Chamber and committees

It is current protocol for all NHS Scotland Health Boards to ensure appropriate referral and testing when Lynch syndrome occurs, and for all patients diagnosed with colorectal cancer before the age of 60.

In relation to the NICE guidelines recommendation to extend referral and testing for lynch syndrome to all patients diagnosed with colorectal cancer; the impacts of this recommendation are currently being reviewed by NHS Scotland’s Molecular Pathology Consortium (MPC).

The decision to invest further in CGM and insulin pumps was made on the basis of robust analysis of clinical evidence by NICE and SIGN. Effectiveness of these technologies is considered over the lifetime.

The Scottish Diabetes Survey enables us to track improvement over time against a range of important indicators including glycaemic control and the complications of diabetes. The Survey shows a developing trend of improvement in glycaemic control in the Scottish type 1 diabetes population over the wider period of investment in insulin pumps.

I would remind the Member that the decision to offer a CGM or insulin pump is a clinical one, and the results for the individual will be monitored by their clinical team. Where the expected outcomes are not being realised, clinicians will consider clinically appropriate changes to the care regime.

The Scottish Government actively supports initiatives being led by the service to encourage practitioners to return to practice in known areas of need. The GP Returner Programme for instance, provides a supported opportunity for practitioners who are eligible to practice, but otherwise not practising, to safely return to general practice in Scotland.

Equally, we are actively supporting activity to encouraged qualified doctors who are settled migrants or refugees to work within NHS Scotland. Through the Bridges Programme, doctors from overseas living in Scotland can access a rolling programme of clinical placements during their pre-registration period and access linguistic support for the Professional and Linguistic Assessments Board examination, which is a pre-requisite of full registration with the General Medical Council.

All medical doctors, whether UK citizens or nationals of countries outside the UK, European Economic Area (EEA) or Switzerland, with a primary qualification from a medical school outside the UK, EEA or Switzerland must undertake parts 1 and 2 of the Professional and Linguistic Assessments Board (PLAB) test. Doctors who have European Community rights, a GMC approved sponsorship arrangement, an approved postgraduate qualification, or who are eligible to enter the GP or specialist medical register do not have to undertake the PLAB test.

In recognition of the difficulties refugees often face in providing the standards of verified evidence normally required for IMG registration, the GMC works with applicants to try to verify their home qualifications through other means if they have been formally recognised as a refugee under the 1951 United Nations Convention, granted limited leave (5 years), granted exceptional leave to remain (granted prior to 1 April 2003), granted humanitarian protection, or granted other leave. The GMC also offers two free attempts at part 1 of the PLAB test and reduced fees for part 2, with the option for successful candidates to pay their initial registration fee in installments.

The Bridges Programme works with NHSScotland to help refugee doctors to meet the criteria for IMG registration including, where necessary, assistance with attaining the International English Language Testing System score required to demonstrate that they have the English language skills to practise safely in the UK. Other assistance programmes are run across the UK by various organisations and professional bodies; however, the Scottish Government does not hold specific information on these.

Scotland’s health workforce benefits enormously from the contribution made by overseas staff. The Scottish Government has consistently signalled that we need to remain an open and welcoming destination for international medical graduates, both from the EU and further afield.

We support initiatives being led by the service to encourage former practitioners return to practice, alongside activity to promote the appeal of NHS Scotland to fresh international talent. NHS National Education Scotland currently operates a successful GP Returner Programme, for former practitioners who have had a career break of who have been practising abroad. Additionally, the service operates an Enhanced GP Induction Programme for overseas GPs, to facilitate their transition to practise in the UK.

Registration and licensing is undertaken by the General Medical Council (GMC), which is the statutory regulator of the medical profession in the UK. The chief executive of the GMC is the registrar for the medical profession; this information is not held by the Scottish Government.

Data on doctors who are registered and/or licensed to practice in the United Kingdom can be found in the GMC’s annual report on the “State of medical education and practice in the UK”, accessible online at: https://www.gmc-uk.org/static/documents/content/SoMEP-2017-final-full.pdf

The information requested on training places for workers in this sector is not held centrally as the activity is not centrally managed. Much adult social care and childcare training is vocational and work-based and training providers with relevant information could include employers, private training providers, colleges, universities and bodies such as the Scottish Funding Council and the Scottish Qualifications Authority.

Introduction of an internship programme would be a matter for the organisations responsible for delivering social care and other stakeholders and this approach has not to date been raised with the Scottish Government. It may be helpful to note that much of the training for this sector is work-based and that many of those studying for qualifications in social care are already employed in the sector.

We acknowledge recruitment challenges in the sector and are working with stakeholders on a number of actions including payment of the living wage in the sector. In addition our NDPB, the Scottish Social Services Council provide a range of resources to support those looking to recruit staff and for those looking at a career in the care sector, including free online career resources, Career Ambassadors and support for modern and foundation apprenticeships.

The Scottish Government is in regular contact with NHS Lothian to discuss all key issues which impact on service delivery.

As far as possible, NHS Lothian minimised the impact on patients as they are aware that any delay in diagnosis or treatment can be worrying, especially for parents of young children and they were able to prioritise those patients requiring urgent MRI scans, and transfer them to other sites within and out with Lothian. Lothian Radiology Management and the Clinical teams worked in collaboration with Estates, Medical Physics and the supplier of the MRI to resolve the problem exercising the safety precautions required when working with an MRI scanner. Radiographers and Radiologists provided additional evening and weekend sessions on various sites in Lothian to minimise the impact. NHS Lothian were able to scan outwith normal working hours to reduce the waiting time for patients.

NHS Lothian will work with Scottish Government to ensure that any lessons to be learned from this incident are addressed appropriately.

Health Boards have fully delegated powers to recruit and deploy staff, in order to meet their service delivery responsibilities. The Scottish Government supports health boards in their efforts to ensure that they have the right staff in place to meet the healthcare needs of the local population. We understand from NHS Lothian they have recently recruited two consultant orthopaedic surgeons, with both taking up post in January 2018.

I recognise some patients in Lothian are experiencing long waits including in the specialty of orthopaedics, that is why I have made £50 million available to NHSScotland - with up to £7.4 million being made available to Lothian. This additional funding will build up their capacity and make sure that all patients are seen and treated in a timely fashion. I expect to see improvements between now and the end of March 2018. Officials continue to meet with the Board regularly to support improvement in waiting time performance.

The Board are also taking a number of actions to improve orthopaedic waiting times for patients this includes redesigning their Muscoloskeletal Allied Health Professional service to ensure that patients with foot and ankle and upper limb conditions are seen by the most appropriate healthcare professional in the right place in a more timely manner.