I will respond first. My colleagues, Peter Stonebridge and Lorna Birse-Stewart, might want to comment on acute services, and Stuart Lyall might want to comment on the finances.
I am a great believer in making comparisons. Since I came to NHS Tayside, I have looked at our board and tried to understand our cost per capita compared to that in the other boards in Scotland. We are not so different that we should have differentiation. We have established which boards are in the upper quartile, or upper quintile, of performance and where we are relative to those boards on length of stay, theatre start and finish times, number of cases on theatre lists and new to return patient ratios in out-patients. In that regard, we have demonstrated that the number of times we bring people back to certain out-patient clinics is very different from what happens in the rest of Scotland—at least, it is different from what happens in the best in Scotland. Therefore, on that granular basis—which takes us back to Mr Stewart’s point—we are getting into all those elements to understand what is driving cost, why we are different and whether there is a good reason for that. If there is not a good reason for it, we expect to correct our delivery.
10:45
Having worked in five NHS boards, I am quite shameless: I think that we should look over each other’s shoulders at each other’s jotters. If people are performing better in any other part of Scotland, we go to see them. There is a lot of interest in looking at international models, but I have encouraged my colleagues to look at Fife rather than Finland, because we have far more in common with Fife, and if they are doing better than us, we only need to drive across the Tay bridge to find out why. We are taking it down to that granular level. When we talk about redesign, we talk about why our models should be different, what the best models are and what the most efficient models are. That is the process that we are undergoing at the moment.
Our staffing model is more expensive, but the standardised nursing staffing model now dictates what we will be using in wards and departments, which will be standard across Scotland.
In relation to our medical staffing model, we have some issues—as do other boards—with utilising locum staff, not least in our mental health services, where they cost a very significant amount. We are considering whether there is anything that we can redesign to change that.
I know that the committee wants to look at mental health later, but we have 14 consultant vacancies in mental health at the moment. Recruiting psychiatrists is a challenge across Scotland; I am not confident that we are going to be able to get those people. In their absence, we have to use locums. I think that locums are a poor use of money, because they are expensive and they are not embedded in the service.
Mike Winter, whom I have mentioned, has identified that we should transfer some of the resources from 10 of those posts to create 10 nurse consultant posts, recruit into those, and redesign the model of care.
Those are examples of what we are developing. It is about not only the numbers in the workforce, but changing how the workforce works.
At this point, I want to applaud our workforce, if you do not mind, convener. We have one of the lowest sickness absence rates in Scotland—it is below the national average. We have a vacancy rate of only 5 per cent, but the vacancies are in key areas, and recruiting to those key areas is difficult. We have a lot of people who are working enormously hard, so when we hear it said that we have an expensive model, I know that that is a challenge to them. Our commitment is to work alongside them to redesign more affordable and different models, not so that we are the same as others, but so that we are in the vanguard.
I turn to some of the decisions that the board made just three or four months after I came in. We have a differentiated model now for urology, which allows a one-stop shop service—sorry, that is a bit of jargon: it means that, when someone turns up at out-patients, they get everything done on the one day, rather than having to come back for several appointments. That service is up and running at Perth royal infirmary as we speak—it is just down the road from here.
We have looked at a separated model around orthopaedics. I was asked about consultation with the public: we have gone out to the public on those plans, and I believe that we have received 375 comments.
We are working on a thrombectomy model, with patients bypassing Perth to get to the excellent established service in Ninewells, which enables them to return home. That is a redesigned model. We are also looking at completely new models, including for thrombectomy. We have just secured £650,000 from the Scottish Government to allow us to progress that.
We are looking at new models and at developing different services, and we are doing that with our staff. However, we also understand that we need to become affordable. We explore that commitment whenever we engage with partnership services, so we know that our partners are clear about that. When we work with our clinician colleagues—Peter Stonebridge will attest to this—the challenge is put again that we need to be affordable. We are absolutely committed to that.
Perhaps Peter Stonebridge or Lorna Wiggin might say something specifically about acute services.