Chamber and committees

The information requested is shown in the following table, which shows the numbers of deaths where pressure ulcers or sores were the underlying cause.

Table 1: Deaths where Pressure Ulcers or Sores¹ were the Underlying Cause, by NHS Board of Residence, for Each of the Last Five Years

NHS Board	2005	2006	2007	2008	2009
Ayrshire and Arran	3	5	2	1	0
Borders	1	0	0	0	0
Dumfries and Galloway	0	0	1	1	0
Fife	0	0	2	0	3
Forth Valley	1	0	0	0	0
Grampian	1	1	2	3	0
Greater Glasgow and Clyde	2	2	3	2	3
Highland	1	1	2	0	0
Lanarkshire	2	2	5	4	4
Lothian	3	1	2	1	1
Tayside	2	1	1	1	2
Western Isles	0	1	1	0	1
All	16	14	21	13	14

Source: General Register Office for Scotland.

Note: 1. International Classification of Disease 10 (ICD-10) L89: Deaths for which decubitus ulcer, which includes, bedsore, plaster ulcer and pressure ulcer, was the underlying cause on the death certificate.

The information requested is shown in the following table, which shows the numbers of deaths where pressure ulcers or sores were mentioned anywhere on the death certificate.

Table 1: Deaths where Pressure Ulcers or Sores¹ were Mentioned on the Death Certificate Either as the Underlying Cause or as a Contributory Factor, by NHS Board of Residence, for Each of the Last Five Years

NHS Board Area	2005	2006	2007	2008	2009
Ayrshire and Arran	11	8	10	6	4
Borders	1	1	5	1	0
Dumfries and Galloway	3	1	4	5	0
Fife	6	9	5	8	8
Forth Valley	3	5	4	5	5
Grampian	14	8	7	8	11
Greater Glasgow and Clyde	28	20	32	29	42
Highland (including Argyll and Bute)	4	8	7	8	5
Lanarkshire	16	10	21	14	17
Lothian	15	17	16	21	12
Orkney	0	0	2	0	0
Shetland	1	2	0	0	0
Tayside	6	8	11	12	9
Western Isles	0	1	3	1	2
All	108	98	127	118	115

Source: General Register Office for Scotland.

Note: 1. International Classification of Disease 10 (ICD-10) L89: Deaths for which decubitus ulcer, which includes, bedsore, plaster ulcer and pressure ulcer, was the underlying cause, or was mentioned on the death certificate.

NHS Board	2009-10	2008-09	2007-08	2006-07	2005-06
NHS Dumfries and Galloway					1
NHS Greater Glasgow and Clyde	3	1	1		1
NHS Highland			1
NHS Lanarkshire			1
NHS Tayside			1*

Data provided by Central Legal Office. The data may not be comprehensive due to the classification of the complaint.

Notes:

All other NHS boards have not had a claim made against them specifically relating to pressure ulcers or sores.

*In one case payment of £20,560.66 was made by the board in relation to pressure sores. The board paid the sum as damages for alleged negligence - the total includes the award to the claimant and his legal expenses. In civil claims, as in this instance, guilt does not arise - it only arises in criminal proceedings where the Procurator Fiscal charges you with an offence. No other payments have been made by NHS boards in respect of pressure ulcers or sores.

No other payments have been made by NHS boards

The health checks delivered under the Keep Well anticipatory care programme may include pulse checks which would identify atrial fibrillation and other arrhythmias, but this is not undertaken in all cases. When detected, appropriate follow-up and treatment are arranged.

The content of the new heart MOT health check is still to be agreed.

GPs are incentivised to improve the quality of healthcare through the Quality and Outcomes Framework (QOF) which was introduced as part of the General Medical Services contract in 2004. Atrial fibrillation is one of the disease areas contained in the clinical domain of the QOF.

Centrally held data can provide some information for patients where malnutrition is identified on their hospital records. However, malnutrition will often not be the principal reason for admission to hospital but will be a co-morbidity or consequence of a more serious condition. Malnutrition may be recorded on a hospital record if it is clinically identified as an active problem requiring significant investigation while the patient is in hospital; or if it is present when the patient is admitted and requires routine management. As there is no standard group of diagnosis codes to identify malnutrition, the definition of malnutrition employed in this analysis includes diagnoses of anorexia nervosa, nutritional deficiencies (e.g. vitamin A, thiamine and calcium deficiencies), nutritional anaemias and malnutrition related diabetes mellitus.

The answer is given in the following table:

Table 1: Number of patients aged 65 years and over, treated in acute hospitals in Scotland, who have a recorded diagnosis of malnutrition; by NHS Board of Residence; financial years 2007-08 and 2008-09.

NHS Board of Residence	2007-08	2008-09
NHS Ayrshire and Arran	61	65
NHS Borders	30	38
NHS Dumfries and Galloway	85	61
NHS Fife	85	67
NHS Forth Valley	16	32
NHS Grampian	73	68
NHS Greater Glasgow and Clyde	215	166
NHS Highland	48	67
NHS Lanarkshire	66	70
NHS Lothian	292	305
NHS Tayside	47	50
NHS Island Boards	9	16
All Scotland	1,027	1,005

Source Information Services Division (ISD), Scottish morbidity record 01 (SMR 01).

These statistics are derived from the ISD linked database containing linked discharge records from non-obstetric and non-psychiatric hospitals in Scotland (SMR01). The figures shown should be treated with caution because they show the instances where malnutrition is recorded on a patient''s record regardless of the main reason for admission to hospital. Improvements in the completeness of coding (the number of diagnoses that are recorded) over the time period reported may artificially increase the number of recorded cases of malnutrition on hospital records year on year. For both 2007-08 and 2008-09, over 80% of the patients have nutritional deficiency, nutritional anaemia or anorexia nervosa diagnosis codes recorded rather than the more severe malnutrition codes.

Note that the figures in these tables may not correspond exactly with figures released previously. This is because databases are continually updated and corrected. Data for 2009-10 is not complete at this time and is, as yet, unpublished. Data for 2009-10 will be available from 28 September 2010.

The following tables show the 28-day hospital emergency readmission rate from surgical and medical specialities for people aged 65 and over in each calendar year from 2005 to 2009, broken down by NHS board of residence.

Table 1: Number of discharges from a surgical specialty for people aged 65 and over with a subsequent emergency readmission within 28 days, and hospital emergency readmission rate as a percentage of all discharges by NHS Board of Residence; calendar years 2005 to 2009^P:

Emergency readmissions and % of total discharges	2005		2006		2007		2008		2009P
	No.	%	No.	%	No.	%	No.	%	No.	%
NHS Ayrshire and Arran	886	6.0%	983	6.3%	1,071	6.4%	1,127	6.2%	1,281	6.6%
NHS Borders	208	5.9%	223	6.5%	226	6.5%	256	7.0%	258	7.0%
NHS Dumfries and Galloway	332	5.0%	321	4.3%	412	5.0%	411	4.9%	456	5.0%
NHS Fife	655	5.9%	743	6.2%	738	6.1%	677	5.8%	782	6.4%
NHS Forth Valley	577	6.6%	587	6.3%	609	6.7%	546	6.6%	566	6.5%
NHS Grampian	851	6.7%	887	6.4%	916	6.7%	876	6.1%	975	5.4%
NHS Greater Glasgow and Clyde	2,719	6.3%	2,951	6.6%	3,178	7.0%	3,307	7.1%	3,222	6.9%
NHS Highland	765	6.3%	757	5.9%	794	5.8%	775	5.6%	815	5.5%
NHS Lanarkshire	1,220	6.8%	1,294	6.6%	1,256	6.5%	1,358	6.3%	1,525	6.9%
NHS Lothian	1,190	6.0%	1,460	7.6%	1,571	7.8%	1,614	7.4%	1,529	7.4%
NHS Orkney Islands	62	6.8%	55	5.9%	81	7.2%	72	6.5%	65	5.6%
NHS Shetland Islands	74	7.3%	69	6.6%	64	5.9%	59	5.6%	65	5.8%
NHS Tayside	823	7.1%	803	7.0%	867	7.4%	852	7.2%	867	7.0%
NHS Western Isles	70	4.8%	55	3.5%	90	5.4%	98	5.5%	92	4.3%
All Scotland	10,432	6.3%	11,188	6.5%	11,873	6.7%	12,028	6.5%	12,498	6.5%

 

Table 2: Number of discharges from a medical specialty for people aged 65 and over with a subsequent emergency readmission within 28 days, and hospital emergency readmission rate as a percentage of all discharges by NHS Board of Residence; calendar years 2005 to 2009^P:

Emergency readmissions and % of total discharges	2005			2006		2007		2008		2009P
	No.	%	No.		%	No.	%	No.	%	No.	%
NHS Ayrshire and Arran	1,804	9.5%	2,113		10.8%	2,473	12.8%	2,335	12.1%	2,361	11.9%
NHS Borders	736	11.7%	760		11.9%	741	11.4%	744	11.5%	822	12.3%
NHS Dumfries and Galloway	646	10.3%	664		10.5%	779	12.6%	839	13.1%	846	13.2%
NHS Fife	1,415	8.7%	1,559		9.0%	1,890	10.9%	1,775	10.2%	1,802	10.4%
NHS Forth Valley	974	11.1%	1,012		11.9%	1,048	12.1%	1,081	12.1%	1,119	12.4%
NHS Grampian	2,270	11.6%	2,313		11.7%	2,401	11.7%	2,577	11.6%	2,584	11.5%
NHS Greater Glasgow and Clyde	6,236	10.6%	6,898		11.2%	7,407	11.6%	7,666	11.6%	7,818	11.5%
NHS Highland	1,428	10.1%	1,592		10.3%	1,722	10.8%	1,932	11.7%	1,910	11.2%
NHS Lanarkshire	2,531	9.6%	2,756		10.2%	2,975	10.4%	3,126	10.8%	3,358	11.5%
NHS Lothian	3,244	11.2%	3,951		13.1%	4,393	14.1%	4,092	12.7%	4,197	12.5%
NHS Orkney Islands	79	9.6%	71		7.0%	105	7.0%	114	8.3%	101	7.0%
NHS Shetland Islands	69	10.6%	91		14.1%	67	11.2%	83	12.4%	66	11.3%
NHS Tayside	1,775	10.1%	1,884		10.8%	1,945	11.4%	2,107	11.7%	2,165	13.2%
NHS Western Isles	166	10.9%	140		9.1%	176	11.0%	191	12.7%	189	12.7%
All Scotland	23,373	10.4%	25,804		11.1%	28,122	11.8%	28,662	11.6%	29,338	11.8%

Source: ISD Scotland.

Notes:

The basic unit of analysis for these figures is a continuous stay in hospital. Probability matching methods have been used to link together individual SMR01 hospital episodes for each patient, thereby creating linked patient histories. Within these patient histories, SMR01 episodes are grouped according to whether they form part of a continuous spell of treatment (whether or not this involves transfer between hospitals or even NHS boards).

All discharges (defined as a continuous stay in hospital), which meet the selection criteria, are included in the analysis. Each discharge is then compared with the next admission to hospital for the same patient. If this subsequent admission occurs within 28 days of the date of discharge for the previous hospital stay and is coded as an emergency admission, it is selected as a relevant readmission.

The following tables show the 28-day hospital emergency readmission rate from surgical and medical specialities in each calendar year from 2005 to 2009, broken down by NHS board of residence.

Table 1: Number of discharges from a surgical specialty with a subsequent emergency readmission within 28 days, and hospital emergency readmission rate as a percentage of all discharges by NHS Board of Residence; calendar years 2005 to 2009^P:

Emergency readmissions and % of total discharges	2005		2006		2007		2008		2009P
	No.	%	No.	%	No.	%	No.	%	No.	%
NHS Ayrshire and Arran	2,216	5.0%	2,519	5.4%	2,726	5.7%	2,871	5.7%	3,203	6.1%
NHS Borders	578	5.4%	637	6.1%	718	6.5%	776	7.0%	740	6.7%
NHS Dumfries and Galloway	811	4.7%	792	4.2%	878	4.5%	919	4.5%	944	4.4%
NHS Fife	1,868	5.2%	2,001	5.2%	2,037	5.3%	1,950	5.3%	1,975	5.3%
NHS Forth Valley	1,461	5.7%	1,476	5.6%	1,656	6.4%	1,493	6.1%	1,553	6.2%
NHS Grampian	2,422	5.2%	2,535	5.2%	2,632	5.4%	2,551	5.0%	2,844	5.0%
NHS Greater Glasgow and Clyde	7,185	5.2%	7,479	5.4%	8,128	5.7%	8,611	6.0%	8,782	6.0%
NHS Highland	1,783	5.1%	1,807	5.1%	1,873	5.0%	1,839	4.9%	1,915	4.9%
NHS Lanarkshire	3,181	5.5%	3,511	5.6%	3,468	5.6%	3,746	5.6%	3,989	5.8%
NHS Lothian	3,362	5.0%	4,042	6.1%	4,289	6.4%	4,708	6.7%	4,391	6.3%
NHS Orkney Islands	140	5.1%	109	3.9%	149	5.0%	144	4.9%	119	3.9%
NHS Shetland Islands	159	4.7%	163	4.6%	155	4.6%	154	4.6%	150	4.1%
NHS Tayside	1,937	5.6%	2,020	5.7%	2,130	6.1%	2,198	6.2%	2,205	6.0%
NHS Western Isles	150	4.2%	122	3.1%	169	4.1%	189	4.4%	208	4.4%
All Scotland	27,253	5.2%	29,213	5.4%	31,008	5.7%	32,149	5.7%	33,018	5.7%

 

Table 2: Number of discharges from a medical specialty with a subsequent emergency readmission within 28 days, and hospital emergency readmission rate as a percentage of all discharges by NHS Board of Residence; calendar years 2005 to 2009^P:

Emergency readmissions and % of total discharges	2005		2006		2007		2008		2009P
	No.	%	No.	%	No.	%	No.	%	No.	%
NHS Ayrshire and Arran	3,871	8.9%	4,267	9.6%	5,132	11.3%	4,851	10.7%	5,068	11.0%
NHS Borders	1,372	10.6%	1,476	10.8%	1,461	11.0%	1,435	10.5%	1,476	10.6%
NHS Dumfries and Galloway	1,263	9.6%	1,308	9.8%	1,551	11.8%	1,575	11.9%	1,624	12.2%
NHS Fife	3,135	8.1%	3,467	8.4%	3,909	9.8%	3,643	9.4%	3,672	9.3%
NHS Forth Valley	2,402	11.0%	2,331	11.0%	2,564	11.9%	2,630	11.9%	2,807	12.8%
NHS Grampian	4,309	10.1%	4,484	10.4%	4,655	10.4%	4,996	10.2%	5,010	10.1%
NHS Greater Glasgow and Clyde	12,594	9.4%	13,871	9.7%	15,052	10.2%	15,739	10.3%	15,874	10.1%
NHS Highland	2,844	8.9%	3,183	9.3%	3,408	9.8%	3,622	10.0%	3,600	9.7%
NHS Lanarkshire	5,683	8.7%	6,310	9.3%	6,481	9.2%	6,752	9.4%	6,970	9.6%
NHS Lothian	6,881	9.6%	8,741	11.6%	10,155	13.2%	8,963	11.5%	8,272	10.5%
NHS Orkney Islands	175	10.3%	151	8.0%	208	8.3%	217	8.4%	182	7.0%
NHS Shetland Islands	163	9.4%	219	12.9%	155	9.6%	166	10.0%	147	9.1%
NHS Tayside	4,357	10.8%	4,655	11.5%	4,674	12.1%	4,574	11.2%	4,767	12.8%
NHS Western Isles	325	9.7%	259	7.8%	298	9.3%	363	11.3%	337	10.7%
All Scotland	49,374	9.4%	54,722	10.1%	59,703	10.8%	59,526	10.5%	59,806	10.4%

Source: ISD Scotland.

Notes:

The basic unit of analysis for these figures is a continuous stay in hospital. Probability matching methods have been used to link together individual SMR01 hospital episodes for each patient, thereby creating linked patient histories. Within these patient histories, SMR01 episodes are grouped according to whether they form part of a continuous spell of treatment (whether or not this involves transfer between hospitals or even NHS boards).

All discharges (defined as a continuous stay in hospital), which meet the selection criteria, are included in the analysis. Each discharge is then compared with the next admission to hospital for the same patient. If this subsequent admission occurs within 28 days of the date of discharge for the previous hospital stay and is coded as an emergency admission, it is selected as a relevant readmission.

The information requested is given in the following table:

Table 1: Number of Emergency Admission Bed Days for Patients aged 65 and Over

Year	2004-05	2005-06	2006-07	2007-08	2008-09
Emergency Admission bed days for patients aged 65+	2,811,417	2,830,625	2,885,894	2,857,316	2,920,138

 

This information is published regularly by the NHS Information Services Division and can be found on their website at http://www.isdscotland.org/isd/3838.html. The 2009-10 data will be published on 28 September 2010.

There is various planned and actual activity around the use of telehealth to enhance the provision of emergency and unscheduled care. The focus for this work is NHS 24 and the Scottish Ambulance Service.

The Scottish Ambulance Service, in partnership with NHS 24 and GP out-of-hours services across Scotland, has established a professional to professional help line that gives ambulance staff the ability to contact another health care professional such as a senior GP for advice and support in real-time decision making and management of patients. This may for example allow a patient who previously would have been transferred from home to a distant hospital to be either managed at home or within their local community.

The ambulance service are also making use of defibrillators that allow transmission of ECGs to the local cardiac or accident and emergency unit to support the early diagnosis of myocardial infarction. This may mean immediate transfer to a centre for the administration of thrombolysis (clot busting). The new defibrillators can also capture further information regarding the crews'' performance during resuscitation, not only giving immediate feedback on the effectiveness of their intervention but also transmitting that information to a database for further detailed analysis and feedback. The ambulance service is currently piloting this.

NHS 24, through the Scottish Centre for Telehealth (SCT), is working with NHS Grampian to develop an integrated telemedicine solution utilising the network of community hospitals across rural Grampian. The evolving model will allow patients to be assessed in their community hospital by either a senior nurse or local GP supported by a specialist consultant in accident and emergency based in Aberdeen.

The Scottish Ambulance Service, through its investment in cab-based technology already has the capability to provide a level of decision making support to front line staff. Following a successful pilot project in Ayrshire where the patient record and clinical recordings were transmitted from the ambulance to the receiving accident and emergency department before the patient arrived, work is now ongoing with NHS Fife to further refine this development with the intention of extending the capability across Scotland.

Currently, first responders have access to senior paramedic support accessed by telephone to the emergency medical despatch centres of the ambulance service. There are currently no plans in place to further enhance this capability in the immediate future. However NHS 24/SCT is engaging with industry to monitor decision support solutions that deliver mobile telemedicine and looking at the future advances in technology and monitoring equipment to determine how these may realistically be deployed to benefit patients and support care providers.