Chamber and committees

The Centre for Sustainable Delivery is responsible for driving clinically-led service redesign and transformation in care across NHS Scotland. It consists of a number of national improvement programmes which are focussed on individual Scottish Government strategic priority areas.

The Programme Team workplans for 2024-25 are still in the process of being finalised and will be approved by Scottish Government.

A summary of the CfSD national programmes of work are as follows:

Modernising Patient Pathways (MPP) Programme: The MPP team deliver national improvements in planned care and support front line clinical teams to develop and implement sustainable improvements in service delivery. A key focus of the team is on developing national clinical pathways and supporting boards to increase the use of Active Clinical Referral Triage (ACRT) and Discharge Patient Initiated Review (PIR).

National Elective Coordination Unit (NECU): The NECU team supports improved access to care by providing a consistent approach to national demand and capacity assessment and allocation as well as providing waiting list validation to ensure lists are up to date.

Unscheduled Care Programme: The Unscheduled Care Programme delivers support and develops improvement tools to help Boards to manage urgent and unscheduled care capacity and capability, including Optimising Flow Navigation Centre (FNC) services, hospital-at-home models and developing pathways to support care home access to urgent care.

Cancer Improvement and Earlier Diagnosis Programme: The Cancer Improvement and Earlier Diagnosis team drives NHS Scotland’s cancer strategic priorities and plays a key role in delivering Scotland’s 10-year cancer strategy, including working with Boards to ensure the Framework for Effective Cancer Management (FECM) is embedded.

National Endoscopy Programme: The National Endoscopy Programme supports Boards to deliver the Endoscopy and Urology Diagnostic Recovery and Renewal Plan. This includes supporting the deployment of the new Endoscopy Reporting System and working with NHS Scotland Academy to promote and maximise training opportunities around non-medical endoscopy and cystoscopy.

Innovation Programme: The Innovation team manages the Accelerated National Innovation Adoption (ANIA) Pathway, which is designed to identify and support national adoption of high-impact innovations at pace.

National Green Theatres Programme: The Green Theatres Programme supports NHS Boards to meet the net zero commitments for NHS Scotland through reducing the carbon footprint of theatres and delivering more environmentally sustainable surgery.

Planned Care Programme: The Planned Care Programme is responsible for monitoring planned care performance across all NHS Scotland Boards. It also leads national improvement work around Trauma and Orthopaedics, Ophthalmology and Radiology.

I can confirm that NHS Boards have received financial and policy support to implement the Health and Care (Staffing) (Scotland) Act 2019. This support has been ongoing since the Bill was enacted. Each NHS Board has been provided with funding for Workforce Leads (proportionate to the size of the Board) to support preparations for the commencement of the Act. This funding has been extended for an additional year to cover the financial year 2024-2025.

In addition to this, the Scottish Government has produced statutory guidance, in collaboration with Health Boards and other key stakeholders, which has offered clarity and better understanding of each duty within the Act. The Scottish Government has engaged extensively with Health Boards over the past two years through in-person and online events and quarterly reporting.

Healthcare Improvement Scotland has been commissioned by the Scottish Government to support NHS Boards, and its Healthcare Staffing Programme has provided support, including an advisor who works closely with each Board and hosting a network of meetings where Board representatives can come together and share learning.

NHS Lanarkshire is responsible for the delivery of primary care services in Lanarkshire.

The headcount of GPs in Scotland is now sitting consistently at over 5,000, with an increase of 271 additional GPs since 2017 towards our 800 target. Training new GPs is key to our approach, and this takes time. We have expanded GP Specialty Training, adding 35 places this academic year and a further 35 places next year. As a result there are currently just over 1,200 trainee GPs in Scotland.

GP training programmes in Scotland have been filling at a very high level since 2019, with 99% posts filled in 2022 and 100% filled in 2023. 2023 is the first year in which GPST has filled at 100% in Scotland, with all 343 posts having filled.

We also invest over £1m per annum in a range of recruitment and retention initiatives so that becoming a GP remains an attractive career choice.

The Centre for Sustainable Delivery (CfSD) has developed strong clinically-led Specialty Delivery Groups (SDG) which promote multidisciplinary team working and support local adoption of service improvement programmes.

This includes the Cataract Sub-Specialty Delivery Group which brings together key ophthalmology clinical, operational and managerial experts from across NHS Scotland and Scottish Government which has been commissioned to support an increase in surgical throughout across cataract only surgical sessions. This short life working group has supported several new and innovative pathway developments, some of which are now being successfully scaled up in a number of sites across hospital eye services, including: high volume cataract surgery in ring-fenced sessions, and delivering one cataract every 30 mins, as per Royal College of Ophthalmologists’ guidelines.

In tandem with this, The National Eyecare Workstream is undertaking clinically led peer reviews which supports new and efficient ways of working and shares best practices across the country across a number of ocular sub-specialties, including cataracts.

Additionally, the national Trauma and Orthopaedic (T&O) planned care team based within the Centre for Sustainable Delivery (CfSD) are responsible for supporting both scheduled (elective) and unscheduled (emergency) orthopaedic service delivery through implementation of sustainable improvements in Scotland.

The orthopaedic services specialty delivery group is multidisciplinary and clinically led to design, develop and implement consensus driven national clinical pathways with focus on high impact opportunities in outpatient management (active clinical triage and patient initiated review), enhanced recovery and same day arthroplasty and also hip fracture standards of care, whilst reducing unwarranted variation. The National T&O team supports delivery of clinically led peer reviews for Health Boards across Scotland, with the cycle repeating every 3 years. These clinically led peer reviews were initiated from the innovative “Getting It Right First Time (GIRFT)” programme. This programme has been highly successful at leading change, reducing variation, improving clinical pathways as well as significantly reducing costs predominantly through reduction in length of stay and improved procurement.

In conjunction with Public Health Scotland (PHS), the T&O team also supports national audits namely the Scottish Hip Fracture Audit and Scottish Arthroplasty Project. These cost effective audits drive continuous improvements through research, standards of care and by a formal governance programme to monitor outcomes. Annual reports are produced for public information.

Furthermore, as part of our wider work to deliver sustained recovery of our Urgent Care services a whole system improvement approach has been adopted. We are working with local teams through the Urgent and Unscheduled Care Collaborative Programme to develop improvement plans which contain actions for the short and medium term focusing across 5 key areas.

This programme of improvement activity is being driven forward by the Centre for Sustainable Delivery (CfSD), which we have commissioned to support Health Boards implement a range of measures to reduce A&E waiting times and improve patient and staff experience.

Some Health Boards have already started to report improvements. These include:

• Improving urgent care pathways in the community and improving links across the primary and secondary care interface.
• Ensuring patients receive the right care in the right place by optimising Flow Navigation Centres and increasing the routes for professional to professional advice and guidance, signposting and scheduling of appointments to A&E where possible.
• Improving access to Hospital at Home services by supporting Boards and partnerships to adopt evidence-based best practice.
• Optimising assessment and care in our Emergency Departments by improving access to ‘same day’ services, the use of early and effective triage, rapid decision-making and streaming to assessment areas.
• Reducing the time people need to spend in hospital by promoting early and effective discharge planning and robust and responsive operational management.
  

The information requested on how many NHS staff have worked within the HR function of the NHS in each of the last 10 years, also broken down by NHS board is not centrally available.

Information on Administrative Services staff in post in the last 10 years, broken down by NHS Board, can be found on the TURAS NHS Education for Scotland workforce statistics site at: 05 March 2024 Workforce | Turas Data Intelligence (nhs.scot)