Chamber and committees

We are committed to meaningful engagement with UK Government and with the devolved governments. The Scottish Government has frequent and ongoing engagement across the Four Nations. The First Minister has been taking part on a weekly basis in four nations ministerial calls – until the UK government cabinet reshuffle last month these were chaired by the Chancellor of the Duchy of Lancaster (as Minister for the Cabinet Office) and they were also attended by first ministers from the other devolved governments. We are now re-configuring these calls with Mr Gove in his new role as Minister for Intergovernmental Relations. The Cabinet Secretary for Health and Social Care also takes part in weekly meetings with counterparts from the UK Government and other devolved governments. We are working extensively with the UK and Welsh Governments and Northern Ireland Executive and seeking to make decisions on a ‘Four Nations’ basis where possible and appropriate. However, it is wholly right and appropriate that we respond to the virus in a way that is right for Scotland, that works in our context and offers us the flexibility to adapt to our changing circumstances. Similarly, UK Government is entitled to make their own decisions on measures that they introduce in England, but it is important to remember that these decisions apply in England only. This includes on Plan A and Plan B.

We welcome the MS Society’s Neurology Now report as an important document highlighting the issues for people with MS and wider neurological conditions throughout the COVID-19 pandemic. I am pleased to say that I recently met with officials from the MS Society to discuss the findings of the report and the ongoing development of MS services in Scotland.

Let me assure the member that the Scottish Government is committed to ensuring that all people living in Scotland with MS are able to access the best possible care and support, and benefit from healthcare services that are safe, effective and person-centred. As you may be aware, we are investing £4.5 million over 5 years to implement our Neurological Care and Support – National Framework for Action. This Framework aims include improving the provision of co-ordinated health and social care and support, developing sustainable workforce models and ensuring high standards of care for people living with neurological conditions, including MS.

Over the past year we have invested over £300,000 to projects which improve the health and wellbeing of people with MS in Scotland.

Regarding a reporting framework to measure improvement, we have commissioned NHS Healthcare Improvement Scotland to work with NHS boards, integration authorities, the third sector and people with lived experience to assess progress in implementing the General Standards for Neurological Care and Support. Undertaking this work will identify areas of improvement across NHS Scotland and help to drive forward better standards of care for people with neurological conditions.

We are working closely with colleagues in Public Health Scotland to develop systems that will collect key data to inform service planning, delivery of clinical standards, and improvement across Scotland. In the first instance we have commissioned an audit of prevalence for neurological conditions from primary care system and we anticipate this data collection will begin during 2022.

We are also working with the Neurological Alliance of Scotland to distribute the first national patient experience survey specifically for people with neurological conditions.

Public Health Scotland collects waiting times data for neurology, which informs current practice in relation to service improvement. We are aware that the pandemic has impacted on waiting lists for neurology clinics and are currently implementing programmes to mitigate this situation. We are working with NHS boards through the Centre for Sustainable Delivery to implement more efficient ways of working such Patient Initiated Review and Active Clinical Referral Triage. These can be applied in various neurological conditions.

Regarding the cost of treating neurological conditions, service areas within NHS health boards carry their own budgets and associated financial improvement plans to manage and improve efficiency of their spend across specialties. Neurology spend data is collected as part of the annual Costs Book exercise published by Public Health Scotland, and we continue to work with health boards and consider data issues as part of this.

I refer the member to the answer to question S6W-02466 on 28 September 2021 which explained that t he First Minister’s former Chief of Staff resigned on the suspension of parliament for the 2021 Scottish Parliament election in line with the Special Advisers Code of Conduct and model contract. I n line with GDPR requirements, the Scottish Government does not provide personal data such as the levels of payments made to individual staff.

All answers to written Parliamentary Questions are available on the Parliament's website, the search facility for which can be found at https://www.parliament.scot/chamber-and-committees/written-questions-and-answers

Our clear ambition is that no one should be inappropriately delayed in hospital once they are clinically ready for discharge. However, given the current challenges health and social care partnerships are experiencing in relation to recruitment of care staff, and the increased level of needs people are presenting with, we need to set a realistic trajectory for reduction. Our intention is therefore to see a return to the position seen between the Summer of 2020 and Spring of 2021, freeing up at least 500 beds for winter.

I refer the Member to the contents of the letter issued to her by the First Minister on 4 October. A copy will be placed in the Parliament's Reference Centre (Bib number 62800).

An analysis of the obtained from the two toxicology providers in Scotland – NHS Grampian which provides approximately 10% of the analysis capability and Glasgow University which provides the rest – is set out in the tables below.

It should be noted however that the extent of toxicological analysis required will depend on the individual circumstances of each case and the extent and nature of substances that are found. Factors such as the need to research the effects of unusual drugs or instruct separate analysis for insulin quantification will result in toxicological reports taking longer to be finalised. 

Additionally, in determining the final cause of death, completion of the toxicological report is only one part of a process which involves a number of separate organisations before a final post mortem report can be issued.

Depending on the circumstances surrounding a death, the pathologist(s) may require a number of further investigations to be completed – including further toxicological analysis as well as input from other experts in the fields of neuropathology or histopathology for example – and the findings of all those enquiries must then be carefully considered by COPFS before a cause of death is confirmed.

GU TOXICOLOGY TURNAROUND TIMES

NHS GRAMPIAN TOXICOLOGY TURNAROUND TIMES

In 2019 COPFS began to experience delays in the provision of toxicology reports from the University of Glasgow, the main contractor for this service. This was further compounded during 2020 due to the pandemic.

Once a toxicological report has been finalised, it is then considered by the pathologist(s) who conducted the post mortem, and thereafter a final post mortem report is issued to the appropriate team in COPFS, who require to review it in detail before the next of kin can be informed of the final cause of death.

Working with Glasgow University, COPFS put various measures in place to address both the backlog and the increasing number of new deaths requiring toxicological analysis. The measures included agreeing a new format of abbreviated report for some cases, and an Improvement Plan which set out weekly performance targets and ensured focused progression with both the backlog of cases and newly reported cases.

Successful implementation of the Improvement Plan in particular means that there is now no backlog of toxicology reports and toxicology analysis is being completed in the majority of cases within 8 weeks.

COPFS and the University of Glasgow agreed an Improvement Plan to reduce the toxicology waiting times. This plan defined performance targets and required the University of Glasgow to provide data to COPFS on a weekly basis. The required data was to highlight the laboratory’s progress with outstanding cases and new cases.

The Improvement Plan has been successful; the toxicology waiting times are now reduced and there is no delay in provision of those reports to the pathologists who require them to finalise the post mortem report.

An indication of the effectiveness of the improvement plan is that, in the week of 25 September 2020, there were 1351 open toxicology cases with University of Glasgow and in the week of 26 September 2021 there were 351 open toxicology cases.

Ambulances are not single-crewed other than in exceptional circumstances, such as short notice unplanned staff absences, and every effort is made to double crew ambulances through rostered and relief staff, overtime or our bank staff.

Unfortunately as a result of COVID-19 there has been occasions where single crewing has had to be used as a result of late notice staff abstractions, however we are continuing to work with the Scottish Ambulance Service to reduce this where possible.

The following table outlines the number of single crew shifts, not ambulances each year since 2017/18.