Health Q&A with Shona Robison

Shona Robison - credit David Anderson/Holyrood

Excessive alcohol consumption persists in Scotland but with minimum unit pricing still in the courts, what else can be done?

We know that there is strong evidence in support of minimum unit pricing and we’re looking forward to the judgement of the Supreme Court. If it is the positive outcome we hope for, we will move as quickly as is practicable to put the policy in place. Our Framework for Action Alcohol Strategy outlines more than 40 measures to reduce alcohol-related harm, including the quantity discount ban, a ban on irresponsible promotions as well as a lower drink drive limit, improved substance misuse education, and our nationwide alcohol brief intervention programme. We will be refreshing our strategy later this year providing opportunity to further consider the additional actions and steps needed to tackle alcohol-related harm in Scotland.

Obesity is a huge threat to both the health of our nation and to the NHS budget. When do you get tough on the causes of obesity?

We are committed to tackling Scotland’s obesity problems and will consult on our new diet and obesity strategy this year. I have already been clear that there is no quick fix for this problem, and it’s important we take the time to get our approach right. This will include taking into account the views of a wide range of stakeholders and interested parties, and examining what further effective actions we can take within this government’s powers. We are also engaging with the food and drink industry on action to offer healthier choices, rebalance promotions, and reformulate products, with a focus on reducing calories, salt, saturated fat and added sugar.

In schools, we are investing in a range of areas to support healthier lives for children and families, including providing £149 million funding in free school meals for all primary 1 to 3 children, £50 million for Active Schools, and a commitment to provide two hours or periods of PE.

It’s really encouraging to see that over 1,000 primary schools across the country are also now starting their own Daily Mile programme and I’m delighted to see that 98 per cent of primary and secondary schools across Scotland continue to provide at least two hours or two periods of PE, which demonstrates remarkable progress since 2004/05 when only 10 per cent of schools were meeting this target.

Health and social care integration remains a cross-party priority but why is it taking so long and why are health boards not punished for failing to eradicate bed blocking?

Health and social care integration is one of the most ambitious reforms we have undertaken, providing a real opportunity to change the way we deliver services. We’re only one full year in but already there is progress. Aberdeen has seen a 58 per cent drop in delayed discharges over two years, Fife a 51 per cent reduction. Bed days lost to delayed discharges in Glasgow City are at an all-time low and they are now turning their attention to an ambitious plan to reduce overall unscheduled bed days, by addressing avoidable admissions.

Theresa May’s so-called ‘dementia tax’ went down like a lead balloon, but isn’t there a valid concern about the long-term viability of the cost of social care?

Changing demographics mean that social care services are going to have to adapt, and we’re already taking action to prepare. The integration of health and social care will help massively, because it will allow the NHS and local authorities to work together to plan and deliver services. We transferred an extra £250 million to social care from 2016/17 onwards to support integration and deliver on our shared priorities – including payment of the Living Wage to adult care workers. And this year we showed our continued commitment to this with an additional £107 million being invested. 

How do you instil a sense of personal responsibility in people who continue to drink, smoke, take illegal drugs and eat too much?

It’s important to recognise that progress has been made in many of these areas – fewer people are smoking and taking drugs, for example, but we do know that more needs to be done. Success in all of these requires not only a commitment from individuals but the support of both our public and private institutions to enable more people, more often, to make the right choices. One approach we’ve taken to instil a sense of personal responsibility has been using marketing campaigns, like our Take It Right Outside campaign on second-hand smoke – which contributed to children’s exposure to second-hand smoke being halved. We’ll continue to explore bold and innovative ways to deliver important health messages to as many people as possible.

As more and more services go digital, are you concerned about the NHS being a victim of another cyber-attack and can we as patients trust in the security of our personal data?

The first thing to say is that during the recent cyber-attack no patient data was compromised in any way. That doesn’t mean that we’re complacent on that point, of course.

More than £350 million was spent on IT and cyber security in Scotland’s health service last year. In light of the recent high-profile incident we have been increasing our patching routines. We’ve also been monitoring to ensure the whole estate is as protected as possible and all anti-virus protection is up to date. All health boards are collaborating and looking for further areas that can be improved.

Protecting our services and data from cybercrime is a constantly evolving challenge for all organisations, but it’s important to note that good information security includes being resilient to any incidents. After the WannaCry attack, most patient services in Scotland were completely unaffected and where services were affected, the vast majority were restored to normal within 24 hours.

With more and more evidence of the health impacts of air pollution, does your department need a stronger voice in the transport debate?

Our Cleaner Air for Scotland (CAFS) strategy sets out an ambitious programme of action to promote air quality. Scotland is the first country in Europe to adopt in legislation the WHO guideline value for particulate matter 2.5 – a pollutant of special concern for human health. Health protection officials – and specialists from Health Protection Scotland – are represented on the CAFS Governance Group, tasked with taking forward the work of the CAFS strategy, including the introduction by 2018 of Scotland’s first low emission zone.

When it comes to funding, health is a bottomless pit, isn’t it?

While we have increased the resources available to the health service, we have limited resources and we need to make the best use of these, ensuring we provide safe and effective healthcare and deliver excellent value for money. We also need to make sure the health service remains sustainable and affordable in the long term, which is why our ambitions for the NHS are founded on the twin approach of investment and reform. I’ve talked already about health and social care integration, but there are many other ways that health boards are working smarter and changing the way they deliver services that allow them to provide the very best care and treatment within the resources available. For example, health boards and GPs across the country are testing new ways of working, including better use of technology, and shifting the balance of care to community health services.  

Is the NHS beyond criticism?

No, of course not. There will always be things that can be done differently, or done better. Given the increasing demands on our services, we are constantly seeking new ways of delivering better services, better care and better value to meet the needs of the people of Scotland. It’s quite right that the NHS is subject to scrutiny and fair criticism when it’s warranted. However, I truly believe that NHS Scotland delivers outstanding care in the vast majority of cases, which is seldom recognised by those so ready to criticise, and therefore we should all recognise that effort and thank the staff who work so hard.  

What’s the naughtiest thing you’ve ever done?

Too many to mention!