Chamber and committees

The Scottish Public Services Ombudsman’s Complaints Standards Authority is already leading work for the Scottish Government on the development of a revised NHS complaints procedure, in line with one of the recommendations of the Scottish Health Council’s Listening and Learning report on how feedback, comments, concerns and complaints can be used to drive improvement across NHS services in Scotland. A working group, with membership drawn from across health boards, was recently convened to progress this and will meet for the first time in September 2015.

Much has already been done to develop an open and honest reporting culture in NHSScotland where staff are encouraged and supported to raise any genuine concerns they may have, particularly about quality of care and patient safety. This includes:

The introduction of the NHSScotland Staff Governance Standard which requires employers to ensure that it is safe and acceptable for staff to speak up about wrongdoing or malpractice within their organisation, particularly in relation to patient safety.

Development and publication of a national whistleblowing policy Implementing and Reviewing Whistleblowing Arrangements in NHSScotland Partnership Information Network policy.

Launch of the NHSScotland Confidential Alert Line (NCAL), a dedicated service for NHS staff in Scotland, which provides a confidential service to staff should they have any doubt about whether or how to raise a concern, or worry about doing so. NCAL provides an additional safe space for staff to discuss their concerns with legally trained staff and, if appropriate, have these concerns passed to the appropriate regulatory body on their behalf.

Removal of the standard inclusion of confidentiality clauses and derogatory statement clauses from settlement agreements across NHSScotland, ensuring that staff entering into such an agreement are clear that this does not compromise their right to whistleblow.

Development of guidance for NHSScotland employees and employers on the appropriate use of confidentiality clauses and derogatory statement clauses in settlement agreements. This guidance has been developed in partnership and is due to be published later in 2015.

To further support the above, and in response to the recommendations from Sir Robert Francis’ ‘Freedom to Speak Up’ review, published earlier in 2015, the Scottish Government has also committed to:

Introducing non-executive whistleblowing champions in each NHSScotland board. The role, which has been developed in partnership, will act predominantly as an oversight and assurance mechanism, as well as a conduit to ensure that internal mechanisms within boards are working effectively to support whistleblowing arrangements and staff in raising concerns.

Developing and establishing an independent national officer to provide an independent and external level of review on the handling of whistleblowing cases. Detailed proposals on this role will be subject to a full public consultation later in 2015.

The Scottish Government fully recognises the importance of providing development opportunities for NHS medical staff in order to encourage those who are keen to move into senior management positions. As such, we are developing and promoting a number of initiatives to encourage leadership and management development through high quality programmes, management training schemes, toolkits and resources.

This includes work with the Scottish Academy of Medical Royal Colleges which has established a ‘Working Group on Professionalism and Excellence’ with the aim of promoting the values of leadership at all levels of the profession. The Scottish Trainer Framework also supports the development of clinical leaders and future senior educators in NHS roles, providing the competences and training required for clinicians to become recognised trainers to support the development of students and doctors in training programmes.

NHS Education Scotland (NES) is also involved in a number of initiatives that directly encourage NHS staff to consider management career paths, including the Leadership and Management Programme which provides online and face to face training that is available for all doctors undertaking speciality training; whilst NES and the Scottish Government offer several Scottish Clinical Leadership Fellowships each year, where doctors in training work with senior medical colleagues in NES, Scottish Government and other partner host organisations including the General Medical Council and Health Improvement Scotland.

The Scottish Government already works closely with health boards, NHS Education for Scotland and the General Medical Council (GMC) to support efforts to fully eradicate bullying and harassment. Any incidence of bullying and harassment is one too many, and we have developed and revised Partnership Information Network guidance (Preventing and Dealing with Bullying and Harassment in NHSScotland) to be followed by all staff in NHS boards. This sets out minimum standards which each board must adhere to locally.

Health boards and their employees, irrespective of their position, are expected to act in line with the values and behaviours expected of everyone in NHSScotland, and we will continue to work collaboratively to tackle workplace bullying, and to encourage and support staff to raise any concerns they have about practices in the NHS.

The GMC also plays an important role in monitoring these issues through its annual national training survey and quality assurance visits. They are also using the findings of a report published earlier this year, Building a supportive environment: a review to tackle undermining and bullying in medical education and training, to better understand the nature of undermining and bullying in medical education and training, and we look forward to their recommendations where further improvements or guidance might be possible in tackling this issue.

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The Scottish Government published Out-of-Hospital Cardiac Arrest: A Strategy for Scotland in March 2015. We continue to work with a wide range of stakeholders to deliver the aims of the strategy and improve outcomes for people experiencing out of hospital cardiac arrest.

In the context of a complex, multi-organisational system, it is difficult to calculate the net additional costs of improving out of hospital cardiac arrest (OHCA) given that it is not clear at this stage what proportion of the proposed improvements might be absorbed through different and more effective use of existing resources. Or what efficiencies might be achieved through better co-ordination amongst stakeholders.

Since announcing in October 2014 that an OHCA strategy would be produced, the government has committed over £300,000 to support delivery. Statutory organisations, including the Scottish Ambulance Service and the Scottish Fire and Rescue Service, and third sector organisations, including Chest Heart and Stroke Scotland and the British Heart Foundation have also invested significant resources.

There are already established emergency care pathways in place for patients who experience out of hospital cardiac arrest (OHCA). These pathways involve support from Ambulance Control Centres to help initiate bystander CPR, rapid response by the Scottish Ambulance Service and a range of emergency co-responders, for example Community First Responders and BASICS responders, resuscitation and rapid transfer to the nearest Emergency Department.

The Scottish Ambulance Service continually works to improve ambulance response times in all parts of the country. In acknowledgement of the time critical nature of cardiac arrest response and the clearly defined elements of the ‘chain of survival’, the service is working with a range of partner agencies, community responder groups and projects to optimise the chain of survival in all parts of the country. Some of these pathways are currently under development such as the Sandpiper Wildcat project, which will create a network of trained cardiac responders across the north east of Scotland. In rural Grampian there are emerging pilot projects between the Scottish Ambulance Service and the Scottish Fire and Rescue Service. In other remote and rural areas the service works closely with BASICS responders and our network of Community First Responders in Scotland.

The government currently has no such plans.

The government acknowledges and welcomes the work of third sector groups, business, public sector organisations and others in providing CPR training.

As part of the implementation of the Out-of-Hospital Cardiac Arrest Strategy, the government is working with stakeholder organisations to develop ideas and initiatives to increase CPR training. In addition, a report is in preparation on how public attitudes and behaviour can be influenced in order to increase rates of bystander CPR. This report will inform our approach to increasing CPR training rates.