Chamber and committees

The Health Technology Assessment Report 9: The Clinical and Cost Effectiveness of Screening for Meticillin Resistant Staphylococcus Aureus (MRSA), published in October 2007 by NHS Quality Improvement Scotland, found that there was an absence of evidence to support the role of staff screening in reducing MRSA. Health Protection Scotland is reviewing all the published literature on the role of staff screening within a work stream of the pathfinder programme. The MRSA Screening Pathfinder Programme interim report published in April 2009 also indicates there was no further evidence to support the role of routine staff screening in preventing transmission of MRSA. Further results of studies published since the interim report will be reported in the final report due in December 2009.

We are unaware of any research studies in the UK or the EU on the role and cost effectiveness of staff screening.

Scottish Government is committed to helping NHS Scotland boards to reach compliance with the Working Time Regulations for their doctors in training. We are actively involved with all boards through discussions and written communications.

In January 2009 the Director General Health and Chief Executive NHS Scotland held a video conference with the Chief Executive of NHS Grampian to discuss the board''s progress against key actions including its plans for reaching compliance with the Working Time Regulations by August 2009. In addition, the Scottish Government Working Time Advisers have met with NHS Grampian officials and provided practical support and guidance in order to help them achieve compliance.

Significant progress towards compliance is being made by boards across Scotland. Recently, Chief Executives have received guidance on calculating Working Time Regulation compliance over a 26 week reference period and they are required to report the extent of compliance to the Scottish Government on a regular basis. These data will provide an up to date picture of the progress being made in Grampian and other boards and will facilitate the effective targeting of further assistance by the Scottish Government.

The Health Protection Scotland (HPS) guidance on hand hygiene is reviewed annually. It can be accessed through the following web link (http://www.hps.scot.nhs.uk/haiic/ic/guidelinedetail.aspx?id=31220), and confirms that:

If hands have patient/client contact before or during a procedure, but are not soiled with any body fluids and, therefore, do not require re-hand washing with soap or an antiseptic hand cleanser, alcohol based hand rub can be used;

Any soilage/organic matter can inactivate the activity of alcohol and, therefore, re-hand washing in these circumstances is essential;

Where infection with a spore forming organism e.g. Clostridium difficile is suspected/proven it is recommended that hand hygiene is carried out with liquid soap and water although it can be followed by alcohol based hand rub, and

Where infection with a viral gastroenteritis e.g. Norovirus is suspected/proven it is important that hand hygiene is carried out with liquid soap and water although it can be followed by alcohol-based hand rub.

The Scottish Government had a very productive meeting with Scothedge, the organisation which seeks to secure legislation on this issue in Scotland, on 2 April 2009. I wrote to the Public Petitions Committee on 23 April to provide its members with an update and a copy of the note of the meeting''s outcomes, which had been agreed with Scothedge. My letter and the meeting note can be viewed on the Parliament''s website at www.scottish.parliament.uk, under Written Submissions for Petition PE984.

I refer the member to the answer to question S3W-23036 on 1 May 2009. 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/Apps2/Business/PQA/Default.aspx. had

To maintain and enhance the quality of healthcare provision, service planners at board level and centrally within the Scottish Government have been undertaking a range of activities to maximise NHS Scotland''s workforce capacity and capability. This means looking at new ways to develop and support skills and new combinations of staff groups better suited to the delivery of care in the 21st Century.

The service model proposed by Visible, Accessible and Integrated Care the report of the 2006 Review of Nursing in the Community, demonstrates a modernised community nursing career pathway. NHS Education for Scotland has developed capability frameworks for the advanced practitioner role and community health nurse role and a five-stage work based learning approach to transitional education underpinned by the capability frameworks.

The service model introduces the Community Nurse Consultant role and work is underway to develop new roles such as the Associate Practitioner. Pilot Sites are also developing new roles for staff nurses and newly qualified nurses on the Flying Start NHS programme. NHS Education for Scotland is currently completing work on the development of a framework document to provide principles and guidelines for the development of staff nurses within the community health nursing team.

The service model promotes leadership at every level and provides opportunity for community nurses to gain competencies and enhanced capability to demonstrate leadership qualities which will enhance their position for future management posts should they wish to progress that route.

The service model will be independently evaluated and the outcome of the Evaluation Study will inform future developments.

The service model proposed by Visible, Accessible and Integrated Care, the report of the 2006 Review of Nursing in the Community, fully acknowledges that community nursing teams require administrative support. However, it is for each NHS board and Community Health Partnership to decide how best to utilise its resources to meet the health needs of its resident population, taking account of national and local priorities.

The 2006 Review of Nursing in the Community found that not only were individuals, carers, families and communities unsure of which community nursing service to access to meet their particular needs, but also that health and social care services professionals were confused and frustrated by the number of community nursing roles and titles which could lead to unnecessary delays in accessing appropriate nursing support and advice.

The service delivery model proposed by the Review report Visible, Accessible and Integrated Care provides for a single point of contact for access to community nursing services and recommends that the disciplines of District Nursing, Public Health Nursing (Health Visiting and School Nursing) and Family Health Nursing be absorbed into a new single Community Health Nursing Discipline.

The service model provides generic nursing services across the lifespan and is being tested in four Pilot Sites: NHS Borders, NHS Highland, NHS Lothian and NHS Tayside. A key feature of the model is its flexibility to meet the local health needs of communities and each Pilot Site is developing the model and configuring its teams to best meet the needs of its area. The model is supported by nursing workforce planning to develop the capacity and capability to meet these needs.

The service model will be independently evaluated and the outcome of the Evaluation Study will determine what approach works best and inform our decisions for the future. Until then I am keeping an open mind on the future of community nursing services.

All NHS boards receive an annual allocation of funds from the Scottish Government. It is for each NHS board to decide how best to utilise these funds to meet the health care needs of its resident population, including community health services, taking account of national and local priorities.

A key development in piloting the service model proposed by Visible, Accessible and Integrated Care the report of the 2006 Review of Nursing in the Community, is the progress being made on community nursing workforce and workload planning systems. This work will enable NHS boards to consider the resources required to support demands within community nursing.

Each Community Health Partnership will have access to detailed knowledge on how current workforce and workloads are impacting on services and will enable them to develop and configure community nursing teams by informed design and to identify other resources required to meet team and service needs.

Local, multi-disciplinary Community Mental Health Teams in each NHS board area already provide care, services and support, according to individually assessed needs. This will also include attention to the physical health needs of people with mental illness.