Chamber and committees

There is no minimum recommended time for the provision of health visitor support to pregnant women. Midwives are the main providers of care to women throughout pregnancy, childbirth and the postnatal period. Health visitors work closely with their midwifery colleagues to augment care where this is indicated.

As far as it is possible to do so, the information requested is given in the table below. It is important to note, however, that in the latter part of the 10 year period in question NHS boards were phasing in a new staff grading classification system as a result of the continuing implementation of Agenda for Change. It is therefore not possible to report fully on staff grades in 2006 and 2007 because there is no direct match between the old and new grades. In addition, the data for 2007 includes only those staff who have been assimilated to Agenda for Change. Over 5,000 (headcount) nursing and midwifery staff have yet to be assimilated. A proportion of those staff will be health visitors, so the apparent dip in numbers in 2007 does not equate to an actual reduction.

Number of Health Visitors Employed by the NHS in Each of the Last 10 Years.

	1998	1999	2000	2001	2002	2003	2004	2005	20061	20072
Head Count	1,680	1,698	1,709	1,756	1,799	1,789	1,825	1,826	..	1368
WTE	1,459.0	1,464.4	1,460.1	1,487.7	1,503.4	1,473.2	1,489.1	1,479.5	..	1,145.3

Source: ISD Scotland.

Notes:

WTE = Whole-time equivalent.

=Not available.

1. During 2006 NHS boards were operating a phased approach to assimilation of staff to Agenda for Change and full assimilation had not yet been achieved. Therefore it was not possible to report fully on staff grades due to non-direct match between old grades and new Agenda for Change pay bands. Only high level summaries are available i.e. only down to registered/non-registered total level.

2. Data for 1998-2005 is based on Whitley Council classification and 2007 data is based on Agenda for Change classification. Therefore the ability to compare trend is limited due to this change in data capture.

The way community nursing is organised in Scotland has undergone a major review over the past two years. The aim has been to modernise how health care is delivered to people in their own homes and communities. The recommendations from Visible, Accessible and Integrated Care, the Review of Nursing in the Community, are currently being piloted in four health boards across Scotland. The new community health nurse teams will provide care that is currently delivered by District Nurses, Health Visitors, School Nurses and Family Health Nurses by maximising the range of skills available. By adopting a more generic, team based approach, services will be more flexible and responsive to the needs of local communities. More opportunities will also exist for other health care professionals and others such as local authorities to participate in the delivery of care and services.

Details are as follows:

Scottish Population Estimates by Health Board, 30 June 2006

Ayrshire and Arran	366,450
Borders	110,247
Dumfries and Galloway	148,030
Fife	358,858
Forth Valley	286,053
Grampian	529,889
Greater Glasgow	1,191,584
Highland	306,701
Lanarkshire	558,139
Lothian	801,310
Orkney	19,770
Shetland	21,880
Tayside	391,639
Western Isles	26,350
Scotland	5,116,900

Source: GRO health board and council area mid-year population estimates 2006:

www.gro-scotland.gov.uk.

The review of nursing in the Community, Visible, Accessible and Integrated Care, made a number of recommendations about the delivery of healthcare to people in their homes and communities. Those recommendations, which included new community health nurse teams providing care that is currently delivered by health visitors and others, are currently being piloted in several health boards across Scotland. A more generic, team based approach will allow services to be more responsive to local needs and provide opportunities for other healthcare professionals and other agencies, such as local authorities, to participate in the delivery of care and services. The type and mix of healthcare staff needed to deliver those service will be a matter for NHS boards to determine.

Health for All Children Guidance (Hall 4, 2005) recommends that every child and parent should have access to a universal core programme of preventative pre-school care. The Scottish universal core programme of contacts includes contact with a health professional within the first 24 hours of life, 10 and 28 days, at six to eight weeks, at two, three and four months, at 12 and 13 months and at three to five years.

The Scottish child health programme includes routine checks to detect any health problems and to ensure that children get any care or treatment they need as soon as possible, including immunisations. Up until school entry, information and advice on a range of health promotion topics should be provided such as weaning, nutrition, child development, safety and dental health. Most of the core programme is undertaken by health visitors/public health nurses, however some of the contacts listed above are undertaken by midwives.

Our aim is to match care to assessed needs and that assessment will inform whether the care should and could be provided at the patient''s own home, from a community facility, or in hospital.

The record funding included within the Scottish budget to 2010-11 for health and social services will ensure continuity of approach and investment by NHS boards, local authorities and other partners on mental health services, including depression, no matter the care setting.

As part of our attention to putting the individual at the centre of care we are providing £910,000 funding to 2009-10 on a pilot to provide free and accessible telephone based cognitive behaviour therapy and guided self help services supported through, and with, NHS 24. Discussions are also underway on training of NHS staff for the delivery of evidence based cognitive behaviour therapy self help programmes that address low mood and anxiety.

Our continuing focus on social prescribing and our established breathing space telephone advice and signposting service also underline our ambition for care provided as close to the individual as possible.

I refer the member to the answer to question S3W-11997 on 25 April 2008. 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/webapp/wa.search.

The numbers of training posts needed to meet the workforce needs of hospitals is determined through use of a supply and demand model informed by input from NHS Education for Scotland (NES) and NHS Scotland Board workforce plans.

Training posts are grouped together into training programmes, and each training programme is approved by NES as well as prospectively by the Postgraduate Medical Education and Training Board (PMETB). Each post within a hospital-based training programme requires a stated level of competence, and as trainees progress through their training the level of service contribution they deliver is commensurate with the workforce needs of their NHS board as set out in workforce plans.

The review of clinical guidelines is a matter for NHS Quality Improvement Scotland.

The care of patients immediately after a myocardial infarction (MI) is set out in SIGN Guideline 93 on Acute Coronary Syndromes (February 2007). The longer term of care of people who have had an MI is covered by SIGN Guideline 57 (January 2002) on cardiac rehabilitation.

SIGN Guideline 57 on cardiac rehabilitation draws attention to secondary prevention guidelines issued by the British Dietetic Association which emphasise the increased consumption of omega-3 fatty acids. Cardiologists, who are responsible for decisions regarding medication following a myocardial infarction recognise the potential benefits from omega-3 fatty acids.