Public health medicine consultant Dr Helene Irvine says an "army of health improvement officers" were hired to put out leaflets which sat in a GP's office and were never used.

Dr Irvine says consultants, "like me", aren't needed and that the money must be spent on specialists and reducing inequality. 

She says the breast cancer screening programme results in more admissions and treatment for lumps which perhaps do not need to be removed.

Lib Dem MSP Alex Cole-Hamilton says screening is capturing things after they have happened but that is not prevention.

Mr Cole-Hamilton says raises the issue of health inequalities and says this can lead to less breast feeding.

The Lib Dem MSP says a lot of time and resource is spent on the "worried well", while the nucleus of people in deprived areas do not take up health opportunities.

Image source, bbc

Public health medicine consultant Dr Helene Irvine says the breast screening programme is not good enough in her opinion.

Dr Irvine says she would look at primary prevention not screening and she calls for regulations on salt, sugar and fat in chip shops and in junk food.

She says increasing time people could drink in Scotland was one of the most bizarre things she has seen and she says health education is not working. 

Image source, bbc

Dr Una MacFadyen from the Royal College of Physicians of Edinburgh says there is good evidence that breast feeding reduces the risk of breast cancer.

Dr MacFadyen says this positive message should be emphasised. 

SNP MSP Ivan McKee asks where the money should be spent.

General practitioner Dr Margaret McCartney says money could be spent on housing because people who live in homes that are not damp tend to be healthier.

Mr McKee says he is trying to ask where the money would be best spent.

Dr McCartney says the questions he is asking would be best put to a health economist and that the committee's questions were not framed in this way.   

Public health medicine consultant Dr Helene Irvine says there is a rising index in inequality and this is increasing every year.

"That is one obvious failing of our strategy she says."

Dr Irvine says that the committee asked her about preventative spend which is why her evidence focused on the breast screening programme.

Image source, bbc

General practitioner Dr Margaret McCartney says: "If we don't have evidence based policy making we are absolutely sunk in the NHS."

Dr McCartney says the NHS is throwing good money after bad.

The GP says there is lots of data saying we are wasting money and causing damage, again citing universal breast screening.

Green MSP Alison Johnstone says GPs are absolutely essential and the committee have heard their concerns. 

Public health medicine consultant Dr Helene Irvine says she has major concerns of the dis-investment in general practice.

Dr Irvine says she cannot see how GPs can be expected to detect cancer early because of dis-investment. 

"We need to review all the public health initiatives," she says. 

Image source, bbc

Public health medicine consultant Dr Helene Irvine says anyone who looked at  breast screening objectively would conclude it was not a good idea to do it at a universal level.

Dr Irvine says screening should be for high risk women. 

General practitioner Dr Margaret McCartney says she is concerned that there is no "opportunity costing" and no cost analysis has been done for some time. 

Dr McCartney also questions whether there is enough sharing in terms of decision making in cancer screening.

Green MSP Alison Johnstone raises the issue of the breast screening programme.

Public health medicine consultant Dr Helene Irvine says a UK wide screening committee decides about screening programmes and they are then implemented by Scotland.

Dr Irvine says she suspects all the evidence on the breast screening programme is not reviewed in Scotland.

The Health and Sport Committee , externalwill now take evidence on the preventative health agenda.

Committee convener Neil Findlay introduces the witnesses: 

• Dr Una MacFadyen, a consultant paediatrician at Forth Valley Royal Hospital and a representative of the Royal College of Physicians of Edinburgh

• Dr Margaret McCartney, a general practitioner
• Dr Helene Irvine, a consultant in public health medicine

Read the written submissions from the witnesses here., external

Image source, Science Photo Library

Dr Margaret McCartney uses her submission to says the following should be investigated: 

• Breast screening - now being dismantled in Switzerland. There is a lack of high quality evidence that it delays death and it does cause overdiagnosis as a consequence
• Health checks - there is no evidence that using Keep Well to do health checks results in improvements to health that would not have occurred with usual GP care
• Media campaigns to promote screening - are expensive, and do unintended harms - for example, promoting cervical screening rather than informed choice about cervical screening   

Read more here., external

  Public health medicine consultant Dr Helene Irvine uses her submission to say: "With the exception of the primary immunisation schedule in pre-school children, no area should be exempt from scrutiny or regarded as sacred and beyond thorough review, and subsequent downgrading, limiting (ie targeting) or even scrapping if justified by the evidence."  

Image source, Science Photo Library

Dr Irvine goes on to say: "We now need to prioritise responding to the genuine needs of patients in real time (e.g provision of high quality health and social care to the elderly) over the theoretical potential to prevent problems in the future (most secondary prevention schemes and many health improvement initiatives), unless that preventive measure is highly cost effective (eg health protective policies such as the ban on smoking in public places, minimum alcohol pricing, etc)."

The consultant calls for a "thorough review is the national breast screening programme (in Scotland, the SBSP). 

Read more here., external

Remit

To seek evidence on and analyse preventative spend through a series of short inquiries on specific health-related topics.

Background

Previous consideration of preventative spend/ preventative agenda can be found in the following documents:

• The Christie Commission - Commission on the Future Delivery of Public Services , external
• Audit Scotland – Changing Models of Health and Social Care, external
• Scottish Parliament Finance Committee – Report on Preventative Spending (2010) , external

Image source, Science Photo Library

Initial Approach

The Committee will hold an initial evidence session where the main features and pitfalls of using preventative spend as a means of scrutinising expenditure on health can be outlined.

On Friday 3 February the Committee issued a general Call for Views from any interested organisations or individuals. The call for views closed on 28 February.

• Read the Written Submissions here, external
• Click here for preventative agenda evidence session on 21 March.

The Health and Sport Committee , externalwill begin by taking evidence on the preventative health agenda.

MSPs will take evidence from: 

• Dr Una MacFadyen, a consultant paediatrician at Forth Valley Royal Hospital and a representative of the Royal College of Physicians of Edinburgh
• Emilia Crighton from NHS Greater Glasgow and Clyde;
• Dr Margaret McCartney, a general practitioner
• Dr Helene Irvine, a consultant in public health medicine.  

Image source, bbc

The committee will then take evidence on the NHS National Waiting Times Centre

MSPs will hear from:

• NHS Waiting Times Centre chief executive Jill Young
• NHS Waiting Times Centre director of finance Julie Carter
• NHS Waiting Times Centre  medical director Mike Higgins
• NHS Waiting Times Centre  director of operations June Rogers

Good morning and welcome to Holyrood Live's coverage of the Scottish Parliament on 9 May 2017.

The Health Committee will take evidence on the preventative agenda from hospital consultants and GPs.

It will then take evidence on the NHS National Waiting Times Centre.

Image source, bbc/PA/Thinkstock

After topical questions, there will be a ministerial statement on forensic examination.

MSPs will then debate the controversial Railway Policing (Scotland) Bill.

Labour MSP Pauline McNeill will then lead a debate entitled ‘Food Banks, Scotland’s Hunger Crisis'.