Chamber and committees

Consultant-led adult immunodeficiency and allergy services in Scotland are provided by Grampian, Tayside and Greater Glasgow and Clyde NHS boards. A service is expected to be available in NHS Lothian by spring 2016 following the appointment of a consultant immunologist.

Paediatric allergy services are organised through the Children’s and Young People’s Allergy Network Scotland, which is a National Managed Clinical Network that focuses on improving health service provision for children and young people with allergies in Scotland.

The National Unscheduled Care Action Plan, which was launched in 2013, moved to an improvement focussed approach to sustainability improving unscheduled care, focussing on six essential actions. This new approach was launched in May 2015 and is a two year programme that aims to minimise long waits in A&E and assessment units by improving patient flow throughout all areas of the hospital and in the community.

The six essential actions are:

Clinically-focussed and empowered hospital management;

Realignment of hospital capacity and patient flow;

Operational performance management of patients presenting at A&E and progressing through the acute system;

Medical and surgical processes arranged to take patients from A&E through the acute system;

Seven day services targeted to increase weekend and earlier in the day discharges;

Ensuring patients are cared for in their own homes or homely setting.

The Scottish Government has invested £9 million this year (2015-16) to support NHS boards across Scotland to implement these actions and in the four months since the launch of the programme we have set up the basic essential elements that will ensure the continuous progress of the programme. For example, we have:

Recruited a national team made up of experts with a range of professional expertise to work with local team across Scotland;

Supported boards to recruit local teams dedicated to implementing the six essential actions;

Implemented appropriate site management structure to ensure focus on all services and targets across the hospital;

Strengthened structured planning and hospital safety huddles to ensure a whole system focus;

Enhanced use of discharge lounges and discharge hub facilities.

Like any programme it will take time to embed the key elements of the six essential actions and bring about long term sustainable improvements across Scotland.

In addition to the programme work we have also provided national additional support to those sites experiencing the biggest challenges. For instance, in order to support and embed the new working practices and processes following the transfer of all acute services from the Western Infirmary, the Victoria Infirmary and the Southern General to the new to the Queen Elizabeth University Hospital (QEUH) it was agreed we would provide a short term support team to work with the local team to implement key measures that would support immediate improvements, complementing the six essential actions work, including:

Improved infrastructure around bed management to ensure the prompt turnaround of beds;

Enhanced use of the discharge lounge;

Early in the day discharges to improve patient flow;

Implementation of criteria led discharge;

Increased ward rounds to support appropriate discharging of patients.

Performance at the QEUH has improved by nearly 17 percentage points since the team were on site in June 2015 (w/e 13 September). The short term support team have also supported other sites across the Glasgow area including the Royal Alexandra Hospital.

In parallel, we have issued winter guidance to NHS boards this summer, two months earlier than last year, to ensure early and appropriate action is taken to minimise risk and disruption to patients during the coming winter period. NHS boards have been asked to publish their final winter plans by the end of October 2015. We hosted a winter planning event for stakeholders and key partners across Scotland on 17 September 2015 where partners will have the opportunity to share good practice.

Finally, it is worth noting that performance against the four hour A&E target over the summer period has been consistently higher than last summer. Scotland’s performance in July 2015 was 95.3% for core sites, which is the highest performance since July 2012, and best performing in the UK – England (92.5%), Wales (81.9%) and Northern Ireland (78.2%).

The Scottish Government provides policies, frameworks and resources to NHS boards to allow them to deliver services that meet the needs of their local populations. All healthcare professionals receive high quality training and education on conditions such as allergy, as part of their respective curriculums, which are developed and informed by professional organisations, and approved and overseen by the respective regulators of each profession, as follows:

a) General Practice Specialty Training is based on the Royal College of GP’s curriculum which is the educational framework that defines and sets the standards for independent general practice, and competency in meeting the standards is subject to regular assessment, including knowledge and skills in allergy. Training for the care of people with allergy problems is covered in the curriculum statements 3.15 and 3.19, and all components of the assessment system must be successfully completed before a Certificate of Completion of Training can be awarded.

b) All nursing and midwifery students have to complete a three year undergraduate pre-registration programme, including training on allergies, in order to practice as a nurse or midwife to the standards set by their regulator.

c) The dietetic workforce in Scotland continues to experience education within their pre-registration degree courses that provides underpinning knowledge relevant to allergy and specifically food allergy. The Food Allergy Specialist Group also holds study days supporting post-registration education for dieticians and others involved in food allergy.

d) Allergy is an important core condition that is taught both throughout the undergraduate pharmacy course, in the pre-registration year and then offered as continuous professional development (CPD) to pharmacists after registration. NHS Education for Scotland provides a range of CPD training materials for pharmacists in these areas, for example the ‘Responding to Minor Ailments Distance Learning Pack’ has been distributed to all community pharmacies in Scotland, and a national webinar was run on the ‘Drug Therapy for Allergy’ which is now available as a teaching webcast.

It is a matter for NHS boards to plan and deliver the services required to meet the assessed needs of their residential populations, taking into account international and other evidence and operating within the policies and frameworks set out by the Scottish Government as well as within their annual funding allocations.

The Scottish Government provides policies, frameworks and resources to NHS boards to allow them to deliver services designed to meet the needs of their local populations.

Attendances at A&E due to self-harm can be recorded in several ways, primarily through the data field ‘intent of injury’. However, this field is not mandatory and Information Services Division is working with NHS boards to increase coverage and consistency.

The GP returner programme started in May 2015 and to date three GPs have completed the programme. There are currently four GPs taking part in the programme and a further eight expressions of interest have also been submitted.

There are two practitioners currently being assessed before joining the Enhanced Induction Programme.

Under the system established last year, if a school or college is concerned by a candidate’s result, in any subject, and believes the final mark does not reflect expectations, it can request a priority marking review, clerical check or a marking review of the exam paper. The Scottish Qualifications Authority, while acknowledging that the 2015 new higher maths paper was more demanding than intended, has ensured that candidates have not been disadvantaged. Its established grade boundary processes take account of any assessments that were easier or more demanding than intended to ensure all candidates received the grades they deserved. This means that those who would have received a grade A, B, C or D last year would achieve the same grade if they had sat this year’s exam.

I refer the member to the answer to question S4W-27241 on 17 September 2015. All answers to written parliamentary questions are available on the Parliament’s website, the search facility for which can be found at:

http://www.scottish.parliament.uk/parliamentarybusiness/28877.aspx.

We currently have the highest medical staffing levels ever in NHSScotland. Under this government, the number of consultant medical staff working in NHSScotland has increased by a record 38.2%. A&E has seen an unprecedented increase in consultant staff of 171.7%, from 75.8 whole time equivalent (WTE) to 205.8 WTE. Overall there are 570.9 WTE medical staff of all grades working in A&E in NHSScotland.

Published information on the number of consultants in emergency medicine can be found at ISD Scotland’s workforce statistics web site:

https://www.isdscotland.org/Health-Topics/Workforce/Publications/2015-09-01/HCHS_by_specialty_J2015.xls

The Scottish Government is also working with doctors and nurses to design the new emergency workload planning tool to be rolled out later in 2015. This will help NHS boards to ensure they have appropriate staffing levels in place to meet variable workload demands.

This investment in emergency medical staff was recognised in March 2015 by Dr Martin McKechnie, Vice President of the Royal College of Emergency Medicine Scotland, who stated: “The College welcomes the support the Scottish Government has given to increasing staffing and tackling crowding in our A&Es.” (Royal College of Emergency Medicine release, 24 March 2015).