Chamber and committees

Estimated numbers of people affected by the pause to breast screening were published when the pause to the programme was announced on 30 March. The figures, which are based on the most recent information available to Information Services Division at the time of the pause, indicate that 46,596 people may have had their breast screening appointment delayed as a result of the pause to the breast screening programme over the past three months.

The resumption of screening services is taking place safely, carefully and in a series of stages, as part of the remobilisation of the NHS in Scotland. The breast screening service is currently assisting acute services to prioritise high-risk familial clinics and post-treatment surveillance screening, while preparing for the resumption of the national programme.

In the meantime, it is absolutely vital for those in between screening appointments or awaiting a rescheduled appointment to be aware of any symptoms or signs of the conditions screened for. Anyone having these symptoms should contact their GP practice.

The Scottish Government expects Health Boards in Scotland to consider all of the recommendations made in the Saving Lives, Improving Mothers’ Care reports. The 2019 report was the 5 th MBRRACE audit report, and the reports have highlighted key actions for Health Boards. The report assists Boards in identifying areas for further action, building on any work undertaken following publication of the 2018 Report.

Following the findings of the 2018 report regarding poorer maternal mortality rates for black and Asian women the National Perinatal Epidemiology Unit in Oxford University, who lead on the MBRRACE-UK reports, commissioned further research to explore in depth the underlying reasons for this inequality. Scottish data is included in this research and we expect that this will give further insight into specific actions that can be taken to reduce this disparity.

Maternity care across Scotland is provided by multi-professional teams with quality and safety for all mothers and babies central to decision making. Clinical teams work in partnership with women to design individualised, person centred care, taking account of all relevant factors, including ethnicity, social complexity, and mental and physical health. The introduction of the continuity of midwifery and obstetric care under our Best Start programme will enable further improvements in person centred care for every pregnant woman, and particularly for those at risk of poorer outcomes.

I refer the member to the answer to question S5W-30230 on 8 July 2020. All answers to written parliamentary questions are available on the Parliament’s website, the search facility for which can be found at: http://www.parliament.scot/parliamentarybusiness/28877.aspx

Estimated numbers affected by the pause to the screening programmes are based on the most recent information available to Information Services Division at the time of the pause. This indicates the following numbers of people may have had their appointment delayed in the three month period since the programmes were paused on 30 March:

• 248,177 bowel screening participants.
• 46,596 breast screening participants.
• 101,963 cervical screening participants.

The cancer screening programmes that were paused on 30 March (breast, bowel and cervical) are now beginning to restart – safely, carefully and in a series of stages.

The Scottish Government were concerned to read the findings of this tragic incident. NHS Lothian have accepted the findings of the Fatal Accident Inquiry and have confirmed that a number of actions have taken place since 2014 to improve the number of staff incorporated within ward establishment figures. Firstly, the Royal Edinburgh Hospital was given an uplift in budget of £3 million which allowed it to review establishment levels. In addition, when the new Royal Edinburgh Building was built, it allowed for an improved number of nursing staff per bed ratio.

NHS Lothian has produced a draft action plan in response to the FAI which includes implementation of the standards within Healthcare Improvement Scotland’s (HIS) "From Observation to Intervention" 2019 guidance. This is being taken to the NHS Lothian Health Care Governance Committee for discussion on 24 th July 2020.

On December 16 2019, the Scottish Government published the first Integrated National Health and Social Care Workforce Plan in the UK. Developed in partnership with COSLA, the Integrated Plan sets out how health and social care services will meet growing demand to ensure the right numbers of staff, with the right skills, across health and social care services. Covid-19 has led to widespread disruption to Health Boards' models of service delivery and we are carefully considering the Integrated Plan to ensure its content and associated guidance are, going forward, reflective of the full range of current and developing planning requirements on Boards and the changing circumstances regarding Covid-19.

In addition, implementation of the Health and Care (Staffing) (Scotland) Act, which is the first multi-disciplinary workload and workforce planning legislation in the UK, will support the wider workforce planning process by enabling a rigorous evidence based approach to staffing decisions. Health Boards have also been supported in planning their nurse staffing in response to the pandemic by the development of a professional judgement decision making template, including for mental health.

The Scottish Government will also shortly reconvene the National Mental Health Quality and Safety Board. This Board will be considering all issues that impact upon the quality and delivery of safe and effective services, including inpatient and community settings.

Test and Protect programme is run by NHS Scotland using NHS staff and resources. Spend on private contractors by Scottish Government to support delivery of the programme is to date limited to support for marketing campaigns, contact centre telephony, data analytics and modelling, and systems development. Detail of spend to date is set out in the following table. A minimum threshold of £10,000 has been applied. Spend on governance support has been excluded as it does not relate to programme delivery. Further expenditure on private contractors may have been incurred by NHS territorial health boards. This information is not held centrally.

Patient safety will be at the forefront of NHS Boards plans as they restart previously paused services, and a number of different steps to mitigate the impact that two-metre physical distance are being put in place. This includes extended working days including evenings and weekends to provide more clinics and see more patients.

The Golden Jubilee providing national support to territorial Health Boards in specialties such as Ophthalmology and Orthopaedics, and continue to support with Cancer surgery.

The Private Sector is supporting NHS Boards by providing a COVID free environment for urgent and Cancer surgery. This provides a safe environment for both staff and patients.

In addition, in order to increase access to diagnostic testing, NHS Boards will be deploying six mobile MRI scanners and three CT scanners, across Scotland. This will enable Boards to ensure patients have appropriate access to diagnostic services while also ensuring physical distancing measures and PPE requirements are followed.

We are also exploring options for further pathways for the NHS Louisa Jordan with the possibility that the facilities can be used to provide outpatient appointments and access to diagnostics testing.

I refer the member to the answer to question S5W-27044 on 3 February 2020. This confirmed that routine health data records hernia operations, bladder operations, etc., using prosthetic implants, not those specifically using mesh implants. Furthermore, NHS Information Services Division (ISD) confirmed that reported complications or problems following surgery cannot accurately be established from routine health data because readmissions are recorded according to the symptom reported, not the underlying cause.

All answers to written parliamentary questions are available on the Parliament's website, the search facility for which can be found at: https://www.parliament.scot/parliamentarybusiness/28877.aspx .

The Scottish Government convened the National COVID19 Cancer Treatment Response Group (CTRG) on 18 th March to form national clinical consensus in Scotland on changes to cancer treatment in response to the new risks associated with COVID-19 ensuring those most urgent cases were prioritised.

The group has produced clinical advice on an ongoing basis and throughout the pandemic the majority of cancer treatments have continued.

We have now established a National Cancer Recovery Group which has been established to offer national arbitration on overall clinical priorities. It will also oversee national data and modelling work in relation to cancer recovery and advise on patient and public communications.

Any cancer patient worried about symptoms should call their existing cancer treatment helpline or the national cancer treatment helpline. Individuals with serious or worrying signs or symptoms are encouraged to use the NHS as normal and contact their local GP practice.

Urgent and emergency care has been maintained throughout this pandemic to ensure those with life threatening conditions were and continue to be seen as a matter of priority.

Through the Re-mobilise, Recover, Re-design: The Framework for NHS Scotland , Health Boards will follow national and local clinical advice to safely and gradually prioritise the resumption of some paused services whilst continuing to protect emergency, urgent, Cancer and maternity care. Health Boards will plan to resume services while maintaining COVID-19 capacity and resilience and providing appropriate support for social care, and also protecting the safety of all patients and staff. Health Boards are taking a careful and considered approach to this, balancing the treatment of COVID-19 patients with the all potential impacts of longer waiting times, including assessing the impact of this on excess death rates.