Chamber and committees

I refer members to my entry in the register of interests.

We all want to be in a position where as much healthcare as possible can be provided to people closer to their homes. Over the past few years, there have been sustained and co-ordinated efforts in providing community alternatives to hospital, all while maintaining and improving patient experience.

It is vital to make it easier than ever for patients to know where to go to get the right care in the right place, as was evidenced during the pandemic, when it saved patients time and freed up space in our GP practices and hospitals. Whether it was through NHS pharmacy first Scotland or the hospital at home service, those initiatives played a key role in relieving pressure on our health and social care services.

During times of ill health, most of us would want to be with or close to our loved ones and in familiar surroundings. The hospital at home service enables people to receive treatments that would otherwise require them to be admitted to hospital, such as an intravenous drip for the administering of antibiotics, or oxygen therapy. It also provides access to hospital tests under the care of a consultant in an individual’s own home.

Hospital at home as an alternative allows patients to receive high-quality person-centred care and treatment in the right place, while at the same time reducing acute admissions and supporting timely discharge. Additionally, the provision of the service has the benefit that it can help avoid some of the risks of healthcare-acquired infection.

The effects on older people of remaining in hospital too long are well documented: deconditioning, pressure sores, and a loss of independence, which can make it harder for the individual to return home. We know that frail patients tend to occupy hospital beds for a longer period of time, and alternatives to that can produce far better health outcomes. That is why admission to hospital should happen only when the patient’s clinical need requires it. If that level of care and treatment can be provided at home, we should endeavour to provide it there.

Hospital at home has been in existence in a number of countries across the world for around 25 years. The first service in Scotland was introduced in 2011 by NHS Lanarkshire, the health board that serves my Rutherglen constituency. That multidisciplinary acute care service delivers specialist, co-ordinated and comprehensive assessment and care to frailer older adults in their own homes.

Although hospital at home is not a new approach, efforts to expand it are currently being ramped up. Only this month, the health secretary announced a further £3.6 million for the service.

The investment for 2023-24, which will take the total funding in the programme to more than £10.7 million since 2020, will increase by 50 per cent the number of patients who are managed through hospital at home, which is the equivalent of an additional 156 beds. From the success of the scheme so far, we can see that there is a real benefit to treating people at home where possible.

Looking at the feedback from patients and relatives, it is clear how valued the hospital at home programme has been and how beneficial it is for patients’ care. From the hospital visits that the service has saved to how supported individuals have felt in their recovery, it is clear that the service is overwhelmingly viewed as positive.

However, as was highlighted by Healthcare Improvement Scotland in 2020, the hospital at home service is not a silver bullet for reducing pressures on acute hospital care provision. As a result of the pandemic backlogs, Brexit-driven staff shortages and UK inflation costs, the Scottish Government is required to look across the wider health and social care system and implement innovative approaches to meet those on-going challenges. Hospital at home, taken together with work in tackling delayed discharge, improving A and E waits and increasing NHS and social care staffing levels, will improve patient experience and ensure better outcomes.

The heart of all this is about being patient-centred and allowing patients to be where they need to be, whether that be at home to recover or to die surrounded by their loved ones. I mentioned funding but I referred to the funding that the Scottish Government has already committed to this.

The next item on our agenda is a further evidence session as part of our inquiry into female participation in sport and physical activity. Today, we will focus on inequalities and the additional barriers to participation in sport that are faced by women and girls from marginalised communities and those experiencing physical and mental health challenges.

I welcome Ewelina Chin, chief executive officer of HSTAR Scotland, which is a member of BEMIS; Lynne Glen, pathways manager at Scottish Disability Sport; Baz Moffat, CEO and co-founder of The Well HQ; Robert Nesbitt, head of physical activity and sport at the Scottish Association for Mental Health; and Heidi Vistisen, policy manager at LEAP Sports Scotland.

We will move straight to questions and we will start with Gillian Mackay.

We are getting a bit tight for time and we have two more themes to cover, so I ask people to keep their questions and answers short, please.

What you are describing is how a whole-system approach of ensuring that there is childcare, housing and so on could be a double whammy: you would get staffing and you would also help to bring families to increase the population of the Western Isles and the sustainability of your communities.

Our next theme is Covid recovery and progress of the recovery plan. We are getting a bit tighter for time, so if we can have concise questions and answers, please, I would be very grateful.

I know that Michael Dickson wants to come in, but could Gordon first explain what level 9 nursing is?

I have a question for Laura Skaife-Knight. Laura, I appreciate that you have only been in post for eight weeks, but you will be aware that NHS Orkney had the lowest overall experience score on the employee engagement index. The committee is keen to hear what steps NHS Orkney has taken or is taking to address that.

Before we finish up, Tess White has a brief supplementary on one of the issues that we discussed earlier.

Thank you, Gordon. That was for lay people so that they are aware of what you are talking about.