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1.45 pm
The Minister of State, Scottish Office (Lord James Douglas-Hamilton): If Highland council disagrees with the distribution formula as operated by COSLA, the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) should advise it to make strong representations, to send in all the available evidence and to copy it for my hon. Friend the Under-Secretary of State for Scotland, who has responsibility for the highlands, and also for me. We will look at it.
On 28 May, the health board submitted an application for bridging finance in 1996-97. A preliminary meeting involving the Scottish Office, the health board, the Highland communities trust and the social work department was held on 30 May. That meeting provided an opportunity for helpful and constructive exchange of views. It is essential to be clear, however, that bridging finance is not the principle means of enabling community development. Funding must continue to come from resources released from the hospital sector for reinvestment in community health services and transfers to local authorities for social care provision.
The hon. Member is obviously interested in service developments at Raigmore. I am aware that the trust has developed proposals to open a new haematology- oncology facility at Raigmore. That will be dependent on the necessary resources being in place. It is one of the
issues being discussed within the current contract negotiations. As hon. Members will appreciate, it is simply not possible to fund all the developments that one might wish to see simultaneously introduced since, despite the billions of pounds of public funds devoted to the NHS, we still have to work within finite resources.
I know that the hon. Member is interested in the proposals that the trust has in mind for increasing the number of clinical sessions for rheumatoid arthritis sufferers. The position on that initiative is similar in that much depends on the outcome of the contract negotiations.
The hon. Member touched on rent increases for student nurses at Raigmore, as did the hon. Member for Moray (Mrs. Ewing) earlier. I understand that the previous rent levels were unrealistically low compared with market levels and levels paid by students in other areas. I understand that the increased rents are now being phased in over one year instead of six months as originally planned.
The hon. Member may be interested to know that there is to be a primary care resource centre at Easter Ross. I congratulate the local Members of Parliament on taking the initiative in undertaking the feasibility study. We welcome the vision and concept behind the proposal and look to purchasers for a definite local commitment on how the proposal is to be developed. The ensuing business case will be considered on its merits.
I welcome the opportunity for the debate. The principle to which the hon. Member alluded is extremely important: patient standards and patient care must not be allowed to suffer. It is, of course, the responsibility of the Minister with responsibility for health to ensure that that does not happen.
I am well aware that the Highland health board has definite challenges because of its particular geographical circumstances, which mean that it is spread over such a large area. It has to strike a balance between delivering services in small local communities and more centrally at Inverness. It is working hard on the development of locality plans in partnership with the trust, the Highland council and other agencies. It is working with local health councils and taking the views of the local communities. I am sure that the board will take those views into account when drawing up its strategy for health care services in the highlands.
The hon. Member mentioned the contract negotiation position affecting the Raigmore Hospital NHS trust. In the current contracting round, a gap remains between what is proposed and the price that the board is prepared to pay for an agreed and appropriate level of service. Several trusts in Scotland are still negotiating with their purchasers about contracts for this year, and Raigmore is no exception. That is not unusual at this stage in the process.
These exchanges are designed to produce better outcomes for patients and better value for money locally. The provision of a high and continuing standard of patient care is of the utmost importance, and all concerned are working to resolve the outstanding contracting issues to maintain and improve the level of services to patients. My officials in the management executive are in close contact with the board and the trust about the current state of negotiations and will press for a resolution to be achieved as soon as possible.
Mr. Kennedy:
Will the Minister reflect on a phrase he used? He said that it was "not unusual" for contracts not
Lord James Douglas-Hamilton:
As I have said, we want to reach a settlement as soon as possible. The officials of the management executive stand ready to give guidance, should there be any impasse in the negotiations.
Mrs. Margaret Ewing (Moray):
Is a deadline being set?
Lord James Douglas-Hamilton:
All I can say is that we shall work extremely hard to ensure that the necessary agreements are reached, and at this stage it is not necessary for me to intervene. I believe that the negotiations are proceeding well, and we shall closely monitor the position and keep a close eye on it.
In general, the Highland communities trust has introduced a range of innovative developments, including new facilities for the treatment of Parkinson's disease and a new drug and alcohol dependency centre. It has begun upgrading the Belford hospital in Fort William, as well as completing new community health centres in Gairloch and Dundonald.
Specific issues confront the Highland health board. For example, I know that facilities for the patients of Craig Dunain are far from ideal at Inverness. I am pleased to hear, therefore, that the health board, the Highland communities trust and Highland council social work department, working together, have made significant progress in developing plans for the care of the mentally ill. There are already some excellent examples of well-resourced care facilities in the highland region for patients discharged from Craig Dunain.
The Highland communities trust has developed proposals for a new acute facility. I also understand that plans for a long-stay unit are well developed. That is encouraging, and we look forward to reading, in the very near future, the finalised and locally agreed plans, which will deliver improved services to all who need them. We will monitor the position.
I now turn to the issue of community care in the Highland health board area. The board is working with the local social work and housing authorities in continuing joint assessments of local care needs. They are working towards the organisation of best local care that matches local needs. In doing so, they are aware of my position that, for the NHS continuing care sector, no long-stay hospital will close before appropriate care facilities and services are well in place in the community, and no long-stay patient should be transferred to alternative models of care before that care and the necessary support and accommodation are in place and available.
Working towards the aim of improving the daily lives of vulnerable people in the area who need support, last year alone the health board transferred about £3.4 million to the local authority towards the cost of care in the community.
The hon. Member for Ross, Cromarty and Skye may wish to know that the sum total of the resources transferred from health to local authorities throughout
Scotland last year was £45 million. Substantial additional resources have been allocated to local authorities to meet their community care responsibilities. In the current year, Highland council has £24.5 million compared with£23.9 million in 1995-96.
The allocation to the former Highland regional council was generous. The council was one of two in Scotland that received additional resources in the form of transitional protection. That reflected the historically high level of Department of Social Security expenditure in the region. Transitional protection was provided for three years to give the council time to plan for the eventual position. The scheme was initiated by the Scottish Office, against initial opposition by COSLA representatives on the distribution committee.
This year, the DSS transfer resources already in the baseline, and the new resources for 1996-97, have been made available to Highland on the same basis as to all other authorities--that is, on the basis of a distribution weighted by the proportion of elderly and disabled people in each area. That is the approach agreed with COSLA's distribution committee, and I am sure that the hon. Member for Ross, Cromarty and Skye will agree that that is a fair and reasonable basis on which to distribute resources.
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