Hansard

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."