Hospitals (Capacity)
To ask the Scottish Government what its response is to reports that over 3,000 patients were boarded in the wrong hospital department for their condition because of capacity shortages. (S4T-00837)
We are aware of the challenge that boarding poses to all healthcare systems. As far as I am aware, Scotland is the first country to take national action on boarding. The studies that we have carried out show that boarding is not good for patient outcomes. The Herald report on 2,000 patients boarding in July and August should be viewed in the context of more than 1 million in-patient episodes each year in Scotland.
Through our £50 million three-year unscheduled care action plan, national health service boards have committed to work to minimise all boarding of patients. Approximately £8.2 million of investment from the action plan has been used this year to support additional capacity and innovative approaches to improve the way in which patients move through and out of hospital.
We have also introduced mandatory nurse and midwifery workload planning tools and we are working closely with NHS boards to develop a bed planning toolkit. That new toolkit, which I believe will be a first in the United Kingdom, will support NHS boards and their partners in Scotland to review capacity on an on-going basis.
I thank the minister for that answer, but the system is in crisis. Some 3,309 patients were in the wrong ward because of capacity shortages, 1,706 were in hospital in July when they should have been discharged and 124 of those waited for more than six weeks to go home. The picture will, of course, get bleaker as the winter goes on. We have had some news today, but it will be too late to improve the situation immediately for the winter months. What measures has the Scottish Government taken to ensure that the health boards are prepared and able to deal with the extra pressures that this winter will bring?
It always helps if the member listens to the first answer. I have outlined the action that we are taking to deal particularly with the winter surge.
Let me put in perspective the fact that 3,000 people were boarded over the summer. That means that 96 per cent of patients were not boarded. Now, 4 per cent were boarded, and the ideal would be that we did not need to board any patient, but there has been boarding of patients since 1948. We have an action plan on unscheduled care and we are working through the recommendations agreed with the Royal College of Physicians of Edinburgh from its report. It is not us who are in crisis. It is the Liberal Democrats.
It is a pity that the cabinet secretary resorts to cheap shots like that. He should maybe listen to the director of the Royal College of Nursing Scotland, Theresa Fyffe, who said:
“It’s time for the Scottish Government to stop hiding behind sound bites.”
Nurses enter the profession because they want to deliver good-quality care, but 55 per cent report that they are unable to deliver care to the standard that they want to reach because of the strain. Boarding means that patients are on wards that are inappropriate for their needs, which puts additional pressure on staff.
What is the Government doing to look properly at the workforce to ensure that we have the right number of beds as well as the right number of people with the right skills to ensure service of the highest quality?
On bed capacity, we are developing a bed planning toolkit. Our health service is the first in the world to develop such a toolkit, and that is on top of the workforce planning toolkit and the plans that I mentioned, which are being activated right now, on unscheduled care and dealing with the specific issue of boarding.
I point out to the member that levels of satisfaction generally in the national health service have risen significantly in the past few years. The reason for that is that patients recognise that we face significant challenges in the provision of healthcare, particularly against a background where we do not have control over our budgets and we are denied the resources from London, but that we are facing up to those challenges and we have plans in place, which are being implemented as we speak, to improve the service even further.
What investments have the Scottish Government and the NHS made in the past two years to improve the way in which patients move through the hospital system and to help to free up beds, reduce the amount of time that patients spend in hospital unnecessarily and thereby increase the acute capacity in our hospitals?
There is a whole list of initiatives. Let me give just one example. One reason why there is sometimes a problem with patient flow, particularly for the third of patients who present to accident and emergency who have to be admitted, is that in some hospitals, because of the daily discharge profile, only 10 per cent of daily discharges of patients are done before lunch time. That is not because patients are not ready for medical discharge. They are ready, but the co-ordination of pharmacy, transport and other services often means that the daily profile is such that most people are discharged in the afternoon or evening.
One of the ways in which we are improving patient flows in hospitals is to improve the daily discharge profile. We should look at hospitals such as Crosshouse hospital, for example. In many parts of Crosshouse hospital—I pick that hospital as just one example—the daily discharge by lunch time has increased from 10 per cent to 40 per cent. That means that beds are freed up for the afternoon and evening admissions. If every hospital in Scotland got to that kind of profile, many of our problems with people waiting for beds after being dealt with in accident and emergency and other issues would take care of themselves.
I find the cabinet secretary’s replies breathtaking in their complacency. Three years ago, when Nicola Sturgeon was Cabinet Secretary for Health and Wellbeing, we pressurised her on boarding and, as the cabinet secretary said, a monitoring system was introduced. Three years on, that is not being used to any purpose, as our freedom of information request showed. We made that request also to assess whether there was any joined-up thinking on boarding. As the cabinet secretary has admitted, it is bad for every patient, but it is particularly bad for those with assessed cognitive problems. Those two things are not joined up at all, as has been admitted.
Can we get a question, Mr Simpson?
When will the cabinet secretary accept that there are serious problems with occupied bed days and boarding out, which is affecting not numbers but 3,000 individual people?
Unlike the previous Administration, we, under my predecessor and me, have taken action to tackle the challenge of boarding. That is why, with the Royal College of Physicians of Edinburgh, we had a piece of work done for the first time in a long time on the specific problem of boarding.
As with many of the other challenges that the national health service faces, the issue relates to better planning and improved patient flow. That is why we took action by introducing a workforce planning toolkit and a bed capacity planning toolkit. Those things do not appear overnight. It is the first time that that has been done in any healthcare system, and they take time to get their results, but that is happening.
Let us get the matter in perspective. As I said earlier, the ideal would be that nobody would need to board, but the numbers represent just under 4 per cent of all patients who were in hospital in Scotland during the time period of the FOI request. Some 96 per cent of patients were not boarded. That is not a system in crisis; it is a system with a 4 per cent challenge that we are working through.
It is not right for Opposition politicians to describe the health service as being in some kind of crisis every time they stand up. In fact, our health service has been rated as the best in the world and the safest in the world.
Bird Flu
To ask the Scottish Government what its state of readiness is for dealing with bird flu, in light of the recent outbreak in Yorkshire, and what priority it now gives this disease. (S4T-00839)
The Scottish Government has published detailed contingency plans for dealing with notifiable animal diseases, including avian influenza, and exercises those plans regularly with operational partners and other Administrations across these islands. Although no cases of bird flu have been reported in Scotland, we have alerted our stakeholders to the outbreak and encouraged them to remain vigilant and seek to maintain high levels of biosecurity. We are in constant contact with the relevant agencies across the United Kingdom and are ready to respond to any outbreak should it occur in Scotland.
Is the minister in a position to give a clear indication that the strain that has been reported in Yorkshire is not likely to give any concern about human health and that, as the specialist poultry industry in Scotland approaches its most important annual market, we can guarantee the quality of the Scottish product and ensure that it sells into a buoyant market?
I can indeed give comfort to consumers and the member that the H5N1 strain, which is the strain that is known to cause risk to human health, has been ruled out in the three cases that are known about across the continent and down south. Therefore, the chief medical officer in England has said that there is a very low risk to public health, and the Food Standards Agency has said that there is no risk to food safety.
We continue to monitor the situation closely, of course, but I certainly agree that, as things stand, we can have full confidence in the Scottish product. Restrictions have, of course, been put in place on exports from this country. I hope that they will be only temporary while we wait to find out about the full scale of the outbreak.
Were we to see a recurrence today of the previous outbreak from a number of years ago, would resources be available to cope in the event that a strain became present that was a danger to human health?
I am confident that we have the arrangements in place. However, we must be very careful. At the moment, the strain that is known to cause a risk to human health has been ruled out. Therefore, we are speaking about a different strain. It is important to convey that message to the country and the poultry industry in particular.
We have contingency plans in place. We have a set of arrangements that will be urgently put in place, should the situation change at any point. However, this particular outbreak does not give rise to concerns of any threat to human health or food safety.
It has been suggested by some experts that the outbreak in Yorkshire originated among migratory birds. Does the cabinet secretary agree? If so, should the public at large be looking for signs among the wild bird population that has migrated here for the winter?
As I said, we are asking everyone to be vigilant, particularly the industry, which should report any dead birds immediately. However, the fact that the three recent outbreaks in Germany, in the Netherlands, and here on these islands have occurred in the proximity of damp areas with wild birds and the absence of any other possible link between the outbreaks points towards wild migratory birds as a possible source of the virus. However, the investigations are on-going. As soon as the facts are available, we will put them in the public domain.
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