Meeting of the Parliament

Meeting date: Tuesday, December 6, 2022

Official Report 991KB pdf

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Urgent Question

The next item of business is an urgent question. Any member who wishes to ask a supplementary question should press their request-to-speak button during the question or enter the letters “RTS” in the chat function.

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Breast Cancer Care (NHS Tayside)

To ask the Scottish Government what its response is to reported claims that there was a cover-up in relation to the publication of the Royal College of Physicians report into breast cancer care in NHS Tayside.

I reject claims that there was a cover-up in relation to the publication of the RCP report. As NHS Tayside has already publicly stated, it was made aware of an error in the first version of the redacted report that was published on its website. As soon as NHS Tayside was made aware of the error, it was corrected and the report was published on the NHS website.

The only thing that has been, to use Michael Marra’s words, covered up is the names of the report’s authors, in line with data protection. The rest of the report is completely unchanged.

There is obviously nothing in the general data protection regulation that mandates the removal of the names of authors of reports. To say otherwise is arrant nonsense. It is vital that we know who the authors are, because this is the second report on the issue to have been hobbled by a conflict of interests. The names were removed after that conflict of interests was put to NHS Tayside. On whose authority did that happen? Who ordered that the names of the report’s authors be hidden from the public?

With the greatest respect, I note that Michael Marra should, of course, put those questions to NHS Tayside, and he should get a satisfactory response. There is a lot that I deal with and manage throughout my day, but I do not busy myself with redactions of reports from the NHS health boards. That is a job for them to do in relation to their own GDPR practices. Of course, if Michael Marra wishes to question that, he absolutely should.

What I was busy doing yesterday was meeting the clinicians in the breast cancer service. When I was at Ninewells, I talked to them for a good hour and a half and engaged with them about the service. I was not looking back. There have been a number of independent reviews and investigations, but all of us around the table—the clinicians included—are interested in looking forward and addressing some of the workforce challenges that the breast cancer service in particular is facing, and that is where my focus will be.

Surely the cabinet secretary accepts that there has to be confidence in the reports that have been issued about this critical service, particularly given that reports have previously been withdrawn. Just days ago, the report that we are discussing was the principal defence that the First Minister used in answering questions from the Labour Party regarding the service. Now, the report is falling apart.

The report contains no data or scientific citations on dosage. On consent issues, it contradicts David Dunlop, NHS Tayside and the General Medical Council. It references standard dosage in National Institute for Health and Care Excellence guidelines. Those do not apply in Scotland, of course, but even if they did, the guidelines that are cited do not contain any guidance on standard dosage, despite what the report claims.

Last week, the First Minister told Labour that she would reflect on the case and decide whether an independent inquiry would happen. Surely the case for that has now been made beyond all reasonable doubt. Will the cabinet secretary back an inquiry today?

No, I am not backing a public inquiry today. Michael Marra, not unusually, is indulging in some element of hyperbole here. To describe the report as “falling apart” because some authors’ names have been redacted is, I think, not an accurate description of what has happened.

There are genuine questions. I do not fault Michael Marra or, indeed, others in the slightest for asking questions about the breast cancer service in Tayside. There are genuine questions around the workforce and its sustainability, and I could give him chapter and verse on what NHS Tayside and the Government have been doing to support that workforce. However, if we have accusations of cover-up and conspiracy when the reality is far more benign—it relates to data protection, as NHS Tayside has said—I do not think that we do that very important issue the justice that it deserves.

If Michael Marra would like to meet me, I am more than happy to go through the issues that he has raised in the chamber and the concerns that have been raised, be it by clinicians whom he knows who have been involved in the service or by patients in Dundee. I am happy to have that conversation with him. However, I do not think that we can say that the number of independent investigations have all “fallen apart” because some authors’ names have been redacted.

In June, I called on the cabinet secretary to release a buried report on allegations of bullying at NHS Tayside oncology. Now, a second report on Tayside cancer services has been redacted, and it seems not to have enough detail in it. A public inquiry is needed now more than ever in order to restore clinicians’ and patients’ faith in the department. Does the cabinet secretary recognise that transparency is a huge issue, not just in our NHS but across Scottish National Party secret Scotland? Will he commit to a public inquiry?

I think that Sandesh Gulhane, with his latter comment and party-political point, exposes his motivation around the issue. As opposed to his motivation being the patients and the breast cancer service, he tries to use the issue as a stick to beat the SNP over the head with. As I said, that betrays his real motivation.

I say to Dr Sandesh Gulhane that there have been three other published reviews of the issue: the Healthcare Improvement Scotland report in April 2019; the work of the Scottish Government’s immediate review group, which reported thereafter; and the report of the independent advisory group. We now have the RCP report. He talked about redaction. It is really important to be clear that what has been redacted—NHS Tayside says that it was done in relation to data protection law, but I will question that, as Michael Marra asked me to do, and he is also free to pursue that with NHS Tayside—is the names of the authors.

All the reviews and reports have similar findings in relation to the clinical practice at the time. My relentless effort in relation to the breast cancer service, and particularly the cancer service more generally, is not necessarily to look back, because reviews have been done, but to look forward and see how I can support the service with the workforce that it requires.

One report is without the right experts and has no evidence references; another is withdrawn because of a conflict of interests; findings are contradicted by experts; numbers are made up; patients are confused; relatives of patients who have passed away are confused; and an oncologist feels under attack. The cabinet secretary must understand that none of this is going to go away. For the sake of the service, therefore, there must be an independent inquiry. Why can he not agree to that?

I do not know whether Willie Rennie has done this—he may well have done so—but I have met the clinicians on a number of occasions, including as recently as yesterday. He is absolutely right that there have been a number of reviews. People will question those reviews. Some will disagree with their findings, and some will agree with those findings.

Given those independent—I stress that word—reviews, which have been done over a number of years, it is exceptionally important not to look backwards but to look forwards at how we will support the service. There are genuine oncology workforce challenges in the breast cancer service and in the cancer services generally in Tayside. I have asked my senior clinicians to do some work in and around that.

The imperative is not for the Government to look backwards. Our focus should be on looking forwards at supporting that service, and that is what I intend to do.

Effective recruitment for an effective workforce is vital to delivering sustainable specialist services in Tayside and across Scotland. Will the cabinet secretary outline how the Scottish Government and the health boards, including NHS Tayside, are supporting recruitment to breast cancer services?

Again, that is an important issue for Tayside breast cancer services. Clearly, the oncology workforce is a challenge not just for NHS Tayside but right across the United Kingdom—in fact, globally, as Emma Harper will know only too well.

NHS Tayside has been working exceptionally hard on those workforce issues. I am happy to report the recent appointment of a locum consultant in NHS Tayside. That will help to reduce the number of patients—currently, around seven a week—who have to travel to other cancer centres for treatment.

In addition, I have asked one of my senior clinicians to chair a national oncology task force, which will provide—and has provided—me with some additional solutions for and recommendations on the oncology workforce across Scotland. We will take forward those recommendations.

We will work closely with NHS Tayside. It is engaged with recruitment agencies across the UK and globally to bring as many oncology experts as possible to the service in Tayside. I will keep members updated on progress.

The cabinet secretary will be aware that this is just the latest in a long list of events that call into question the leadership of NHS Tayside and cause people to question the care that they might receive. That is not good for any of our public services. The cabinet secretary has also indicated that he does not think that a public inquiry is necessary. I think that many of us disagree with him. If not an independent investigation, what kind of open, transparent and independent process does he consider necessary to restore people’s trust and confidence in the service?

Maggie Chapman has asked me what kind of independent investigation I consider necessary. There have been a number of independent investigations, including a report of the RCP, which is independent of Government. The report is independent of the health board. The royal college is a very respected organisation. As I have said, those findings can be read in detail. I am happy to provide Maggie Chapman with a copy of that report if she has not seen it.

As I have said, my focus is on looking forward at how I support the breast cancer service and the other cancer services in Tayside, as opposed to looking back over the independent reviews that have been done.

I go back to what I said to Willie Rennie: with almost any review that is conducted, independent or otherwise, some people will agree and some will disagree with the recommendations or the analysis. It is exceptionally important that we objectively recognise the independence of those reviews and the clinical expertise of those involved in them, and that we move forward as opposed to looking back.

That concludes discussion of the urgent question.