Chamber and committees

There have been two occasionswhen NHS Quality Improvement Scotland (NHS QIS) has not directly adopted NationalInstitute for Health and Clinical Excellence (NICE) technology appraisal recommendations.This was because the Scottish Executive had already stated its policy position onthe issues under consideration which were:

(a) NICE Technology AppraisalNo. 32 entitled Beta interferons and glatiramer acetate for the treatment of multiplesclerosis published by NICE in February 2002. The Scottish Executive had alreadytaken a policy decision to take part in a UK-wide Risk Sharing Scheme for beta interferonsand glatiramer acetate.

(b) NICE Technology AppraisalNo. 48 entitled The Use of Liquid-based Cytology for Cervical Screening (Review)published in October 2003. This was because a policy decision on liquid-based cytologyhad already been taken by the Scottish Executive.

There has been one occasion since2003 when NHS Quality Improvement Scotland decided not to adopt NICE guidance andthis was NICE Technology Appraisal No. 48 entitled The Use of Liquid-based Cytologyfor Cervical Screening (Review) published in October 2003. This was because a policydecision on liquid-based cytology had already been taken by the Scottish Executive.

Funding for the development ofgymnastics facilities is available through sportscotland’s Building for Sport programme.

A table recording the numberof patients ready for discharge in each NHS board since the first census in April2001 has been placed in the Scottish Parliament Information Centre (Bib. number41472).

The number of suicides in farmersand farm workers from 1999 to 2005 (latest available year) is shown in the followingtable.

	1999	2000	2001	2002	2003	2004	2005
Intentional self-harm (suicides)	13	10	7	11	3	11	3
Events of undetermined intent*	1	6	3	6	2	4	2
Total	14	16	10	17	5	15	5

Source: General RegisterOffice for Scotland.

Note: *Deaths classified as“Events of undetermined intent” are included as it is believed that the majorityof these are probable suicides.

The review based the communityhealth nurse model on evidence from:

·Workshops which explored what nurses working in the communityare good at and their frustrations, as well as what they could do in the futurein terms of Delivering for Health.

·Workshops with users and carers.

·A consideration of the current model of service deliveryas well as other models of nursing roles, namely the generic role of the familyhealth nurse and community matrons.

·A consideration of the policy drivers of care provision.

·The literature review conducted by Napier University.

·The results from WHO Europe researchers who conducteda multi-national evaluation across all countries taking part in the familyhealth nurse pilot.

Two conferences involving a rangeof practitioners, nurses and other managers, educationalists and other stakeholders.

Project officers began liaisingwith individual NHS boards in late 2005. From the start of 2006 two reference groups– practitioners and patients/carers – and a steering group examined the best wayforward for the future of nursing in the community. The work of these groups wascomplemented and informed by a wide range of workshops which took place across thecountry in the first half of 2006. Furthermore, two conferences were held allowinga wide range of practitioners the opportunity to inform the draft model. The draftreport of the review was circulated for comment from 6 June with responses invitedby 23 June 2006. All responses which missed this deadline were nonethelessconsidered.

A consideration of the policydrivers of care provision was undertaken by the review team as well as an examinationof international models of nursing in the community. A literature review was alsoconducted by Napier University.

The Review of Nursing in theCommunity commenced in December 2005 with the report of the Review published on14 November 2006. The timescale for the review was sufficient to enablethe following to be undertaken:

A scopingexercise of current community nursing services.

A literaturereview.

Workshopsin health boards areas for all community nurses and managers.

Examinationof different models of nursing in the community.

Developmentof a new model.

On-goingconsultation with services users and professional groups.

Developconclusions and recommendations.

Publisha report.

The recommendations from thereview will be piloted in four development sites over the next two years which willaddress the implications of the proposed model and highlight any further work tobe done. Any further implementation will take several years.

A formal written consultationprocess was not carried out. There was on-going involvement of key stakeholders,patients and carers and professional groups which informed the process and outcome.

Consultation with key stakeholderswas an integral part of the entire review process. In light of the comments receivedthe report was redrafted and more information was provided on the evidence collected.An additional “core element” was added to the Practice Framework, however, the modelwas not changed as we believe it is the right way forward for patients, carers andnurses.

All comments received have beencollated and summarised and are available at:

http://www.scotland.gov.uk/Topics/Health/NHS-Scotland/nursing/communitynursing/homepage.

A patient and carers referencegroup met several times during the review process. A patients’ representative wasalso invited onto the review steering group. Members of the public were also giventhe opportunity to comment on earlier drafts of the review report and revisionswere made in light of their comments. Two conferences were held which allowed practitionersand invited members of the public to inform the draft model. A section of the ScottishExecutive website outlining the review also gave people the chance to submit commentselectronically.