Chamber and committees

I refer the member to the answer to question S4W-23868 on 20 January 2015. 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/parliamentarybusiness/28877.aspx.

All patients categorised as ‘code 9’ are included on the delayed discharge data recording system, and are published in the quarterly delayed discharge census available at:

http://www.isdscotland.org/Health-Topics/Health-and-Social-Community-Care/Delayed-Discharges/Previous-Publications/.

Data on the number of patients accessing a stroke unit on the day of admission is published annually in the Scottish Stroke Care Audit (SSCA). Boards are also able to access their own real time data, and the SSCA team provides them with monthly and quarterly reports.

The Scottish Stroke Improvement Team supports Managed Clinical Networks (MCNs) to evaluate board performance, identify areas of concern and work with them to implement local action plans to improve the delivery of stroke care across Scotland. This support includes visiting all boards at least once per year to review stroke care with board representatives (board management and clinical teams), to assess performance, to highlight achievements and good practice and to formulate an improvement plan for areas of concern where necessary.

The Scottish Stroke Improvement Team met with board representatives from NHS Forth Valley on 16 December 2014, a follow up meeting to review progress will be arranged for May 2015.

We have invested over £29 million this year (2014-15) to support the NHS and help boards cope with the added pressures they are experiencing as well as manage winter pressures.

We have invested £9.5 million through our National Unscheduled Care Action Plan. This was allocated to all boards, including the Scottish Ambulance Service and NHS 24. The allocation to each board was determined by using the NHSScotland Resource Allocation Committee (NRAC) formula.

We have invested £10 million to support improvements in relation to delayed discharges, whilst minimising potential disruption to services, patients and carers over the winter period. Some of this funding was allocated to boards on a NRAC basis and the remainder was determined by assessing the level of delayed discharge.

In December 2014 we announced a further £10 million investment to support winter resilience by increasing capacity during winter months and help stop patients being admitted to or delayed in hospital unnecessarily, easing the impact of pressure on both scheduled and unscheduled care. The allocation of this funding will be determined by a number of factors including, NRAC, level of local pressures, delayed discharge and elective cancellations/pressures.

NHS boards have also invested around £20 million to support improvements in unscheduled care and winter resilience. This is a combined investment from central and local funding to of £50 million.

This level of detailed information is not held centrally.

The vast majority of code 9 patients are delayed because they lack capacity to make their own decisions, and are awaiting completion of applications for guardianship.

Good progress has been made reducing the number of adults with incapacity delays. To help streamline processes we issued a Good Practice Guide in 2010, and republished this last year. We are also supporting Age Scotland to promote Power of Attorney across Scotland in a bid to reduce these delays over the longer-term.

Other code 9 delays are patients with highly complex needs, where no alternative safe community care is available. Local partnerships are working with the joint improvement team to better understand the needs of this cohort of patients and to ensure that services that address these needs are put in place.

The Scottish Government’s eHealth Division monitors information security via its annual and mid-year eHealth business reviews of boards and via ongoing relationships with board information governance and security leads. There is no formal Scottish Government inspection of information security, but this area is considered by Audit Scotland in its rolling programme of audits and boards also employ external auditors as and when required. Subsequent to a new process introduced in August 2014 all significant information security incidents are reported to the Scottish Government and lessons learned reports are produced when required.

All three drugs have been approved by the Scottish Medicines Consortium (SMC) for use in the management of patients with atrial fibrillation and venous thromboembolism.

NHS board Area Drug and Therapeutics Committees consider this SMC advice in the context of their overall use of anticoagulant drugs, and decide on inclusion into their local joint formularies: https://www.scottishmedicines.org.uk/Home

NHS boards also consider the advice issued by Health Improvement Scotland, which helps identify those groups of patient, with atrial fibrillation, most likely to benefit from either dabigatran or rivaroxaban, when compared to more traditional anticoagulants: http://www.healthcareimprovementscotland.org/our_work/cardiovascular_disease/stroke_and_systemic_embolism/stroke_and_systemic_embolism.aspx

The Scottish Government considers that further central advice is not required at this stage.

There is no intermediate target set for boards to meet the national standard for stroke patients requiring carotid endarterectomy. Boards are expected to work towards the Scottish stroke care standard where 80% of patients undergoing carotid endarterectomy have the operation within 14 days of the stroke event.

The Scottish Government recognises the importance of carotid endarterectomy and has included it as one of the eight priorities in the Stroke Improvement Plan (published August 2014).

Data on the number of patients accessing a stroke unit on the day of admission is published annually in the Scottish Stroke Care Audit (SSCA). Boards are also able to access their own real time data, and the SSCA team provides them with monthly and quarterly reports.

The Scottish Stroke Improvement Team supports Managed Clinical Networks to evaluate board performance, identify areas of concern and work with them to implement local action plans to improve the delivery of stroke care across Scotland. This support includes visiting all boards at least once per year to review stroke care with board representatives (board management and clinical teams), to assess performance, to highlight achievements and good practice and to formulate an improvement plan for areas of concern where necessary.

The Scottish Stroke Improvement Team met with board representatives from NHS Lothian on 3 November 2014, and a follow up meeting has been arranged for March 2015. They are scheduled to meet representatives from NHS Highland on 1 April 2015.

The following NHS boards are using clinical portals: NHS Borders, NHS Dumfries and Galloway, NHS Fife, NHS Greater Glasgow and Clyde, NHS Lanarkshire, NHS Lothian, NHS Tayside, NHS Ayrshire and Arran and NHS Golden Jubilee. NHS Grampian use the TrakCare patient management system (PMS) as the clinical portal as it provides, in their case, the majority of agreed information. NHS Shetland and NHS Orkney are implementing PMS hosted by NHS Grampian and will follow their approach. NHS Highland implemented the TrakCare PMS system in March 2014 and effort is concentrated on this. Their portal strategy is yet to be developed although links with the Greater Glasgow and Clyde portal are in place for NHS Highland patients based in Argyll and Bute who receive the majority of their treatment within Greater Glasgow and Clyde. NHS Western Isle have just completed testing of their portal solution and intend to commence implementation on an incremental basis by the end of March 2015.

Access by clinicians to another health board’s portal is not monitored centrally. There are over 65,000 clinicians registered to use the clinical portal across Scotland. Through regional working health boards are exploring how best their clinical portals can be integrated to provide clinicians with the access they need across health board systems. This area of work is receiving added emphasis in the refreshed eHealth Strategy for 2011-17 which will be published shortly.