Chamber and committees

The national performance standard for cancer is 95 per cent of patients referred urgently with a suspicion of cancer are to begin treatment within 62 days of receipt of referral.

We know further work is needed to shorten waits for diagnostics and in September 2017 we formed a Ministerial Cancer Performance Delivery Group to drive forward service redesign and improvement, backed by £1 million investment on top of
£4.85 million already allocated to boards.

Among a series of actions the group will audit processes for managing patients with a suspected cancer, implement new scrutiny and monitoring processes for health boards struggling to meet the 62 day standard, and invest in the roll-out of new technology to assist with pressures on diagnostic services.

Unlike local authorities and integration authorities, NHS Boards do not publish draft accounts. NHS Boards publish their annual accounts once the accounts have been audited and laid before the Scottish Parliament.

All NHS Boards received an unqualified audit opinion for their 2016-17 accounts.

The Chief Medical Officer’s reports, Realistic Medicine and Realising Realistic Medicine, seek to put the person receiving healthcare at the centre of decision-making and create a personalised approach to their care. Realistic medicine aims to reduce harm, waste and unwarranted variation, all while managing risks and innovating to improve.

One of the actions arising from the Health and Social Care Delivery Plan in support of this is to review the consent process for patients in Scotland with the General Medical Council and Academy of Medical Royal Colleges and make recommendations for implementation from 2018 onwards. This is a key element in supporting shared decision making and transforming the relationship between individuals and medical professionals.

In addition, our world-leading action plans on health literacy are working to build the skills, confidence, knowledge and understanding that people need to cope with the complex demands of the health and care system. This is vital to supporting people’s greater involvement in decisions about their care and treatment.

The welfare of NHS staff is critically important, every health board is required to have policies in place and to comply with national policies on managing health at work, which includes activity to support staff wellbeing.

Scotland has led the UK in the development of nursing and midwifery workload and workforce planning tools. A Nation with Ambition – the Government’s Programme for Scotland 2017-18, published on 7 September 2017, published our commitment to introduce Safe Staffing legislation, enshrining our world leading workforce planning tools in law, commencing with the nursing and midwifery professions.

The Nursing 2030 Vision, launched by the Chief Nursing Officer earlier this year, sets a direction for nursing through to 2030. It recognises that when nurses are happy and valued, patient outcomes improve and services flourish. The Vision prioritises activity to support nurses’ health and wellbeing.

Statistics published by Information and Statistics Division (ISD) Scotland on 21 February 2017 show that the mortality rate for heart disease had fallen 37.6% per cent between 2006 and 2015. ISD statistics for cancer mortality, published on 31 October 2017 also show a fall in mortality rates of 11% between 2006 and 2015. Whilst we know that Scotland is behind other UK countries, it encouraging to see that mortality rates for heart disease and cancer have decreased over the last decade.

We know more needs to be done to tackle the risk factors associated with heart disease and cancer. Healthier eating, being more active, stopping smoking and drinking sensibly can all play their part in reducing the risk of heart disease and cancer, and we are taking firm action in all these areas to support people across Scotland to live healthier lives. This includes our Heart disease plan published in 2014, our £100 million Cancer Strategy published in 2016 and our upcoming Obesity Strategy, which is currently out for consultation.

These plans emphasise the Scottish Government’s commitment to tacking heart disease and cancer and outline key ambitions and actions to improve the detection, diagnosis, treatment and aftercare of heart disease and cancer for all people in Scotland.

We will develop a medium term financial framework by February 2018 to support national, regional and local financial planning for the next 5 years.

The Scottish Government Equality Evidence Strategy, published on 18 July 2017, identifies evidence gaps across policy areas for all protected characteristics and sets out its general approach to filling these.

Over the four year period of the strategy, the Scottish Government will carry out further engagement with stakeholders to prioritise these gaps and define projects aimed at improving the equality evidence base.

Equality Evidence Strategy: http://www.gov.scot/Publications/2017/07/9574/1

NHS Scotland’s Information Services Division (ISD) has recently published its Equality Evidence Finder, which summarises information about the availability and use of equality data from key national administrative health datasets. A companion report, Measuring use of health services by equality group, sets out a number of steps that ISD aims to take forward in order to build upon the work presented in the report and through the Equality Evidence Finder.

ISD Equality Evidence Finder: http://www.isdscotland.org/Health-Topics/Equality-and-Diversity/Equality-Evidence-Finder/

Measuring use of health services by equality group: https://www.isdscotland.org/Health-Topics/Equality-and-Diversity/Publications/2017-06-27/2017-06-27-Measuring-Use-of-Health-Services-by-Equality-Group-Report.pdf

Since 2012, the Scottish Government has included a core set of questions in each of the three major household surveys it conducts. This has been done specifically to allow responses to be combined across the surveys. This large sample enables the analysis of key health indicators with reference to sexual orientation, religious belief, and disability (as measured through the presence of long-term conditions and limiting long-term conditions). This data was used earlier this year to inform a report on sexual orientation in Scotland.

Scottish Survey Core Questions: www.gov.scot/SSCQ

Sexual Orientation in Scotland 2017: A Summary of the Evidence Base: http://www.gov.scot/Publications/2017/01/4911/0

The Chief Medical Officer’s vision is that by 2025, all healthcare professionals will demonstrate realistic medicine principles and values through their professionalism.

The posters that have been developed and displayed by NHS Borders support one of the key principles of Realistic Medicine, which is to strengthen the relationships between healthcare professionals by encouraging people to ask their healthcare professionals questions that will support shared decision-making and giving people informed choices about their treatment and care.

The NHS Borders poster initiative is highlighted in the Chief Medical Officer’s annual report, Realising Realistic Medicine and NHS Dumfries and Galloway, NHS Lanarkshire and NHS Forth Valley are now piloting similar posters. We would encourage all NHS Boards to consider adopting this person centred approach.

The Scottish Government supports improvement of foot care service delivery through nationally produced tools and resources including the Traffic Light tool and CPR for feet.

We understand that, NHS Valley are at present piloting a fast track referral/triage system to improve service delivery in a standardised manner and reduce variation in practice within their Board. The results will be discussed with our Scottish Diabetes Foot Action Group so that best practice can be shared nationally.

The Chief Medical Officer’s second annual report, Realising Realistic Medicine sets out the need to strengthen relationships between professionals and individuals, with the person at the centre of all decisions and the need to tackle unwarranted variation. The report can be accessed here: http://www.gov.scot/Publications/2017/02/3336/downloads#res-1

The Chief Medical Officer’s vision is that by 2025, all healthcare professionals will demonstrate realistic medicine principles and values through their professionalism.

Different types of variation exist within the health and care system. Variation in health practices and outcomes exist, as well as variation in the volume of procedures carried out. There is a range of work, either planned or under way, that aims to strengthen person centred approaches and shared decision making to help tackle unwarranted variation. The Health & Social Care Delivery Plan which contains a series of priority actions that will begin to help embed Realistic Medicine across Scotland. They include:

• Refreshing our Health Literacy Plan, to support everyone in Scotland to have the confidence, knowledge, understanding and skills we need to live well with any health condition;

• Reviewing the consent process for patients in Scotland with the General Medical Council and Academy of Medical Royal Colleges and make recommendations for implementation. This is a key element in transforming the relationship between individuals and medical professionals;

• Commissioning a collaborative training programme for clinicians to help them to reduce unwarranted variation. This will support a workforce that can find more effective and valued ways of delivering medicine;

• Incorporating the principles of realistic medicine as a core component of lifelong learning in medical education and mainstream the principles of realistic medicine into medical professionals’ working lives at an early stage.

• Developing a Single National Formulary to further tackle health inequalities by reducing inappropriate variation in medicine use and cost and reduce the overall cost of medicine.

We will report progress towards achieving these actions through regular updates to the Delivery Plan Programme Board.

There is already some evidence of change in practice from individual clinicians, departments and NHS Boards as described in the CMO’s annual report Realising Realistic Medicine and we encourage boards to share and adopt good practice.

The Scottish Government is committed to ensuring that NHSScotland delivers high quality services and improved outcomes for patients. The Modern Outpatient Programme and Scottish Access Collaborative will deliver sustainable improvements. We have adopted a collaborative approach for Unscheduled Care and Scotland’s A&E performance has been the best in the UK for the last 30 months.