Chamber and committees

The practice of company employment or company sponsoring of specialist stoma nurses within NHS Scotland ceased in 2006. The nurses' transfer into direct NHS employment was one of the outcomes from a Scottish Executive review of the supply of stoma appliances in the community, which were circulated to NHS Scotland through a Health Department letter, HDL (2006) 15. A link to that letter is as follows:

https://www.sehd.scot.nhs.uk/mels/hd2006_15.pdf

The rationale for the decision was to improve governance and reduce the risk of conflict of interest for stoma care nurses within Scotland, and that remains the position of the Scottish Government.

The information requested is not held centrally.

Within the first Tackling Child Poverty Delivery Plan we have set out clear analysis on the anticipated impact of our policies and approaches. This analysis is provided for all actions which directly impact on the three key drivers of poverty reduction: increasing income from work and earnings; reducing household costs, and, maximising income from social security and benefits in kind.

We will provide further detail of impact within our first annual progress report, and set out our plans for evaluation in the longer term, later this month.

The Scottish Government is currently undertaking analysis of potential policy and delivery options for the income supplement.

I will provide an update to Parliament on this work, and progress against the wider measures in the Tackling Child Poverty Delivery Plan, later this month.

At the meeting on 7 March, the Homelessness Prevention and Strategy Group (HPSG) agreed pathways should be developed in sequence to allow work to be focused, take advantage of learning opportunities and to ensure experts in homelessness service delivery across Scotland could engage effectively with the work as a whole. The work is starting with groups who are most straightforwardly identifiable and where there is a clear opportunity to make progress.

The A Way Home Scotland Coalition, who are members of HPSG, are focused on developing and implementing work around youth homelessness in general. The HPSG has deputed the Coalition to develop the care leavers pathway, and Coalition members CELCIS have convened a working group to take this forward. The first meeting took place on 20 May, setting out the groundwork for this activity. The work is expected to proceed at pace over the summer.

Scoping work has been carried out on further pathways in relation to people experiencing domestic abuse and people with experience of the armed forces.

We have made significant progress in implementing the recommendations of Dr Montgomery’s review. This progress is reflected in the increasing proportion of medicines for rare, very rare and end of life conditions that are now approved by the Scottish Medicines Consortium (SMC) for general use on the NHS in Scotland. This approval rate for submitted medicines in these categories now stands at over 78 per cent, compared with 48 per cent between 2011 and 2013.

Increasing access to new medicines has been assisted by:

• An established part of the SMC decision making process that hears and gives weight to patients’ and clinicians’ experiences;
• New public summary documents which explain SMC decisions about routine access to medicines in a patient friendly format;
• A new “ultra-orphan” pathway that allows medicines for very rare conditions to be available on the NHS in Scotland on an interim basis whilst data is collected on their clinical effectiveness; and
• The Peer Approved Clinical System Tier Two, which allows wider access to medicines on an individual case-by-case basis where those medicines have not been accepted by the SMC.

Steps have also been taken to implement Dr Montgomery’s recommendations related to data about the use and effects of medicines. A Data Scoping Taskforce was established in 2017 with a remit to determine the digital capabilities required to utilise real world health data to support the assessment and introduction of new medicines, together with ensuring on-going safe, effective use of established medicines. The Taskforce published its report on 18 September 2018 and actions are being considered as part of a range of ongoing policy initiatives, including our Digital Health and Care Strategy, and the implementation of a Hospital Electronic Prescribing and Medicines Administration system.

Important final steps towards the completion of implementation include new steps that will make the fullest use of devolved powers to achieve the best prices for new medicines.

Continence specialist nurses can be found under the continence specialty in the Clinical Nurse Specialist (CNS) table published on the ISD website available here: ‎ https://www.isdscotland.org/Health-Topics/Workforce/Publications/2018-12-04/Clinical_Nurse_Specialists_S2018.xls .

The whole time equivalent for the continence clinical nurse specialists by board since September 2014 can be seen in Table 1.

ISD Scotland data on CNS categories is incomplete because of data quality concerns in a number of NHS Boards, ISD Scotland is working with these NHS Boards on their concerns. The CNS data for the following nine NHS Boards (NHS Ayrshire & Arran, NHS Borders, NHS Fife, NHS Greater Glasgow & Clyde, NHS Highland, NHS Lanarkshire, NHS Lothian, NHS Tayside and State Hospital) has been omitted from published data for September 2018. The * in Table 1 represent omitted data.

Table 1: Whole Time Equivalent for Continence Clinical Nurse Specialists as at
‎ 30 September each year from 2014.

NHS Boards regularly reassess continence patients' needs, with the reassessments undertaken by dedicated Bladder and Bowel Teams or community nursing staff. This ensures that patients' needs are met, either through treatment or provision of appropriate containment products. Referrals can also be made by patients' GPs where necessary.

An Excellence in Care Working Group is currently considering a key performance indicator (KPI) relating to continence management, which would include both the initial patient assessment and subsequent reassessments.

Training on intermittent self-catheterisation (ISC) is a clinical skill and is delivered at NHS Board level. Therefore, the information requested is not held centrally.

The Scottish Government is continuing to develop the final Culture Strategy and plans to publish it later this year.