Chamber and committees

It is the responsibility of NHS boards to plan and deliver clinical services, including paediatrics. However, in preparing their workforce plans, boards are required to consider relevant local issues and demographic changes and assess the resultant demands and implications for service delivery.

Prior to 2009, the annual decisions in respect of the number of trainee places across Scotland for each specialty, including paediatrics, was based on information submitted to the Scottish Government by boards in respect of projected future medical workforce requirements. Trend information on number of leavers and the age profile of the medical establishment was also factored into national modelling.

Since 2009, the Scottish Government has been working in partnership with NHSScotland to move away from a service delivered by trainee doctors to one which is delivered predominantly by trained doctors.

In 2009, boards were asked to develop models of care to reflect the proposed reduction in trainee doctors under the Reshaping the Medical Workforce Project. They were invited to consider which activities undertaken by trainee doctors were directly service related, were training related and which only a doctor could deliver. Boards were then asked to consider the best way to replace or redesign all of these activities and assess the workload required to be done by doctors, how many and at which grade.

This information was analysed by the National Reshaping Medical Workforce Project Board, supported by the Reshaping Governance Working Group, and informed advice to Ministers in respect of specialty trainee intake for the years 2010 to 2012 and to give indicative numbers for entry in 2013 and 2014. A working assumption of 1% growth per year was applied to most specialties, including paediatrics, on the basis of predictions for future growth (and the subsequent number of trainees required to supply future consultant requirements).

Every year since, the working group has liaised with boards and NHS Education for Scotland on projected future medical workforce requirements and reviewed relevant working assumptions, before submitting its recommendations to the project board, which in turn forwards its advice to ministers. To date, the 1% growth assumption has been considered appropriate and been applied in respect of paediatrics.

I refer the member to the answer to question S4W-11485 on 7 December 2012.

Following the period of restricted inpatient services at St John’s Hospital, beginning on 9 July 2012, the unit returned to full operation by the first week in August.

A new training rotation began on 01 August 2012, and trainees returned to support out of hours services at St John’s.

In late October 2012, at a routine meeting with Scottish Government officials and the South East Heath Boards, an indication was given that gaps were beginning to appear in the middle grade trainee rotas for February 2012.

In November 2012, following further confirmation of emerging gaps, the Cabinet Secretary for Health and Wellbeing met with NHS Lothian and the Dean of Postgraduate Medicine for the South East and agreed that the Scottish Government would provide funding to support appointments to up to four fixed term Clinical Fellows posts to improve the resilience of children’s services in Lothian and an international recruitment campaign for trained staff to help maintain neonatal and paediatric services across the region.

All answers to written parliamentary questions are available on the Parliament’s website, the search facility for which can be found at:

http://www.scottish.parliament.uk/parliamentarybusiness/28877.aspx.

I refer the member to the answer to question S4W-11487 on 7 December 2012. All answers to written parliamentary questions are available on the Parliament’s website, the search facility for which can be found at:

http://www.scottish.parliament.uk/parliamentarybusiness/28877.aspx.

Officials meet regularly with representatives from Lothian, Fife and Borders health boards to discuss developments and actions being taken to maintain services.

At a regular meeting on 23 October, a verbal report was received regarding notification from the Dean of Post Graduate Medicine for the South East of a deterioration in the number of middle grade trainees projected to be available from February 2013. Further information was sought and a report on the emerging situation was passed to the Cabinet Secretary on 7 November.

As the First Minister reported on 22 November, it has been made clear to the three NHS boards involved that the Scottish Government will support every effort to ensure that the best quality paediatric services are maintained for children across the region.

Following a meeting on 20 November with NHS Lothian chief executive Tim Davison, the Cabinet Secretary for Health and Wellbeing allocated up to £100,000 in this financial year with a further £500,000 to be made available over the next two years to support immediate action. This will start with the appointment of four Clinical Fellows to support the resilience of the service. This will be part of a series of actions to support the paediatric and maternity services.

This funding will also support the launch of a national and international recruitment exercise, so that every effort is made to find suitably qualified permanent staff.

The Scottish Government is also working with NHS Education Scotland to develop a training programme that increases the number of Advanced Nurse Practitioners working in paediatrics.

Patient safety is a top priority for the Scottish Government and the three NHS boards, who are working with their partners to ensure the continued provision of safe, effective and person-centred healthcare for children across the South East of Scotland.

The following table shows the numbers of trained staff and senior grade trainees (Whole Time Equivalent) required to run Paediatrics Services in the South East Region.

The numbers of trainees required for each Board are calculated to allow adequate daytime service, out of hours cover, prospective cover for sickness and study leave and an acceptable standard of training and education.

These numbers may be supplemented by junior grade trainees who are not able to work without supervision.

The information shown above is accurate as of 5-12-12, although numbers in post and future predictions will change as staff/trainees notify periods of absence or return from periods out of programme.

Notes

Variation in Lothian trainee figures caused by uncertainty over whether trainee will return after maternity leave working 0.6/0.7/0.8

Numbers may go down in Lothian by up to 2.0 WTE should 2 trainees due to achieve Certificate of Completion of Training (CCT) in February/March 2013 be successful in obtaining consultant posts.

SCOTTISH GOVERNMENT

No decisions have been taken about changes to children’s services in NHS Lothian, Fife or Borders.

In developing any proposals for change, health boards would be expected to comply fully with CEL 4(2010) on Informing, Engaging and Consulting People in Developing Health and Community Care Services.

I refer the member to the answer to question S4W-11487 on 7 December 2012. All answers to written parliamentary questions are available on the Parliament’s website, the search facility for which can be found at:

http://www.scottish.parliament.uk/parliamentarybusiness/28877.aspx.

As set out in CEL 4 (2010), for those changes considered to be major, ministerial approval on the board’s decision will be required.

I refer the member to the answer to question S4W-11450 on 6 December 2012. All answers to written parliamentary questions are available on the Parliament’s website, the search facility for which can be found at:

http://www.scottish.parliament.uk/parliamentarybusiness/28877.aspx.

I refer the member to the answer to question S4W-11450 on 6 December 2012. All answers to written parliamentary questions are available on the Parliament’s website, the search facility for which can be found at:

http://www.scottish.parliament.uk/parliamentarybusiness/28877.aspx.

I refer the member to the answer to question S4W-11450 on 6 December 2012. All answers to written parliamentary questions are available on the Parliament’s website, the search facility for which can be found at:

http://www.scottish.parliament.uk/parliamentarybusiness/28877.aspx.