Chamber and committees

On Tuesday 2 July, NHS Lothian alerted the Scottish Government to an issue with the ventilation system at the Royal Hospital for Children and Young People (RHCYP) in Edinburgh.

I was not satisfied that the issue could be resolved within the very short timeframe available before services were to move to the new hospital, and I required further assurance on all aspects of compliance with standards across the new hospital.

For this reason, I instructed that the planned move be halted in the interests of patient safety. There is no greater responsibility of the NHS than to ensure the clinical safety of their patients, not least when those patients are children.

Work has been initiated to identify the solution needed to ensure the ventilation in the critical care unit in the new site meets the required clinical and safety standards.

I have commissioned NHS National Services Scotland (NSS) to undertake a detailed assessment of all buildings systems in the new hospital which could impact safe operation for patients and staff, recognising how infection prevention must always be embedded within the design, planning, construction and commissioning activities of all new and refurbished healthcare facilities. This work will be phased, with assessment of water, ventilation and drainage systems prioritised, including the proposed fix for the ventilation unit. This will determine the timeframe for migration of services to the new hospital and a full report is anticipated in September.

Running in parallel, NSS will also provide assurance that current and recently completed major NHS capital projects comply with national standards. This work will take a risk-based approach and will inform development of the potential expansion of the current function and services provided by Health Facilities Scotland; including providing assurance going forward that NHS buildings meet extant standards.

Where required, additional specialist expertise will be secured by NSS to facilitate their work.

It is also important that we understand the factors, including information flow and timeframes, that led to the decision, announced on 4 July, to delay the move to the new hospital. KPMG have been engaged to conduct an independent audit of the governance arrangements for RHCYP, to provide an external and impartial assessment of the factors leading to the delay. This work began on 15 July and in the first instance will focus on collecting and reviewing all pertinent documentation. This will inform next steps, including interviews with key personnel and timeline for reporting, and I expect to have further clarity on this within the next week.

I recognise that the cumulative impact of the significant work required to complete the move to the new RHCYP, together with the requirement for improved performance across a number of other areas, including scheduled and unscheduled care, cancer, delayed discharge and mental health, will place significant pressure on the leadership capacity of the Board. Reflecting the significance of this challenge, NHS Lothian have been placed at Level 3 of the NHS Board Performance Escalation Framework which is defined as: ‘Significant variation from plan; risks materialising; tailored support required’.

A formal Recovery Plan has been requested from the Board, setting out clear milestones to address each of the areas I have highlighted. A package of tailored support will be made available to the Board, in order to develop and implement the Recovery Plan.

I understand that this is a disappointing time for parents and carers of patients who have appointments at the new RHCYP, and for staff.

Parents and carers are being contacted directly by the team at the existing Royal Hospital for Sick Children to confirm arrangements for their child's appointment. Those with appointments in July are being contacted by phone in the first instance and those with appointments in August onwards will be contacted by letter. Every effort is being made to retain the same appointment date and time wherever possible. A dedicated helpline – 0800 028 2816 – is in place for families and carers to discuss any concerns about appointments or treatment with the clinical team already caring for their child.

NHS Lothian staff have all made considerable efforts to help make the move and some have made personal and domestic plans to coincide with the move. I have written to staff today to thank them for their hard work in preparing to for the move, for all that they are doing to help manage the situation and for their excellent track record of providing high quality patient care. NHS Lothian have also carried out a number of staff sessions and a Q&A has been posted on the NHS Lothian Intranet to answer questions received from staff to date, and going forward. The Senior Team at NHS Lothian will continue to work with all staff as we proceed with the work required to allow the move to take place.

Safe, effective and high quality clinical services continue to be delivered from the existing site in Sciennes and my officials are working very closely with the management of the Board and clinical professional organisations to ensure that we take all the necessary actions to allow the move to go ahead as quickly and safely as possible.

The Scottish Government will keep Parliament informed of progress of the reviews being undertaken and the timeframe for moving to the new hospital.

Fair Start Scotland (FSS) is Scotland’s devolved employability support service and is designed to offer personalised support on a voluntary basis to help people, including those who are further removed from the labour market, who want help to find work and stay in work.

The Scottish Government has proactively published information on its devolved employability services since December 2017. Today we are publishing the third set of statistics on Fair Start Scotland, outlining performance during the first twelve months of operation. In addition, for the first time the Scottish Government will report on employment outcomes for this new service.

These statistics show a total of 10,063 people joined Fair Start Scotland in its first year.

The publication also provides further information on the transitional services introduced in April 2017 and the Health & Work Support Pilot, which launched in June 2018.

We will continue to publish statistics on Fair Start Scotland on a quarterly basis.

The Scottish Government remains committed to improving the lives of autistic people, their families and carers through the Scottish Strategy for Autism. The funding allocated to the strategy, as detailed below, has been spent and used to help embed the strategy across local and national services and has focussed on key outcomes including diagnosis, education and transitions. This funding has also been used to support local and national projects working with autistic people, their families and carers through the Autism Innovation and Development funds.

Information on funding is included in the Budget Bill which is published annually. Current funding is provided to the strategy on an annual basis subject to the UK wide spending review in line with all other Scottish Government departments. It is expected that £3m will be allocated to the strategy in financial year 2019-20.

The role of Autism Network Scotland is to support the implementation of the Scottish Strategy for Autism. Their outcomes and conditions of grant are agreed annually and monitored quarterly by the Scottish Government. Their main outcomes are to:

• deliver a hub of professional autism support,
• highlight and share best practice across Health and Social Care Partnerships,
• support Health and Social Care Partnerships in the implementation of autism action plans across Scotland
• provide support to the Scottish Strategy for Autism priorities
• and act as administrator for strategy governance and events.

Funding for financial year 2018-2019 was £450,000.

The Scottish Government has set out its commitment to autistic people and their families through the Scottish Strategy for Autism. In 2012, as part of this strategy, the Scottish Government provided funding to the three national autism charities to work jointly to deliver six one-stop shops in Scotland and develop local support services for people with autism.

Each One Stop Shop (OSS) was set up with seed funding from the Scottish Government. The expectation was that One Stop Shops would be sustainable in each locality by the end of government funding.

Strategy funding was intended to encourage the development of innovative services in localities and is not a source of funding for core local services, which are the responsibility of Health and Social Care Partnerships (H&SCP). They determine the services that are required to meet local needs.

It is regrettable that the valued One Stop Shops have not been sustained in all the localities where they were piloted or replicated in other localities with H&SCP funding. However, the Scottish Government respects that local services are the responsibility of Integration Joint Boards, who are aiming to deliver better care for people by making better use of the significant resources we invest in health and social care services. Their strategic commissioning approach ensures that partnerships must work with local communities, including families, and listen to their views and opinions as they seek to improve the quality and sustainability of services in their area.

In South Lanarkshire they have developed an Autism Resource Coordination Hub. It is a ‘hub’ for all autism services and support groups within South Lanarkshire Health and Social Care Partnership area. Whilst we welcome the continued funding of current OSS and the development of further OSS or Autism Hubs, we respect that this is a matter for individual Integration Joint Boards.

The following table provides the total number of repatriations registered each year with the Death Certification Review Service (DCRS). It also sets out the number of repatriations reported by DCRS to the Crown Office and Procurator Fiscal Service (COPFS) and the number of post-mortem examinations subsequently instructed by COPFS.

The Inquiries into Fatal Accidents and Sudden Deaths etc. (Scotland) Act 2016 came into force on 15 June 2017. Prior to that date COPFS could not carry out investigations into deaths abroad and accordingly no cases were reported by DCRS to COPFS. Since 2015 COPFS and DCRS have been in frequent contact regarding deaths, including repatriations, and the system works well.

Prior to DCRS being established, the Scottish Government was responsible for examining the death certification of individuals repatriated to Scotland who were to be cremated, and, where appropriate, authorising the cremation to take place. In cases where the Scottish Government found paperwork to be incomplete, cremation would not be authorised.

Unlike DCRS, which examines all repatriations whether for burial or cremation, the Scottish Government did not review paperwork where a burial was to take place, nor did it refer cases to COPFS. Information on the total number of repatriations prior to the establishment of DCRS is, therefore, not held centrally.