Chamber and committees

I recognise the waiting times for orthopaedics in NHS Lothian are very much below the level I require, with patients experiencing exceptionally long waits to be seen and treated. NHS Lothian has received £3.7 million as part of the £25 million initially issued to Boards from the £50 million announced at the end of May. The Board are using £500,000 of this funding, plus £1.5 million from Access Support funding to improve waiting time performance for orthopaedics. The further £25 million funding will be issued to NHS Boards shortly

NHS Lothian recognise the issue of growing demand and has undertaken significant work to redesign the musculoskeletal pathway in the community, first for lower back pain through the development of an integrated back pain pathway, and now a foot and ankle and upper limb integrated community pathway. The foot and ankle and upper limb musclosketal allied health professional community pathways has reduced orthopaedic demand by 2,700. They have also redesigned their arthroplasty service to provide a service better aligned to realistic medicine which reduces the number of return appointments. These initiatives have created more additional new outpatient capacity. This combined work has effectively reduced acute orthopaedic demand, and increased service efficiency and productivity - as result of the changes the Board now have 810 more new outpatient capacity which has brought the outpatient service into balance.

The Board are also taking action to reduce the number of cancelled elective orthopaedic operations caused by long stays of hip fracture patients by providing

• Additional Occupational Therapy resource - enable patients to be returned home quicker.
• Additional resource for orthopaedic supported discharge and orthopaedic rehabilitation - to reduce delayed discharges
• Enhanced AHP resource in Midlothian IJB - enable faster flow of patients from Edinburgh Royal Infirmary to rehabilitation

The Board will also make use of the independent healthcare sector to see and treat between an estimated 580-690 of the longest waiting outpatients.

I will be raising the issue of waiting time performance with the Chairs of all Boards at their next meeting.

The Scottish Government promotes the use of Integrated Pest Management (IPM), which aims to help landowners reduce their reliance on the use of pesticides, including those containing glyphosate, and help them to make the best possible and most sustainable use of all methods for controlling pests, weeds and diseases.

IPM is a site specific, whole farm approach to maximising the efficiency of production whilst minimising negative effects on the environment. IPM is a broad set of tools which aim to minimise pest, weed and disease risks whilst also reducing reliance on pesticides.

Food Standards Scotland (FSS) leads on matters relating specifically to food safety in Scotland. FSS liaises closely with Food Standards Agency (FSA) in the rest of the UK on food safety matters, particularly those regulated at EU level.

The Health and Safety Executive (HSE) leads for the UK on pesticide safety assessments. Neither FSA nor HSE have contacted FSS to discuss glyphosate as current residue levels in food are not considered to provide concern for food safety.

Data provided by the University of Strathclyde for the 2017 intake, and the University of Dundee for the 2018 intake, shows that the number of applicants to their postgraduate educational psychology courses were 71 and 62 respectively.

In Scotland, the Dispenser Payments and Prescription Cost Analysis report provides (on an annual basis), information on the volume of drugs prescribed in the community. The report is published on the National Services Scotland Information Services Division website:- www.isdscotland.org/Health-Topics/Prescribing-and-Medicines/Community-Dispensing/Dispenser-Remuneration/

In addition, ISD Scotland also publish the following Cardiovascular publishing data: https://www.isdscotland.org/Health-Topics/Heart-Disease/Publications/2018-01-30/DDD_cost_number_prescriptions_Board_G2.xlsx

These reports show that for the year ending 31st March 2017 , there were 303,551,535 Defined Daily Doses of Statins issued within the community in Scotland. For the year ending 31 st March 2016 , there were 300,009,193 DDD.

A Defined Daily Dose (DDD) is defined by the World Health Organisation (WHO) as “the assumed average maintenance dose per day for a drug used on its main indications in adults”. DDDs are commonly used as a proxy measure of how many patients in the population are taking a particular drug and this allows for some comparison between Health Boards.

NHS England publish figures on prescribing in the community at: https://www.gov.uk/government/statistics/prescription-cost-analysis-england-2017

NHS Wales publishes figures on prescribing in the community at: http://www.primarycareservices.wales.nhs.uk/data-publications

NHS Northern Ireland publishes figures on prescribing in the community at: http://www.hscbusiness.hscni.net/services/2930.htm

The figures published in each of the UK nations use different timeframes and datasets and are therefore not comparable.

I am advised on food safety matters by Food Standards Scotland. FSS considers that current levels of pesticide residues in food, including glyphosate levels do not provide concern for food safety based on current information.

The relevant guidelines for statin prescribing in Scotland are SIGN 149 which is available here:

https://www.sign.ac.uk/assets/sign149.pdf

In England, the equivalent guidelines are published by NICE which are available here:

https://www.nice.org.uk/guidance/cg181

NICE guidelines are in use in Wales and Northern Ireland as well as additional local guidance as required.

With respect to a comparison between guidelines, the National Institute for Health and Care Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN) have a shared interest in the drive to improve quality of care for patients through the development of clinical guidelines.

A Directors of Planning Thrombectomy Advisory Group (TAG) are progressing development of a national planning framework for the provision of thrombectomy for stroke in Scotland. It is anticipated the framework will be completed by spring 2019.

The framework will be submitted to the National Planning Board (NPB) and follow due process for the planning of NHS Scotland services.

The Scottish Government’s commitment through the Edinburgh and South East Scotland City Region Deal includes up to £120 million for the grade separation of the A720 Sheriffhall Roundabout which will bring improved economic benefits and inclusion across Edinburgh and South East Scotland and is being progressed by Transport Scotland as part of the City Region Deal. Subject to completing the necessary statutory procedures the improvements at Sheriffhall will be delivered within the timeframe of the City Deal.

Additionally Transport Scotland is undertaking a review of the Strategic Transport Projects Review over the lifetime of this parliament. The A720 is a key part of Scotland’s transport network and will be assessed in its entirety within this Review which will gather robust evidence to enable decisions on investment in strategic infrastructure across Scotland.

The health and safety of frontline non-NHS staff in the health and social care sectors falls under the governance and care of employers and their occupational health systems.

Vaccination against flu should be considered an integral component of standard infection control procedures. Social care providers and independent primary care providers such as GP, dental and optometry practices, and community pharmacists, should arrange vaccination of their staff.

Each year the Chief Medical Officer and Chief Nursing Officer issue a letter to the NHS setting out arrangements for the flu season. This letter highlights the importance of staff or other individuals who may be at risk of occupational exposure being offered the vaccine by employers. This programme is supported by a range of marketing materials to raise awareness amongst staff, including posters and leaflets.