Meeting of the Parliament

Meeting date: Thursday, March 29, 2012

Official Report 1082KB pdf

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Scottish Executive Question Time

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Health, Wellbeing and Cities Strategy

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NHS Lothian (Meetings)

1. To ask the Scottish Executive when the Cabinet Secretary for Health, Wellbeing and Cities Strategy last met NHS Lothian and what issues were discussed. (S4O-00859)

I last met the chair and, separately, the chief executive of NHS Lothian on 21 March to discuss the findings of the PricewaterhouseCoopers report into NHS Lothian’s waiting times management and processes. I made clear to them, as I did to the Parliament last week, my expectations of NHS Lothian in responding to the findings of the report.

Following the waiting times scandal at NHS Lothian, a number of Lothian members have been contacted by staff complaining about a culture of bullying, pressure from management and understaffing, which has impacted on patient care. I am sure that the cabinet secretary will agree that we cannot ignore those issues. She has already told me that she will not conduct a fully independent and comprehensive review of NHS Lothian. What, then, will she do to look into those serious matters?

I am pretty sure that the member was in the chamber last week when I made a statement on the issue. I made it clear that I have tasked the chair of NHS Lothian with carrying out a comprehensive review of the suggestion in the PWC report that there was a cultural problem in NHS Lothian that prevented staff from bringing concerns to light. That review will be carried out. As I said last week, I made it clear to the chair that I expect to see the outcome of that work by the end of April. I am sure that the Parliament will pay close attention to that and will ensure, as I will, that any further action that needs to be taken is taken.

As I think I said last week, a senior expert team of my officials is working with NHS Lothian to ensure that some of the underlying issues that were identified in the PWC report—on capacity planning and what must be done to ensure that all patients are treated within the guaranteed time, as they have a right to expect—are resolved and addressed. The team will continue to work with NHS Lothian for as long as is required. If Neil Findlay or any other member has specific issues or concerns that they want to bring to my attention at any time, I would welcome that, and he has my assurance that they will be treated extremely seriously.

My question follows on from the cabinet secretary’s final point. Many patients throughout Lothian who have had issues with their appointments might be concerned that those issues could point to wider problems additional to the ones that were identified by the PWC report. Will the cabinet secretary say how individuals who suspect that they have fallen victim to appointment irregularities can best bring their experiences to the attention of the officials at NHS Lothian who are investigating the issue?

That is an important question, which I will answer as quickly as I can and with a number of key points. The patients who were given offers of appointments in England at unduly short notice—we should remember that that was the issue that brought the whole episode to light—have now all been treated. The patients who surfaced on to the waiting list at the end of last year as having already reached the waiting time in the guarantee are in the process of being treated. We are working with NHS Lothian. I have made clear to it the expectation that those patients must be treated as quickly as possible.

Marco Biagi raises a legitimate question about other patients who are concerned that their appointment time or waiting time might have been affected. Any patient who is in that position should make those concerns known to the health board. All health boards have a well-established complaints procedure. I say to Marco Biagi, as I said to Neil Findlay, that any member who wants to bring constituents’ concerns to my attention is perfectly free to do so, and those will be given due consideration.

In June 2008, I raised my concerns about the level of deletion of patients from waiting lists for social reasons under the new system. As we know, since then, the level has tripled. In October last year, I suggested that there was manipulation of the data, but I was told that I was exaggerating. However, we now know that, for Lothian, the situation was actually worse than I originally thought.

Why does the cabinet secretary not accept that a broader look across all health boards is required? Has the Information Services Division not warned, or at least advised, her of the concerns—other than those about information technology in Glasgow and Grampian—of variation in other boards?

The retrospective changes measure was supposed to be exceptional. In some boards, the number of those changes is in only single digits. In others, it is in the hundreds. Within boards, there is a variation from single digits or tens to hundreds—indeed, sometimes 400 or 500. That level of variation does not smack of an exceptional measure. We still think that a full independent investigation is required. Will the cabinet secretary agree to that?

I will take those points in turn, because they are all serious and I think that they all deserve serious consideration and serious answers.

The ISD has not brought specific concerns to our attention. Had it done so on any occasion, the concerns would have been treated as seriously as Richard Simpson would expect.

Patients who are socially unavailable are not deleted from anywhere. One of the key differences between the new ways waiting time system and the old system, which the previous Administration presided over, is that patients who are unavailable do not lose their waiting time guarantee; instead, they have a period of unavailability.

I understand why Richard Simpson talks about the rise in unavailability, although in recent quarters, unavailability has been coming down again. As he is a clinician, I am sure that he will understand the point that unavailability has increased as waiting times have reduced because as waiting times reduce, the notice that patients get for appointments also reduces. Therefore, there is an understandable increase in the number of patients who have short-term unavailability.

I think that I quoted in the chamber last week a statistic that I will quote again, because it is important: three quarters of all patients with a period of social unavailability have a period of unavailability of less than three weeks. That suggests that that statistic is in line with the phenomenon that I have just described.

I assure Richard Simpson and other members that we are looking very carefully at all those things. As I said last week, all chief executives have assured me of the appropriate use of new ways and unavailability.

I consider those things carefully on an on-going basis. In 2010, Audit Scotland carried out a review of new ways. It updated that review in the middle of last year and said that it did not consider that any further investigation was required. However, as I said last week, I have asked all boards to carry out an internal audit. We will seek Audit Scotland’s advice on the terms of that audit, because it is important that we ask boards to audit the right things.

Members should be under no illusion about how seriously I take this issue. Staff in our health service have worked incredibly hard to get waiting times to their lowest level ever. I will not allow any health board to compromise the integrity of that record through any misuse of the system. I will take any action that is required of me.

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PIP Breast Implants

2. To ask the Scottish Executive what discussions it has had with the Medicines and Healthcare products Regulatory Agency regarding PIP breast implants. (S4O-00860)

Scottish Government officials have been in regular contact with colleagues in the Medicines and Healthcare products Regulatory Authority and the Department of Health about PIP silicone breast implants.

I take this opportunity to inform members that we have recently been advised that one patient from NHS Highland received PIP implants at St John’s hospital in 2006. Our extensive checks have not identified any further patients who had PIP implants on the NHS. Therefore, with that one exception, the position remains that no NHS patients were affected.

There are many issues and anxieties for the women affected. I will raise a couple on behalf of a constituent who has contents of a ruptured PIP implant inside her body. First, will the cabinet secretary put pressure on the MHRA to analyse the contents of my constituent’s implants, which were removed by the NHS? Failing that, will she ensure that the contents are tested in Scotland? Secondly, given that the MHRA put out an alert two years ago this month, is it not reprehensible that the women affected heard nothing about the problem until December 2011?

Malcolm Chisholm will appreciate that two reviews are on-going just now. The one into the more recent incidents around notification and how the matter was handled is due to report soon. It is appropriate for all of us to wait and see what that review has to say about whether all the correct information was given at the correct time.

I understand the reason for Malcolm Chisholm’s first question and the desire to ensure not only that all the women affected get the clinical care, treatment and support that they need and deserve, but that the right testing and data audit are carried out so that lessons can be learned. The MHRA is responsible for collecting all the evidence, but that does not require it to retrieve every PIP implant, although it needs sufficient evidence to carry out the checks.

I will pass the concerns that Malcolm Chisholm has raised on behalf of his constituent to the MHRA, and I will be happy to share its response with him.

The cabinet secretary will be aware of the report that was published this week by the House of Commons Health Committee, which criticised as

“flying in the face of common sense”

the situation whereby women who are entitled to the removal of PIP implants on the national health service for clinical reasons, because their private provider refuses treatment or because the provider no longer exists, must have any replacement surgery done separately, outside the NHS, even if they are prepared to pay for the replacement as part of the same surgery. In those limited circumstances, will the cabinet secretary give consideration to how a single removal and replacement surgery might be possible, particularly in view of the risk for women of undergoing two surgeries in rapid succession?

I am more than happy to give consideration to that. We will give careful consideration to the House of Commons committee report, which was published this week. I have made clear on previous occasions our position on removal and replacement: any woman whose private provider has not delivered the level of service that I would expect it to deliver will be cared for appropriately within the NHS. The NHS will not routinely replace implants unless there is a clinical reason to do so. When there is a clinical reason, I expect the decision whether there should be one or two operations to be a clinical decision as well. There is guidance on co-payment arrangements in the NHS, which I expect would apply. Many of the issues require clinical decisions, and I expect clinicians in the NHS who are dealing with any women in that situation to put the clinical needs of the women first. That is our clear expectation of the NHS.

We have been dealing with extraordinarily important matters, but if we can have succinct questions and answers we might get to the end of the questions.

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Child Poverty

3. To ask the Scottish Government what progress has been made with its child poverty strategy. (S4O-00861)

Last Thursday, we laid in the Parliament our first annual report for the child poverty strategy for Scotland. It highlights a range of measures that we have taken since the publication of the strategy, such as the inception of a £270 million early years change fund. The actions that are highlighted in the report are extremely important, and it is crucial that we continue our efforts to tackle poverty in Scotland. However, the reality is that, without the Parliament having control of the tax and benefits systems, our ability to make real progress on the headline figures is severely restricted.

I welcome the range of work that the Scottish Government is undertaking, within the powers that are available to it, to lift children and families out of poverty and to reduce the pressure on household budgets through the social wage. The social wage is, once again, under attack from the opponents of universal benefits, who argue that measures such as the council tax freeze and free prescriptions benefit only the well-off. Does the minister agree that it is struggling households and the working poor for whom such benefits are of particular importance and that, without the relief on household incomes that the social wage provides, many more children and families would be left vulnerable?

The Government is very much committed to the social wage for Scots in order to protect their incomes, especially in the face of the welfare spending cuts that are being imposed by the United Kingdom Government.

The implementation of the social wage has involved a range of different matters to ensure that we protect Scottish families, particularly those who are most vulnerable and who have young children.

We have met a number of our commitments in implementing the social wage, from free concessionary travel through to abolishing prescription charges, and we are implementing the living wage in the areas of public sector responsibility that we have direct control over.

We recognise that to assist us in continuing to make significant progress in tackling issues around child poverty, we need to deal with two of the most fundamental factors—taxation and welfare. Until we are in a position to have control over those areas, we will have to continue to try to mitigate the actions that are taken by UK Governments.

I join Christina McKelvie in welcoming the publication of the report and many of the actions identified in it. However, it was my understanding that the child poverty figures were also due to be published towards the end of the month. If that is now not the case, will the minister advise why, and will he indicate whether he expects that the latest figures will show a decrease, an increase or no change?

All the detail is provided in the annual report. It is the first annual report and we are listening to different stakeholders on how they might wish future reports to be formulated.

The most recent statistics on child poverty—which have been published independently—are from the Institute for Fiscal Studies. It carried out an analysis of the impact that the UK Government’s taxation and benefit changes will have on the UK as a whole. It indicated that, by 2021, almost 700,000 more young children in the UK will find themselves in poverty as a result of that policy.

As a Government, we will do what we can to try to mitigate some of the measures, but the two key factors that continue to drive child poverty in this country are taxation and benefits. We can talk as loudly as we want in demanding that the UK Government does different things on this agenda, but until we have the powers to deal with those factors ourselves, we will continue to struggle to tackle the scourge of child poverty in Scotland.

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Attendance Allowance (Care Home Residents)

4. To ask the Scottish Government what discussions it has had with the United Kingdom Government regarding the withdrawal of attendance allowance for residents in care homes in Scotland who are supported by free personal and nursing care contributions. (S4O-00862)

The removal of the attendance allowance to self-funders in care homes in Scotland was estimated to have saved the Department for Work and Pensions £23 million in 2002. Current estimates of the saving to DWP sit at around £300 million over the past 10 years. Despite repeated attempts to resolve the matter, we have been unable to reach a successful conclusion. However, we continue to raise the matter on appropriate occasions with the UK Government.

I thank the cabinet secretary for her response and also for her efforts on the attendance allowance. I was going to ask her for an estimate, but I understand from her answer that £300 million has been taken out of the pockets of older people in Scotland as a result of the petty “you’re no havin it” attitude of the UK Government. Will she advise how we could repatriate the powers to Scotland to ensure that that no longer happens? [Interruption.]

If Jackie Baillie wants to answer the question and say that the best future for the people of Scotland is as an independent country, I would be the first to welcome her to her feet. For once, that would be something that we could agree on.

The issue is serious and I hope that it is one on which we can all agree. I gave Fiona McLeod the estimated figure in my initial answer. The saving is closer to £320 million. Let me put that as a cost to individuals—it breaks down to almost £4,000 a year from the potential income of each individual who self-funds their care. I hope that we can all unite to put pressure on the UK Government to change its position and repatriate the funds but, if, as I suspect, it continues to take the same approach, that is just one more of many, many reasons why getting the powers to this Parliament would be the best outcome.

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Medical Negligence Complaints (Guidelines)

5. To ask the Scottish Government what good practice guidelines are given to national health service boards for handling medical negligence complaints. (S4O-00863)

The NHS complaints procedure good practice guidance was recently reviewed to reflect the provisions in the Patient Rights (Scotland) Act 2011. The revised guidance will be available shortly and I will ask my officials to provide the member with a copy.

Legal actions for medical negligence are not dealt with under the NHS complaints procedure. When a patient indicates that they wish to pursue a damages claim against an NHS board, Scottish Government advice to the patient and the board is to seek the advice of legal professionals. The central legal office handles individual legal actions and provides advice to NHS boards on them.

Will the cabinet secretary acknowledge the sometimes difficult distinction between medical negligence and negligence in care? I receive many complaints from elderly people and their families about care beyond the medical. Dignity and care for the elderly at Hairmyres hospital were discussed yesterday by the board of NHS Lanarkshire. Unfortunately, the report was verbal; I am not able to access it and am waiting for information. By giving an assurance that she is keeping a watching eye on care for the elderly, can the cabinet secretary offer any comfort to people who may have formed a perception about hospital care for the elderly beyond their medical treatment?

Linda Fabiani raises an important issue. Without wanting to generalise—although I may be a little anecdotal—I hear many complaints about the issue of dignity and care, as opposed to medical treatment. That is especially true for the elderly. The complaints procedure in the NHS has been strengthened by the Patient Rights (Scotland) Act 2011. I feel strongly that, if patients have a complaint, they should exercise their right to complain. That will allow lessons to be learned.

Not only will I keep a watching eye on care for the elderly, but I have instructed that inspections of care for the elderly be carried out by Healthcare Improvement Scotland. The first of those inspections has been conducted, and the first inspection reports will appear soon. I am sure that issues for improvement will be highlighted, which is as it should be. Every older person deserves the best possible standard of care, which is what the inspections are designed to help to deliver.

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Methadone Detoxification

6. To ask the Scottish Executive what structures the national health service has in place to assist people detoxing from methadone. (S4O-00864)

All NHS boards adhere to “Drug misuse and dependence: UK guidelines on clinical management”, which is also known as the orange book. The guidelines were jointly drafted and agreed by all four United Kingdom Administrations. They are based on current evidence and professional consensus on how to provide drug treatment, and they describe how and when to safely introduce methadone as a treatment and how and when to detoxify from it when it is safe to do so.

With an investment of more than £162 million over the past five years in front-line drug services, almost 40,000 new clients have been referred to care and treatment services for specialist assessment in relation to their drug use. More than 80 per cent of those individuals were seen within three weeks.

We also know from the most recent data, from October 2011 to December 2011, that substitute prescribing—such as methadone prescribing—accounted for around 20 per cent of treatments offered.

In Scotland, methadone prescriptions have been rising relentlessly over the past few years. In 2010-11, well over half a million prescriptions were issued, costing more than £28 million, yet neither the Scottish Government nor anyone else holds any reliable data on how many methadone patients either reduce their prescriptions or come off methadone altogether. How can such an uninformed and unmeasured approach be fair to the methadone patient, and how can it be justified to the taxpayer?

In “The Road to Recovery”, we set out clearly the range of measures that are necessary when an individual’s drug problem is being addressed as effectively as possible. There are certain individuals for whom methadone is clearly the appropriate route to take. As I suggested, around 20 per cent of NHS treatments in this area involve methadone. It is extremely important that we recognise that the increasing number of people on methadone also require support to allow them to exit, and recover from, the use of methadone.

The Government is committed to continuing to make progress on this issue. The Cabinet Secretary for Justice has stated that he feels that too many people are on methadone; we are considering what further measures we can take to address that. Annabel Goldie should be in no doubt that the Government is committed to continuing to tackle Scotland’s drug problem, and “The Road To Recovery” gives us a good framework for doing so effectively. Clearly, we have more to do. We will continue to do what can be done to continue to make improvements in this area.

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Cardiac Assessment of Young Athletes Programme

7. To ask the Scottish Government what its plans are for the cardiac assessment of young athletes programme. (S4O-00865)

Sudden cardiac death is thankfully very rare, but for those who have lost a child, friend or colleague to sudden cardiac death there can be no greater tragedy.

Since 2010, we have invested more than £150,000 in Scotland’s cardiac assessment of young athletes programme, which has enabled more than 1,500 young people from numerous sports—including football, basketball, swimming, gymnastics, cycling, hockey and rugby—to be tested. We further extended the scheme in 2010 to include satellite assessment in rural areas.

The programme has been running for some years now, as the cabinet secretary said. Can she tell me what satellite assessment units have been created? She mentioned the ones in rural areas, but I would like some detail on that. How many young people have been assessed in each year in those units? What have the outcomes from the programme been so far?

Satellite clinics have been performed in Aberdeen, Inverness, Dundee, Dingwall, Selkirk and Perth. Further clinics are planned for the outer isles and Ayrshire. Since October 2011, 714 young people have been assessed. Key health issues that have been identified to date include ventricular hypertrophy, elevated blood pressure and atrial arrhythmias.

Thankfully, there have been very few cases of cardiomyopathy, which is abnormal thickening of the heart muscle. Where a cardiac problem is found, the athlete concerned is directed to an appropriate clinic for care. A full report detailing the outcomes of the programme is expected later this summer.

Given the undoubted success of the campaign since October 2010, does the cabinet secretary intend to extend it beyond October this year, which I gather is the current end date?

Nanette Milne is right: the programme in its current form will come to an end in October this year. She will appreciate that I do not want to pre-empt any decision that I may take later in the year, and I have already indicated that a full report is expected this summer. I have extended the programme once already, and I think that it is doing good work.

There have been calls to consider extending the programme, and I pay particular tribute to the Sunday Express, which has repeatedly highlighted the issue. I will look carefully at any such proposals.

I think that we all agree that the programme has done outstanding work in protecting athletes since it was launched. However, while it covers young people taking part in organised sports, it does not yet cover all schools. Will the cabinet secretary look at the work that would be involved in extending screening to all senior school pupils so that as many young people as possible are tested for heart problems and potential tragedies can be averted?

Maureen Watt raises a good point, and I am prepared to look at that more closely. I am sure that members will appreciate that it is a complex clinical issue. As was reported recently in connection with the footballer Fabrice Muamba’s collapse, it is possible to have a number of heart scans without any abnormalities being detected.

It is important that we learn from the evidence that has been yielded by the Scottish programme. That will help us to understand better the potential benefits of cardiac assessment for young people. We will consider all those things when we receive the full report later this year. The report will also be submitted to the United Kingdom national screening committee’s review of screening in that area.

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Veterans (Support)

8. To ask the Scottish Government what support it provides to veterans. (S4O-00866)

We are fully committed to arranging public services for veterans in Scotland in a way that meets their particular needs and aspirations. We have made considerable progress in that regard, which has been warmly welcomed and recognised by veterans’ organisations and the wider veterans’ community.

The list of achievements is long, but I will mention a few. We have created a Scottish veterans fund with resources of around £320,000; given priority national health service treatment to veterans who have a service-related condition; launched the veterans first point service with NHS Lothian; and provided Combat Stress with £1.7 million for the provision of specialist mental health services.

We are continuing to make progress in improving services for veterans overall, in light of the United Kingdom Government’s armed forces covenant. In that regard, we will publish a new strategy for further action later this spring.

I thank the Scottish Government for the excellent work that is being done to support veterans in Scotland.

In light of the concerns that have been raised about the detrimental impact of the damaging United Kingdom Tory-Liberal Democrat Welfare Reform Act 2012, in particular about the payment of housing benefit in terms of single-occupancy rules and the non-assignation of the benefit, what work is the Scottish Government doing to seek to promote the best interest of our veterans?

The member might be aware that veterans who find themselves homeless or threatened with homelessness or who have a high level of housing need receive priority within the social housing sector in Scotland. We have highlighted to the UK Government our concerns around its welfare reform agenda and in particular some of the issues around housing benefit. We will continue to make representations in that regard.

However, I would prefer not to be in a position in which we can only make representations; I would prefer to take action to deal with the issue. Until this Government and this Parliament have the necessary powers, we will continue to be at the mercy of UK Governments on such issues.

Veterans will continue to receive priority by virtue of being in one of the reasonable preference groups in relation to social housing. We will continue to do what we can to help to support those veterans who might find themselves in difficulty as a result of policy decisions that have been made in other places.

Question 9, in the name of Hanzala Malik, has not been lodged. That has happened before, which we very much regret.

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Insulin Pump Funding (Glasgow)

10. To ask the Scottish Executive what impact the recently announced additional funding for insulin pumps will have on Glasgow. (S4O-00868)

In addition to our substantial funding commitment, national guidance was issued to every national health service board in February setting out our ambition to dramatically increase pump provision for children and adults across Scotland. By the end of March 2013, insulin pump therapy will be made available to 25 per cent of children and teens with type 1 diabetes within NHS Greater Glasgow and Clyde. In addition, we expect to see a dramatic increase in the number of pumps for adults with type 1 diabetes over the next three years.

I welcome the announcement by the Scottish Government of that extra funding. I note in the plans that were outlined by the chief executive of the NHS and reiterated by the minister that the increase in pump provision is not timetabled to begin until 2013-14. However, many people in Glasgow have been waiting several years for the local health board to increase provision from its current dismal rates, and a further wait will add to the difficulty of their situation. Are there any interim plans to start increasing the provision now in order to build up to the 2015 target?

We expect all boards, including NHS Greater Glasgow and Clyde, to take immediate action to start to increase the number of insulin pumps that are available to all age groups, including adults, but children and young people in particular. We have asked each health board, including NHS Greater Glasgow and Clyde, to provide us with a detailed action plan for how it intends to achieve that increase. We expect those plans to be submitted by all health boards shortly. We will continue to scrutinise those plans once they have been submitted to monitor the progress that has been made by individual boards towards achieving the increase that we want in the provision of insulin pumps.

The member can be reassured that, given the clear commitment that the cabinet secretary has given on this matter, we will scrutinise closely the progress that boards are making on this matter. We expect immediate improvements to start to be made by boards in the coming year to ensure that what we see as the right level of availability of insulin pumps to young people in Scotland is achieved.

Question 11 has not been lodged, for entirely understandable reasons.

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Heart Surgery

12. To ask the Scottish Government whether it will consider introducing the transcatheter aortic valve implantation heart valve procedure. (S4O-00870)

Transcatheter aortic valve implantation—TAVI—is already available to Scottish patients through consideration by an individual case panel. Patients who are considered suitable for TAVI are referred by their local health board to an appropriate provider. However, I have been kept regularly informed of the growing body of evidence regarding the effectiveness of TAVI and I am aware of the impact of travel on the particular cohort of patients who are clinically expected to benefit from TAVI, and, indeed, of the costs that are associated with that travel. I have therefore asked that proposals be developed as quickly as possible for the high-quality, safe and consistent provision of TAVI across the national health service in Scotland.

It appears that the TAVI procedure is already deployed in many countries; indeed, the British Heart Foundation has estimated that some 40,000 such procedures have been carried out worldwide. I am grateful to the cabinet secretary for giving me an assurance, which will be welcomed by many patients in Scotland who suffer from a heart condition and may benefit from the procedure. Is there any possible indication of when the procedure may be available and the locations in Scotland at which it will be available?

I fully understand Willie Coffey’s question. TAVI is relatively new and the evidence behind its effectiveness is increasing all the time, as I said in my initial answer. I am well aware of the difficulties of travel and, wherever possible, I want Scottish patients to be treated in Scotland. As with all such procedures or all new or specialist procedures, sufficient numbers of patients are required to allow the clinicians to acquire and maintain sufficient skills.

I will not give Willie Coffey a precise date at the moment, but I will keep him updated. Suffice it to say that, I attach considerable priority to the matter, and I have asked for the work to which I referred in my original answer to be carried to a conclusion as quickly as possible.

TAVI has been available for selected patients in England, Wales and Northern Ireland for the past four years, but no operations have been carried out in Scotland, so I welcome the cabinet secretary’s sense of urgency. However, can she assure me that clinicians will not encounter obstacles at the health board level? Can the 73-year-old woman who now has to travel to Belfast for a TAVI operation—we are both aware of her—have her treatment in Scotland at the Golden Jubilee hospital?

I am aware of the patient to whom Jackie Baillie refers, but I will not go into detail about her, because I do not have permission to talk about her individual clinical details. Suffice it to say that, my advice is that treating that patient in Scotland would not be the safe and best option at this time. My office has been in touch with her son, and my officials are liaising closely with Greater Glasgow and Clyde NHS Board about the arrangements that are being made for her care. As I said in my earlier answer, patients who are likely to benefit clinically from the treatment can get it.

On the first part of Jackie Baillie’s question, I have made it pretty clear in my answers thus far that I consider the provision of a service in Scotland to be a priority. It is clear that any service that is delivered in Scotland must pass the test of safety for patients, but I expect to see progress being made on the issue quickly. I assure all members that I will assure myself that progress is being made as quickly as I expect it to be made.

Questions 13 and 14 have not been lodged for entirely understandable reasons.

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Vitamin D Supplements

15. To ask the Scottish Government what progress has been made with using vitamin D supplements or additives to tackle long-term health issues. (S4O-00873)

All four United Kingdom chief medical officers recently wrote to health professionals to reiterate the current advice on vitamin D supplementation for at-risk groups. That followed a Scottish awareness-raising leaflet that was aimed at the general public and which was distributed widely in 2011. In recent years, a wide variety of reports have linked vitamin D to various different conditions. The Scientific Advisory Committee on Nutrition is considering all the relevant evidence in its current review of recommended supplementation levels.

I asked the question because it has been shown that greater levels of vitamin D intake may prove beneficial in relation to the incidence of a number of illnesses and diseases, in particular multiple sclerosis, which is a scourge in Scotland. The shine on Scotland campaign has been successful in focusing attention on that.

I recognise the widespread interest in vitamin D. As I said, the Scientific Advisory Committee on Nutrition is currently reviewing the recommendations on vitamin D supplementation. Some of the evidence that links vitamin D with MS to which the member referred is conflicting and some of it is disputed, which is why the advisory committee process is vigorous. It will allow us to consider the evidence in detail before we consider any change to the current arrangements. The committee’s report is expected to be completed by 2014, at which time, in accordance with the committee’s findings, we will reconsider the current recommendations on vitamin D. Given that the research and surveillance data show that inadequate awareness and intake in at-risk groups is a key issue, our primary focus at this stage is to ensure that we encourage compliance with the current guidelines.

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Maternity Services (West Scotland)

16. To ask the Scottish Government what its position is on the review of the provision of maternity services in West Scotland. (S4O-00874)

As the member is aware, no decisions have been made about local maternity services. All health boards keep their services under review. NHS Greater Glasgow and Clyde will conduct a review later this year; the board assures me that all local stakeholders will be fully engaged in that. As with any other examples of major service change, should change be proposed, a final decision would come to ministers for approval.

The cabinet secretary will be aware of a previous public campaign, created in Inverclyde, in support of the retention of the community maternity unit at Inverclyde royal hospital. Does she agree that the CMU is an important cog in IRH’s future and that removal of the birthing unit is not inevitable or desired? Will she meet me to discuss the issue?

I will be happy to meet the member at an appropriate time. He will understand that, should change be proposed, I will have a particular part to play in the process. It is important that we allow the process to take its course.

The CMU has played an important part. All health boards have to keep their services under review, and I expect NHS Greater Glasgow and Clyde to give due consideration to all representations on the issue.

Will the cabinet secretary ensure that proposals from NHS Greater Glasgow and Clyde are subject to full consultation before changes are made to the midwife-led service at Inverclyde?

Of course proposals will be subject to full consultation. When I took office as health secretary, I recall inheriting from the time of the previous Administration a proposal to close the community midwife unit. I was clear then that consultation must be full. Consultation about any service change in the health service must be as full as possible.