Chamber and committees

Scottish participation in the UK National Cardiac Audit Programme (NCAP), managed by the National Institute for Cardiovascular Outcomes Research (NICOR), was previously enabled through the Healthcare Quality Improvement Partnership (HQIP).

The Scottish Government had been working with HQIP since November 2018 to identify a mutually agreeable legal basis that would support Scotland’s continued participation in a number of UK wide audits, including the NCAP programme. It was not possible to identify one and as a result, throughout 2020/21 there was a phased withdrawal of Scottish Government participation in HQIP associated audits as an appropriate point was reached in each.

As replacement for the NCAP, in April 2021 we commissioned Public Health Scotland (PHS) to develop the Scottish Cardiac Audit Programme. PHS have been actively seeking data submissions from all sites across Scotland which previously contributed to the NCAP.

PHS are currently working with clinicians and patients across Scotland to undertake further development of the audit programme.

a) NHS Staffing

In all areas of NHS Scotland, a great deal of effort is going into ensuring that services have sufficient capacity to deal with COVID-19, manage other risks and resume planned services as safely and effectively as possible. Although NHS Scotland’s staffing levels are at a record high, following nine years of consecutive growth, we are fully aware of the difficult circumstances that Boards and frontline staff are working in. That is why we have announced a record £300 million of new investment in measures to help services deal with system pressures over winter.

Measures we are taking as part of this investment include the recruitment of 1,000 additional healthcare support staff to support patients in hospitals and in community health teams, as well as £4.5 million of funding to attract registered nurses to Scotland. This activity is supplemented by an additional £1 million to enhance Boards’ capacity for recruitment.

Decisions on local staffing requirements and recruitment are the responsibility of individual NHS Boards. However, Scottish Government officials are continually engaging with NHS Boards to identify particular areas of concern.

(b) Social Care Staffing

The Scottish Government launched a national recruitment campaign on 8 November to attract more people to the social care sector. This campaign emphasises the value of a career within social care by showcasing the benefits of the sector beyond pay, and towards the extrinsic and intrinsic rewards of the role.

Officials are working at pace with SSSC and other key sector partners to develop a national induction programme to support new entrants into Adult Social Care; to promote career opportunities and deliver policies on fair work, upskilling and developing the workforce. This commitment is crucial to improving the experience of the social care workforce and addressing long standing recruitment issues in the sector.

As a result of lobbying efforts from the Scottish Government, the Home Office have temporarily extended the Shortage Occupation List for EU workers. Social care workers, care assistants and home care workers are to become eligible for a health and care visa for a 12-month period.

The Scottish Government will continue to push for a migration system tailored to Scotland’s needs, including a Scottish Visa, and work with partners and employers to develop proposals that suit their requirements.

(c) Public Transport Staffing

For bus service staffing, Transport Scotland and Scottish Government Officials are continuing to work closely with bus service sector representatives and other partners to help facilitate solutions to the staffing pressures brought by the COVID-19 pandemic compounded by the consequences of EU Exit. This has included work to help connect local employability partnerships with bus service operators as well as ensuring that the sector is represented in the Labour and Skills Shortages Action Plan process.

For rail service staffing, due to an increase in COVID-related absences and subsequent disruption in December, ScotRail has put a temporary timetable in place to provide a more stable and reliable service. ScotRail staff COVID-related cancellations have now reduced significantly following the successful introduction of a reduced timetable on 4 January. Around 8% of services have been withdrawn in this temporary timetable – largely additional peak services – leaving a more reliable core timetable in place. It is planned to retain the revised timetable until the end of the month, but ScotRail will keep this under review to balance staffing resources and demand from passengers as best as possible.

All 14 NHS Boards have hospitals providing acute stroke care. A map showing all hospitals that contribute data on stroke unit admission to the Scottish Stroke Care Audit can be found in the Scottish Stroke Improvement Programme report at: https://www.strokeaudit.scot.nhs.uk/index.html . Of those sites shown on the map, Stracathro, Stobhill, Vale of Leven, Queen Margaret, Falkirk Community Hospital and Stirling Community Hospital are shown because they contributed data solely on stroke rehabilitation.

The remaining hospitals provide acute beds for stroke patients, either in a unit which has solely acute beds with offsite stroke rehabilitation units for ongoing care, within an integrated stroke unit (combining acute and rehabilitation beds) or in a hyperacute unit. The seven smallest general hospitals define stroke unit admission as gaining access to the appropriate acute medical ward.

The current Scottish Stroke Care Standards are available at the following link ( https://www.strokeaudit.scot.nhs.uk/index.html)x . At present, they largely relate to acute stroke care.

However, the Scottish Stroke Improvement Programme also includes performance targets which reflect access to rehabilitation in inpatient settings, intensity of provision in stroke units and access to stroke specialist Early Supported Discharge and community teams. The Rehabilitation Sub-Group of the Stroke National Advisory Committee is currently considering future updates to measure rehabilitation service delivery, patient outcomes and experiences within the Scottish Stroke Improvement Programme report.

Further to the answer given to question S6W-04701 I can confirm that the team of reviewers in NHS Lothian were made up of clinical staff at consultant and senior nurse level who are all suitably qualified in their fields and span across various disciplines including Haematology, Microbiology, Infection Prevention and Control and Critical Care.

Further to the answer given to question S6W-04701, I can confirm that one of the seven clinicians who undertook the peer review was an experienced Haematology consultant who has expertise in the care of haematological malignancies and the associated protocols.

The requested information is not centrally held. Data is published annually, by NHS Education for Scotland on the total medical agency spend by NHS Scotland Boards; and the total WTE hours and cost for Nursing and Midwifery bank and agency staff, but this data does not specify start dates. This information can be found on the following link: NHSScotland workforce | Turas Data Intelligence

Priority 2 within the Heart Disease Action Plan makes clear our commitment to developing nationally agreed pathways of care for all cardiac conditions.

This work is underway. It is led by our recently appointed Heart Disease Improvement Coordinator, who is engaging with clinical colleagues across Scotland to understand service provision, identify needs and collate examples of good practice to inform this programme of work.

The Treatment Time Guarantee already outlines that after a diagnosis is determined and treatment agreed, each health board must ensure that patients receive inpatient and day case treatment within 12 weeks. This applies to all treatments and services apart from fertility treatment, obstetrics services, organ and tissue transplantation, direct referrals to Allied Health Professionals, dental treatment provided by undergraduate dental students, direct access referrals to diagnostic services, and mental health services.

The current unprecedented pressures on the NHS means that Health Boards are not currently able to reinstate services to such a degree as to be in a position to meet the existing waiting times standards and targets, which is why we published the NHS Recovery Plan. This includes a focus on providing alternative pathways of care that will allow people to be treated more quickly closer to home, delivering long term sustainability.

At this time, the Scottish Government has no plans to develop any further waiting time targets for cardiovascular disease.

Through our Programme for Government commitments we are already reflecting the aims of the European Stroke Organisation’s Stroke Action Plan for Europe.

In particular the ESO’s target that 90% of all patients with stroke in Europe should be treated in a stroke unit as the first level of care is already reflected within the Scottish Stroke Care Standards (Access to Stroke Unit - 90% within 1 day of admission).

The ESO also recommends ‘national plans for stroke encompassing the entire chain of care’. We already have a national plan on stroke - the Stroke Improvement Plan - which we are in the process of refreshing. To do so, we are developing a progressive stroke pathway document which will set out our vision for what stroke services across Scotland should deliver across the entire patient pathway. Following this, a refreshed improvement plan will support its delivery.