Chamber and committees

In the interests of appropriate corporate governance, the Scottish Government has taken over the management of the external audit. This will ensure not only that the governance arrangements for this piece of work are independent and transparent but that they are seen to be so.

An external audit of NHS Lothian’s waiting times management process is currently underway. We await the findings of the final audit report and will expect the board to take forward any recommended actions to ensure that patients in Lothian receive the best possible care as swiftly as possible.

The Scottish Government takes its assurance on the corporate governance arrangements of NHS Lothian from the external auditors; in this case Audit Scotland. The following is an extract from the most recent audit report, for the fiscal period 2010-11:

Corporate Governance is concerned with the structures and process for decision making, accountability, control and behaviour at the upper levels of an organisation. Overall, the high level corporate governance and control arrangements for NHS Lothian operated satisfactorily during the year, as reflected in the Statement on Internal Control.

The Permanent Secretary is required to sign a Statement on Internal Control in respect of the Scottish Government consolidated accounts. To enable him to sign the statement, which forms part of the accounts, he requires assurance on the maintenance and review of internal control within or affecting the Scottish Government.

Within the Health and Social Care portfolio, this assurance is provided by statements from each of the accountable officers. Their statements are supported by, among others, statements of assurance from the sponsored bodies, including NHS boards and special health boards.

Chairs of the audit committees of sponsored bodies are required to write to the Chair of the Health and Social Care Audit and Risk Committee to advise of:

Any significant issues arising locally or specifically highlighted by internal or external audit;

Any disclosures in their Accountable Officer’s Statement on Internal Control in respect of weaknesses or deficiencies, and

Any significant frauds notified during the year.

No issues were reported in the Statement of Assurance from NHS Lothian for the fiscal period 2010-11.

There are no plans to review corporate governance arrangements at NHS Lothian. The Scottish Governments seeks assurance on these arrangements from NHS Lothian’s external auditors, Audit Scotland.

In the interests of appropriate corporate governance, the Scottish Government has taken over the management of the external audit. This will ensure not only that the governance arrangements for this piece of work are independent and transparent but that they are seen to be so.

No.

Patient safety is a top priority for the Scottish Government and NHS Lothian is committed to ensuring the continued provision of safe, effective and person-centred healthcare for children across Lothian. The Scottish Government is being kept informed of the situation at St John’s, as are key stakeholders. I have asked that Scottish Government officials work closely with NHS Lothian to support them in maintaining and sustaining paediatric and neonatal services at St John’s Hospital and to support the maternity service at the hospital that delivers 2,800 babies every year.

As publicly stated by NHS Lothian, in January 2012, the Dean of Postgraduate Medicine for South East Scotland advised NHS Lothian of the decision to withdraw paediatric trainees (with the exception of one community health trainee) from St John’s Hospital from April 2012. The Postgraduate Dean has been working closely with the NHS boards in the South East of Scotland for some time to maintain safe staffing levels for senior trainees in all paediatric units in the region. While the services provided by St John’s Hospital are a priority for all stakeholders, unprecedented gaps (outwith the Deanery’s or health boards’ control) have resulted in the remaining senior trainees being redistributed to other units in the region, in order to both maintain rotas and services in those other units, and to maintain safe and high quality training for the trainees. This decision followed consultation between the South East Postgraduate Dean and the General Medical Council (GMC), Royal College of Paediatrics and Child Health (RCPCH), and clinicians from the boards in the south east region.

NHS Lothian has made a considerable investment in childrens’ services at St John’s Hospital to ensure that they can maintain a high standard of patient care and they are now assessing all of the options available, with their key partners, to sustain this important service. In particular, the board are vigorously pursuing all staffing options in the short and long-term; including both the recruitment to additional consultant posts and supplementary medical and nursing staff. This facilitates a move towards a trained doctor delivered service (in line with national policy) to compensate for the gaps left by trainees. It is important to make clear that the issues being experienced by St John’s Hospital are not as a result of insufficient funding but of gaps in senior trainee rotas.

At a national level to help increase the clinical team available to work in paediatrics, the Scottish Government is currently reviewing a number of specialties and specialty specific educational programmes that may be provided to other clinical professionals to facilitate continuity of care. Paediatric and neonatal nurse practitioners are one area where staff numbers may need to be increased to ensure a safe environment in the event of continuing medical staffing issues. The Scottish Government will shortly be approaching NHS boards to seek information on the numbers of advanced nurse practitioners in paediatrics and neonatology in post together with the numbers required to ensure that safe operating rotas can be maintained.