Tory MSP Miles Briggs asks about concerns raised by the former chair of NHS Lothian regarding the new Royal Hospital for Children and Young People.

A former NHS board chairman has accused the health secretary of lying over circumstances surrounding a last-minute delay to a flagship hospital.

Brian Houston, who resigned from the post at NHS Lothian in January, criticised Jeane Freeman's handling of the delay in opening the new Royal Hospital for Sick Children and Young People in Edinburgh.

He also claimed Ms Freeman said she would fire him if he did not quit.

The Scottish Government said it rejects the allegations.

Rev Dr Marjory MacLean, convener, Chaplains to Her Majesty’s Forces Committee, Church of Scotland delivers today's time for reflection.

Image source, AYRSHIRE AND ARRAN HEALTH BOARD

Here's what's on in the chamber this afternoon...

2:05pm: Topical Questions: The health secretary is up again, this time getting the chance to respond to claims from the former NHS Lothian chair Brian Houston that she lied about the board's position on the delayed opening of Edinburgh’s Sick Kids

2.20-2.50 pm: Ministerial Statement: Novel Coronavirus COVID-19 Update

2.50-3.20 pm: Ministerial Statement: COP26 – Our Contribution to Global Climate Action

3.20-4:20pm: Scottish Government Debate: The Local Government Finance (Scotland) Order 2020

Image source, BBC/Getty Images

4.20-5.30pm: Stage 3 Amendments: Scottish Biometrics Commissioner Bill

5.30pm - 6.15pm: Stage 3 Debate: Scottish Biometrics Commissioner Bill

followed by the Appointment of Auditor General for Scotland

6.15pm: Members’ Business: Stuart McMillan – Communication Failure? A Review of the Accessibility of Health Information for Blind and Partially Sighted People

The committee now considers the Public Health etc. (Scotland) Act 2008 (Notifiable Diseases and Notifiable Organisms) Amendment Regulations 2020 (SSI 2020/51).

The instrument adds Covid-19, a strain of coronavirus, to the list of notifiable diseases.

That means that if a registered medical practitioner in Scotland suspects that a patient might have that strain of coronavirus, they are now under a legal duty to notify their health board, which in turn will be under a duty to notify the national health service’s Common Services Agency.

The regulations are already in place, breaking the rule that they should be laid in advance of them being implemented. The committee agreed it was content this rule was broken given the context of the coronavirus outbreak.

SNP MSP Emma Harper turns discussion to medicine waste and mitigation, asking about improving understanding of where it occurs and how to tackle it.

Not all waste is avoidable, replies Rose Marie Parr.

The chief pharmaceutical officer says there are measures in place to reduce it, such as NHS Tayside using protocols to reduce over-prescribing in care homes.

Committee convener Lewis Macdonald asks about the creation of a Single National Formulary.

The Scottish government's principal pharmaceutical officer replies work is underway to create a single national formulary based on from the bottom up.

In 2017, in response to an FOI, the government replied the target had been to implement a Single National Formulary (SNF) by September 2019.

Ms Strath explains work is underway in Lothian to look at this, which will morph into a regional and then national approach.

Tory MSP Miles Briggs wonders about future-proofing the pharmacy workforce and raises the workforce survey undertaken last year.

Bryan Lamb accepts there are workforce challenges across the NHS and points to an agreement with Community Pharmacy Scotland to encourage people to stay in or come back to pharmacy.

We will look to reward and incentivise contractors to offer better conditions which are more comparable with other areas of the healthcare system, he adds.

Rose Marie Parr says there is a need to be more flexible going forward, pointing to some contracts which allow people to work a few days a week in a pharmacy and a few days at a GP.

Image source, Thinkstock

The focus of the committee’s inquiry is to look at the management of the medicines budget, including the clinical and cost effectiveness of prescribing.

The inquiry will encompass four distinct but related parts covering in effect the supply and demand for services:

• Purchasing (including procurement and medicine price regulation, a reserved area undertaken at a UK level)
• Prescribing (covering all licensed to write prescriptions)
• Dispensing (covering hospital, pharmacy and GP)
• Consumption (looking at effectiveness and wastage)

The inquiry will not cover advice on the clinical and cost-effectiveness of new medicines or whether new medicines should be routinely available for prescribing by the NHS in Scotland.

Tory MSP Brian Whittle asks how more social prescribing can be introduced to the system.

Social prescribing, sometimes referred to as community referral, is a means of enabling GPs, nurses and other primary care professionals to refer people to a range of local, non-clinical services.

Ms Freeman answers there are some examples of social prescribing working well and there are two ways to move this forward:

• through the work of pharmacists with patients
• community link workers

The health secretary ponders how best to bring about a national strategy on this without dampening local innovation and adds the public health minister is looking into this.

Alison Strath says despite drug pricing being reserved, responsible bodies across the UK are involved in discussions.

She explains different parameters can be attached to the deals made with pharmaceutical firms which can impact pricing differences between the UK nations.

She points to the cancer medicines fund in England as an example.

Does Scotland need a cancer drugs fund, asks David Stewart.

No, replies Ms Strath.

Rose Marie Parr adds that due to the size of NICE it has sometimes overwhelmed discussions and we have to remind colleagues the Scottish Medicines Consortium is important as well.

Principal Pharmaceutical Officer Alison Strath says efforts have been made to increase transparency and ensure uniformity of drug prices in Scotland.

Ms Strath cites Dr Brian Montgomerie's review around access to medicines and achieving better pricing, pointing out drug pricing is a reserved matter.

The review, published in 2016, called for fresh reforms to the way new medicines were approved to facilitate better access for patients in Scotland.

The Scottish government confirmed it would take forward the recommendations of Dr Brian Montgomery’s Review of Access to New Medicines, external.

The review’s recommendations set out how the process for appraising medicines can be made more open, transparent and robust.

Following his recommendations, a revised approval process for true ultra-orphan medicines was to be devised.

The SMC was also to be given an additional decision option to consider accepting a medicine on an interim basis so its clinical effectiveness can be further assessed.

Ms Freeman says the governance around prescribing is there for very good reason and politicians must be mindful of the balance between keeping people safe and layers of governance which are not critical.

Convener Lewis Macdonald wonders about encouraging pharmaceutical manufacturers for applying for additional licences.

The chief pharmaceutical officer says this can be encouraged and we are seeing lots of older medicines being re-purposed now.

Chief Pharmaceutical Officer Rose Marie Parr says licensing measures are important but boards have policies on how to use medicines that are unlicensed or off-label.

Principal Pharmaceutical Officer Alison Strath adds lots of medicines are used off-label, for example in the treatment of cancer.

Off-label use means that the medicine is being used in a way that is different to that described by the licence.

Ms Freeman says scientists in Scotland are currently looking at existing anti-viral medicines to see if they will be in any way effective against the coronavirus.

Tory MSP Brian Whittle asks whether HEPMA will allow better mapping of medicines as patients move between primary and secondary care.

Rose Marie Parr confirms this is the case, adding the discharge programme will be made more seamless and more integrated.

The health secretary explains individual health boards have policies on patients using their own medicines as in-patients but the government is aiming to have all boards allow patients to manage their medication, subject to risk assessment.

The aim of a Hospital Electronic Prescribing and Medicines Administration (HEPMA) system is to replace the paper based processes for prescribing and medicines.

From a clinical perspective, delivery of HEPMA is critical to improving patient safety and delivering a key component of the electronic health record.

Health Improvement Scotland (HIS) and National Services Scotland (NSS) will be commissioned to deliver a strategic national approach to capturing and sharing the learning from implementations alongside benefits realisation activities and coding, capture and use of HEPMA data.

The first question for the health secretary is on the roll-out of HEPMA across Scotland.

What is HEPMA, external? It stands for Hospital Electronic Prescribing and Medicines Administration.

Ms Freeman explains four health boards already have or are close to completing implementation of HEPMA.

The health secretary tells the committee the majority of boards in Scotland will have concluded implementation of HEPMA by the end of this year.

Chief Pharmaceutical Officer Rose Marie Parr says: "I think HEPMA is absolutely important."

Nevertheless improving on HEPMA is the goal, Ms Parr adds.