Chamber and committees

I refer the member to the answer to question S6W-01559 on
‎ 24 August 2021. 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

I refer the member to the answer to question S6W-01559 on
‎ 24 August 2021. 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

I refer the member to the answer to question S6W-01559 on
‎ 24 August 2021. 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

Thank you for submitting the series of parliamentary questions in relation to NHS Forth Valley, with a specific focus on the External Review around Culture in the Emergency Department, Forth Valley Royal Hospital. I have responded to each of the questions in this one response.

Firstly, you asked about the number of people that were directed away from the A&E department at Forth Valley Royal Hospital without a correct clinical assessment during 2020 and from 1 January to 30 June 2021, we do not collate that level of data therefore I am unable to provide a response on this.

Regarding the findings of the External Review around Culture in the Emergency Department, this was an independent report commissioned by NHS Forth Valley and we are pleased that the Board took swift action after serious allegations were made by staff representatives.

The Scottish Government has noted the findings of the independent review and welcome that the Board has accepted the recommendations. We meet regularly with all Boards, including Forth Valley, and we will support the Board in taking forward these recommendations, seeking assurance that these are fully implemented.

We are also committed to supporting staff within the Board. All staff in our NHS must have the confidence to raise any concerns they have about patient care and not suffer any repercussions for doing so. The NHS Scotland Whistleblowing Policy requires boards to have an impartial, confidential contact that all staff can access to raise concerns should they feel that they cannot raise these concerns with their line manager or senior management.

In addition the confidential, Independent National Whistleblowing Officer (INWO) advice line provides information, support and signposting for those raising whistleblowing concerns, including former staff - the number of this service is 0800 008 6112. The INWO, which came into force in April 2021 and is the first of its kind in the UK, provides a mechanism for external review of how a Health Board, primary care or independent provider has handled a whistleblowing case.

Furthermore, staff working in health and social care can access support services available through the national wellbeing hub this can be accessed via www.promis.scot or by calling 0800 111 419. Both the INWO and wellbeing hub are available to current and former members of staff.

You have raised a number of issues including communication with patients in case of any subsequent legal or civil action. The decision on whether or not an action for damages is time-barred is a matter for the courts to determine. If there is any doubt as to when the limitation period should start to run, a court could hear arguments about when the pursuer became aware of his or her entitlement to pursue a claim, as part of the court’s application of the date of knowledge test.

The Scottish government and NHS Scotland have a shared vision for an open and learning culture and we want to learn when there has been dissatisfaction or harm and encourage organisations to identify improvements. Safety is at the heart of everything we do in NHS Scotland and it is vital to building a culture, which allows all frontline professionals time and safe spaces to learn, without fear of censure.

As part of our commitment to transparency, improving standards and learning lessons when something goes wrong, we have introduced a Statutory Organisational Duty of Candour. This makes it a legal requirement for all care providers, including Health Boards, to review certain types of adverse events, meet personally with those affected, and to publish an annual report to support openness and learning.

Part of that includes an organisational emphasis on staff support and training to ensure effective implementation of the organisational duty of candour. Staff must feel that they have the necessary skills and confidence if they are to be meaningfully involved in the delivery of the procedure and they are supported after an incident occurs. Being candid promotes accountability for safer systems, better engages staff in improvement efforts, and engenders greater trust in patients and service users.

The Scottish Government is clear that there should be robust site management in place across NHS Boards at all times, including access to senior decision makers, with operational overview of all emergency activity. Through our unscheduled care programme we continue to work closely with Boards, including NHS Forth Valley, with a specific focus on supporting the implementation of a series of improvements, including the workforce model in emergency departments, for example staffing levels, systems and processes as well as a nursing workforce review.

In terms of redirection, the Scottish Government policy is that patients may be referred to another service or provided with self-care advice once assessed by an appropriate clinician and deemed not to require emergency care. We are aware that during peak times of the pandemic some Boards had to take necessary measures to keep patients and staff safe by redirecting people following triage at the front door. We would expect any Board utilising this approach do so based on risk assessment.

During the summer months NHS Forth Valley, supported by the national programme for unscheduled care, have been working to explore the option of a care navigation area at the front-door to safely direct people to the onsite Minor Injury Unit and Urgent Care Centre if these areas are appropriately medically staffed.

In addition, the Scottish Government unscheduled care programme commissioned a Short Life Working Group, with representation including clinicians and managerial staff, during this year to review existing Redirection and Signposting Guidance to support Boards to implement best practice and ensure a consistent, coherent and safe approach to the right care in the right place. A key aim is to ensure people can be seen at services which better meet their healthcare requirements avoiding unnecessary exposure to a hospital environment. This will be published in September.

I would firstly like to thank the fantastic, flexible and supportive response from anaesthetists across the UK in supporting the pandemic surge requirements, particularly in Intensive Care, and as we now move to remobilise the NHS.

From the recruitment that has taken place so far in 2021, there were 67 posts advertised in Core Anaesthetics and 66 in ST3 Anaesthetics. All advertised posts have been filled. There were 5 appointable candidates who were not allocated a Core training post and 15 appointable candidates who were not allocated an ST3 post. This was a result of competitive entry and is similar both to previous years and the ratios seen in several other specialties. It does not automatically mean that these doctors are unemployed. This is because applicants ordinarily apply for multiple training posts and where an applicant is unsuccessful with one application, they may still be able to secure a post in another medical specialty or UK Nation. Unsuccessful applicants are also able to take up employment in alternative medical posts which are crucial to NHS Scotland, such as locum training posts (time which can count towards training), and are not prevented from reapplying for specialty training posts in subsequent recruitment rounds.

Where trainees are experiencing issues regarding their progression, NHS Education for Scotland are working with them and their educational supervisors on an individual basis to address these.

We are unaware of any alleged technical failures with Medical Royal College examinations and would encourage any trainee who feels that they have been disadvantaged to raise this matter formally with the College in question. We are also unaware of any alleged communications disruptions which have impacted on the specialty trainee recruitment process. Trainee recruitment this year has so far been an unprecedented success, with 94% of specialty training posts having been filled and one recruitment round still remaining.

I refer the member to the answer to question S6W-01559 on
‎ 24 August 2021. 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

Cancer continues to be a top priority for this Government. On 28 June I announced £10 million of funding to support cancer waiting times improvements during 2021-22. This funding will support targeted diagnostic activity, including for breast cancer. We have also provided five mobile MRI scanners and four mobile CT scanners to increase diagnostic capacity across NHS Scotland.

The Scottish Cancer Registry, hosted by Public Health Scotland, collects information on registrations for primary cancers. It does not hold information on secondary cancers.

There is work ongoing to develop systems for the routine collection of secondary cancer data, including secondary breast cancer. However, validation of these systems would require clinical time that is being focussed on seeing patients as we continue to prioritise cancer in the NHS. Any national system for the routine collection of secondary breast cancer would take several years to produce the first tranche of data. The Scottish Government’s National Cancer Plan has committed up to £114.5m until March 2023 which will drive a range of improvements across all cancer services.

There are no plans to undertake a metastatic breast cancer audit. Officials continue to closely monitor all patients referred with an urgent suspicion of cancer in NHS Scotland to ensure they are seen and treated as timely as possible.

NHS Scotland’s staffing levels are at a record high and the nursing and midwifery staff group is the largest, accounting for just under 64,000 Whole Time Equivalent (42%) of the workforce, an increase of 5% from the previous year. Information on the number of Clinical Nurse Specialists by specialist cancer fields is not held centrally.