Meeting of the Parliament

Meeting date: Tuesday, September 5, 2023

Official Report 906KB pdf

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NHS Borders Paediatric Ambulatory Care Unit

The final item of business is a members’ business debate on motion S6M-09590, in the name of Christine Grahame, on NHS Borders paediatric ambulatory care unit celebrating its 20th anniversary. The debate will be concluded without any question being put.

Motion debated,

That the Parliament congratulates NHS Borders on the 20th anniversary of its Paediatric Ambulatory Care Unit, which is based at Borders General Hospital, in Melrose; understands that the Paediatric Ambulatory Care Unit is a fundamental part of the wider innovation of children’s healthcare at NHS Borders with a focus on keeping children at home and avoiding time in hospital where possible; notes that the Unit was set up on 20 May 2003 to allow children to receive treatment and return home rather than having to be admitted to a ward and that, over the last 20 years, thousands of children have attended the Unit to have a range of assessments, procedures, investigations and treatments, and pays credit to the paediatric nursing team on their commitment, quality of care and innovation in developing the service, and contributing to a better experience for children and families who have been able to avoid being admitted to hospital thanks to the Paediatric Ambulatory Care Unit.

17:11  

Presiding Officer, you will be delighted to learn that I am not going to mention the words “point of order.”

It is a privilege to lead this debate, and I thank all members who signed the motion to allow it to proceed.

Hospital is a scary enough place for adults, and more so for children. For their parents and carers, it can be very stressful and, indeed, upsetting. The philosophy behind ambulatory paediatrics—which is a bit of a mouthful—is that children should not be admitted to hospital unless it is absolutely necessary to do so and that, as far as possible, care should be arranged in their own homes. I might add that that is perhaps especially important in rural areas, with long distances to hospitals—whether local or outwith the area—and with the issues of remoteness and limited public transport. I have no doubt that the ambulatory paediatrics process helps with the entire experience, including children’s treatment and healing and recovery process. Indeed, on seeing the success of the paediatric ambulatory units, adult services have since built similar models. So, tonight, I am pleased to congratulate NHS Borders paediatric ambulatory care unit, which has recently celebrated its 20th anniversary.

The unit is based at Borders general hospital—known locally as the BGH—in Melrose, and I understand that the ambulatory care unit is a fundamental part of wider innovation in children’s healthcare at NHS Borders, which also includes social care, with a focus on keeping children at home and, as I say, avoiding them having to spend time in hospital where possible.

As I stated, the unit was set up on 20 May 2003 to allow the children to receive treatment and return home rather than have to be admitted to a ward. Over the past 20 years, thousands of children have attended the unit to have a range of assessments, procedures, investigations and treatments.

Located in ward 15 of the BGH, the unit—named “only for the day”—was set up to provide day care for children who require such things as blood tests, medical assessments and allergy testing. Before the unit opened, those children would have gone to the Noah’s ark ward and been treated alongside children who had been admitted to ward as in-patients. The unit also runs BCG immunisation clinics.

Importantly, the service separates in-patient and out-patient services. The only for the day ward also provides a friendly, relaxed environment for the children. The nurses can dedicate their time to caring for them and can build up relationships with the children and their families—again, that all helps the healing process. Of course, that means that there is less time waiting for treatment and less anxiety for everyone.

The success of the unit is a credit to the paediatric nursing team’s commitment, quality of care and innovation in developing the service and contributing to a better experience for children and families who have been able to avoid being admitted to hospital, thanks to the unit. Indeed, former patients and parents have shared their thanks for the unit, including one mum whose daughter was the first child diagnosed with a nut allergy at the unit and who has just celebrated her 24th birthday. As I have said, adult services have built in similar models because of the success of the unit.

I want to end on a quote from Dr Andrew Duncan, consultant paediatrician and associate director of medical education at NHS Borders. He said:

“Over the past 20 years, the backbone of the service has been our amazing paediatric nursing team. They have shown huge amounts of flexibility and imagination in development of the service.

New skills have been developed in intervention, blood tests, psychological support and undertaking specific procedures such as specialist immunisations and accessing medical devices. This has meant many children have been able to have treatment locally, rather than travelling outwith the Borders. We know staying at home makes a huge difference to the lives of children and families and we are proud to have provided this service for the past 20 years.”

I once again congratulate everyone on the team, NHS Borders and the BGH on the service, and I look forward to hearing contributions from other members to see whether the good practice is reflected in other parts of Scotland.

17:15  

I thank Christine Grahame for securing this important debate, which recognises the work of NHS Borders paediatric ambulatory care unit, following its 20th anniversary in May, and I join her in celebrating its achievements.

As Christine Grahame has said, over the past 20 years, the care unit, with its specialist team of nurses, has provided blood tests, medical assessments and allergy tests and has supported thousands of children in the comfort of an out-patient setting. That approach means that fewer children are admitted into hospital for treatment or have to travel to be treated in other parts of the country. For children and their families, the reassurance that is provided by being in that familiar setting results in less stress.

The unit has also helped to free up bed space at the BGH across local services, offering peace of mind for children and their parents, and the paediatric nurses there have developed skills including the delivery of specialist immunisations and the use of medical devices. As Christine Grahame alluded to, they have also offered psychological support to children and parents across the Scottish Borders. The staff deserve our praise, recognition and thanks for their work—I thank them hugely.

I also want to take this opportunity to address some of the pressures that health services in the Borders are presently facing. Having visited the BGH last week, it is clear that the present Scottish National Party-Green Government has not yet delivered a meaningful national health service recovery plan. During the visit, I learned about the severe pressures that are being felt across the service, and there is simply no capacity to flex as this winter approaches. Problems are being seen in the accident and emergency department, through the wards and into the step-down Borders view interim care facility.

It is unfortunate that you are taking this opportunity to attack the health service—

Through the chair, please.

It is unfortunate that the member is taking this opportunity to attack the health service rather than, just for once, congratulating the unit at the BGH on something that it is delivering. You were doing so well until then, but you have disappointed me entirely.

You were also doing well up to a point, Ms Grahame. Please speak through the chair.

I thank Christine Grahame for her suitable chastisement. I am sure that we will continue to clash on “Representing Border”. However, I want to take this opportunity to address some concerns that were raised with me directly by senior NHS managers, including the chair of the health board, when I visited the hospital last week. The problems that I said had been seen in A and E, through the wards and into the Borders view interim care facility reflect the real pressures that our local health service is facing, particularly in social care and care at home. Many hospital patients who are ready to be discharged are being forced to wait several weeks and sometimes months for care packages to be arranged so that they can be discharged from hospital. At the time of my visit, 80 out of 310 beds were occupied by patients who were ready to be discharged, which was creating bottlenecks throughout the hospital. Despite the huge efforts of staff—I say to Ms Grahame that I celebrate those efforts—the issue is still resulting in elective surgery appointments being cancelled.

Alongside the board chair, Karen Hamilton, I visited the medical assessment unit. That unit is supposed to signpost patients to a ward or another setting within 72 hours. However, last week there were five patients receiving end-of-life care in the unit. As one member of staff said:

“This is a busy place. This is not a good place for people to die.”

Those patients deserve better.

I recently met general practitioners from Earlston medical practice, who, increasingly, are being asked to deliver secondary care in a primary care setting, through no fault of national health service staff whatsoever but simply because of the capacity in the system. Innovations such as the paediatric ambulatory ward and the health board’s hospital at home pilot, which I had the privilege and honour to see in action, are very much to be welcomed, as is the commitment that is shown by staff.

However, as we prepare for winter, NHS Borders wards and facilities are already above capacity, and there is no room to flex. The hard-working workforce is operating at full capacity, so I hope that the minister will listen to patients and clinicians and will properly resource our NHS and social care sector in rural areas. I commend staff at NHS Borders for their efforts in paediatrics, wards, operating theatres, specialist mental health services and other services. As winter approaches, I urge ministers to give them the tools and the resources to do the job.

On a point of order, Presiding Officer. I seek your guidance. Is it not important that a member who takes part in the debate speaks to the motion that is before the chamber and does not deviate so far that they are not actually speaking to the motion?

I thank Christine Grahame for her point of order. That is indeed a requirement under standing orders. However, I did not see any reason to intervene on the member, who referred to the motion at various stages throughout his speech.

17:21  

I thank Christine Grahame for lodging her motion for debate, which provides a welcome opportunity to commemorate the 20th anniversary of the paediatric ambulatory care unit at Borders general hospital and is a chance to thank all NHS staff, past and present, for the outstanding care that they have provided for children across the Borders over many years. I am immensely proud of and grateful for the remarkable contribution that the unit and the wider NHS Borders team make every day to support so many of my constituents and those of other members, no more so than in these incredibly challenging times.

Two decades ago, NHS Borders embarked on a journey to enhance healthcare accessibility for the region’s children and families. The inception of the unit—known, as Christine Grahame has said, as “only for the day”—on 20 May 2003 was a testament to the staff’s commitment to the wellbeing of our youngest citizens. Since then, as we have heard, the team that works from the unit has treated thousands of children—crucially, without the need for them to be admitted to a ward or, as sometimes happened, travel outwith the region for treatment. That has made a significant contribution to the innovation of children’s healthcare in the NHS.

As Dr Andrew Duncan, consultant paediatrician and associate director of medical education at NHS Borders, said at the time of the 20th anniversary, when paying tribute to the paediatric nursing team,

“New skills have been developed in intervention, blood tests, psychological support and undertaking specific procedures such as specialist immunisations and accessing medical devices.”

Prior to the unit being set up to provide day care for such things as medical assessments and allergy testing, children would have had to come into hospital—to Noah’s ark—and be treated alongside children who had been admitted to the ward as in-patients, with all the anxiety that that can mean for children and their parents. The new unit that was formed in 2003 was forward thinking and, 20 years on, it continues to play a hugely important role in the care of Borderers and in influencing other such initiatives across the rest of Scotland.

However, the unit does so at a time when our NHS is facing its biggest challenge in its 75-year history—no more so than in the care of children in the Borders. For all the positive achievements of the unit, we still have the challenge of the average wait time for paediatric surgery out-patients in the Borders, which is currently running at an average of 74 weeks. Child and adolescent mental health service waiting times in the Borders mean that, currently, only 31 per cent of young people are being seen within 18 weeks. That falls short of the Government’s legal—

Do you welcome the fact that paediatric ambulatory care nurses are trained in mental health first aid? Going to hospital can provoke anxiety, and the training can also help to deal with some young people who have mental health challenges.

I know that we are at the start of a new term, so I remind members that all comments should be made through the chair.

I very much welcome that fact, but we have a challenge because the Government’s legal target is 90 per cent of those young people being seen within 18 weeks and, at the moment, Scottish Borders is running at 31 per cent. I know that a lot of work is being done particularly to tackle the longest waiting times, but we have a lot of progress to make. Those are not just statistics—they are all children and families who are dealing with the anxiety and uncertainty that comes with prolonged waiting times.

Our NHS staff in the Borders and across the country are working tirelessly to deliver the best possible standard of care, but we need to redouble our efforts to make sure that they have the resources to enable them to do so. Too many, including children, are still waiting too long, and two years on from the publication of the Scottish Government’s recovery plan, those waiting times are not going down as they need to. The hard work and professionalism of our NHS staff is inspiring, but let us give them the resources and support that they need to provide the high-quality care that our children, families and communities right across the Borders and Scotland deserve.

The paediatric ambulatory care unit is a shining example of that high-quality care and of the NHS values that we are all proud of—compassion, accessibility, equality and innovation. It is not just leading the way in children’s healthcare; it is also inspiring changes in the way in which we deliver adult healthcare.

I wish a very happy 20th anniversary to the paediatric ambulatory care unit at Borders general hospital. I wish all those involved many more decades of the excellence and the compassionate care that they provide every day, for which we are immensely grateful.

17:26  

I welcome the opportunity to speak in this debate and congratulate my friend and colleague Christine Grahame MSP on securing it. What an excellent contribution the member made in speaking to her motion.

I also start by thanking all the staff at NHS Borders for the work that they do every day but, in relation to today’s debate, I particularly thank those staff who are working in the paediatric ambulatory care unit at Borders general.

As a registered nurse myself, I have experience in adult ambulatory care and a wee bit of paediatrics, so I know about the vital importance of ambulatory care. It bridges the gap between the hospital and community children’s services, concentrates on areas such as accident and emergency and out-patients, works at improving communication with families and the primary health care team, and, importantly, works with the home care nursing services to develop new services such as day units.

The unit at Borders general is a fundamental part of the wider innovation of children’s healthcare at NHS Borders, with a focus on keeping children at home and avoiding time in hospital where possible. The paediatric ambulatory care unit was set up 20 years ago in May 2003, to allow children to get treatment and go home rather than needing to be admitted to a ward as an in-patient. In the past 20 years, more than 8,000 children have attended the ambulatory care unit to have a range of assessments, procedures, investigations and treatments.

As Dr Andrew Duncan said,

“Over the past 20 years, the backbone of the service has been our amazing paediatric nursing team.”

It is worth mentioning that again. Dr Duncan went on to say:

“They have shown huge amounts of flexibility and imagination in development of the service.”

We know that new skills such as intravenous interventions, blood tests and psychological support, which I mentioned in my intervention, have been developed. It is important that we help to support and address mental health in young people when they come to us through any service, including the ambulatory care service.

The work that has been carried out by the exceptionally dedicated and specialist healthcare professionals has meant that many children have been able to have treatment locally, rather than having to travel outside the Borders. We know that staying at home makes a huge difference to the lives of children and families and all the team at NHS Borders, both past and present, should be proud of the service that they have created.

Ambulatory paediatrics is an exciting and challenging area to be involved in, with much scope for development. I was interested to read that, during the past 10 years, there has been a 30 per cent increase in the number of under-fives attending emergency departments. That compares to an increase of 15 per cent for all children and young people seeking urgent care in the same time period.

Those figures are due to changes in demographics and in carer behaviour that have arisen for a number of reasons. I swithered about whether to include more detail about attendance issues at emergency departments, but I will say that lack of paediatric experience in primary care and in the assessment of risk play a role in the increase in referral rates to secondary care services, which demonstrates why paediatric units, such as the one in Borders general, are so important.

The investment in virtual hospital care models in paediatric medicine is increasing as acute settings struggle to manage the pressures caused by increasing demand. I ask the minister what learning can be taken from the unit at Borders general and replicated across other health boards, both to alleviate pressure on those boards and to improve outcomes for children and young people.

I place on record my thanks to all the staff at NHS Borders for leading the way with the paediatric ambulatory care unit and congratulate Christine Grahame on securing the debate.

17:30  

I thank Christine Grahame for bringing the motion to the chamber and, on behalf of the Scottish Labour health team and as a member for the region, congratulate NHS Borders on the 20th anniversary of the paediatric ambulatory care unit at Borders general hospital in Melrose.

There are few things more important than the health and wellbeing of our children, and that such specialist and focused provision remains in the Borders is a real positive and shows the importance of dedicated paediatric care.

It is heartening to learn from the NHS Borders description of the ward that the key aims of the unit include reducing waiting times for children and having nurses with specific responsibility to care for them when they visit the ward. As other members have said, that will be well received by the young people and their families.

It is important that this service remains in the Borders. At a time when so many have to leave for work and to access other services, this NHS provision remains firmly within the Borders and serves the people of the area. As a member for South Scotland, I cannot count the number of occasions when I have heard of residents having to travel to Glasgow, Lanarkshire or Edinburgh to receive services. It is undoubtedly the case that the provision of services, including health, can be severely limited in rural areas, so this service should be welcomed. Long may it continue in the Borders.

As the motion states, it is apt that we take time to give credit to paediatric nursing teams in the Borders and across the country. The care that they provide, the compassion that they show and the contribution that they make to the operation of our NHS have been rightly recognised in the motion and by all speakers in this debate.

However, it would be remiss of me, as an Opposition member, not to mention the problems in the NHS, which we should consider. We learned this morning of a staggering one in seven Scots waiting for treatment and of thousands of children and young people on long waiting lists for child and adolescent mental health services. The Government has not yet met the 18-week target for CAMHS waiting times. It is important that we discuss those figures when we have the opportunity.

However, we are here to commend the work of the paediatric ambulatory care service and I again do so. Like my colleague Emma Harper, I thought that the medical director’s words were wonderful when he made the point about how well nursing services have done during the 20 years of the service.

It is right that we have come together to debate this important unit, but it is our responsibility to ask the minister to tell us about how we can improve services. I hope that the minister will congratulate that service tonight but will also outline some of the issues that must be addressed and, particularly on a day when we have heard the programme for government, explain how the Government will do that.

I invite Maree Todd to respond to the debate.

17:34  

Let me start by passing on my congratulations to NHS Borders on the 20th anniversary of its paediatric ambulatory care unit and by thanking Christine Grahame for bringing that important anniversary to the attention of the Parliament. The innovation that NHS Borders has shown in children’s healthcare locally is something that it should be very proud of.

The health and wellbeing of our children is of the utmost importance, and it is our aspiration that Scotland should be the best place in the world to grow up in. Supporting and maintaining the health and wellbeing of Scotland’s children will, in turn, make for a happier, healthier and more prosperous future adult population, but at a more fundamental level, we have an obligation to protect, nurture and care for our next generation. To put it simply, we have to get it right for every child.

It is in that context that our child health surveillance programme and network of children’s nurses become vitally important. I am proud to say that each young family in Scotland is entitled to the support of a health visiting service from pre-birth to a child starting school. Our universal health visiting pathway provides families with a series of 11 home visits as a minimum standard. That sequence of visits best ensures that the health and development of Scotland’s children can be well monitored and promoted.

Our health visiting service is universal, but we also offer young mums the option of accessing more intensive support through the family nurse partnership, which helps to guarantee flexibility of approach and the provision of targeted care to children and families who need it most.

All our children are able to access the support of a school nurse as they move through education between five and 18. Our school nursing service is designed to focus support around priority areas that are most likely to influence health and wellbeing in later life. That approach ensures that school nurses can focus on prevention and early intervention, thereby helping children to navigate health and wellbeing concerns and go on to thrive in adulthood.

All those services provide significant benefits, but it is really important that they do not operate in isolation. Our getting it right for every child framework therefore provides the foundation upon which complementary children’s services can integrate effectively. GIRFEC ultimately offers fertile ground for the development of initiatives such as the paediatric ambulatory care unit in NHS Borders. As we have heard today, the ambulatory care unit is an innovation that puts the needs of children at the heart of care and ensures that, as far as possible, services are tailored to the individual. To address Emma Harper’s point, that is exactly what we would like to see all over Scotland. We are more than happy to work with NHS Borders to examine what it is doing and how much of that can be rolled out across Scotland.

Of course, NHS Borders has already inspired the hospital at home service, which the Parliament has debated. Our investment of a further £3.6 million in hospital at home provides acute level care at home and avoids hospital admissions for adults. In the past year, the service has supported more than 11,000 people.

I ask the minister to look again at hospital at home and the home first programme, which is especially important in rural areas. Will she consider providing additional funding for rural council and health board areas, given that the cost of delivering such services in those areas is significantly higher?

I would not dream—on the hoof, in the chamber—of interfering with the NHS Scotland resource allocation committee formula, which, I understand, already accounts for the extra burden that rural authorities have. However, I agree with Craig Hoy that it is more important than ever that, in rural areas, such services are delivered closer to home.

We remain absolutely focused on ensuring that the health service recovers from the greatest challenge in its history—the pandemic. I recognise that challenges remain and that there are still unacceptable waits in some specialities, but we are committed to delivering sustained improvements and year-on-year reductions through service redesign and by enhancing regional and national working.

We have provided record funding of more than £19 billion in the 2023-24 budget to support recovery and reform to secure sustainable public services. As well as helping to speed the recovery from the pandemic, the range of reforms across primary and acute services will reduce unnecessary demand for services and develop new pathways of care that are better for patients as we face the health challenges of the coming years.

That includes building on and investing in the recruitment and retention of staff. National health service staffing levels are historically high under this Government, with nearly 23 per cent more people in post. We have introduced measures to help retain staff and look after their wellbeing, including through the development of a wellbeing hub. We continue our long-term investment in healthcare education by funding a record number of nursing and midwifery student places.

We have also seen a 143.1 per cent increase in the staffing of psychology services since 2007. That demonstrates our commitment to mental health services, which includes improving access to community mental health and wellbeing support. Through our investment in community mental health services, we are providing local authorities with £15 million per year to fund community-based mental health supports for children, young people and their families. In the most recent quarter, 5,093 children and young people started treatment at CAMHS in Scotland, and the past six quarters have seen each of the six highest figures on record for the number of children starting treatment from CAMHS.

Not for one second would I deny the challenges that we face or the improvements that we still need to make, but we cannot dismiss or ignore the seismic and continuing impact of the pandemic and what that has meant for the NHS and its workforce. Therefore, it is disappointing that my colleague Craig Hoy was unable to resist the opportunity to score some political points in this debate. We did not hear him talk up Scotland for being the only part of the UK to have avoided strikes in our NHS. We did not hear him say that our health and social care staff in Scotland are paid more than their counterparts in any other part of the UK—and that was true even before today’s announcement of £12 per hour from next April for social care staff. We did not hear him mention that, in our NHS, we have more staff of all professions per head of population. We certainly did not hear that, in Scotland, we have had the best-performing A and E services in the UK for not only this week, this month or this year, but the past eight years.

Our NHS is still in recovery; the NHS all across the UK is in recovery. Every country faces challenges in improving health as we move through and out of the pandemic, but we must move forward and ensure that recovery and reform are not only words, but concrete actions that ensure that—like in NHS Borders—we are getting it right for every child and getting it right for everyone.

Meeting closed at 17:43.