Chamber and committees

Recommended actions from the Review of the Storage and Spreading of Sewage Sludge on Land in Scotland which have already been completed include publication last year of the James Hutton Institute report on the impacts on human health and the environment arising from the spreading of sewage sludge to land, and implementation of the remedial actions that were recommended to be taken by Scottish Water.

The legislative changes recommended by the review are being implemented via the forthcoming Integrated Authorisation Framework regulations. A consultation on proposed regulations is due to be published in 2023 and stakeholders will have the opportunity to comment on the proposals relating to sewage sludge.

The decision to escalate or de-escalate an NHS Board is based on a combination of evidence. Escalation addresses complex issues and an element of judgement will always be required. In order to support robust decision-making in this sphere, the Scottish Government regularly convenes the National Planning and Performance Oversight Group which considers a range of data and intelligence relating to the delivery of health and social care across Scotland and the performance of our health boards. Should there be a requirement to escalate any additional NHS Boards, for any reason, I will update Parliament in the first instance.

The Scottish Government recognises the importance of day services to both those who use them and to their families and carers and has been working closely with local areas to ensure that services are delivered safely. Revised guidance for buildings-based day services was published on 26 May 2022 and 28 September 2022. The guidance says that such services should return to pre-pandemic capacity wherever possible, while operating safely in line with COVID-19 guidance.

Healthcare Improvement Scotland (HIS) was commissioned to gather and provide insights into different approaches to the redesign of learning disability day services, recognising the challenges the COVID-19 pandemic has created for service users, their families and service providers. A range of methods have been used to progress this programme of work including national learning sessions, connections sessions and focus groups. As a result, services have collaborated with people who use services, families, carers and disabled people's organisations to develop new community-based approaches to day service provision. Information on the work currently being undertaken can be found on the ihub website at: New Models for Learning Disability Day Support Collaborative | Healthcare Improvement Scotland - New Models for Learning Disability Day Support Collaborative (ihub.scot)

This programme of work concludes at the end of March 2023 and a final report will be published on the ihub website.

The Scottish Government are aware of the importance of ensuring consistent and non-stigmatising communications and welcome the World Health Organization’s announcement that mpox is the new preferred term for monkeypox.

Public Health Scotland (PHS), who lead on communications, are currently working with stakeholders to assess the impact and consider what action is required to highlight the change of name to the public.

Scottish Government will continue to work closely with PHS and stakeholders to amplify any agreed messaging.

The Scottish Government expects all women at all times, to receive high-quality, person-centred maternity care, tailored to their needs, with quality and safety for mothers and babies central to decision-making. Implementation of The Best Start is driving transformation in maternity care in Scotland, with women receiving continuity of carer throughout their pregnancy, resulting in improved relationships and outcomes. All women are asked as part of their booking process a variety of wellbeing questions in order to assess for additional care needs to assist women, and their families, to prepare for parenthood and facilitate positive maternal health.

The work of the primary midwife is likely to be particularly important for women with additional needs, including those related to mental health and learning disabilities. This is why we have prioritised the introduction of continuity of carer for the most vulnerable women and their families, as we know that, for women with a range of medical, social and psychological complexities, early intervention and coordinated multi-agency care can make a real difference to outcomes.

I refer the member to the answer to question S6W-12811 on 12 December 2022. 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

NHS Forth Valley has been unable to demonstrate the necessary governance, leadership and culture required to drive sustainable improvements in poor performance.

The Scottish Government has established an Assurance Board, chaired by Christine McLaughlin, co-Director of Population Health. The Assurance Board is supporting NHS Forth Valley in determining what steps are necessary to ensure the delivery of high quality governance, leadership and culture in, and in doing so is intended to support improvements in performance in out of hours, unscheduled care, mental health, and integration.

The ongoing work to address the underlying issues impacting poor performance is even more crucial as NHS Forth Valley faces one of the toughest winter periods ever experienced.

The Scottish Government is fully committed to ensuring that the NHS in Scotland delivers high quality, safe, effective and person-centred care to all patients, every time they access health services. The Scottish Patient Safety Programme (SPSP) continues to be implemented in every NHS Board, including NHS Forth Valley. It is designed to improve the safety of care. It is vital for patients to have confidence that when they access any part of the healthcare system, they will receive the best available treatment without fear of harm.

The Stage 4 escalation is not a reflection of the staff working tirelessly to provide care for the population of Forth Valley. The wellbeing and support for staff is paramount. This escalation decision has been made to allow the leadership team to take forward the transformational change required to improve the culture and leadership, but with the appropriate additional support through the Assurance Board, to ensure effective and efficient change which they have not been able to implement to date. NHS Forth Valley are responsible for delivering improvement against an agreed Plan, and support will be provided to assist NHS Forth Valley in delivery.

If staff do wish to raise concerns during this time then they should be supported to do so and they should be protected throughout the process and not suffer any harm as a result of speaking up. Boards are expected to investigate concerns fairly and appropriately.

The leadership of NHS Forth Valley has been unable to demonstrate the necessary governance, leadership and culture required to drive sustainable improvements in poor performance.

The Scottish Government has established an Assurance Board, chaired by Christine McLaughlin, co-Director of Population Health. The Assurance Board is supporting NHS Forth Valley in determining what steps are necessary to ensure the delivery of high quality governance, leadership and culture in, and in doing so is intended to support improvements in performance in out of hours, unscheduled care, mental health, and integration.

I have asked Professor Hazel Borland, former Nurse Director and interim Chief Executive of NHS Ayrshire & Arran, and Dr John Harden, Deputy National Clinical Director, to lead the senior level external support to the board. Healthcare Improvement Scotland (HIS) will also provide tailored support to deliver on the actions they set out following recent inspections.

Escalation addresses complex issues and an element of judgement will always be required. The timeline will be driven by the actions within NHS Forth Valley’s Improvement Plan and their associated timelines. My expectation was for the Improvement Plan to be developed and presented to the Assurance Board for scrutiny at its first meeting, with a focus on completing immediate actions by the end of the year.

The overall aim of escalation and the related package of scrutiny and intervention put in place is to support any NHS Board, including NHS Forth Valley, to deliver the required improvement and address the underlying issues effectively and sustainably so that they can be safely de-escalated as swiftly as possible.

The Assurance Board, which has been established to bring direct SG oversight of NHS Forth Valley’s escalation, will provide advice to the Director General about the future escalation status of NHS Forth Valley, including criteria for de-escalation.