Meeting of the Parliament

Meeting date: Tuesday, May 30, 2023

Official Report 990KB pdf

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Topical Question Time

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Orthopaedic Appointments and Surgeries

To ask the Scottish Government what its position is on whether orthopaedic appointments and surgeries, when they do not require the use of general anaesthetic, should be carried out in local community hospitals. (S6T-01410)

Health boards will always try and offer patients appointments in their local area. However, patients may be offered an appointment at a different location, such as a national treatment centre, to ensure that they are seen as quickly as possible. Treatment decisions are made by clinicians, taking into account the patient’s treatment needs and ability to travel.

Estate availability and staffing are key considerations for health boards to maximise the number of patients seen. Boards may try to protect theatres for arthroplasty procedures requiring anaesthesia or spinal blocks and undertake local-anaesthetic cases in community hospitals, treatment rooms and day theatres.

The national treatment centre is a great addition to the Highlands and we all appreciate it up there. However, patients in Caithness welcomed orthopaedic surgeons travelling to Caithness general, for example, to carry out minor surgeries and to review cases. That meant that they did not have to travel all the way to Raigmore, which could take two hours. An orthopaedic surgeon could carry out a series of, say, 40 case reviews on his list over a period of two days. Surely that is good use of the surgeon’s time and national health service resources.

I recognise the concerns that Mr Mountain has raised. As he also acknowledges, the national treatment centre in the Highlands at Raigmore will offer significant additional capacity for elective procedures in the Highland area. I also recognise the need to minimise the need for patients to travel excessive distances within the Highlands—in particular, where they have longer, enduring painful conditions or where they are going through on-going treatment.

I would certainly encourage NHS Highland to look at how it can minimise the need for patients to travel to Raigmore, where possible, and to look at whether there is scope for further procedures to be undertaken at Caithness general hospital, including review visits where possible. I am also conscious that not all of that work requires orthopaedic surgeons. Some of it can be carried out by MSK—musculoskeletal—physiotherapists or by advanced nurse practitioners who specialise in orthopaedics, all of which could help to reduce the need for patients to travel to centres such as Raigmore.

I welcome that answer from the cabinet secretary, but my issue is in relation to patients in remote rural areas, where being able to see an orthopaedic surgeon is extremely useful, especially when a case is being reviewed, for example, after an operation. My constituents are concerned, having heard that NHS Highland will have to reduce its budget by £60 million, that this is one of the outcomes of that. I ask the cabinet secretary to urge NHS Highland to speak more fully with the orthopaedic department to make sure that it is taken along with NHS Highland’s plans.

I would expect the health board to look at how it can maximise the benefits that it gets from the clinical group that it has within its orthopaedic department at present and how it can utilise those skills to the best of its ability in order to meet the needs of those who require orthopaedic procedures within the NHS Highland area, whether that be treatment that is being carried out at the national treatment centre at Raigmore or procedures that can be carried out in district general hospitals. I would certainly want to encourage the board to do so, and I will make sure that I raise the issue with the board and encourage it to look at what further action it can take in order to address the concerns that have been raised by Mr Mountain.

I thank my colleague, the member for Dumbarton, who lodged the parliamentary question that uncovered the extent of orthopaedic waiting times in Scotland as reported in the press over the weekend. The Government is quick to point to the national treatment centre that opened in Fife back in March, but people are still languishing on orthopaedic waiting lists. Does the cabinet secretary accept that his predecessor failed to deliver an end to the two-year orthopaedic surgery waiting times and can he confirm how many orthopaedic surgeries have been carried out this year, so far, and say whether the new national treatment centre will meet its target?

I am sure that everyone in the chamber, including Mr Sweeney, recognises that we have gone through a pandemic, which has had a significant impact on capacity in our national health service. That has resulted in many elective procedures having to be significantly reduced in number or cancelled, which has resulted in a significant backlog.

The NHS in Scotland faces the same challenges as are faced across the rest of the United Kingdom and, to some extent, in healthcare systems globally in that we are having to work our way through those significant backlogs. We have made steady progress in reducing them, particularly for people who have had the longest waits. Capacity is increasing across our territorial health boards and we are adding to their capacity through the creation of the national treatment centres, which have already started to open and provide additional capability. That will help us to reduce the overall times that people will have to wait.

I do not want anyone to wait for a procedure longer than they have to but we also have to acknowledge the significant disruption that there has been to the NHS over the past two years. It will take some time to reduce those backlogs but we are doing everything that we can to increase capacity and reduce the waits as much as we can.

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Support for Parents and Carers (Cost of Nappies and Infant Feed)

To ask the Scottish Government what advice and support it can provide to parents and carers who are struggling to afford nappies and infant feed, in light of recent reports regarding nappy need, difficulties in accessing baby formula at foodbanks and families with young children being forced to cut back on essentials. (S6T-01415)

Tackling poverty and protecting people from harm is one of the Scottish Government’s three critical missions and we are working closely with national and local partners to understand the scale and nature of infant and maternal food insecurity to support longer-term responses.

It is crucial to ensure that people get the right help where and when they need it. I encourage anyone who is in need to get advice from a range of services or to speak to their midwives, health visitors or family nurses, who can provide appropriate guidance on people’s money worries and help families with infants to get prompt access to appropriate nutritional support during the cost of living crisis.

Of course, I always encourage everyone who is eligible to do so to apply for the Scottish Government benefits to which they might be entitled, including best start foods, best start grants and the Scottish child payment. The Scottish Government recognises the pressure on household budgets, which is why, last year and this, we allocated almost £3 billion to support policies that tackle poverty and protect people as far as possible during the continuing cost of living crisis.

I know that the cabinet secretary shares some of my concerns about some of the heartbreaking findings that were in the Sunday Post’s special investigation at the weekend, including the findings of a Joseph Rowntree Foundation survey. There was a lot in that investigation, but I will pick up on the perceived rules around the UNICEF guidelines on baby formula.

Mums are being turned away from food banks. It is not the fault of the food bank volunteers and charities, but mums are being left in tears because of the interpretation of the guidelines. Paediatrician Dr Ruth Bland has warned that watering down formula to make it last longer will quickly have a negative impact on babies’ health and we know that children are going without the nutrition that they need. What can the Government do to work with a range of partners, including food bank charities, to ensure that people who are asking for baby formula can access it when they need it?

I thank Monica Lennon for raising that important issue and pay tribute to the Sunday Post for highlighting the very concerning aspects of the situation that it covered at the weekend.

The UNICEF guidance recognises that, in certain circumstances, where there is no immediate alternative, food banks can make use of crisis funding to support families to purchase the right supply. The main point that UNICEF makes—and we agree with it on this—is that food banks and anyone else supporting a family that is in desperate need should refer the family to a local authority or health professional who can ensure that they get holistic support, including financial advice.

I also highlight the work that has been done on, for example, the Parent Club website to provide parents with information on how to safely make up baby formula. Monica Lennon is a right to point to the dangers of watering it down, and the information on that website sets out the point that all first formula is required to meet the same nutritional standard. It also makes the point that price does not equate to a better product. Again, we encourage everyone to seek advice from their health visitor, midwife or family nurse to ensure that they are getting the widest possible support during these difficult times.

I am grateful to the cabinet secretary. I want to mention the campaign charity Feed UK, which was founded by Dr Erin Williams. It says that many food banks do not supply baby formula because they wrongly believe that it is illegal to do so. That is not the case and we need to get that message out there.

On nappy need, I was recently asked along to NappiRunz, a small charity that is based in Edinburgh and which supplies thousands of nappies every week to families who are in need. When I was there, a health visitor popped in to collect nappies for a young mum and her baby who are in poverty. Toyin Ware, who runs the charity, fears that mums and children are becoming socially isolated because they cannot afford all the changes that their baby needs, so they are rationing nappies. Those are words that I never thought that I would say in 2023.

I have asked this of the Government previously but I will ask it again. What work is being done to address the hidden issue of nappy need? What support is available to help charities such as NappiRunz and nappy libraries provide support for families who need it?

Monica Lennon has raised a very important point. I and my fellow minister, Jenni Minto, who is here with me today, would be happy to ensure that we are doing everything that we can right across Government to work with food banks, food bank networks and others so that there is a shared understanding of the UNICEF guidance and what more we can do on that, and ensure that we are doing everything that we can to look very carefully at the issue of nappies and nappy rationing. I agree with Monica Lennon that it beggars belief that we are talking about that today in Scotland.

As I said in my previous answers, a degree of support for the issue can be given by the health service and wider advice services, but I am always happy to work with Ms Lennon on this and other issues, as I hope she knows, to see if more can be done. I include my fellow ministers in that.

There is no doubt that, as Monica Lennon has just highlighted, the soaring price of essential products is exacerbating the already challenging circumstances facing parents, particularly those who are on low incomes. What additional action is the Scottish Government taking within its limited powers and budget to support people during this cost of living crisis? What more does the cabinet secretary consider that the UK Government should be doing to help?

I will point to one thing that the Scottish Government is doing, and that is of course our five family payments, including the Scottish child payment, best start foods and the three best start payments, which could be worth up to £10,000 by the time that an eligible child turns six. I have also recently announced that we will change the regulations to remove the income thresholds from best start foods so that around 20,000 additional pregnant mums and children under three will be able to benefit from February 2024.

I also highlight the information that came out today, which is that, in 2023-24, the Scottish Government made £83.7 million available for local authorities to spend on discretionary housing payments to mitigate the bedroom tax and ensure that we are protecting families from the other damaging impacts of UK Government welfare cuts, including the low rates of local housing allowance and the benefit cap. That is £83.7 million that we could be using on further anti-poverty measures if we were not mitigating other aspects of the UK welfare system.