Chamber and committees

The NHS Quality ImprovementScotland report on routine ultrasound scanning before 24 weeks of pregnancy iscurrently a consultation document. The Executive will consider the guidance inthe report when it is finalised together with any advice from the UK NationalScreening Committee on pregnancy screening.

The Executive cannot commenton implementation timescales until the report is finalised.

The planning and provision of maternity services is in the first place a matter for NHS boards.

Thereport of the expert group on acute maternity services (2002) makes it clearthat acute maternity services should be planned and commissioned in a regionalcontext whilst taking account of local needs, priorities and facilities. Iemphasised the importance of this approach when I responded to the proposalsmade by NHS Argyll and Clyde.

Tofacilitate this, we have provided funding for a regional maternity services co-ordinatorin each of the three regional planning groups which should ensure that all NHS boardsare adopting a pan-regional approach to planning maternity services. Each regionis about to or is currently scoping existing maternity services, taking accountexisting infrastructures and current and recent NHS board maternity servicereviews. Boards which have recently reviewed or are reviewing their maternityservices include Highland, Orkney, Shetland, Tayside, Forth Valley, Glasgow andArgyll and Clyde.

A Framework for Maternity Services (2001) also notes the importance of cross-boundary planning and statesthat NHS boards should make sure that local consultation and public involvementtakes place when planning maternity services.

I have made it clear to NHS boardsthat when considering proposals for reconfiguration I will have to be satisfied that they are consistent with these national policy documents.

The report of the expert groupon acute maternity services (EGAMS) stated that one-to-one midwifery careshould be the norm for all women during labour and childbirth. It also statedthat professionals at all levels of maternity care must have appropriatetraining.

As such all NHS boards areworking towards achieving this standard to ensure that all women receiveone-to-one skilled, evidence-based midwifery care whilst in labour. However, at present the information regarding which boards haveachieved this is not centrally held.

EGAMS stressed that allmidwives caring for women in labour should have identified core competenciesand skills. The Scottish maternity development programme provides localmaternity courses which will help to achieve this.

The Executive is developinga maternity services performance assessment framework for NHS boards that willtake into account the standards set out in the EGAMS report.

Staffing levels matchplanned establishment given current development and rollout requirements overthe coming year. We consider NHS 24 to be a virtual service therefore staffingis projected over the organisation not individual centres.

NHS boards and trusts areexpected to meet their statutory obligations under Part 3 of the DisabilityDiscrimination Act 1995.

The Agenda for Changenegotiations were completed last year and early implementation of the new paysystem is now under way in England. In Scotland, the protection arrangements under Agenda for Changehave been enhanced to ensure that no member of staff suffers a salaryreduction.

The Agenda for Changeagreement will ensure that part-time workers will receive the same entitlementson a pro-rata basis as full-time colleagues and it will ensure that they receiveno detriment.

The new terms and conditionsagreed under Agenda for Change also enhance out of hours payments for somestaff. This may result in a reduction in payments for those who workpredominately nights and weekends but in many cases the percentage reduction inthe out of hours payments may be offset by new pay bands reflecting higherhourly rates. The potential impact on these staff and any recruitment andretention issues which may result are being clearly monitored through the earlyimplementation process.

This information is not heldcentrally.

There are currently twostatutory schemes which allow full or partial reimbursement of travellingexpenses of patients, and where medically necessary, their escorts, which arenecessarily incurred when attending a hospital for the purpose of patientsavailing themselves of services provided under the care of a hospitalconsultant, namely:

(a) A means tested schemecovering the whole of the country, and

(b) The Highlands andIslands scheme which provides for the reimbursement of travelling expenses inexcess of £8 without test of means. To qualify the patient must be resident orwork in the former Highlands and Islands Development Board area. The distancetravelled from the patient’s home must be 30 miles or more or involve a journeyby sea of more than five miles.

Record levels of funding toNHS boards are increasing over the spending review period in terms of bothrevenue and capital.

Any expenditure necessary toimplement measures to comply with the requirements of Part 3 of the DisabilityDiscrimination Act 1995 will be met by prioritisation within NHS boardfinancial allocations.

Although extracorporealmembrane oxygenation (ECMO) is provided at Yorkhill, it is designated andfunded through National Services Division (NSD) as a national service. I wouldexpect any proposals emerging from NHS Greater Glasgow’s review of maternity servicesto confirm that the impact on all services has been properly considered andthat key national services, such as ECMO, will be protected. The National ServicesDivision will be monitoring the position on behalf of the Scottish Executive Health Department.