Health, Wellbeing and Cities Strategy
Carers (Mental Health)
We have—[Interruption.]
Can we get the minister’s microphone on, please?
We have legislation that has, at its heart, fundamental principles to ensure equal access to healthcare for all, including carers. Carers have a legal right to an assessment of their own healthcare needs, and services and support should be put in place to meet those needs.
The latest figures show that there are 657,000 carers in Scotland. According to a recent study by the Princess Royal Trust for Carers, six in 10 carers have suffered a mental health illness. A majority of all the carers who took part in the poll had never sought help or support. Should we not ensure that the national health service takes a much more proactive approach to supporting carers, and that information about what help is available and where to find it is prominently displayed in health centres and libraries?
The member raises an important point, and I am aware of the report to which she refers. It is important to recognise the invaluable role that carers play in our society, in supporting cared-for individuals. The Government is doing what it can, through our strategy, to try and assist and support carers in that caring role. I understand the challenge that many carers face in accessing services, and that is why, over the past three years, we have provided £14 million to health boards through the carers information strategy to make sure that information is provided and available to carers on how they can access support and assistance through the health service.
Question 2 is in the name of Joan McAlpine. I note that she is not in the chamber to ask the question. This is not the first time, nor is it the second time, that Ms McAlpine has acted in this way. I expect an explanation from her and an apology for the discourtesy to the chamber by the end of the day.
Health Waiting Times (NHS Grampian)
Ministers meet regularly with national health service chairs and discuss issues of importance to the NHS, including waiting times. The Minister for Public Health also discussed waiting times at the board’s annual review on 1 November 2011.
I understand from comments reported in The Sunday Times that concerns about social unavailability codes were raised with NHS Grampian as long ago as 2009. Did ministers consider making those concerns known to the public? If so, what action did they take?
The Information Services Division did not make concerns known to ministers. I am not sure whether Lewis Macdonald was in the chamber for the debate earlier today. If he was, or if he was watching it, I am sure that he appreciates the importance that members on all sides of the chamber attach to the issue.
Clostridium Difficile (Raigmore Hospital)
Two outbreaks of Clostridium difficile in Raigmore hospital have been reported to the Scottish Government in 2012. The first was in January and affected eight patients in wards 4C and 3A. More recently, the Scottish Government was advised of an outbreak in April, which affected three patients in ward 2C. That outbreak was declared over on 23 April. The lessons from debrief meetings that were held by NHS Highland following those outbreaks are currently being taken forward, locally, by the board.
Members will be well aware that C diff can be a serious intestinal disease, particularly for the old, the frail and the vulnerable. Is the cabinet secretary aware of the Roslin institute study that highlighted the risks of C diff for patients who transfer from large to small hospitals, which is a regular occurrence in the Highlands and Islands? Will the cabinet secretary confirm what detailed screening protocols are in place to protect patients who move from one hospital to another, in order to prevent outbreaks of C diff across Scotland?
That is a serious question, and I take the issue extremely seriously. I am aware of the study that the member referred to. As he would expect, as with any such study, the Scottish Government and our HAI task force will carefully consider it and ensure that any lessons that can be learned are applied.
Although the infection-control measures in hospitals are welcome, we should not ignore the role of antibiotics in cases of C diff. I understand that antibiotics can kill harmless bacteria while allowing C diff bacteria to multiply in greater numbers. Given the two outbreaks at Raigmore this year, has an audit been done of the prescription—or, perhaps, the overprescription—of antibiotics in the area?
I am happy to furnish Mary Scanlon with that information specifically as it applies to NHS Highland and Raigmore. Because she takes a close interest in these matters, I know that she will be aware that antimicrobial prescribing forms a key plank of our efforts to reduce C diff outbreaks. Ensuring that we have appropriate prescribing of antibiotics is an important part of reducing all healthcare associated infections, but it is particularly important in relation to C diff. Indeed, the success in improving the appropriate prescribing of antibiotics—in particular, certain types of antibiotics—has played a significant part in the reductions that I have referred to. Those issues and others must always be kept uppermost in the minds of everyone who is involved in our health boards in order to ensure that reductions of the kind that we have seen continue in the years to come.
New-build Community Health Facilities
NHS boards must routinely communicate with and involve the communities and people they serve to keep them informed of their plans and performance. When boards propose to change the way in which local health services are provided, including where services are delivered in the community, it is important that there is robust, visible and effective engagement with the public.
In Kilsyth, there are much-welcomed plans for the development of a new community health centre. However, along with existing health centre medical staff, I have concerns that there are accessibility issues relating to the preferred site. What can the cabinet secretary do to continue to assure my constituents that users of the new facility will be fully consulted before a final decision is taken on site selection?
I will ensure that the member’s comments, which I am sure reflect the views of his constituents, are made known to the local health board. The member will appreciate that the matter is one for NHS Lanarkshire. However, it is my understanding—I think the member’s question reflects this—that the board has not yet reached a final decision on the site for the new Kilsyth health centre.
National Health Service (National Planning Forum)
On completion, national planning forum reports are published via the Scottish Government website. They are also available locally via NHS board chief executives and directors of planning.
As the cabinet secretary will be aware, the national planning forum completed a crucial report on transcatheter aortic valve implantation in November 2010, but the report was not published until 17 months later. It has been suggested to me that the report was kept hidden for fear of fuelling an already hot debate on the issue. However, it would appear that it is not the only report dealing with a controversial issue that has been held back. The health economic evaluation study of Eculizumab—a paper that has been referred to on the Scottish Medicines Consortium website since late 2010—has still not been published.
In general terms, I agree with the member. There were two issues in his question, which I will deal with separately, although I appreciate that he is making a more general point.
Will the cabinet secretary advise when, as a result of the national planning forum’s work, TAVI treatment will be provided in Scotland? Will it be routinely available on the basis of clinical judgment, as it is in the rest of the United Kingdom?
Work is going on just now to make a TAVI service available as quickly as possible. I am happy to keep Parliament advised of progress on that, and as soon as it is possible to do so I will give a definite indication of when the service will go live.
Waiting Times (NHS Greater Glasgow and Clyde)
We continue to support all boards, including NHS Greater Glasgow and Clyde, to ensure that patients get swift access to the services that they require.
Health boards are required to ensure that the minimum length of time from arrival at accident and emergency to admission, discharge or transfer is four hours for 98 per cent of patients. However, none of the A and E departments in Greater Glasgow and Clyde is meeting that standard. What will the Scottish Government do to address that?
As Hanzala Malik and other members will appreciate, the four-hour A and E standard is extremely important, not just for patients who are admitted to accident and emergency, but to ensure that patients move through all parts of the system as quickly as possible.
Obesity (Schoolchildren)
We jointly published with the Convention of Scottish Local Authorities the prevention of obesity route map in February 2010. The route map makes a long-term commitment over 20 years to tackling overweight and obesity issues in order to help to achieve a healthier Scotland and to contribute towards sustainable economic growth.
Will the minister consider additional initiatives, which could be rolled out across Scotland, to remove vending machines that contain unhealthy food and drink from schools?
The Nutritional Requirements for Food and Drink in Schools (Scotland) Regulations 2008, which we introduced, explicitly proscribe the sale of unhealthy food and drinks in all schools, including from vending machines. The impact of those regulations is evident in the results in the World Health Organization study that was published earlier this month, which showed that the consumption of fizzy drinks by 11 to 15-year-old schoolchildren has halved in the past decade.
Does the minister agree that our efforts to tackle obesity must start long before school? Given that research suggests an increased probability of formula-fed infants being obese by the age of three, what action is the Scottish Government taking to encourage and support breastfeeding as part of the measures to tackle obesity among children?
I thank Elaine Smith for her question, and for her long-standing efforts in that area. She is right: the evidence is clear that the earlier the intervention, the better, and that—as we set out in our route map—breastfeeding is an important part of preventing obesity.
The Government will be delighted to hear that, at the European Union congress in Lyon last week, Scotland was recognised as being a world leader in an evidence-based weight programme. I refer to the counterweight programme. Is the Government as dismayed as I am to learn that, despite the cabinet secretary’s answer to my previous question on the issue, all six staff in the national counterweight programme were declared redundant at the end of April and the programme has therefore effectively been abandoned as a national programme?
Not for the first time, the member is being very economical with the truth. It has not been abandoned at all; in fact, it has been mainstreamed into the work of health boards. As the member knows as well as I do, not every health board used counterweight. We have allowed allow health boards to choose how they take forward this important work. I hope that that will correct the member’s misinterpretation of the facts.
Question 9, in the name of Patricia Ferguson, was not lodged. The member provided me with an explanation and an apology.
Ambulance Cover (Shetland Islands)
A proposal for a retained ambulance scheme was approved by the Scottish Ambulance Service board in spring 2009. The operation of the scheme was formally evaluated during the first six months of operation and it is now the subject of on-going clinical audit and governance arrangements.
I thank the cabinet secretary for her reply. It has, in fact, covered my supplementary, which was going to be about that model being used in other rural areas of Scotland.
Lung Cancer (Early Symptoms)
Earlier this year I launched the final implementation plan for the detect cancer early initiative. Lung cancer is one of the three cancer types that the initiative will focus on in the first instance. A social marketing and fieldwork campaign has already been run to help to address fears and negative attitudes to cancer and its treatment. The campaign is designed to encourage people to present earlier with any suspicious signs or symptoms. As a follow up, cancer-specific symptoms and signs campaigns will be run from the summer and continue over the winter period. Those will start with a campaign on breast cancer, followed by one on colorectal cancer and then one on lung cancer.
I thank the minister for her very comprehensive answer. I apologise for the fact that only since I lodged the question last week have I become aware of a national television campaign, which is doing exactly what we want to be done. I must apologise for the Conservative Party in general. We will take the lesson from today that we should read the papers and watch the television more.
I call the cabinet secretary.
However—[Laughter.]
Let us have the “However”, then.
My specific follow-up question relates to an issue that the cabinet secretary touched on. The TV campaign that is running features a middle-aged man. As the incidence of the disease gradually drops, the balance shifts towards more women being affected as a proportion. Will she undertake to ensure that there is monitoring of the performance of any campaign in raising awareness among women, to ensure that they do not miss the symptoms?
I say, in the spirit of consensus, that no member should apologise for raising the important issue of cancer awareness and detection in the chamber. I am happy that the member has done so.
Day-case Targets (NHS Tayside)
As part of the delivery of the nationally agreed target for day cases, NHS Tayside was set a board target of 75.2 per cent, to be met by the end of March 2011. The latest published data for the end of March 2011 shows that that target was delivered by NHS Tayside when it reached a performance level of 76.7 per cent.
As the cabinet secretary knows, day cases are a cost-effective way of treating patients. They are much cheaper than overnight stays in hospital. However, cost-effective day cases in Tayside have been reduced by almost one third since Labour left office in 2007. What is the cabinet secretary doing to ensure that national targets are being met and that the number of day cases climbs back up to the levels that existed under the previous Labour Administration?
I am not going to turn the question into some kind of party-political ping-pong because I agree with Jenny Marra about the importance of increasing and promoting day-case surgery. That is not just because it is cheaper and more cost effective for the national health service, although it undoubtedly is, but because it is also more convenient for patients. Most patients would prefer to have any procedure done on a day-case basis than be admitted to hospital as an in-patient.
Health and Social Care Integration
On 8 May I launched the consultation on the integration of adult health and social care. During the three-month consultation period, a thorough engagement process will take place with a wide range of stakeholders in the national health service, local government and the third and independent sectors. The analysis of the consultation will take place in the autumn, and it will inform and develop the policy and legislative proposals that will follow.
I thank the cabinet secretary for her answer, which partially answered my supplementary. I am sure that she was aware of the concerns that were raised last year by the Royal College of Nursing and Audit Scotland about the proposed model for the integration of health and social care that was being pursued by NHS Highland and Highland Council. Is she able, at this point, to say whether those concerns have been addressed as the integration of those services has proceeded?
As the member knows, NHS Highland has been pursuing a particular model of integration—the lead commissioning model—and I support the health board in doing that. Any process of change, whether in health and social care or in any other walk of life, leads to anxieties, and it is important that health boards and local authorities work with staff and others to make sure that their views are taken into account as the process develops.
I have spoken to many interested parties about the Social Care (Self-directed Support) (Scotland) Bill that is going through the parliamentary process. Does the cabinet secretary agree that, to be effective, the development of SDS must go hand in hand with the further integration of health and social care? I would also be interested to know whether she can give us a timetable for the proposed legislation.
I agree with the member that we should see our integration of health and social care agenda and the Social Care (Self-directed Support) (Scotland) Bill as two sides of the same coin. They will work best if they develop in tandem. The Minister for Public Health, Michael Matheson, is leading for the Government on the Social Care (Self-directed Support) (Scotland) Bill, and I know that he welcomes views from members of all parties on how we can ensure that it delivers what we want it to. As always, there will be adequate opportunity for members to scrutinise the bill as it goes through Parliament and to propose amendments, when they think that that is appropriate. I know that Michael Matheson would be happy to have further discussions with the member if she would find that helpful.
The cabinet secretary will be aware of the significant underspend that occurred in the first year of the change fund. According to the Scottish Council for Voluntary Organisations, that was a result of pressure caused by
We need to get all such issues right and to work in a collaborative way to deal with them. A number of comments have been made about the procurement process—bodies such as Audit Scotland have had things to say about it. As we take forward the consultation on the integration of health and social care, it is important that we see the process as an opportunity not just to bring the structures together, but to deal with any other barriers to the effective and fair commissioning of services. I would welcome submissions to the on-going consultation on how we might do that better from members of all parties, all of which will be treated in the spirit that members would expect. If good suggestions are made, we will take them forward.
National Health Service Dentists (Orkney)
As at 30 September 2011, 55.6 per cent of adults in Orkney were registered with a dentist under NHS general dental services, whereas the figure for Scotland as a whole was 73 per cent.
I thank the minister for his response and, indeed, for his correspondence with me over recent months. I acknowledge that progress is being made, but the figures for Orkney on adult registrations with an NHS dentist and participation rates remain far below the national average. I discuss that concern regularly with the chief executive of NHS Orkney, and I know that meetings have been held recently to consider how improvements might be accelerated.
The member is correct to say that we have been in correspondence on the issue. Although it is disappointing that the registration level in Orkney is below the national average, since 2007 there has been a 21.4 per cent increase in the number of adults in Orkney who are registered with an NHS dentist. Significant progress has been made, but it is clear that there is more to be done.
General Practitioners (Remote and Rural Areas)
A range of financial, educational and practical support is available to GPs who work in remote and rural areas.
The Acharacle medical practice in Ardnamurchan in my constituency is to lose its two doctors and its practice manager on 31 August. It appears that provision of out-of-hours cover, 24/7 working and the need for more established support from NHS Highland have been major factors in the decisions of the doctors and the practice manager to resign. Will the cabinet secretary—who I know is well aware of the issues in Ardnamurchan—give me an assurance that she will look into that serious situation as a matter of urgency?
I recognise the close interest that Dave Thompson has taken in the issue and in other issues that affect Ardnamurchan. I am well aware of the circumstances surrounding the medical practice in Acharacle. All members will appreciate that service provision in some geographical locations is challenging, but that does not take away from the fact that people who live in such areas deserve the same quality healthcare as people who live elsewhere in Scotland receive. I expect the health board to work closely with the local community to ensure that adequate service provision is put in place. I am happy to give Dave Thompson an assurance that I will keep a close eye on developments. I would be happy to discuss the issue with him or his constituents at any time.
Selective Dorsal Rhizotomy
Decisions on the use of the treatment for individual patients who might benefit are a matter for national health service boards, following the advice of clinicians in collaboration with their patient in each case.
NHS Tayside has approved referral pathways and criteria for the use of SDR. My constituent Brooke Ramsay has been advised that, as she meets the criteria, her operation will be funded by the NHS. Will the same or similar pathways and criteria be adopted in other parts of the country and, if so, will the detail of the pathways and criteria be made available to parents of young cerebral palsy sufferers so that they can determine whether their child is likely to benefit from the procedure?
I am glad that Graeme Dey’s constituent has had her treatment approved and I hope that he passes my good wishes to her and her family. In my initial answer, I made it clear that the decisions are a matter for individual health boards, based on the circumstances of individual patients.
Commonwealth Games 2014 (Edinburgh)
The Scottish Government is committed to creating a lasting legacy and maximising the benefits for the whole of Scotland from Glasgow hosting the 2014 Commonwealth games. Edinburgh’s refurbished Royal Commonwealth pool reopened on 20 March 2012. It will host the diving events for the Commonwealth games and is now available for the local community to enjoy. More than 100,000 visits have been made since it reopened.
Does the minister agree that the Commonwealth pool, which is already a legacy of a previous Commonwealth games, provides a fine example of how to ensure a lasting and effective legacy from an event such as the Commonwealth games?
I was fortunate enough to visit the pool just before it reopened. It is a fantastic state-of-the-art facility of international quality. I look forward to the Commonwealth pool playing an extremely important role in the Commonwealth games in two years. I am sure that it will also attract a number of international events, which of course will benefit the local economy in Edinburgh.
Question number 18, by Liz Smith, has been withdrawn. The member provided an explanation.
Air Ambulance Helicopters (Faults)
The safety of patients, air crew and paramedic air ambulance teams are of paramount importance. When a fault was discovered at the beginning of April in a component part of the rotor hub on one of the service’s EC135 helicopters, a replacement part was fitted and the aircraft returned to operational service. Subsequently, and as a result of a similar fault being discovered in two EC135s in service elsewhere in Europe, an enhanced regime of safety checks has been introduced.
Will the new air ambulance contracts provide any guarantees that the kinds of faults that were discovered last week in the EC135 helicopters that are used by Bond Air Services and other operators can be avoided in the future?
The contract is yet to be awarded and announced, so Rob Gibson will understand that I am limited in what I can say about the detail of that contract. Suffice it to say that it is incumbent on the Scottish Ambulance Service and those it contracts with to ensure that everything possible is done to minimise any faults occurring in any of its air ambulance aircraft. Clearly, there can never be an absolute guarantee that faults will not develop. That makes it all the more important that robust safety checks are in place, that safety checks are carried out, and that appropriate action is taken at all times to secure and ensure the safety of those who fly in them.
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