Chamber and committees

The information requested on the number of consultant rheumatologists per 100,000 population by NHS board is shown in the following table: 

Sources: Population data as at 30 June 2010 - General Register Office for Scotland. Consultant data as at 30 June 2011 - Scottish Workforce Information Standard System – Information Services Division Scotland.

It is a matter for NHS boards to decide how to deliver their services to meet the needs of the population. This includes how best to utilise funding and staff, taking account national and local priorities to meet local health needs. The Scottish Government accordingly does not set a recommended level of consultant rheumatologists per 100,000 population.

Information on similar recommendations by the British Society for Rheumatology and the World Health Organisation is not centrally available.

The Royal College of Physicians recommend one consultant rheumatologist (whole time equivalent) per 86,000 population. The report also states that this figure will change depending on regional variations in patient demographics and models of care. (Source: Consultant physicians working with patients, The duties, responsibilities and practice of physicians in medicine, 5^th edition, Royal College of Physicians, 2011).

It is a matter for NHS boards to decide how to deliver the services they provide to best meet the needs of their population. This includes how best to utilise funding and staff, taking account of national and local priorities to meet local health needs.

Whilst talks between the ambulance service management and unions are ongoing it may prejudice these to provide further detail on potential costs. It is, however, a key aim of the Scottish Government to support a negotiated agreement which provides a cost effective solution to this long running issue.

The pre-existing arrangement for those staff on the voluntary register was £250 per annum for their flexibility, with £5 paid each time they were disturbed. The interim arrangement introduces a payment regime of £250 per annum plus £100 per disturbance.

Staff who had previously volunteered have already received a £250 annual payment but will now receive £100 per disturbance in place of the previous £5. Those staff who did not previously volunteer will receive £62.50 (one quarter of the £250 annual payment) for the interim three month period, plus £100 per disturbance.

New ways of defining and measuring waiting lists were introduced on the 31 December 2007 and led to a significant change in how NHSScotland collects and defines waiting times. Data prior to this is not directly comparable.

Information on the median wait to be admitted as an inpatient or day case for rheumatology treatment for the years ending 31 March 2009 to 2011 and for the quarter to 30 June 2011, by NHS board is provided in the following table.

Source: Waiting Times Data Warehouse, ISD Scotland.

Notes:

n/a not applicable

*When medians are based on a small of cases, there is a risk that their value is potentially misleading as only one or two cases may significantly alter the “typical” wait. Therefore, where the number of valid cases is less than 50 information has not been provided.

As I stated when answering questions on the issues raised in my statement to parliament on 6 October, additional resources that the interim arrangements will necessitate will be provided by the Scottish Government to the Scottish Ambulance Service.

However, as talks between the ambulance service management and unions are ongoing during the interim arrangement, it is right to let those talks proceed to try to reach a permanent solution which staff feel able to support, without being definitive at this stage about the level of funding required, which may prove to be speculation at this point.

The information requested is not available centrally. The time of any second or subsequent outpatient appointments would be a matter for the consultant to determine based on the individual patient’s clinical need.

As part of the Scottish Government’s commitment to reduce waiting times, the Health Directorate’s Quality and Efficiency Support continues to work with all NHS boards to redesign and transform services across Scotland to improve access through all stages of the patient pathway. This work aims to help all NHS boards to deliver the 18 weeks referral to treatment time target that is due to be delivered by end December 2011.

New ways of defining and measuring waiting lists were introduced on the 31 December 2007 and led to a significant change in how NHSScotland collects and defines waiting times. Data prior to this is not directly comparable.

Information on the median wait for a first outpatient consultation in rheumatology for the years ending 31 March 2009 to 2011 and for the quarter to 30 June 2011, by NHS board is provided in the following table.

Source: Waiting Times Data Warehouse, ISD Scotland.

Notes:

n/a not applicable

*When medians are based on a small of cases, there is a risk that their value is potentially misleading as only one or two cases may significantly alter the “typical” wait. Therefore, where the number of valid cases is less than 50 information has not been provided.

Scottish Intercollegiate Guideline Network (SIGN) Guideline 123, provides the most recent expert advice on the management of early Rheumatoid arthritis (RA). SIGN expects that the guideline will help ensure:

early referral to a rheumatology specialist;

early diagnosis and assessment of disease activity;

early initiation of disease modifying anti-rheumatic drug therapy to control symptoms, signs and radiological damage; monitor disease severity, response to treatment and to modify treatment where necessary;

multi-disciplinary team involvement, and

active involvement of patients in managing their condition.

SIGN has said that implementation of national clinical guidelines is the responsibility of each NHS board and is an essential part of clinical governance. Mechanisms should be in place to review care provided against the guideline recommendations. The reasons for any differences should be assessed and addressed where appropriate. Local arrangements should then be made to implement the national guideline in individual hospitals, units and practices. Implementation of this guideline will be encouraged and supported by SIGN.

In addition, the Scottish Government has asked the Scottish Public Health Network (SPHN) to update the Public Health Institute for Scotland (PHIS) report Rheumatoid arthritis in adults: Gaining health from effective treatment (2002), as part of its current work plan.

The overall aim of the project is to identify ways in which NHSScotland and its partner organisations can improve the quality and delivery of current services, for people living with RA. The first part of the final report will be published in later in the autumn and the health economic analysis will be published in early 2012.