Outgoing MSP David Stewart uses his final Parliamentary member’s business debate to pay homage to the nurses and doctor who staffed and founded the Highlands & Islands Medical Service of 1913 – “the greatest achievement in the history of the region”

A PARLIAMENTARY debate was secured yesterday (Thursday, February 18) by North MSP David Stewart.

In what was his final members’ business debate before retirement, Mr Stewart paid homage to the early pioneers of 1913 who founded and staffed the Highlands & Islands Medical Service, the forerunner to the National Health Service.

Here is the speech in full:

This will be my last Members’ Debate before I retire; could I therefore thank all members who have signed my motion – and for those who have not, I warmly welcome all sinners who repent.

The establishment of the Highlands & Islands Medical Service in 1913 was, in my view, the greatest achievement in the history of the region.

“Picture the scene.

“All part of one great awe-inspiring effort to bring care and treatment to people in what would later become recognised as the world’s first provision of state-funded healthcare.

“Nurses riding push-bikes and motorbikes, cutting across some of the most difficult terrain in the country. Doctors – sleeves rolled up, strong arms at the oars, moving from one scattered and rural population to another, navigating from place-to-place by simple rowing boat.

“Bringing medicines, creams, and critical medical expertise to super rural, isolated estates where there was no care at all.

“And its practices and principles were to become the bedrock, the very foundation upon which our National Health Service was created.

The nurses and doctors took healthcare to where it was needed – free at the point of delivery

“The Highlands and Islands Medical Service came into being after it was discovered that crofters were exempt from the 1911 National Health Insurance Act.

“This meant that many people all across the Highlands and Islands were receiving no form of health care.

“And all at a time when the region’s healthcare was inadequate.

“Chaired by Sir John Dewar, the Dewar Report of 1912 sought to understand the impact poor housing, health and income was having across the region.

“And this was no armchair exercise.

“His large team travelled across huge swathes of the Highlands and Islands, engaging with, and listening to, communities in Inverness, Orkney, Shetland, Lewis, Skye, Oban, and many other settlements.

The intepid team had all corners covered including the Sleat peninsula on the isle of Skye.

“It is difficult to exaggerate the enormity of this task, with the inadequate transport infrastructure available back then in the early part of the 20th century.

“Doctors, crofters, fishermen and others were consulted across the region.

“It was found that the geography of the Highlands and Islands was proving problematic, both for doctors to reach people and for patients to travel to receive treatment.

“Poverty meant diets were poor, homes were damp, and disease spreading from livestock was rife.

“Many people died needlessly.

“Here’s an extract from the evidence of Dr James Reardon in South Uist, published in the Dewar Report:

“What do you blame? To begin with, there is no foundation for the children. At the age of three months they are supposed to be able to take porridge and sops. The reason for that is that the milk of their cows is given to the calves, and there is no milk for the children. It is a case of the survival of the fittest.”

“The Dewar Report was to change lives for the better.

“Its philosophy was that income, class and geography should be no barrier to receiving healthcare.

“It recommended the establishment of a minimum wage for doctors, funding for more district nursing associations, and the standardisation in the cost of a doctor’s visit – regardless of distance.

“Parliament approved these recommendations, and the Highlands and Islands Medical Service was swiftly established in August 1913 and handed an annual grant of £42,000 – worth more than a million pounds today.

“Good value for money.

“The Service was a rousing success.

The tentacles of care rolled right around the region.

“The grant provided accommodation, transport, further study, and holidays for healthcare workers, and the standard of healthcare began to exceed the rest of Britain.

“These successes were detailed in the Cathcart Report of 1936, a review of the state of Scotland’s healthcare systems.

It said:

“On the basis of the family doctor, there has been built up by flexible central administration a system of co-operative effort, embracing the central department, private GPs, nursing associations, voluntary hospitals, specialists, local authorities and others, to meet the medical needs of the people.”

“Additional funding from the Treasury in the 1930s led to a further expansion of the Service.

“Stornoway now had a surgeon, as did Wick, ahead of Shetland and Orkney which had one by 1934. And by 1935 the first air ambulance service was established.

“The first patient lifted by the air ambulance was fisherman John McDermid in 1933.

“He was in urgent need of a stomach operation that couldn’t wait for travel by sea or road. An hour after he was lifted in Islay, Mr McDermid arrived at the Western Infirmary in Glasgow and received treatment.

“By 1948, the air ambulance service was carrying 275 patients a year.

“Some 300,000 people across the Highlands and Islands – half of Scotland’s land mass – were able to experience a revolution in healthcare that greatly improved their quality of life, social mobility and community spirit.

“The Highlands and Islands Medical Service had been running for 35 years by the time the NHS was established by the Attlee Labour Government in 1948.

“And the rest of the United Kingdom was able to learn from and be inspired by the successes of communities all across the Highlands and Islands.

“The early pioneers of 1913 deserve our praise, admiration, and recognition. I have no doubt they inspired Beveridge and Nye Bevan in the concept of a national health service – free at the point of use.

“Not for the first time, the Highlands and Islands provided inspiration and leadership with a philosophy of “better to light one candle that to forever curse the darkness”.

Shetland.

:

Highlands and Islands MSPs back improved end-of-life and palliative care

Highlands and Islands Labour MSPs, David Stewart and Rhoda Grant, are backing calls for improved end-of-life and palliative care as new research shows that by 2040, 95% of people who die in Scotland may need additional support in their care.  

Charity Marie Curie Scotland says another 60,000 people are projected to be dying with a terminal condition by 2040 – with an increase in people dying in the community rather than hospital – and has urged end of life care to be made a priority for the Scottish Government with a new national strategy.  This is being backed by Scottish Labour.

Mr Stewart and Mrs Grant have previously called for end of life care to be at the top of the political agenda as home care services for the dying in Scotland are patchy at best. Around 10,295 people die in the Highlands and Islands each year and of these 7,720 have palliative care need. Marie Curie, in an opinion poll of Scots, highlighted that 61% would prefer to die at home.

Mr Stewart, who is also Labour’s Shadow Public Health Minister, held his cross-party member’s debate on the ‘Right to Full Care to Die at Home’ in the Scottish Parliament last year.

The debate was prompted by a plea from Shetland GP Susan Bowie that there should be an automatic right for people to have full care at home day or night for their last few days of life, so that then can have their wish fulfilled by being able to die at home with suitable palliative care.

Mr Stewart stressed that parents currently have the right to have their child born at home and the national health service provides midwives, but we do not have the right to carers to enable us to die at home.

“A new national strategy is desperately needed,” said Mr Stewart.

“What we have learnt from the pandemic is that end-of-life care is extremely important to families and carers as they struggle with lockdown restrictions and limits to hospital and care home visiting.

“It would be a huge relief to many GPs across Scotland that when someone says they want to die at home they know for sure they can get the compassionate care to back up the palliative care that is provided.”

Mrs Grant added: “A national strategy will help ensure that those living with and dying from terminal illness will get the support they need to live as comfortably as they can with the time they have left.

“It is not so much about dying at home it is more about living at home. When days are few they are precious. There is a greater need to live them to the full, to savour and appreciate things around you. That is much better to do at home than in an institution.”

Dr Bowie said: “I am incredibly grateful to the Scottish Parliament for discussing this, and for the cross-party support. Indeed, when days are few they are precious.

“As a Highlands and Islands GP I want to be able to care for my patients at home in their last few days. But that doesn’t always happen as my patient may have wished, because we don’t have the necessary care at home, or nurses. 

“At the moment we can be born at home, even though we can’t decide that. Our parents can, and the midwives have to help, as it’s the law. You have a right to have a baby at home, no matter the risk, and the state must provide a midwife.

“But there are no such rights for death.

“There is much talk about people having the choice to die at home, in palliative care strategies, both national and local. However, when it comes to death 60% of folk in Scotland want to be able to die in their own beds, with their loved ones in attendance.

“If, however, home care or district nurses decide they don’t have the means to support it, it forces people ‘at the last’ to be taken off to care centres or hospitals against their wishes, if the relatives are unable to manage entirely on their own.

“Sometimes relatives caring for a dying person at home just need a few nights help to care, or even just a few hours, or just help with the dignity of personal care. Help to make their loved one comfortable. Homecare don’t have to provide that help. It’s up to the Integration Joint Boards, and whilst they don’t have to provide, then many won’t. It’s all wrong and the only way we can sort this is legislation, so that councils and Health Boards will make it happen.”

https://www.mariecurie.org.uk/media/press-releases/end-of-life-care-must-be-a-priority-for-incoming-scottish-government/288561

Campaigners say their case for speed cameras in a Highland tourist village has been strengthened by the results of a traffic survey

And it’s hats off to veteran road safety campaigner MSP David Stewart who says speed camera victory “could be near”

TRAFFIC speed survey results have “strengthened the case” for speed cameras on the A82 at Drumnadrochit.

The community has thanked MSP David Stewart for his campaigning support

A November study revealed two out three drivers were speeding between Borlum Bridge and Lewiston crossroads.

And one in three were speeding along the straight at the Esso filling station.

Veteran road safety campaigner MSP David Stewart – who asked for the surveys to be carried out – has written to Scotland’s Transport Minister Michael Matheson underlining the need for speed cameras.

Mr Stewart said: “The results showed 68 per cent of drivers are speeding between Borlum Bridge and Lewiston crossroads, and 33 per cent are speeding past the Esso garage. This only strengthens community’s call for traffic calming on the stretch of other A82. And the picture probably worsens when traffic is returned to pre-lockdown levels.”

Glen Urquhart Community Council chairman David Fraser said the speed survey result would come as no surprise to people living in Drumnadrochit.

He said: “This proves two out of three drivers are speeding at a road junction which has poor visibility and confirms what we already know. Despite the 30mph limit being extended from Balmacaan Road to Borlum Bridge, traffic is still travelling too fast through the village.”

He added: “We look forward to hearing Transport Scotland’s proposals to reinforce the speed limit message in Lewiston and Drumnadrochit and we would like to thank David Stewart MSP for his support on this project, and more generally for his excellent road safety campaigning.”

Drumnadrochit resident John Slater said fast action was needed to slow traffic.

He said: “Just at the weekend there, I watched a 4×4 truck go through the crossroads driving at a speed I estimated to be somewhere between 60mph and 70mph. It was unbelievable.”

Mr Stewart said he was also pressing Transport Scotland for results of an earlier survey carried out last year at the A82 stretch by the Clansman Hotel.

Stewart continues to call for Covid passports telling Scotland’s Cabinet Secretary for Transport, Infrastructure and Technology “time is of the essence”

At Holyrood’s health and sport committee today, Shadow Health Minister, Highlands & Islands MSP David Stewart, asked Cabinet Secretary for Transport, Infrastructure and Technology, Michael Matheson, for his view on Covid Passports as a route to opening borders and returning to international travel.

Mr Stewart, who has been keeping the issue at the forefront of his communications with the Scottish Government – raising it initially with National Clinical Director Jason Leitch and arguing its merits in Holyrood with First Minister Nicola Sturgeon – today told Mr Matheson he strongly believed Scotland and the UK risked being left behind if it did not begin to seek international co-operation for some form of digital passport which holds a traveller’s COVID-19 immunity status.

In his reply, Mr Matheson echoed the sentiments of Miss Sturgeon, saying he was “not persuaded that it was the right approach at the present moment”. He said there were too many challenges around new variants of the virus and a lack of understanding around how the vaccine operated in the transmission stages. He also said civil liberty issues first needed to be addressed.

Speaking afterwards, Mr Stewart said: “I was grateful to the Cabinet Secretary for his response and wanted to make the wider point that these passports could be an additional longer-term strategy to quarantine. I wanted to raise it because I feel this is a massive issue which needs to get straightened out and Scotland and the UK have leadership roles to play. I just cannot see how international travel and our tourism industry can be built back up until an internationally-recognised passport showing people’s immunity status is brought in. Already, Europe is working at pace with this with the Greek government active. And we are already see airlines approaching this initiative which has been raised by people like our former Prime Minister Tony Blair and we’ve had it raised, albeit rather ambiguously, at UK government level. Obviously, it’s a longer term issue, but I believe it is going to happen. Mr Matheson and the First Minister have both said too little is known about the virus, it’s too soon for this scheme, but surely, given the scale of the pandemic and the research into COVID-19, our understanding around the nature of infection and immunity is going to rise rapidly. Leading scientists have said it: the clinical infection, with or without a measurement of antibody response, could form the basis of a time-limited immunity passport. What is really concerning me is the ability of government to deliver such a robust system if they are not already actively working on it.”

Mr Stewart said he agreed there were ethical issues but he believes those can be addressed.

He added: “It does indeed raise questions around is it right that some people should be allowed greater freedoms if they have been vaccinated while those who might want the vaccination but are still waiting cannot be allowed those freedoms? The way I look at it is every decision we make right now is going to come with consequences but allowing people to travel as soon as they are able to will help the global economy to rebuild. And for those individuals who don’t want to be vaccinated for personal reasons, that is their democratic right and I respect that. But while people have the freedom to have the vaccine or not, they do not have the freedom to place others at risk because of that decision.”

HMRC decision on Healing Process compensation a victory for common sense.

Highland and Islands Labour MSP, David Stewart, has been notified today that HMRC has decided NHS Highland bullying and harassment victims will not have to pay tax on any compensation awarded through the Healing Process.

“This will come as a great relief to those being awarded money for the bullying and harassment they’ve endured,” he said.

“Constituents have been writing to tell me the huge amount of tax they have had to pay, sometimes on a relatively small amount of compensation.

“That has not only caused them further upset and harm, but in some cases has disrupted their benefit or pension payments.

“It is good that those who have already accepted compensation, and already have banked it, will be receiving a rebate of the tax.”

More on-line:

https://www.nhshighland.scot.nhs.uk/News/Pages/HMRCadvicereceivedontreatmentofNHSHighlandHealingProcesspayments.aspx

Too early to push for “health passports” says Scotland’s First Minister

MSP David Stewart, Shadow Health Minister, questioned the First Minister in Holyrood today.

The First Minister has said it is too early to be discussing the roll out of a coronavirus vaccine passport system.

Pressed for her view in Parliament today, Nicola Sturgeon said there was” much still to be learned” about how the virus transmits after someone has been vaccinated.

The SNP leader said the outcome of global discussions around the technical details, and the ethical and equality issues and privacy standards, would guide the Scottish Government’s work on the area.

The concept was raised at First Minister’s Questions by Labour’s Shadow Health Minister David Stewart.

Addressing the First Minister, he said: “The recovery phase of the pandemic will see a weakened global economy, with our domestic tourism industry in freefall.

“An internationally-recognised digital passport could contain details of vaccination history and recent results of COVID-19 tests accessed through a QR reader. Does the First Minister agree with me that the UK presidency of the G7 gives an opportunity to lead on this issue, an idea whose time has come?”

Miss Sturgeon replied: “Yes, I do believe there is an opportunity to lead on this discussion. Is it an idea whose time has come around now? I’m not sure we are yet at that stage because I don’t think we know enough and understand enough about the impact of the vaccine to know exactly what certification we would be certifying, and I think the whole world has to know more about this before we can take final decisions. But in the fullness of time I think they may well have a role to play.”

It comes after former prime minister Tony Blair called for the UK to use its G7 leadership to introduce such a scheme globally.

A report by his think tank, the Tony Blair Institute, said an international Covid Pass should include the traveller’s vaccination details – including what brand of vaccine they had been given, two shots or one, and the date it was injected.

Mr Stewart said he agreed it was inevitable countries would seek to bring in vaccine passports in the global race to achieve herd immunity.

Financial Conduct Authority issues handy checker for companies wanting to claim on business interruption insurance

A link has been passed to Highlands and Islands Labour MSP, David Stewart, by the Financial Conduct Authority for any company wanting to check their business interruption insurance against the recent court ruling on insurance company pay-outs.

There is also a question and answer section too.

Mr Stewart said: “As you know I’ve been pressing for the insurance sector to reconsider decisions not to issue payouts for a large number of firms in dire straits due to the pandemic. This information gives more advice on those who can now claim.”

https://www.fca.org.uk/firms/business-interruption-insurance/policy-checker

Immunity passport ideas ‘premature’ says Scotland’s National Clinical Director

INTRODUCING so-called vaccination passports has been downplayed by Scotland’s National Clinical director – but it has not been ruled out.

At Holyrood’s Covid Committee this morning, Jason Leitch told Labour’s shadow public health minister David Stewart the idea that people carry a certificate showing they have had the vaccine, giving them more freedom in daily life, was “an interesting concept”.

However, he said he remained unattracted to the concept of “red and green bar codes that allow you to behave differently – because I just don’t know the science suggests that’s the way we should go”.

MSP David Stewart wanted to know the clinical director’s opinion of Tony Blair’s calls overnight for immunity passports to be rolled out.

The former Labour leader has urged the UK to take advantage of its upcoming position chairing the G7 to push other countries to do the same.

Mr Stewart told Mr Leitch: “What Tony Blair describes is a digital process which would be capable of tracking and verifying an individual’s coronavirus status, details of vaccinations and the results of Covid-19 tests. The data will be scanned quickly. We are desperate to make sure our economy survives, and I speak as a Highlander when I say tourism is of massive importance. Can I ask for your view on this Professor, I think it is an interesting concept?”

Mr Leitch said it was indeed an interesting concept.

He insinuated the idea was premature but said the model which won his future support would be “public health-led”.

Pointing to similar models, such as surgeons unable to perform operations without showing their Hepatitis B status or being unable to visit certain places with a Yellow Fever certificate, Mr Leitch said there “certainly was precedent” for immunity passports and it was “probably something that will happen in the future”.

But he said an intelligent model would be “global rather than regional” and centred around solid public health knowledge, however more information is needed to understand more fully the transmission of the virus.

“So, I’m supportive but I am probably a little bit slower to be so than some”, he added.

Speaking afterwards, Mr Stewart said: “This needs international leadership. This is the sort of thing President Biden would perhaps look at. Whatever government does, airlines are not going to accept people on flights without some form of vaccination passport. We need something that is internationally recognisable. If we want to build up our tourism industry in the Highlands and Islands, we need to allow foreign visitors to come in.”

Rise in self-harm 999 calls lead to call on government for better handling of COVID-19 mental health spill-over

MSP David Stewart.

SELF-HARM incidents have increased since lockdown prompting Highlands & Islands MSP David Stewart to call on government to address the mental health spill-over from Coronavirus.

Dr Martin McKechnie, the national clinical lead from the Scottish Trauma Network, told MSPs at a virtual meeting of today’s heath and sport committee in Holyrood “people have struggled”.

Following questions from Mr Stewart, Mr McKechnie said: “We have unfortunately seen a lot of serious and violent self harm and harm to others and a lot of it is lockdown or pandemic-related. People have struggled.

“That has been, I wouldn’t say unpredicted, but a new feature of some of the cases that we are seeing during this last year.”

He added however that the ongoing after-care of these patients is “much improved now”.

Speaking afterwards, Mr Stewart, who is Scottish Labour’s Shadow Minister for Health, said: “It was shocking to hear the evidence from the front line practitioners today. A rise in self-harm is one spike we probably could have expected, but nevertheless it is just another element of the sad nature of the Covid pandemic.

“We truly are facing another epidemic, which is an epidemic of mental health and emotional problems, following the Coronavirus epidemic. The government must not lose sight of this when they are concentrating their efforts a public health response to the pandemic. That must include attention to the psychological aspects of care for patients, families, and staff affected by COVID. This is evidence that comes from the front-line today.”

MSP surprised by FOI response on NHS Highland compensation payments

Highlands and Islands Labour MSP, David Stewart, has been surprised by an answer to his NHS Highland FOI on compensation payments to victims of bullying and harassment.

Mr Stewart asked for the full content of any legal advice taken before taxable payments were decided for any pay-outs to people who signed up for the Healing Process.

NHS Highland answered

“The advice was not received in any formal documents or emails, but was discussed throughout the set up and launch of the Healing process by those working on the administration and delivery of the scheme, which included our legal and taxation advisors from Shepherd Wedderburn.”

The MSP also asked for minutes of any NHS Highland meetings, including sub-committees, where Healing Process compensation payments were discussed

NHS Highland responded:

“The Healing Process compensation payments are an operational matter and have not been discussed in any such meetings.”

In December, after pressure from those going through the Healing Process and politicians including Mr Stewart, NHS Highland said it had written to HMRC to ask if payment could be made without tax and outwith its payroll system.

Mr Stewart lodged the FOI to see if he could find out more about the background to the earlier decision to use the payroll as he was concerned that no-one envisaged the problem with a taxable system.

“I must say I was taken aback by the answers that were given as decisions were made behind closed doors and not taken for discussion at any committee or board meeting,” said Mr Stewart.

“This was not discussing people’s individual cases, but just the system of payment. I know from previous NHS Highland answers that any case recommended for compensation has to go to NHS Highland’s renumeration committee for governance reasons, although no personal details of that case is revealed.

“It’s just a mystery therefore that there was no oversight of the compensation system.”

  • FOI response and also previous response from NHS Highland re remuneration committee

Did NHS Highland approach HMRC for advice about how it could pay those receiving compensation from the Healing Process?

As set out in the update to MSPs on Thursday 17th December, a detailed request was sent to HMRC on 14th December 2020 to review the status of the payments, based on the specific and detailed information in the healing process guidance and two sample recommendations from the panels which we provided.

Ahead of this, throughout the healing process co-creation, it was stated that payments were subject to applicable tax and national insurance. It was not explicitly stated how the payments would be made during the healing process coproduction discussions and guidance, although the inclusion of “subject to applicable tax and national insurance” was this was therefore to be paid through payroll

This was because the nature of the financial payments did not fall into any of the categories which would permit tax free status or to be paid outside a PAYE arrangement and this was discussed and reviewed with the accountable executive and the legal and tax experts from Shepherd and Wedderburn, at the point arrangements for payment were being set up as well as earlier in the process..

With the benefit of hindsight, it is clear that those involved had different assumptions of what this meant, but it wasn’t covered in any detail so it wasn’t clear until the payments were made that people had expectations that this would be treated in a different way both in terms of the process and the tax position. That has clearly been a learning for us, and we are sorry for any confusion that this may have caused.

If so, when was that approach made and what was the advice?

As above, this was request on 14th December and is currently pending.

If not, who did NHS Highland approach for independent legal and tax advice?

As above, Shepherd and Wedderburn have been advising on legal and taxation matters throughout the healing process set up.

What was the full content of that legal/ financial advice?

The advice was not received in any formal documents or emails, but was discussed throughout the set up and launch of the Healing process by those working on the administration and delivery of the scheme, which included our legal and taxation advisors from Shepherd Wedderburn.

I am also requesting minutes of any NHS Highland meetings, including sub-committees, where Healing Process compensation payments were discussed

The Healing Process compensation payments are an operational matter and have not been discussed in any such meetings.

I hope this response is helpful. If you are unhappy with my response, I am very happy to discuss this with you further. Alternatively you have the right to ask for an internal review by making a formal request in writing to the:-

Freedom of Information Officer

NHS Highland

Assynt House

Beechwood Park

Inverness, IV2 3BW

or via email High-UHB.FOIRequestsHighland@nhs.scot

What David Stewart and constituents were told by NHS Highland last year:

“The Healing Process has been fully coproduced with representatives of interested groups including the Whistleblowers and staffside and it has been approved by the Board and Scottish Government. This is now in operation and consultation on the design has ended. NHS Highland is a publicly funded body and any payments or financial commitments made by the Board must comply with Standing Financial Instructions and other Board and Government policy and be fully and properly scrutinised and audited. Any payments from public monies also have to comply with the appropriate oversight and governance standards – this is national not locally determined policy. There will be no circumstance under which public monies can be given to individuals without due process and consideration, and nor should there be. I would further point out that the remit and the required membership of the Remuneration Committee is set out in the national governance standards for NHS Boards, This is not open for individual boards to amend or alter.”