Chamber
Plenary, 05 Jun 2008
05 Jun 2008 · S3 · Plenary
Item of business
Remote and Rural Health Care
Margaret Curran talked about Western Isles NHS Board. On behalf of all of us and for the sake of NHS staff and patients in the Western Isles, I hope that people there can now look forward to a period of stability.
I commend all those who contributed to the excellent report on remote and rural health care. Urban models, such as that for allocating funding under the NRAC formula, are all too often inappropriate to rural health care, particularly given that, for example, the out-of-hours service in the Highlands costs five times more than that in Glasgow. We are minded to support the Liberal amendment, but we would like to hear more. We will decide whether to support the Labour amendment after hearing more speeches.
The report highlights well the differences of remote and rural areas, such as the higher suicide rates, higher incidence of alcohol-related disease, higher number of accidents on roads and through climbing, farming, diving and fishing, and the palliative care workload, which the cabinet secretary mentioned. I pay tribute to the excellent work of Marie Curie Cancer Care and Macmillan Cancer Support nurses in the Highlands, where many people choose to die in their own homes and localities.
The proposed integrated teams that would be based in GP practices and the potential increase in mobile diagnostic facilities for aneurysm, breast and osteoporosis screening are good news for locally delivered health care. My colleagues throughout Scotland tell me that GPs in remote and rural areas are asking for the flexibility to do what meets the needs of patients in their localities, rather than be forced to follow centrally prescribed agendas. I will leave the matter there—that debate is for another day.
It is worrying to read in the report that the workforce in remote and rural areas
"is ageing and organised"—
if "organised" is the right word—
"in a fragmented and reactive way."
We have heard about integration, partnership working and seamless care for many years. The situation has improved, but there is still a long way to go to put the patient at the heart of the service.
The role of allied health professionals is not entirely clear. Given the 18-week target for referral to a consultant, it is possible to see a consultant long before one can see a podiatrist or a physiotherapist. Waits for psychiatry and psychology services, particularly in the Highlands, are very long and just as difficult.
The role of community and rural general hospitals is critical to the model of care: my colleague Murdo Fraser will say more about community hospitals.
I will concentrate on two issues: mental health services and the Scottish Ambulance Service, although I have scored out quite a lot of what I planned to say about the Ambulance Service because of yesterday's statement. I commend NHS 24 for developing cognitive behavioural therapy in the islands. That is an excellent example of the delivery of high-quality professional care and support over the telephone to meet the needs of patients in isolated areas.
It is disappointing that NHS Highland has not provided the small amount that is needed to fund the Depression Alliance Scotland self-help group in Inverness. When people take the initiative and the time to understand and address their mental health problems, surely we should encourage that. The report concluded that consistent difficulties were experienced in managing patients with mental health crises, especially out of hours. Early diagnosis and intervention are as essential in rural areas as they are elsewhere—for example, to prevent mild depression from becoming severe and chronic. However, there is no doubt that community hospitals could be enhanced to deal with mental health and various other issues, as outlined on page 18 of the report.
Although an inquiry is being carried out into the management of the Scottish Ambulance Service, we cannot ignore the substantial part of the report on that service, or the fact that many aspects of patient care are dependent on it. I will move my amendment, although I appreciate that many of the issues were addressed in yesterday's ministerial statement on the Scottish Ambulance Service. To give some examples of the issues, there is a lack of an integrated response, delays occur in accessing health care, little or no planning or co-ordination takes place within agencies, and there is a fragmented approach in which there is duplication and inefficient use of resources.
The report asks for a nationally co-ordinated response and suggests that the service be
"more embedded in the NHS Territorial Boards".
A merger of the Scottish Ambulance Service with NHS boards is not our policy or something that we have discussed but, in the current circumstances and with the serious issues relating to patient care, the suggestion is undoubtedly worthy of further consideration. I hope that the Government inquiry into the Scottish Ambulance Service considers not only what is happening in the service, but how the service works in partnership with other agencies. I cannot say much about the target on responding to 999 calls, given that the data collection is questionable. I simply point out that there is a target to respond to 63 per cent of calls within eight minutes, although people in Bettyhill have a 1 per cent chance of seeing an ambulance in that time.
Page 51 of the report comments on support workers. I am not sure who the new generic support workers are, but the Conservative party welcomes support for young families from all backgrounds. However, my understanding is that a support worker is not a registered nurse and does not have the training and experience of a health visitor. Health visitors are paid at band 6 or 7, but support workers are paid at band 3 or 4, yet they are expected to support individuals with self-care, to carry out health promotion work, to manage chronic conditions, to prevent unnecessary hospital admissions, to support young families and to screen people who are over 75. Although all health professionals have a role, we do not want support workers to be expected to do the work of health visitors but at a significantly lower salary.
I move amendment S3M-2056.1, to insert at end:
"further notes the concerns raised regarding the provision of ambulance services, and asks the Scottish Government to ensure that those living in rural communities are not disadvantaged."
I commend all those who contributed to the excellent report on remote and rural health care. Urban models, such as that for allocating funding under the NRAC formula, are all too often inappropriate to rural health care, particularly given that, for example, the out-of-hours service in the Highlands costs five times more than that in Glasgow. We are minded to support the Liberal amendment, but we would like to hear more. We will decide whether to support the Labour amendment after hearing more speeches.
The report highlights well the differences of remote and rural areas, such as the higher suicide rates, higher incidence of alcohol-related disease, higher number of accidents on roads and through climbing, farming, diving and fishing, and the palliative care workload, which the cabinet secretary mentioned. I pay tribute to the excellent work of Marie Curie Cancer Care and Macmillan Cancer Support nurses in the Highlands, where many people choose to die in their own homes and localities.
The proposed integrated teams that would be based in GP practices and the potential increase in mobile diagnostic facilities for aneurysm, breast and osteoporosis screening are good news for locally delivered health care. My colleagues throughout Scotland tell me that GPs in remote and rural areas are asking for the flexibility to do what meets the needs of patients in their localities, rather than be forced to follow centrally prescribed agendas. I will leave the matter there—that debate is for another day.
It is worrying to read in the report that the workforce in remote and rural areas
"is ageing and organised"—
if "organised" is the right word—
"in a fragmented and reactive way."
We have heard about integration, partnership working and seamless care for many years. The situation has improved, but there is still a long way to go to put the patient at the heart of the service.
The role of allied health professionals is not entirely clear. Given the 18-week target for referral to a consultant, it is possible to see a consultant long before one can see a podiatrist or a physiotherapist. Waits for psychiatry and psychology services, particularly in the Highlands, are very long and just as difficult.
The role of community and rural general hospitals is critical to the model of care: my colleague Murdo Fraser will say more about community hospitals.
I will concentrate on two issues: mental health services and the Scottish Ambulance Service, although I have scored out quite a lot of what I planned to say about the Ambulance Service because of yesterday's statement. I commend NHS 24 for developing cognitive behavioural therapy in the islands. That is an excellent example of the delivery of high-quality professional care and support over the telephone to meet the needs of patients in isolated areas.
It is disappointing that NHS Highland has not provided the small amount that is needed to fund the Depression Alliance Scotland self-help group in Inverness. When people take the initiative and the time to understand and address their mental health problems, surely we should encourage that. The report concluded that consistent difficulties were experienced in managing patients with mental health crises, especially out of hours. Early diagnosis and intervention are as essential in rural areas as they are elsewhere—for example, to prevent mild depression from becoming severe and chronic. However, there is no doubt that community hospitals could be enhanced to deal with mental health and various other issues, as outlined on page 18 of the report.
Although an inquiry is being carried out into the management of the Scottish Ambulance Service, we cannot ignore the substantial part of the report on that service, or the fact that many aspects of patient care are dependent on it. I will move my amendment, although I appreciate that many of the issues were addressed in yesterday's ministerial statement on the Scottish Ambulance Service. To give some examples of the issues, there is a lack of an integrated response, delays occur in accessing health care, little or no planning or co-ordination takes place within agencies, and there is a fragmented approach in which there is duplication and inefficient use of resources.
The report asks for a nationally co-ordinated response and suggests that the service be
"more embedded in the NHS Territorial Boards".
A merger of the Scottish Ambulance Service with NHS boards is not our policy or something that we have discussed but, in the current circumstances and with the serious issues relating to patient care, the suggestion is undoubtedly worthy of further consideration. I hope that the Government inquiry into the Scottish Ambulance Service considers not only what is happening in the service, but how the service works in partnership with other agencies. I cannot say much about the target on responding to 999 calls, given that the data collection is questionable. I simply point out that there is a target to respond to 63 per cent of calls within eight minutes, although people in Bettyhill have a 1 per cent chance of seeing an ambulance in that time.
Page 51 of the report comments on support workers. I am not sure who the new generic support workers are, but the Conservative party welcomes support for young families from all backgrounds. However, my understanding is that a support worker is not a registered nurse and does not have the training and experience of a health visitor. Health visitors are paid at band 6 or 7, but support workers are paid at band 3 or 4, yet they are expected to support individuals with self-care, to carry out health promotion work, to manage chronic conditions, to prevent unnecessary hospital admissions, to support young families and to screen people who are over 75. Although all health professionals have a role, we do not want support workers to be expected to do the work of health visitors but at a significantly lower salary.
I move amendment S3M-2056.1, to insert at end:
"further notes the concerns raised regarding the provision of ambulance services, and asks the Scottish Government to ensure that those living in rural communities are not disadvantaged."
In the same item of business
The Presiding Officer (Alex Fergusson):
NPA
Good morning. The first item of business is a debate on motion S3M-2056, in the name of Nicola Sturgeon, on remote and rural health care. I remind members th...
The Deputy First Minister and Cabinet Secretary for Health and Wellbeing (Nicola Sturgeon):
SNP
I am happy to open yet another health debate. I suspect that there are members here this morning who have not been home since last night's member's business ...
Jeremy Purvis (Tweeddale, Ettrick and Lauderdale) (LD):
LD
I have heard that mantra on many occasions. It is, however, disingenuous. Although the baseline grant has not been affected for this year, boards such as Bor...
Nicola Sturgeon:
SNP
Jeremy Purvis came in right on cue when I was talking about irresponsible members. What I said is not a mantra; it happens to be the truth. No health board w...
Rhoda Grant (Highlands and Islands) (Lab):
Lab
Will the cabinet secretary take an intervention?
Nicola Sturgeon:
SNP
No—I have to move on and discuss the Liberal Democrat amendment. The amendment is sensible, because a funding formula should not be static. It should be kept...
Margaret Curran (Glasgow Baillieston) (Lab):
Lab
On what I hope is a consensual note, I begin by saying that Labour feels that this is certainly a welcome debate on an important issue. Health care in remote...
Nicola Sturgeon:
SNP
I am more than happy to engage in debate, but debate usually involves suggesting solutions as well as making criticisms. Does Margaret Curran agree that she ...
Margaret Curran:
Lab
I think you should pay attention to the exact details of what I said. My argument is not about the amount but about the share, and you know that full well, c...
The Minister for Public Health (Shona Robison):
SNP
Will the member take an intervention?
Margaret Curran:
Lab
No. I did Nicola Sturgeon the courtesy of taking an intervention, but she did not do me the same courtesy. I would prefer it if you would allow me to pursue ...
Shona Robison:
SNP
Will the member take an intervention?
Margaret Curran:
Lab
No, thank you.We are talking about the range of resources from funding for ambulance services to funding to ensure equal access to major Government commitmen...
Nicola Sturgeon:
SNP
Margaret Curran makes an important point, but will she acknowledge that the appointments in NHS Western Isles that have attracted much criticism were made un...
Margaret Curran:
Lab
I say with the greatest respect that the cabinet secretary has missed the point. The point is not party political. Laughter.
The Presiding Officer:
NPA
Order.
Margaret Curran:
Lab
The point is not political. It is about the NHS's management. The NHS's appointments procedures are governed not by politicians, but by its administration. W...
Mary Scanlon (Highlands and Islands) (Con):
Con
Margaret Curran talked about Western Isles NHS Board. On behalf of all of us and for the sake of NHS staff and patients in the Western Isles, I hope that peo...
Ross Finnie (West of Scotland) (LD):
LD
I am delighted that we are having a debate on rural health care, as this is the first occasion since the new Government was formed on which I have been able ...
Dr Richard Simpson (Mid Scotland and Fife) (Lab):
Lab
Will the member give way?
Ross Finnie:
LD
No—I will press on, because I want to make a point about the purpose of our amendment that I hope will be helpful to Mary Scanlon and other Conservative memb...
The Presiding Officer:
NPA
We move to the open debate. Speeches should be around six minutes, please.
Christine Grahame (South of Scotland) (SNP):
SNP
I welcome the temperate and considered speech that my colleague on the Health and Sport Committee, Ross Finnie, has just made.The foreword to "Delivering for...
Margaret Curran rose—
Lab
Christine Grahame:
SNP
I want to move on. I have only six minutes in total.On staff issues, we should consider the delays in implementing the agenda for change. That is not a Scott...
Rhoda Grant (Highlands and Islands) (Lab):
Lab
I am pleased to take part in this debate on remote and rural health care and I welcome the report. The cabinet secretary is pleased to endorse its recommenda...
Shona Robison:
SNP
The member has just said that the report referred to the minimum level of service that we would expect. Where there are more comprehensive services, we would...
Rhoda Grant:
Lab
I am grateful to the minister for that reassurance. I am sure that the people of Caithness will be grateful for it, too.The report states that there has been...
Jamie Stone (Caithness, Sutherland and Easter Ross) (LD):
LD
The Howard Doris centre is funded jointly by NHS Highland and Highland Council. Does Rhoda Grant agree that there is a question mark over Highland Council's ...
Rhoda Grant:
Lab
Indeed. However, my point is that if the community had not brought forward that initiative, there would be no joint funding. It was the community that raised...