she had assurances from the cabinet secretary that there were no plans to close Lightburn hospital. It seems that the cabinet secretary is denying that that was the case.

Now, six months later, the proposals are in black and white. That same MP and a local SNP MSP are now holding public meetings in the area claiming that they are the ones who will try to save Lightburn hospital. That is a betrayal of people in the east end of Glasgow. The cabinet secretary should be honest with Parliament today and say that the proposals are real and that she will accept the will of Parliament to call the proposals in. We believe that the proposal should be to reject closure of Lightburn hospital.

Shona Robison

I am surprised that Anas Sarwar is criticising MPs or MSPs for listening to their constituents. [Interruption.] I expect MPs and MSPs to listen to the views of their constituents—[Interruption.]—whether on the future of Lightburn hospital or any other issue. I have now said in response to two questions that there is no formal proposal. A consultative public engagement process is currently under way. It is at a very early stage, and proposals may or may not emerge from it. Nothing has come to me in terms of formal service change proposals. If such proposals do come to me, I have set out very clearly the criteria that they must meet. The change must improve the patient experience, be fully consistent with national policy and address local concerns. I do not think I could be clearer.

I take the opportunity to remind members to be careful with the language that they use in the chamber. I also urge all questioners—yet again—to ask briefer questions.


NHS Ayrshire and Arran (Meetings)

To ask the Scottish Government when it last met NHS Ayrshire and Arran and what matters were discussed. (S5O-00398)

Ministers and Scottish Government officials regularly meet representatives of all health boards, including NHS Ayrshire and Arran, to discuss matters of importance to local people.

Willie Coffey

As part of the independent review that was announced last week into the baby deaths at Crosshouse hospital, I ask that the parents of Elijah Kennedy, who died in 2011, and Joseph Campbell, who died in 2012, be included in that review, so that their stories are heard and any lessons are learned and acted on.

Shona Robison

First of all, I certainly wish to put on record my condolences to any family who lose a baby. We would all want to make sure that the views of families are very much at the centre of the review that Healthcare Improvement Scotland has been asked to carry out. I have asked HIS to look into whether the processes and procedures in Ayrshire and Arran were properly followed in the cases that have been highlighted. I have asked HIS to meet the affected families as part of the review and to report back to me with its findings at the earliest opportunity.

I will certainly ask HIS to make contact with the families whom Willie Coffey mentioned, but I would expect it to meet any families who wish to discuss their concerns with the organisation, and I have indicated that to HIS in taking forward its important review.

Jamie Greene (West Scotland) (Con)

Unfortunately, NHS Ayrshire and Arran has been in the news an awful lot recently. We have had numerous reports of understaffing, lengthy waiting times and unfillable vacancies. There was the case of a 19-month wait to see a consultant that was resolved only after we brought it up with the First Minister in the chamber, and we have heard about the tragic cases of avoidable stillbirth deaths at Crosshouse hospital. What steps is the cabinet secretary planning to take to restore public trust and confidence, not just in NHS Ayrshire and Arran but across the entire Scottish health service?

Shona Robison

The member raises a number of issues, but I want to deal first with the issue of maternity and neonatal care. It is very important to stress that, despite the serious issues that have been raised about NHS Ayrshire and Arran, there has been a marked improvement in the number of stillbirths in the maternity and neonatal units in Ayrshire and Arran and, indeed, in all such units across Scotland. The number of stillbirths is down—in 2015, the figure was the lowest on record—and the numbers of neonatal and maternal deaths are also down. It is important that we provide the public with the reassurance that, despite the issues that Healthcare Improvement Scotland has been asked to look into, overall the units are safer than they were previously. We should welcome those figures.

Jamie Greene raised issues about the general performance of NHS Ayrshire and Arran, and John Scott previously raised concerns about scheduled care performance. I have made it clear to NHS Ayrshire and Arran—as I would to any other board—that we expect it, through its spending of its share of the £10 million, to bring about a marked improvement in out-patient performance and in scheduled care performance. We also expect improvements in accident and emergency performance at Ayr hospital. There has been significant improvement in A and E performance at Crosshouse hospital. Performance has improved in some areas in Ayrshire and Arran, but there is still room for improvement in others. I would be happy to write to the member with more details if he would find that helpful.


Mental Health Strategy (NHS Lanarkshire)

To ask the Scottish Government what discussions it has had with NHS Lanarkshire regarding the implementation of the mental health strategy. (S5O-00399)

The Minister for Mental Health (Maureen Watt)

During the implementation of the “Mental Health Strategy for Scotland: 2012-2015”, implementation review visits by Scottish Government officials to NHS Lanarkshire took place in May and November 2012, May and November 2013, May and November 2014, and May 2015.

In the engagement process for the forthcoming 10-year mental health strategy, the Scottish Government received a written response to its engagement paper “Mental Health in Scotland—a 10 year vision” from the planning partnerships for North and South Lanarkshire. The response was the result of a collaboration by North Lanarkshire health and social care partnership, South Lanarkshire health and social care partnership, NHS Lanarkshire, North Lanarkshire Council, South Lanarkshire Council and the local voluntary sector. The Scottish Government has carefully considered it, along with the other 597 responses that were received, in developing the final strategy.

Christina McKelvie

I thank the minister for all that information.

The minister will understand the value of working closely with community-based organisations, along with the national health service and other organisations. I draw her attention to the work of an organisation in my constituency that is called FFAMS—Families and Friends Against Murder and Suicide. Will she ensure that organisations such as FFAMS will be invited to contribute and work with NHS Lanarkshire to roll out the mental health strategy in my local area?

Maureen Watt

Organisations such as FFAMS have a key role to play. The prevention and reduction of suicides in Scotland is a key priority for the Scottish Government. Engagement in development of the next suicide prevention strategy will take place in spring 2017. During that period, we expect to receive input from a range of agencies, including organisations such as FFAMS. It is the role of NHS boards to draw on the knowledge, ability and resources of such local groups to develop solutions that reflect the needs of their population.

Monica Lennon (Central Scotland) (Lab)

The draft 10-year mental health strategy states that there will be actions to improve perinatal mental health. NHS Lanarkshire perinatal mental health did not begin until November 2014 and NHS Lanarkshire does not have in-patient specialist perinatal mental health services. Instead, it relies on NHS Greater Glasgow and Clyde services. I note from the minister’s previous reply that she has not met NHS Lanarkshire recently, but have her officials discussed the issue with NHS Lanarkshire recently or will she do so in the near future? Does she find that situation to be acceptable?

Maureen Watt

It is up to NHS boards to decide how best to provide those services, and co-operation across health boards is vital in taking forward health services in Scotland. Regarding perinatal mental health, the mental health strategy will dovetail with the review that Jane Grant from NHS Forth Valley has been undertaking into neonatal and maternal health services.


Lung Disease

To ask the Scottish Government what its position is on the establishment of a respiratory task force to help tackle lung disease. (S5O-00400)

The Minister for Public Health and Sport (Aileen Campbell)

We are working closely with the respiratory national advisory group to support local improvement in respiratory care through the development of a respiratory health quality improvement plan. The plan will aim to support national health service boards and respiratory managed clinical networks in making local improvements in respiratory diagnosis, treatment and care.

Emma Harper

Does the minister agree that charities such as Chest Heart & Stroke Scotland, the British Lung Foundation and Asthma UK are doing important work on lung health in Scotland? Will she maintain regular contact with those stakeholders and engage with their recommendations for how best to deal with lung disease?

Aileen Campbell

We recognise the valuable contribution that our third sector partners make in supporting people who live with respiratory conditions. To offer a couple of examples, we supported the development of resources with £160,000 of funding, and one of those—my lungs, my life—is an online resource that was developed by Chest Heart & Stroke Scotland to help people to understand and self-manage their condition. We also recently approved funding of £112,000 to CHSS to support the development of an online learning resource for professionals.

Colin Smyth (South Scotland) (Lab)

There has been a welcome decrease in the proportion of people who smoke—not least as a result of the ban on smoking in public places that Labour introduced in 2006—but the rate of decline is much slower in the most deprived areas. That level is not expected to reach the Government’s 2034 target, although 60 per cent of those who access smoking cessation services live in the most deprived areas. Given that chronic obstructive pulmonary disease is the only major cause of death for which levels are rising in Scotland and given that it is much more prevalent in socially deprived areas, does the minister believe that developing an action plan to tackle the slow pace of decline in smoking in the most deprived areas should be a Government priority?

Aileen Campbell

Regardless of party membership, we probably share the understanding that inequalities exacerbate some of the public health challenges that we face as a country. The Labour Party is to be congratulated on having introduced the groundbreaking legislation that was mentioned. In the same spirit of cross-party co-operation, it should be recognised that we have taken forward other bits of work to stop some of the poor choices about smoking, alcohol or drug dependency impacting most heavily on our most deprived communities.

We should work together to tackle such things. We have a tobacco strategy that sets out some of the areas in which we want to make more progress, and Colin Smyth will recognise that the legislation to ban smoking in cars with children will come into force next week. Work goes on across the political parties to ensure that we can make a difference but, like Colin Smyth, sometimes we are all impatient for change to ensure that everybody has a fair chance to flourish and that our most deprived areas get the chance for better health outcomes. I hope that we can work across the political parties in a spirit of consensus to make the difference that we all seek.

Donald Cameron (Highlands and Islands) (Con)

I note what the minister said about the diagnosis and treatment of lung disease. The minister might be aware of the British Lung Foundation’s report “The Battle for Breath”, which considers the impact of lung disease across the United Kingdom. It states that more can be done to improve awareness, availability of screening and prevention, in particular. What is the Scottish Government doing to improve in those areas?

Aileen Campbell

We know that “The Battle for Breath” sets out a number of recommendations, which we will take on board. We will continue to work hard to ensure that diagnosis is better, and I have outlined some of the ways in which we have funded our third sector partners to help people to cope better with their condition. We will consider all ideas and recommendations to improve the situation across the piece.


Seasonal Health Risks (Vulnerable Groups)

To ask the Scottish Government what analysis it carries out to ascertain which groups are most vulnerable to seasonal health risks. (S5O-00401)

The Cabinet Secretary for Health and Sport (Shona Robison)

The Scottish Government relies on analysis that is provided by a range of experts and specialist advisory committees on seasonal risks to health. The sources of those analyses vary depending on the specific issue concerned, as seasonal health risks are relevant to a wide range of health matters. For example, the Joint Committee on Vaccination and Immunisation provides advice on which groups should receive the seasonal flu vaccine, and Health Protection Scotland provides the Government with on-going analyses of threats to health, such as infectious diseases, that might have a seasonal trend to them.

Maurice Golden

The Scottish Government’s figures show that, last year, almost 3,000 of our fellow Scots died during winter, which is above and beyond the average rate for the rest of the year. That figure is completely unacceptable. World Health Organization research shows that around one third of those 3,000 deaths could be attributed to cold homes.

In our manifesto, our party committed to improving all properties in Scotland to at least an energy performance certificate band C rating. That would improve energy efficiency, tackle fuel poverty and make homes easier to heat. The National Institute for Health and Care Excellence makes the same recommendation. Will the Scottish Government help to tackle those needless deaths by committing to a similar call, and will it set out a plan of action to achieve that?

Shona Robison

A lot of analysis is done of deaths during winter to discern trends and see whether anything in particular is emerging from those trends that we should take into account. That is an on-going process. The member makes an important point when he notes that issues of fuel poverty are critical to our attempts to prevent deaths from cold homes. It is not only the health service, but services across Government, that must respond to the issue.

We will consider ideas from across the chamber on this point. I point out that the Government has for a number of years taken forward measures that have been important in lifting people out of fuel poverty, although there is no doubt that the task is challenging. The situation is not helped by some of the welfare reforms that the United Kingdom Government has introduced, which have put pressure on family budgets, particularly for those on low incomes. That has done nothing to help to reduce fuel poverty and, in fact, it can make the situation much worse.


General Practitioners (Dumfries and Galloway)

To ask the Scottish Government how many general practitioners have been recruited in Dumfries and Galloway through the bursary incentive, and how many posts remain vacant. (S5O-00402)

The Cabinet Secretary for Health and Sport (Shona Robison)

Of six GP specialty training posts that were eligible for the bursary in the Dumfries and Galloway region, three posts were initially filled, but one individual has since declined their job offer. That leaves four vacancies, which will be advertised in the forthcoming 2017 recruitment rounds.

Finlay Carson

In Galloway and West Dumfries, rural GP practices are in crisis. GPs are working longer hours than ever, practices are being forced to merge and there is a fear in communities that some practices will close. Will the cabinet secretary meet me to discuss giving Galloway community hospital in Stranraer training hospital status and to explore seconding armed forces doctors to ensure that vital GP services can be delivered in rural areas?

Shona Robison

I am certainly happy to meet the member to discuss those ideas. I am always happy to speak to members from across the chamber about ideas. Obviously, we would have to look at whether the ideas are practical and deliverable, but I am certainly willing to meet the member to discuss them further.

We have a huge amount of work under way to improve the position in primary care. There will be a £500 million investment in this session of Parliament and there are short-term measures to stabilise the position and address recruitment and retention issues, particularly in rural areas. I am happy to furnish the member with more details, but I am also happy to meet him to discuss the issues that he raised.


Health Services (Moray)

To ask the Scottish Government what its assessment is of health services in the Moray area. (S5O-00403)

The Cabinet Secretary for Health and Sport (Shona Robison)

Health services across Grampian are assessed at board level, and the NHS Grampian annual review took place on 6 October. The process ensures the rigorous scrutiny of the board’s performance while encouraging accountability and as much direct dialogue as possible between local communities and NHS Grampian. I have issued a letter to the board that contains my observations on the board’s performance in relation to a range of issues and which details a number of initiatives and actions to be taken forward in the coming months. The letter shall be posted on the NHS Grampian website in the near future.

Douglas Ross

I have a constituent from Moray who is being treated for breast cancer at Raigmore and who faces significant challenges with her treatment because she lives in the NHS Grampian area. For example, she cannot have her blood taken at the Oaks in Elgin, which is an excellent facility and which would save her from going into a general practitioner waiting area with her low immune system. That is because the Oaks does not send samples to NHS Highland; it only sends them to NHS Grampian. Also, my constituent had an NHS Highland prescription for a wig, but the hairdresser closest to her home in Elgin could not deal with that, because she did not have an NHS Grampian prescription.

What can the Scottish Government do to improve the service and care for patients in the Moray area who face similar problems because they choose to be treated closer to home at Raigmore rather than in the NHS Grampian area?

Shona Robison

The member raises important issues, and I am happy to look into the specifics. It sounds as though boundary issues are potentially getting in the way of sensible solutions that would make it easier for the patient to whom the member refers. It would help if the member wrote to me with further detail, and I can then follow that up and respond on the important issues that he raises.

Richard Lochhead (Moray) (SNP)

The cabinet secretary will be aware that one reason for some of the pressures on the Moray health service is an issue with attracting health professionals to live in our more rural areas and, in the case of consultants, to work at some of our smaller hospitals. Is the cabinet secretary willing to look at the extent to which incentives are available to attract health professionals to work in such areas? That could make a real difference and could help to address some of the pressures.

Shona Robison

There have already been a number of incentives to encourage health professionals to work in rural communities. For example, bursaries and golden hellos are available in particular specialties to try to attract people to harder-to-fill posts. We also have the regional workforce plans, which are being developed and which are another opportunity to look at the particular needs of remote and rural Scotland. However, I will ask my office to get in touch with Richard Lochhead to get more details on the issues that are of concern to him in the Moray area. I am happy to respond to him on that.


Abortion

To ask the Scottish Government what improvements it considers necessary to the provision of abortion in Scotland. (S5O-00404)

The Minister for Public Health and Sport (Aileen Campbell)

National health service boards are responsible for the provision of abortion services in Scotland. The Scottish Government recognises that there are opportunities to improve the provision, which is why we funded research by the University of Glasgow on issues surrounding women who require abortion later in pregnancy and women who have more than one abortion. Both of those pieces of research are now published and will inform how NHS boards deliver abortion services.

Patrick Harvie

I thank the minister very much for that answer. The Abortion Act 1967 allows abortion up to the time limit of 24 weeks but, as the minister is no doubt aware, research has shown that, in practice, unofficial time limits are operating in Scotland, ranging from 15 to 20 weeks, leaving women in many circumstances having to travel elsewhere, and requiring the time and money to do so, as well as having the unnecessary stress that is added to their experience in order to access abortion. Why are women in Scotland facing those unacceptable barriers to exercising their reproductive rights?

Aileen Campbell

I thank Patrick Harvie for raising this incredibly important issue. I know that we had a meeting planned and we will meet in future to discuss the wider issues that he raised at First Minister’s question time. One reason for some NHS boards offering other local time limits to abortion is often to do with delivering a sustainable and safe service for a very small number of patients who require that specialised procedure. Women travel from Scotland to England for later abortions if that is required, and the costs of that are met by NHS boards in Scotland.

I am happy to look more fully at the issue and to engage with Patrick Harvie when we are scheduled to meet, and also to engage with any other member who is interested, but there are issues around sustainability and the safety of the service for women, and that is one of the reasons why NHS boards sometimes offer different time limits. However, there are partnership relationships with other NHS boards to ensure that women have access. Some women have to embark on journeys of some distance to access the right that they have, and we are also looking at that issue, because we understand the points that Patrick Harvie raises.

Brian Whittle (South Scotland) (Con)

Statistics show that abortion rates are higher among women living in the more deprived areas. What will the Scottish Government do to ensure that all women have equal access to contraception and sexual health advice?

Aileen Campbell

That is one of the reasons why we asked the University of Glasgow to look at some of the issues around abortion, including why women have more than one abortion. We also ensure that women have access to adequate sexual health advice and support should they need it. One of the issues about public health is that sometimes our most deprived communities suffer the most, and we need to tackle that.

Again, I would be happy to engage with Brian Whittle on the issue, but we are certainly making progress. We have commissioned research from the University of Glasgow to look at some of the elements, but if the member has other issues that he thinks require a further look I would be happy to engage with him. It is important to get it right and to act to prevent issues before a woman takes the very difficult decision to have an abortion should she require it.


Social Care Charges (Dumfries and Galloway)

10. Joan McAlpine (South Scotland) (SNP)

To ask the Scottish Government what its position is on the reported sharp rise in social care charges for disabled people under 65 in Dumfries and Galloway, and whether it considers this a consequence of the Convention of Scottish Local Authorities recommending an applicable income allowance of £132 per week. (S5O-00405)

The Cabinet Secretary for Health and Sport (Shona Robison)

I am disappointed that Dumfries and Galloway Council has chosen to adopt a lower income threshold for people under the age of 65. However, the Scottish Government funding has ensured that the threshold at which people begin to be charged for their social care has not been lowered further still in Dumfries and Galloway. The additional funding of £6 million that we provided to local authorities as part of the £250 million additional funding for social care in 2016-17 was intended to enable all local authorities to increase their charging thresholds to a minimum of 25 per cent, in order to take those on the lowest incomes out of social care charges altogether and to reduce social care charges for many more service users.

Joan McAlpine

Although several local authorities do not begin charging until well above the COSLA minimum, only Labour-controlled Dumfries and Galloway Council has chosen to immediately and dramatically reduce the threshold for care charges for existing service users and to increase the rate at which they pay, despite the money that it has been given by the Scottish Government to reduce charges. That has resulted in vulnerable people with severe disabilities facing charge increases of 500 per cent and bills of £70 a week, which must come from their already pressured benefits. Does the cabinet secretary agree that that is cruel and unjustified?

Shona Robison

As I said, I am disappointed that Dumfries and Galloway has chosen to reduce the threshold for social care charges. The COSLA charging guidance gives the threshold as a minimum, not a maximum, and other local authorities have higher thresholds.

We provided additional funding to local authorities in 2016-17 to tackle poverty. If people on the lowest incomes are worse off now as a result of the changes to the charging thresholds in Dumfries and Galloway, that flies in the face of the council’s being provided with extra money to reduce those charges, and I hope that Dumfries and Galloway Council seriously considers the representations that have been made on this issue both locally and in this chamber.

That concludes portfolio question time.