Chamber and committees

The Spending Review 2002 settlement reflects the Care Development Group's costing assumptions for free personal care. These assumptions estimated an increase in demand from unmet need and a shift from informal to formal care of approximately 12% building up over the first two years of the policy to 2004-05. Within that framework, identification of individuals in need of care is a matter for local authorities. The Scottish Executive has provided the necessary resources.

Building a Better Scotland indicated additional resources of £23, 50 and 100 million towards health improvement initiatives. £18, 44 and 61 million of this has been allocated to portfolios other than health but for clarity has not been included in the health portfolio allocation.

We do not have information about alternatives to the Arbuthnott formula. NHS boards are provided with figures for their allocations and will be given any additional information which they wish to obtain about the basis of the calculations.

We are taking positive steps on a number of fronts to increase capacity, enhance career development opportunities and retain the current nursing workforce.Facing the Future, the Report of the National Convention on Recruitment and Retention in Nursing and Midwifery, identified the need to make an explicit connection between supply and demand, planning and distribution and the mix and diversity of nurses and midwives. In partnership, we are working to ensure that career development opportunities within Scotland are fostered and expanded.The Scottish Executive is also committed to recruiting more nurses in NHSScotland. Over the next five years 10,000 more nurses and midwives will qualify in Scotland, 1,500 more than previously planned and a raft of other initiatives have been put in place to ensure that NHSScotland recruits and retains the number of nurses it needs.Like other health care professionals, nurses and midwives want to take the opportunity for personal and professional development to enable NHSScotland to meet the demands of developing more flexible, needs-driven services in partnership with the public and fellow health professionals including innovative approaches to care. Support for staff to do so is provided through appropriate educational opportunities and through workforce planning so that individuals can follow career opportunities. Nurses and midwives themselves seek opportunities to establish nurse-led clinics focussing on the delivery of patient centred care. The benefits for nurses include the opportunity to expand their skills and knowledge, being able to take autonomous clinical decisions and enabling patients to experience a smooth transition through their pathway of care. When developing nurse-led clinics it is important that cognisance is taken of the implications of changes to workload within the wider multi professional team. As part of the new arrangements set out in Working for Health, the workforce development action plan for NHSScotand, workforce officers will have local responsibility in their NHS board for ensuring that effective integration of service planning and workforce development takes place at trust and board level in order that services can be delivered in the most appropriate way. Nurses have been at the forefront of seeking the opportunity to prescribe as part of the care they provide in the areas of minor ailments, minor injuries, health promotion and palliative care. Appropriate training is being provided and will ensure that nurse prescribing brings real benefits in terms of access to care for patients. Some nurses seek to develop a specialist role within a given clinical field. A specialist nurse will have successfully completed a post qualification course of study in a specific clinical field and be able to apply a level of judgement, discretion and decision making in clinical care to improve the quality of patient care, meet the needs of patients within the speciality and in the specific area of practice. The development of these roles also requires a workforce development approach. The role of cleanliness "champions" has been planned in partnership with NHS boards and trusts to ensure that it fits with the clinical environment and existing infection control structures with appropriate support mechanisms being put in place. An education programme is currently being developed by NHS Education for Scotland, which will ensure that individual nurses are well prepared for the role.

The information requested by the member is currently being collated by NHS 24 and I am awaiting a response. Once complete, I will write to the member with a full response and place a copy in the Parliament's Reference Centre.

Earlier this year, ISD Scotland, in collaboration with Audit Scotland, carried out a week-long audit of non-in-patient clinics held in Scotland. Preliminary results from parts of the survey on nurse-led clinics are available at:http://www.show.scot.nhs.uk/isd/isd_services/NHSiS_services/Data_quality/nurse_led_clinics.docSystematic information on the number of patients treated in nurse-led out-patient clinics is not available centrally. However, this survey is part of the work being undertaken to identify the potential advantages of collecting information about out-patient contacts other than those by consultants.

The Information and Statistics Division of the Common Services Agency do not currently have plans to compile key health indicators, using the same criteria as the Organisation for Economic Co-operation and Development.

The algorithms are a copyrighted product used under licence by NHS 24 and are not widely available. NHS 24 involved Scottish clinicians in an extensive programme of structured review and adaptation of the algorithms in 2001. NHS 24 also arranges for clinicians to view the system on which the algorithms sit as required, and will share specific examples in order to gain clinical confidence in the algorithms and the decision support system used by it. However, the algorithms on their own are not the clinical end product and they need to be used by experienced and trained nurses to provide the NHS 24 service.

The algorithms, or series of logically structured questions, were initially developed by an American clinical software company. During 2001, NHS 24 involved Scottish clinicians in an extensive programme of structured review and adaptation of the algorithms, known as the "Airth Process".The Clinical Standards Board for Scotland (CSBS) was informed of the detail of the "Airth Process" and acknowledged the process as an example of good practice. This process involved a clinical review of the algorithms by some 50 practising clinicians, including doctors, nurses, pharmacists, dentists, surgeons, accident and emergency consultants, paediatricians and other specialists, to incorporate best evidence or best practice where it existed, including reference to Scottish Intercollegiate Guidance Network guidelines. The review meetings took place in a structured manner allowing clinicians to concentrate on ensuring the algorithms were appropriately adapted to the Scottish clinical situation.NHS 24 is also implementing a quality strategy plan to demonstrate, among other things, the clinical effectiveness of its processes and is discussing with CSBS how an external review process should be put in place.

NHS 24 is a confidential service for the public. The confidentiality extends to the standard NHS interpretation of "confidentiality" and all clinical and other patient information is bound by standard NHS confidentiality regulations. All patients are asked, in every consultation, whether they consent to information being passed on to their GP or other relevant service in order for them to obtain further care. If a patient requests that the information should not be transferred, then this will be respected.However, there are clearly situations where patients or others may be at significant risk - for example, where issues of child protection arise. Under these circumstances information may require to be shared among the social, health care or police services contrary to the patient's expressed wish. These circumstances are extremely rare and NHS 24 staff are trained in order to both recognise and deal with these situations in a sensitive and professional manner.