Time is of the essence, so let us move on to agenda item 5. I invite Caroline Gardner to brief us on the Audit Scotland report on medicines in hospitals.
Thank you. As Barbara Hurst said, "A Scottish prescription" is the second report that we published during the summer recess. We considered the arrangements that NHS boards and their operating divisions have in place to manage the use of medicines. In our work, we included financial management, risk management and how pharmacy services are provided. We also considered the roles of the Scottish Executive Health Department and a range of national organisations in providing support and advice to health boards.
I find the report really interesting, particularly given what has been said this morning about how improvements in medicines that are available can improve the quality of care, although on the other hand they generally seem to increase costs. It must be difficult for NHS boards to try to balance that in making predictions. When you were doing your work, were you aware of what advice was being given to patients about use of medicines? I am thinking in particular about patients who have been given a range of medicines without having been given much help with how to use them most effectively.
There is a lot in those questions. I will kick off and then ask Tricia Meldrum to follow up. First, on information that is available to patients, it is probably fair to say that, on the whole, less attention has been given to that in relation to patients in hospital than in relation to people who go to their GPs and receive primary care. That is partly because people tend to be in hospital for a fairly short time and prescribing for them turns over quite quickly—drugs are tried and changed quickly as the results are considered. It is also because, in general, patients in hospital are not responsible for self-administering medicines as they are at home. Tricia Meldrum might want to say more about that in a minute.
I will talk first about the advice that patients receive about medicines. As Caroline Gardner said, that subject has perhaps not received as much attention, but it was dealt with in "The Right Medicine: A Strategy for Pharmaceutical Care in Scotland", which was published a couple of years ago. That had several objectives and recommendations about ensuring that all patients in hospital received advice from a clinical pharmacist. That involves talking to patients about their medicines and ensuring that they understand what medicines they take and why they take them. As we went round hospitals, we saw work to implement those recommendations. As Caroline Gardner said in her briefing, not all hospitals or all specialties have a clinical pharmacy service, but when one is available, that is the source of such advice and support to patients.
That is interesting.
The report sets out much that is interesting about sharing of information across boundaries, whether in primary care and hospitals generally or in emergency care settings. To what extent do cultural and attitudinal barriers to that continue to exist, or are we now overcoming the technical obstacles to full sharing? Historically, the former was fairly significant, because different professional groupings were unwilling to share data and so on. However, I sense that the world has moved on a bit. You will have a better sense of that than any of us—certainly better than I have.
The experience of the audit was that issues related not to culture and attitudes but to the practicalities of sharing information. My impression is that there is willingness to share information and an appreciation of the importance of full information about what has happened in primary care when a patient enters hospital. People in hospital are very aware that it is not in a patient's best interests for that information not to return to primary care on discharge, in order to support continuity of care. I was aware not of cultural difficulties, but of difficulties just with the mechanics of conveying information to people.
That is helpful. Do you have a sense—I use that word again—of whether such change and wider implementation of the national pharmaceutical strategy and so on have provided as much emphasis and impetus as have other forms of change and reform in the NHS?
It varies—there is variation in whether the national pharmaceutical strategy is on NHS boards' agendas and in the level that it has reached on boards' agendas. One recommendation in our report concerns where pharmacy sits in organisations. Pharmacy involves big financial risks and big clinical risks to patients, but pharmacy managers may not be at the appropriate level in organisations to put such issues on the agenda and to explore them fully in order to ensure that board members and other senior managers are aware of the issues and how to follow them through.
What about within the health department?
We talked about the national pharmaceutical strategy and we are aware that there is monitoring of the strategy, so there is something in place that is being followed up. We talked to the Health Department about information management and technology issues. There are some concerns there that although those issues are a priority there is not yet a project plan or any timescale. We want to see some action on that to get it moving forward.
The issue of timescales comes through time and again.
We heard a bit about HEPMA this morning. Dr Woods said that there had been a pilot in Ayrshire—"for some time" was his phraseology—and that it was a complex issue. Do you share that view? Do you have any concerns that HEPMA will not be delivered because of its complexity? Do you have any general thoughts on it? It seems that it could be quite effective in picking up on some of the points in the report, but is taking time in coming to fruition.
There are complexities. We went to Ayrshire and talked to managers there who had been involved in HEPMA. They were very clear on the various processes that have to be gone through and they were clear that it is not a quick fix. We talked earlier about culture, and about staff being signed up to the new way of working. However, there are also practical issues, such as having a national drug dictionary so that all systems are populated with the same information about medicines. That has been agreed only recently on a UK-wide basis.
I notice in the briefing a comment about a shortage of pharmacy staff, which I think Caroline Gardner also referred to. Did you get a sense that that issue had been recognised and that people are trying to address it, or is it something that we need to flag up and hear the department's response to?
When we carried out the work, there was no national workforce planning for pharmacy staff. It is probably fair to say that attention had been focused more on groups such as doctors and nurses, where the shortage was more apparent and had had a more immediate effect on patient care. Since the report has been published, the national workforce strategy has been published; it picks up on pharmacy staff as well. However, there are some long-term issues about getting the right number of staff with the right calibre of qualifications—as Tricia Meldrum described—on wards, with patients and as part of the clinical team. There is a catch-up job to be done.
We should recognise what has been happening locally, where pharmacy managers have been looking quite hard at redesign. They have been considering whether pharmacy technicians can increasingly be given extended roles in order to free up pharmacist time so that pharmacists can do more clinical work. There is quite a lot of work going on at local level to identify the issues and to try to address them.
Those were all our questions on the report. We will deliberate on the report later. I thank Caroline Gardner and Tricia Meldrum for that full briefing on medicines and hospitals.