Chamber and committees

There is no intermediate target set for boards to meet the national standard for stroke patients requiring thrombolysis within one hour of arrival at hospital. Boards are expected to achieve the Scottish stroke care standard for thrombolysis where 80% of patients receive the bolus within one hour of arrival at hospital.

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

The Scottish Government notes the publication of this study which sought to explore the relationship between clinicians’ mindfulness and their perceived therapeutic alliance with their clients. The evidence that the quality of the therapeutic relationship is associated with client outcome is well recognised and this paper finds aspects of a mindfulness approach as being effective. Mindfulness based practice and training are therefore recommended.

Currently the concept of mindfulness is widely promoted in a variety of mental health settings. This is both for staff in their therapeutic encounters and personal occupational mental health, and for patients as a therapeutic tool in enhancing their mental health and wellbeing. Training opportunities exist for NHS Scotland staff and partners.

Overall, health in Scotland is improving, and people are living longer, healthier lives. Reducing the health gap between people in Scotland’s most deprived and affluent communities is one of our greatest challenges.

Our approach to improving mental health services is exactly the same as our approach to physical health. We are working with NHS boards and partners to ensure monitoring information about who is accessing services, such as ethnicity and sexuality, is consistently available to inform decisions about service design and to remove barriers to services.

NHS Forth Valley commenced their clinical programme from January 2012 based on the clinical portal approach in NHS Tayside. The programme is ongoing with approximately 1,100 clinicians now having access to patient demographics, GP details, clinical correspondence, test results, inpatient episodes, outpatient appointments, community contacts and the substance misuse service with Emergency Care Summary being available from March 2015. There are no connections to other health board information systems at this current time although there is work underway as part of the West of Scotland eHealth Leads Group to look at portal to portal connections for the region.

This information is not collected. However we recognise that LGBT people can experience more difficulty than others in accessing mental health services to meet their needs. This can be because some groups are less likely to try to access services, for example due to stigma, or because there are gaps or lack of capacity in some services.

The Scottish Government is working with NHS boards and partners to ensure that monitoring information about who is accessing services is consistently available to inform decisions about service design and to remove barriers to services.

We also provided £410,000 of funding to the LGBT Centre for Health and Wellbeing to run the Demonstration Project. This project was launched in response to evidence of the inequalities experienced by LGBT people around mental health. The project completed in 2014 and an impact report, which will be used to inform next steps, was published in November 2014.

Boards are able to access their own real time data, and the Scottish Stroke Care Audit 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.

Within the context of the Scottish Stroke Care Audit 2014 report, the need for ‘innovation service redesign’ is highlighted in relation to thrombolysis and carotid endarterectomy.

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

As part of this stroke improvement work, work is already progressing with the Scottish Ambulance Service to improve door to needle time for patients requiring thrombolysis. In order to facilitate a seamless patient experience, the Scottish Ambulance Service alerts the receiving stroke unit of a patient’s arrival to allow the receiving unit to prepare for this.

Work is also planned to modify the patient pathway to ensure that at least 80% of patients undergoing carotid endarterectomy for symptomatic carotid stenosis have the procedure within 14 days of their index transient ischemic attack/stroke event.

A total of almost £15.7 million has been spent on mental health research since 2007.

The majority of this funding has come from the Chief Scientist Office – almost
£15 million. The combined annual awarded funding for mental health related research grants and funding to the Mental Health Network is as follows:

Analytical Services in the Scottish Government spent a further £0.7 million on
policy-related evaluation and research. Please note this is presented as the year the funds were committed, not necessarily the year they were spent.

A number of other studies and surveys commissioned by Scottish Government Analytical Services also collect and report on mental health and mental wellbeing as part of their remit. It is not possible to disaggregate the costs of the mental health component. These include the Scottish Health Survey, Growing Up in Scotland, the Scottish Schools Adolescent Lifestyle and Substance Use Survey and GoWell.

Information regarding how many prisoners serving sentences of under six months have alcohol problems is not collected in this way and therefore not held centrally, however the Scottish Prison Service Prisoner Survey 2013 – Substance Misuse shows that alcohol harms are a significant feature of the prison population.

The Scottish Government’s Alcohol Brief Intervention (ABI) programme is evidence-based, with the three priority settings (primary care, accident and emergency, antenatal) identified in line with Scottish Intercollegiate Guidelines Network Guideline 74. The programme also allows for 10% of ABI delivery to be in wider settings, as determined by local partners. Alongside other work to tackle substance misuse, a number of ABIs are delivered within the prisoner population as part of this wider setting activity.

There is no current programme of work with the sole aim of making laboratory results available to any NHS clinician in any location who requires access. Laboratory results are just one of the elements of the electronic patient health record that NHS boards are working to make more widely available to healthcare staff both within and across boards. NHS boards copy laboratory results into their local Scottish Care Information (SCI) Store repository to provide a highly available source of information that can be used directly or by other systems. The capability already exists for boards to agree cross-boundary SCI Store connectivity, and they decide together how it will be used and managed. All NHS boards have established live store to store connections with neighbouring or other boards where there are recognised clinical pathways. For example NHS Golden Jubilee, which routinely treats patients from across Scotland, has increased SCI Store connections from 8 to 11 since August 2013. Since August 2013, the number of live store to store connections across NHSScotland has increased from 39 to 70. The case for providing store to store connectivity for ad hoc or emergency access would be determined by individual boards in line with local policies. NHS boards are increasingly providing access to laboratory results through their clinical portals, and work to progress portal to portal information exchange is ongoing.

The Scottish Government recognises the importance of anticoagulation in patients with atrial fibrillation and has included it as one of the eight priorities in the Stroke Improvement Plan (published August 2014).

The Scottish Quality and Outcomes Framework contract 2014-15 has an agreement to identify those patients with atrial fibrillation, who are suitable for treatment with an anticoagulant.

According to the Scottish Stroke Care Audit (SSCA) data for 2010 to 2013, whilst the percentage of patients with atrial fibrillation who take anticoagulation treatment following assessment at outpatient clinics has fallen slightly from 79% (2010) to 77% (2013), there has been an increase in the actual numbers from 232 (2010) to 308 (2013).

The 2014 SSCA report can be accessed via:

http://www.strokeaudit.scot.nhs.uk/Reports/main.html