Chamber and committees

As part of ongoing analysis of the annual outcome of Trainee recruitment and selection in Scotland, the Scottish Government discusses with NHS Education for Scotland(NES) whether different approaches may be required to make training posts more attractive, while being mindful of the need for every post to provide the educational experiences and opportunities that fulfil the educational standards required by the General Medical Council.

We are clear that more innovation and flexibility in our recruitment approaches for Trainees is needed, and to then retain them upon completion of training. A key challenge is to ensure that surgical teams in remote areas can maintain their skills when patient numbers are small, and this is being addressed by developing networks between rural and urban hospitals. In a highly competitive recruitment environment for medical trainees where multiple choices exist, the Scottish Government is clear that concerted efforts are needed by NES, Health boards and Medical Royal Colleges to make training posts as educationally attractive as possible, that offer the job flexibilities and enhanced skill opportunities Trainees now seek, and where appropriate offer local recruitment incentives to Trainees. In remote and rural circumstances, such incentives might include offering assistance towards accommodation costs, employment offers to partners, travel and subsistence to attend learning events.

There is widespread recognition of the need for transformational change to enhance the quality of care, improve outcomes and ensure we have a sustainable service for all. As implementation of the National Clinical Strategy progresses, it is inevitable that the restructuring of service provision at national, regional and local levels will drive new approaches to how surgical training is configured, and the new national and regional workforce planning system will need to ensure training placements adapt to such change.

This is a matter for the Crofting Commission. I have asked the interim Chief Executive to write to you about this matter.

There are numerous reasons which contribute to recruitment and retention challenges in such areas of Scotland, and actions and solutions require the sustained and combined efforts of the Scottish Government, NHS boards, Medical schools and Medical Royal Colleges.

Providing a quality, sustainable health service is one of the Scottish Government’s top priorities, and the National Clinical Strategy provides the strategic framework for transformational change in the NHS over the next 10-15 years, based upon providing services around the needs of local communities; supporting people to manage their own conditions; working in multidisciplinary teams and restructuring how our hospitals can best serve the people of Scotland. It follows that the restructuring of service provision must drive the future workforce requirement, and workforce planning must adapt to better match our workforce capacity to overall demand in a sustainable and affordable way taking into account of the skill sets required.

In the short to medium term, there are a range of actions already being taken to support NHS boards recruit in remote and rural areas, from abroad, and also to encourage those who trained or worked in NHS Scotland to return and work in the health service. For example, we are supporting the development of flexible networks between rural and urban hospitals. This can be seen by the reciprocal surgeon rotation between Belford Hospital and Edinburgh or NHS Highland and Caithness. NHS boards can also use either the UK or the Scotland specific Shortage Occupation List to permits recruit from abroad where evidence of shortages exists, and we are regularly reviewing these lists to ensure boards can use these where the need exists. In terms of a more sustainable medical workforce, we have increased by 50 the SG-funded medical school places from 2016, and announced Scotland’s first graduate entry medical programme with 40 additional places starting from August 2018. The aims of these initiatives are to boost future supply, but also to increase the amount of time spent learning in remote and rural settings as such experience may help influence future career choices.

The Scottish Index of Multiple Deprivation uses reliable administrative data sources to identify relative deprivation across the whole of Scotland, not just areas commonly associated with poverty. Any planned changes to SIMD are recommended by the ‘Measuring Deprivation Advisory Group’, which is a group of experts from academia, local government, NHS and other services. The income aspects of SIMD relies on benefits and tax credits data from the Department of Work and Pensions and HMRC. The current limitations on sharing data with these UK government departments means it is not possible to look more closely at households' personal financial circumstances.

The latest year for which the Scottish Funding Council (SFC) hold official data on full-time student numbers is 2014-15.

The number of college student enrolments on full-time recognised qualifications is published by the SFC in the National Statistics publication ‘College Performance Indicators’.

In 2014-15 there were over 79,000 full-time students at Scotland’s colleges – 16.5% more than in 2006-07. Over the last Parliament we maintained the commitment we made in 2011 – to deliver 116,000 Full-time Equivalent college places. We will continue this commitment, focused on purposeful, job-focused learning.

Consultant numbers in NHS Scotland are at a record high, with 5,202.3 WTE in place - a 43.1% increase under this Government.

While the Scottish Government provides the policies, frameworks and resources for high quality healthcare, it is for each NHS board to plan its workforce to meet the needs of its population.

We are fully committed to providing sustainable, high quality patient-centred services in remote and rural areas, ensuring that care is delivered as close to the patient as possible when appropriate. That is why we are supporting the development of flexible networks between rural and urban hospitals.

Patient safety is, and will remain, paramount. We have committed to placing our innovative workforce planning tools on a statutory footing to ensure safe and sustainable staffing levels, including within remote and rural areas. Work will begin this year to consult with stakeholders on how best to take forward our commitment.

The Scottish Government took a wide range of evidence into account when considering its policy in this area including data from the Student Awards Agency Scotland, the Student Loan Company, and the Higher Education Statistics Agency. In addition, labour market and population data, the age cap policies in place elsewhere in the UK, the estimated cost to the Scottish Government of any change to the age cap, the findings of the EQIA and changes to the state pension and retirement age, were also considered.

The Scottish Government consulted a number of independent organisations, including Universities Scotland, NUS Scotland and the Scottish Older Person’s Assembly.

The Getting It Right For Every Child (GIRFEC) approach has been national policy since 2010 and as part of their existing work, public authorities in many parts of Scotland already operate a “named person” approach.

Part 4 (Provision of Named Persons) of the Children and Young People (Scotland) Act 2014 (the Act) has not yet commenced.

As the Scottish Government works towards commencement of Part 4 of the Act, named person service providers, including local authorities, health boards, and partners, will continue to progress the GIRFEC approach and to develop and deliver named person services.

Under Part 4 of the Act, a Named Person has a responsibility to respond to a request for help or a concern about a child's or young person's wellbeing but there is no requirement on children, young people or parents to take up any offer of advice or support. The rights and responsibilities of parents to raise their children and provide for their wellbeing needs remain the same. Named Persons have no new legal powers to compel parents, children or young people to accept advice, support or help.

The provisions of Part 4 of the Act do not change current child protection procedures and the police and/or social work should continue to be contacted immediately if a child is believed to be at risk of significant harm.

As a result of the ring-fenced element of the Highlands & Islands contract not being fully met for the National Third Sector Fund, a fresh procurement exercise is now underway which is exclusively for the Highlands & Islands area. This action has been taken to try and ensure that bids will be received from all geographical areas in Highlands and Islands, including Shetland.

The Work Able Scotland programme will have four contract package areas. Area One, which includes the Highlands & Islands, Clyde Coast and Grampian is not split into Local Authority areas. Instead SDS have created a Sub-Contract Package Area and indicated the volumes that will apply. This is intended to encourage the successful contractor to work with a network of sub-contractors thus ensuring that there is appropriate provision for areas with smaller numbers, such as Shetland.

Additionally, and to support rural areas like Shetland, a rural supplement of an additional £250 per person per sub-contract package area has also been added to the service fee payment for delivery of the Work Able Scotland contract.