Chamber and committees

There is a range of evidence that indicates that location is a significant factor in the training choices made by newly qualified doctors. NHS Education for Scotland has recently published its first education research and innovation report which outlines research undertaken to assess the extent to which factors, such as location, influence the career choices and preferences of doctors.

http://www.scotlanddeanery.nhs.scot/news/medical-directorate-education-research-and-innovation-annual-report-2018/

Published research studies on the impact of geography on trainee career choices include the following.

What factors are critical to attracting NHS doctors into specialty or core training? A discrete choice experiment. (Scanlan et al) 2018

What factors influence UK medical students’ choice of foundation school? (Miah et al) 2017

What do UK doctors in training value in a post? A discrete choice experiment. (Cleland et al) 2016

https://bmjopen.bmj.com/content/8/3/e019911

A number of specific actions are being taken that will contribute towards a more secure and sustainable medical workforce more representative of the communities it serves. These measures have been developed not only to address the more immediate recruitment and retention challenges faced by NHS Scotland Boards, and specifically in primary care services, but in response to strategic requirements to widen access into medical education in Scotland, and respond to demands for enhancing the skills of our GPs within a multi-disciplinary team model.

We are investing £23 million in an undergraduate medical education package comprising the 50 widening access places, a pre-medical entry programme with 40 places, and 55 places for Scotland’s first Graduate Entry Medical programme.

The Scottish Government’s National Health and Social Care Workforce Plan also commits to creating additional undergraduate medical places, and 85 places have been awarded to three of Scotland’s University medical schools.

Regarding selection criterion, the Scottish Government is also collaborating with the Scottish Funding Council which has issued Health related outcomes to University medical schools. The medicine outcomes include a commitment to:

• Retain more graduates of Scottish medical schools in Scotland and working for NHS Scotland throughout their careers.
• Encouraging more of our young doctors to enter GP and other shortage specialities.
• Simplify and clarify the admissions process across all the medical schools in Scotland.
• Increase the number of Scottish domiciled applicants to medicine.

Reach is a national programme which is supported by the Scottish Government via the Scottish Funding Council and focuses on schools with below average progression of pupils into higher education, and pupils from the 40% most deprived communities in Scotland. It aims to increase the number of applications, offers and entrants from students from disadvantaged backgrounds into high demand and competitive areas of study such as medicine.

ISD Workforce does not collect Consultant Vacancy data at hospital level. However they do collect vacancy data for Consultants at National and Board level.

The number of consultant vacancies as well as the vacancy rate (number of vacancies over establishment) is published quarterly and the most recent data, published on 5 th June 2018, can be found at http://www.isdscotland.org/Health-Topics/Workforce/Publications/2018-06-05/Medical-and-Dental.asp . The data show four Paediatrics specialties (Paediatrics, Paediatric cardiology, Paediatric surgery and Paediatric dentistry) as well as the Obstetrics and Gynaecology specialty and provide a breakdown by NHS Board.

Further notes:

Further information on the statistics, including information on how the data are collected and notes to aid interpretation, is given in the 'FAQs' section of the Workforce Statistics website at http://www.isdscotland.org/workforce/

Scotland’s first Graduate Entry Medical programme (ScotGEM) will commence in autumn 2018. ScotGEM includes a ‘return of service’ (bonding) bursary of £4,000 per year. The optional grant, worth £16,000 over the 4 year course, will be payable to all students who agree to work one year of service for each £4,000 claimed.

Currently, there are no other plans to introduce any similar additional measures.

In 2014 the Scottish Government requested that Health Boards suspend the use of transvaginal mesh. At the time no such action was taken in England. The recent decision to pause trans-vaginal mesh procedures in England is therefore seen as bringing clinical practice in the two nations into alignment.

Nonetheless, in both Scotland and England it is recognised that for some women with debilitating symptoms, surgery may be the only treatment option. In such circumstances, women must have choices and access to the care they need, delivered with appropriate governance and oversight. In light of this, the Scottish Government has been clear that:

• the protocols in NHS Scotland for care include ensuring that patients receive the information they need to make decisions about their treatment. All options should be considered and treatment can only go forward once a patient gives informed consent; and
• treatment is to be delivered by a multidisciplinary team with appropriate audit, reporting and surveillance.

Furthermore, Healthcare Improvement Scotland has established an Oversight Group which is reviewing trends in procedures and reported adverse events; and the Scottish Government continues to liaise with colleagues in NHS England and the other devolved administrations with a view to establishing a cross-UK registry of mesh procedures.

The Scottish Government's request that Health Boards suspend the use of transvaginal mesh has resulted in a significant reduction in mesh procedures being carried out, with the number of procedures in 2016-17 at 10 per cent of the total number in 2013-14.

The Scottish Government and COSLA Leaders agreed on a multi-year revenue and capital funding package to deliver the expansion in funded Early Learning and Childcare entitlement to 1140 hours by 2020.

As set out in the funding allocation letter that issued to local authorities on 1 May 2018, this funding reflected local authority estimates of the full costs of delivery within their area as set out in their March 2018 finance templates (less adjustments which were agreed with COSLA Leaders to ensure consistency in the source of population projections and in the application of agreed capital funding principles to proposed new build projects).

Local authority finance templates reflected local variations in service delivery costs, including factors such as rurality, deprivation, and estimated trends in the number of children with additional support needs.

Local authorities have already received additional funding in 2017-18 and 2018-19 to support capacity building required for the expansion to 1140 hours by 2020. The methodology for allocating this funding, the pre-school education Grant Aided Expenditure distribution methodology, has been agreed by local authorities and Scottish Government and includes an adjustment for rurality.

The Scottish Government and COSLA Leaders agreed on a multi-year revenue and capital funding package to deliver the expansion in funded Early Learning and Childcare entitlement to 1140 hours by 2020.

As set out in the funding allocation letter that issued to local authorities on 1 May 2018, this funding reflected local authority estimates of the full costs of delivery within their area as set out in their March 2018 finance templates (less adjustments which were agreed with COSLA Leaders to ensure consistency in the source of population projections and in the application of agreed capital funding principles to proposed new build projects).

Local authority finance templates reflected local variations in service delivery costs, including factors such as rurality, deprivation, and estimated trends in the number of children with additional support needs.

Local authorities have already received additional funding in 2017-18 and 2018-19 to support capacity building required for the expansion to 1140 hours by 2020. This has been allocated as grant specific funding and, as set out in the revenue funding allocation letter which issued to local authorities on 22 February 2018, one of the uses to which the funding is to be applied is for enhanced provision for children with additional support needs.

In addition, an Early Learning and Childcare Inclusion Fund has been set up to help cover one-off costs associated with delivering ELC to a child with ASN. Individual settings will be able to bid into the fund to help cover the costs associated with staff training, as well as resources, equipment and adaptations. The fund will distribute up to £500,000 in total per annum over four years to ELC settings delivering the funded hours.

The Rural General Practice Short Life Working Group, which is chaired by Professor Sir Lewis Ritchie and includes representation from rural GPs, had its first meeting on 12 June. The group will work with clinicians and healthcare providers from a range of remote and rural communities to help implement the new GP Contract. My officials are in dialogue with its members to identify issues for the group to discuss at the next meeting, expected to be held in September.

This is a question for the Keeper of the Registers of Scotland. She advises me that, in the last financial year, more than 70% of land register applications to Registers of Scotland were dealt with inside 5 days, with the majority of first registration applications being completed within 20 days. Some applications, in particular more complex first registrations, are taking longer than anticipated. Registers of Scotland are working closely with their customers to improve the processes and technology that support land registration; in particular focussing on how new mapping technology can be used to speed up the first registration process.

The Mortuary Review Group made 13 recommendations in its report published in January 2018 which were grouped into the following categories - Roles and Responsibilities, Mortuary Provision, Contracts, Facilities and Quality Improvements. Responsibility for implementing the majority of the recommendations rests with Health Boards, Local Authorities, Police Scotland and the Crown Office and Procurator Fiscal Service, so it is necessary to create a framework and reporting mechanism that allows progress to be visible to the Scottish Government.

We are therefore working with Healthcare Improvement Scotland (HIS), who will follow their recently established Quality of Care Approach, to deliver quality assurance activity that drives improvement in mortuary services. HIS are testing the new methodology to deliver quality assurance activity this year with a phased roll out in secondary healthcare settings and independent hospitals. This framework will allow us to demonstrate quality improvement and best practice in mortuary services.

In addition, Health Facilities Scotland published Scottish Health Planning Note 16-01 in November 2017 which provides facility guidance for mortuary and post mortem services’ premises in Scotland, to support public bodies to design new buildings, adapt or extend existing buildings and assess the standards of existing facilities consistently.