Seòmar agus comataidhean

I recognise that we have cantered across quite a lot but might not have addressed all the issues that the petitioners have raised. I recognise that raising issues through a petition, which often involves talking about very personal healthcare issues that affect the petitioner or their family members, can be incredibly traumatic and difficult. If I have not fully responded to any points, for whatever reason, I am happy to address them in correspondence to you, convener, because it is very important that we continue to do so.

Our colleague Emma Roddick has brought great attention to Ehlers-Danlos syndrome and to the work of the petitioner to ensure that the matter is brought to the attention of the Parliament and that there is greater public awareness of the effects of some rare conditions and diseases.

As you acknowledge, convener, we have perhaps not had information across our desks about some of these conditions before. In those cases, we have to find a balance with regard to demand—the level of need for treatment—and the ability to deliver the treatment safely. The clinician who is delivering the treatment must be able to do that at a level at which they continue to be safe to practice. That is always a balancing act.

Territorial boards have different levels of demand for treatment for these conditions, so local decision making is important, because the boards need to make decisions with regard to local priorities—for example, if they have higher levels of Ehlers-Danlos syndrome or other conditions that they need to prioritise and invest in treatment for.

I recognise that travelling for treatment can be extremely challenging. I am originally from the Northern Isles—from Orkney—and I recognise that travelling for healthcare can be challenging, but it is also an expected part of living in some communities. We need to ensure that the boundaries between health boards are blurred so that, where a specialist service is being delivered, it can be provided on a national basis, co-ordinated through National Services Scotland. Our rare disease action plan focuses on that, to ensure that we have better co-ordination of where services are delivered for some rarer conditions.

Davy Russell has alighted on an incredibly salient point, on which we have been working with boards over the past six to 12 months to optimise the capacity that is available within the system. In some cases, that will involve asking people to travel—from Lanarkshire to Fife, from Grampian to the Golden Jubilee hospital, or to NTC Highland, with which Mr Mountain and Mr Ewing will be very familiar—in order to ensure that, where capacity is available, it is utilised according to demand. It might well be that NHS Lanarkshire needs help to get through its waiting times for cataracts, for instance. Exactly that process is under way, to optimise the planned care capacity.

I appreciate Mr Mountain’s point, although I do not agree with the first point that he made. I do not think that it is an inevitability that services will always be lost from the Highlands, not least because, in relation to all the points that I have already raised, there must be a balance between population-based planning and safety, travel and access to services for people who live in the Highlands. Given the travel that is already involved for people to get from Wick or Dingwall—or, indeed, from Skye, where I was in the summer—to Raigmore, and the onward travel to wherever that service might be, what Mr Mountain set out is not how we are approaching how services should be configured.

I have already given a good example of people in the central belt travelling to services that are provided in the Highlands, which is in good evidence through NTC Highland. I have no interest in seeing the situation that Mr Mountain has set out continue.

That is done in concert with the UK National Screening Committee. Like all Governments across the UK, we take our lead from the experts in that committee. Based on their recommendations, we seek either to implement a population-based screening programme or to target screening, if that is more appropriate.

I am very appreciative of that, and I am happy to have a discussion with her after the meeting, if that would be helpful.

I am grasping that particular jaggedy thistle and we are pursuing the process of reform. I pray in aid the merger of NSS and NHS Education for Scotland, which is happening in order to provide a new service for NHS delivery. We are blurring the boundaries between territorial boards to ensure that services are being delivered on the basis of it being a national health service, as Ms Baillie referred to earlier. As Mr Ewing is aware from his time in Government, structural reform is incredibly challenging and time consuming, and it can be very costly and distract from what we need to happen at the moment, which is an improvement in service delivery. I am focused on ensuring that we improve and reduce waiting times and improve people’s access to services. We are starting to see the fruits of that particular labour of our incredible NHS staff. That is not to say that structural reform is not required and that it could not be taken forward. However, right now, I am focused on getting the same outcomes that the type of reform that Mr Ewing speaks of could achieve but without having to go through the pain and cost of a top-down reform process.

Healthcare Improvement Scotland is leading on that, and I agree that we need to make progress. It is also working on the regulation of cosmetic implants and surgeries, which is another area where there is a pressing need for reform. It is my understanding that this will go to a public consultation—next year, I expect—and I expect progress to be made in that regard.

I absolutely agree with Mr Russell that that is part of the cancer treatment; it is the conclusion of the cancer treatment and it needs to be considered as such. In my role as health secretary, I have met women who are in those circumstances, and I understand their pain and anguish and the mental health impact of having to wait for surgery. The challenge is the demand on cancer treatment services, because the theatres that are used for what is sometimes very complex breast reconstruction surgery are the same theatres that are used for the initial treatment.

We need to get the balance right with regard to ensuring that we are concluding a woman’s cancer treatment through reconstruction surgery. However, I think that Mr Russell understands, as I do, the need to ensure that the initial treatment is prioritised. We are working with the relevant boards to ensure that there can be the necessary recruitment of specialist surgeons, so that we have the ability to get through the waiting lists. I absolutely agree that the length of wait that some people are experiencing is not acceptable.

I very much appreciate the petitioner’s advocacy for the issue in an incredibly challenging situation—it is more than challenging; it is a tragic situation, for which I offer my deepest sympathies and condolences. A lot has changed since the petitioner lodged the petition and since the tragic situation that she set out happened. We have surpassed the commitment that we made to expand the number of mental health practitioners in accident and emergency units, general practice surgeries and other locations. We have surpassed the 800 that we anticipated. I recognise that, in many cases, that is still not enough—I have my own constituency cases where that has been the case—and we need to do better to support people in a crisis situation.

I am also keen—this is where the Government’s real priority is—to move further upstream and prevent people from moving into crisis in the first place. That is about looking at whole-family support opportunities and enabling the drivers of poor mental health—in relation to poverty and other environmental and social factors that colleagues will be aware of—to be addressed much earlier, so that the acute level of mental health demand is lessened. Clearly, that is where we all wish to be, rather than having to treat the symptoms at an acute stage when people are in crisis.

On the first point, I have been clear with our health board chief executives and chairs on my expectation about working with industry and academia on the utilisation of new health technology and medical products. We have set out a national programme for the adoption of health innovation called accelerated national innovation adoption. That is led by the chief scientific officer in Scotland, Dame Anna Dominiczak, who is well respected across the health service in Scotland and, indeed, in industry. That programme is helping to pull together the triple helix that I referred to earlier—the health service, industry and academia—to ensure that we are co-ordinated.

I will give the member an example, as I recognise his concern about start-up companies, which are often spin-outs from universities and which have, in the past, struggled to get access to the health service. That situation is changing. The linkage between the Techscaler network and the NHS test beds means that the risk to those who are innovating is reduced, because they have access to health service clinicians who are telling them, “Yes, this is the type of thing that we need,” or, “No, this won’t work in an NHS setting.” That gives them the opportunity to develop products and services that will be applicable to the health service. My challenge is to ensure that, rather than our having to go to 14 boards, the technology is proven and adopted nationally as quickly as possible.

The second point that the member raised is around how quickly we can adopt technology to ensure that it is not immediately outdated. That is built into the digital front door programme, as it is described, and the app is being developed to ensure that technology will be serviceable, can be used as it is rolled out and is still relevant to what people need and expect.