Chamber and committees

Treatments are person-centred according to the individual needs of the child.

Each child is placed in the care of a dietician and is regularly reviewed in terms of dietary needs. Regular individual assessments take place and tube feeding will be reduced or ended as appropriate to clinical need, dependent on oral motor skills and sensory issues, whilst simultaneously increasing oral intake to ensure nutritional requirements are met at all times.

Multi-disciplinary teams are involved as appropriate, eg: dietetics, speech and language therapy, clinical psychology, paediatric gastroenterology, and the community children’s nurse. Teams encourage focussed food activities and feed time routines from an early age, taking into account the parental and family situation.

Priority is always given to return to oral feeding, where there is potential.

For those children who are physically able to eat but refuse to do so, a more intensive treatment plan will be developed involving sensory work around different textures of foods, a psychologist reviewing and assessing parent/child interaction at meal times, messy play and general faddy eater strategies.

The multi-disciplinary approach, using the core skills and expertise of paediatric dieticians and speech and language therapists, and with a network of support from the children’s hospitals for more complex cases, is considered, effective, safe and person-centred.

Children will be referred to the appropriate children’s hospital.

The Yorkhill Specialist Multi-Disciplinary Feeding team consists of a paediatric dietician, clinical psychologist and consultant paediatrician, supported by a specialist paediatric registrar, assistant psychologist and an administrator, with speech and language therapy input if required.

There is one clinic session per week. First clinic appointments, last one hour. All team members co-consult to gather medical, developmental, behavioural and feeding history, parental management of meals and the family structure. Clarifying what the family are seeking and an explanation of the child’s usually complex growth data are essential. A specially designed growth database is used as well as measuring skinfolds to assess body fat levels. Changes the family feel able to make are also explored, such as manipulation of feeds to induce hunger and a videoed meal, which the clinical psychologist reviews with parents to help them identify behavioural changes they can make, eg limiting meal length, offering more praise for food eaten.

Families are usually followed up in clinic every one to three months. Between clinic visits one-to-one sessions and phone calls are delivered by individual team members, according to individual family needs.

Multi-disciplinary specialist services are also available, including speech and language therapy and paediatric gastroenterology.

The approach of the Royal Hospital for Sick Children (Yorkhill) is similar to that of other NHS boards, although it may be more intensive dependent upon the needs of the child. It is considered that a multi-disciplinary team pathway that is individualised is the best way to wean children off tube feeding.

The paediatric dietician links with the lead consultant, general practitioner and speech and language therapist before initiating weaning, and, as appropriate, with an occupational therapist, psychologist, clinical nurse specialist and health visitor. A multidisciplinary decision would be taken to commence weaning, dependent on each child’s clinical need.

Speech and language therapists rule out functional eating difficulties and actively promote oral motor skills in tube fed children where appropriate.

Occupational Therapists provide assessment and treatment of sensory issues.

Dieticians monitor nutritional status and advice on feed reduction.

Psychology provides support.

Gastroenterology advises on associated medical issues such as gastro oesophageal reflux and constipation.

The dietician links with colleagues in the appropriate children’s hospital when necessary.

The Scottish Affairs Committee’s inquiry into blacklisting in employment is considering evidence from the Information Commissioner’s Office investigation. We are following the progress of the Committee’s inquiry with interest and we will respond to their final report in due course. The Scottish Government, in liaison with the Unions, is developing guidance on the exclusion from public contracts of companies which engage in the practice of blacklisting and Scottish Ministers will soon be in a position to publish this.

The value of the fees reclaimed from non-salaried dentists working in the NHS within the four year period covering (2009-10 to 2012-13) is provided in the following table.

Note:*Information provided by Practitioner Services Division.

Scottish Government officials have regular discussions with their UK Government counterparts regarding procurement matters including blacklisting.

We note that evidence of blacklisting is being considered as part of the Scottish Affairs Committee’s inquiry into blacklisting in employment and we will respond to their final report in due course. Scottish Government, in close liaison with the Trade Unions, is developing guidance on the exclusion from public contacts of companies which engage in the practice of blacklisting and Scottish Ministers will soon be in a position to publish this.

The Scottish Government is pleased to see that the Scottish Affairs Committee is continuing its rigorous investigation into this issue. It remains appropriate for the Committee to carry out these investigations and to publish their final recommendations, which we will give careful consideration to. It would not be appropriate for the Scottish Government to conduct an inquiry at this time or pre-empt any conclusions or recommendations that the Committee is considering.

However, in line with the commitment given by the Deputy First Minister at a debate on 17 April on Public Procurement Reform, secured by the Infrastructure and Capital Investment Committee, the Scottish Government has now engaged with the unions on developing guidance for purchasers on how to address the issue of blacklisting when awarding public contracts. Government officials have been in close liaison with the unions and have had a number of meetings to discuss guidance on the exclusion from public contacts of companies which engage in the practice of blacklisting. Scottish Ministers will be in a position to publish this guidance shortly.