Chamber and committees

The question is relevant to patients who are on a waiting list for hospital treatment and who become unavailable for treatment for medical reasons. Decisions about how best to manage the patient''s medical condition are clinical matters for the healthcare professional responsible for that patient''s treatment. The responsible health care professional will normally be the hospital consultant or another appropriate member of the clinical team, who will decide whether to discuss management of the patient''s case further, taking account of the individual circumstances of the case.

Published national guidance on the management of waiting lists makes it clear that the patient and the patient''s GP should be informed if a decision is made to return a patient to the care of the GP. The GP can of course decide to re-refer the patient.

A decision to return a patient to the care of their GP can be made only by the health care professional responsible for treating the patient, who will not remove a patient from a waiting list if it is clinically inappropriate to do so.

I refer the member to the answer to question S3W-10537 on 13 March 2008. The implementation of Getting it Right for Every Child is continuing through pathfinding activity and in partnership with agencies, who are starting to test how readily they can put Getting it Right for Every Child into practice. If this suggests that legislation would help remove barriers to applying the getting it right approach fully, this would be considered at some future point.

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 pattern of specialist services required to deliver care for their population is a matter for NHS boards. The three regional planning groups have indicated that no boards have declined to participate in a supra-regional specialist service.

The information held centrally on the number of NHS patients treated as in-patients or day cases in the independent health care sector, for the years 2005 to 2007, is provided below. The figures are based on incomplete submissions to ISD Scotland and are therefore of limited value.

ISD Scotland is working with NHS boards and the independent health care sector to ensure the submission of complete and accurate data on the numbers of NHS patients treated by independent health care providers, and will publish this information in the future.

NHSScotland: NHS Patients Treated as In-patients/Day Cases in the Independent Health care Sector^* in the Years Ended⁺ 31 December 2005, 2006 and 2007

Independent Hospital1	2005	2006	2007
Abbey Carrick Glen Hospital	567	514	158
Abbey King''s Park Hospital	4	35	0
Albyn Hospital	399	664	381
Fernbrae Hospital	244	18	1
Glasgow Nuffield Hospital	4	149	87
Murrayfield Hospital	230	134	128
Ross Hall Hospital	126	90	16
Total	1,574	1,604	771

Source ISD Scotland: SMR01 “ in-patient and day case episodes in general and acute wards (non-obsteric non-psychiatric specialties. 

Notes:

^* Activity recording of NHS-paid activity in the independent health care sector is known to be imcomplete. ISD Scotland are engaged with NHS boards and the Independent Healthcare Sector to resolve this.

⁺ Year end based on date of discharge.

1. Independent Hospitals as identified by Independent Healthcare Division, Scottish Commission for the Regulation of Care.

Each project in the Scottish efficiency programme has an assigned portfolio manager who works with the relevant portfolio to monitor progress across the financial year. Each portfolio will be assessed against delivery of its overall efficiency target firstly in June 2008, then in September, December and March each year, with the annual outturn report, based on an assessment of what has been delivered in the full financial year, being published in autumn. The assessment will consider not only the progress on delivery of the individual projects within a portfolio, but also the extent to which the portfolio is on course to deliver against its overall target and the action being taken to ensure delivery.

The planning and deployment of staff to meet service need is a matter for NHS boards to determine locally. All NHS boards are undertaking work to assess their current capacity to deliver evidence based psychological therapies. Work is also underway nationally to support the growth in therapeutic interventions that could benefit patients, for example, the pilot with NHS 24 on telephone based cognitive behaviour therapy and the roll out of Living Life to the Full. Work has also been commissioned to analyse the evidence base for psychological therapies in relation to different conditions and patient groups. NHS boards will use this information when taking forward future planning around this agenda.

As part of the development work related to talking therapies, NHS Education for Scotland has provided 0.5 whole-time equivalent funding for each NHS board.

Published guidance on the management of waiting lists makes it clear that when treatment cannot be provided locally, the patient should be made aware of this as early as possible, ideally when the decision to treat is made. This should ensure that the patient is part of the decision-making process.

An offer of treatment from an alternative NHS board is deemed to be a reasonable offer if it comprises at least two offers of appointment or admission dates, with 21 days or more notice from the date the offer is made. If a patient declines a reasonable offer, then they will either be returned to the care of their GP or their waiting time clock will be reset to zero from the date on which the last offer was declined.

This guidance can be viewed at:

http://www.isdscotland.org/isd/files/New-Ways-Applying-Guidance-V3.pdf.

The Scottish Government and the NHS in Scotland ensure that they are aware of performance trends and issues in the NHS in England as well as in Wales, Northern Ireland and other European countries. Relevant comparisons are made where possible, to help set performance and efficiency in Scotland in context. However, there are significant differences in the way in which the NHS operates north and south of the Border, in response to different needs and circumstances and different policy approaches. We review regularly our approach to publishing performance data on the NHS in Scotland to see what further useful data can be made publicly available, and to ensure that we respond to and comply with best practice in public performance reporting.

The Scottish Executive Health Directorates are taking a number of steps to encourage more effective use of benchmarking and good practice across the NHS. To support NHS boards to learn from each other more quickly, national collaborative improvement programmes have been run in a number of specific areas including unscheduled care, primary care, planned care, ophthalmology, out-patients, depression and diagnostics. These programmes, which involve all territorial NHS boards, have been organised to bring front-line staff from the NHS together at learning events and share good practice about improving services with the goal of supporting delivery of specific targets and goals.

Successful case studies from the service help to provide the evidence base for High Impact Changes which can be adapted to suit local conditions but which have been tried and tested in other NHS settings thereby helping local clinicians and managers focus on what is known to work. Through these programmes case studies of local improvements are shared and publicised to help speed up the spread of good practice. These case studies are available in hard copy and electronic format. A copy of The Planned Care Improvement Programme, Improvement Stories published by The Scottish Government in 2008 is available in the Scottish Parliament Information Centre (Bib. number 45207).

In addition, an educational programme is in place to support staff learning from others about good practice. This includes providing regular core improvement skills training, providing a free to use on-line toolkit and specific master class educational events which are broadcast via webcast to ensure more remote staff can access training.

The national benchmarking programme was established to identify areas of potential improvement in productivity and cost reductions. The national benchmarking programme reports to the NHS Chief Executives Group. Through service specific projects, operational level indicators are identified to focus on and track areas for improvements in front line services. The benchmarking information is shared widely across the service to support changes locally. In 2007-08 the benchmarking programme covered theatres, whole system measurement, mental health, radiology, older people and estates. A copy of The Mental Health Project Final Report: National Benchmarking Project Report 2 published by The Scottish Government in 2008 is available in the Scottish Parliament Information Centre (Bib. number 44673).

 

General Medical Practitioners and General Dental Practitioners generally refer patients to a service rather than to a named clinician. The decision on which list to place a patient is a clinical one taken by the hospital.

A patient added to a waiting list will be given at least two offers of admission for treatment within the current national maximum waiting time of 18 weeks, with 21 days or more notice from the date the offers are made. This comprises a reasonable offer. The terms of a reasonable offer do not extend to treatment by a specific clinician or health care professional.

If a patient declines a reasonable offer, then they will either be returned to the care of their GP or their waiting time clock will be reset to zero from the date on which the last offer was declined.