Chamber and committees

The Scottish Government is committed to ensuring that national performance measures across health and social care lead to the best outcomes for people being cared for, whether in hospital or in the community. The Scottish Government, with support from COSLA, commissioned Sir Harry Burns to undertake an independent review of targets and indicators in health and social care to provide recommendations on how we can have a clearly understood measurement framework across the whole health and social care system. The report was published on 15 November and identifies some key principles and recommendations for using and developing targets and indicators going forward.

The Scottish Government will use these principles and recommendations to undertake a further stage of work, with the aim of ensuring a broader based assessment of the overall quality of care.

Statistics published by Information and Statistics Division (ISD) Scotland on 21 February 2017 show that the mortality rate for heart disease had fallen 37.6% per cent between 2006 and 2015. ISD statistics for cancer mortality, published on 31 October 2017 also show a fall in mortality rates of 11% between 2006 and 2015. Whilst we know that Scotland is behind other UK countries, it encouraging to see that mortality rates for heart disease and cancer have decreased over the last decade.

We know more needs to be done to tackle the risk factors associated with heart disease and cancer. Healthier eating, being more active, stopping smoking and drinking sensibly can all play their part in reducing the risk of heart disease and cancer, and we are taking firm action in all these areas to support people across Scotland to live healthier lives. This includes our Heart disease plan published in 2014, our £100 million Cancer Strategy published in 2016 and our upcoming Obesity Strategy, which is currently out for consultation.

These plans emphasise the Scottish Government’s commitment to tacking heart disease and cancer and outline key ambitions and actions to improve the detection, diagnosis, treatment and aftercare of heart disease and cancer for all people in Scotland.

The Scottish Government has published a clinical care governance framework as part of the suite of statutory guidance for Integration Authorities. In 2018 we will be working with stakeholders who are delivering arrangements locally to learn from their experiences of implementing the framework to date and to provide updated guidance and support as necessary.

The Scottish Government Equality Evidence Strategy, published on 18 July 2017, identifies evidence gaps across policy areas for all protected characteristics and sets out its general approach to filling these.

Over the four year period of the strategy, the Scottish Government will carry out further engagement with stakeholders to prioritise these gaps and define projects aimed at improving the equality evidence base.

Equality Evidence Strategy: http://www.gov.scot/Publications/2017/07/9574/1

NHS Scotland’s Information Services Division (ISD) has recently published its Equality Evidence Finder, which summarises information about the availability and use of equality data from key national administrative health datasets. A companion report, Measuring use of health services by equality group, sets out a number of steps that ISD aims to take forward in order to build upon the work presented in the report and through the Equality Evidence Finder.

ISD Equality Evidence Finder: http://www.isdscotland.org/Health-Topics/Equality-and-Diversity/Equality-Evidence-Finder/

Measuring use of health services by equality group: https://www.isdscotland.org/Health-Topics/Equality-and-Diversity/Publications/2017-06-27/2017-06-27-Measuring-Use-of-Health-Services-by-Equality-Group-Report.pdf

Since 2012, the Scottish Government has included a core set of questions in each of the three major household surveys it conducts. This has been done specifically to allow responses to be combined across the surveys. This large sample enables the analysis of key health indicators with reference to sexual orientation, religious belief, and disability (as measured through the presence of long-term conditions and limiting long-term conditions). This data was used earlier this year to inform a report on sexual orientation in Scotland.

Scottish Survey Core Questions: www.gov.scot/SSCQ

Sexual Orientation in Scotland 2017: A Summary of the Evidence Base: http://www.gov.scot/Publications/2017/01/4911/0

The Chief Medical Officer’s vision is that by 2025, all healthcare professionals will demonstrate Realistic Medicine principles and values through their professionalism.

Delivery of the CMO’s vision will not happen overnight. The desired change in culture will require strong collaborative clinical leadership across the health and care system and there are a series of priority actions set out in the Health & Social Care Delivery Plan that aim to strengthen relationships between professionals and individuals, with the person at the centre of all decisions, reduce waste and tackle unwarranted variation. All of which will help embed Realistic Medicine across Scotland. We will report progress towards achieving these actions through regular updates to the Delivery Plan Programme Board.

There is already evidence of some change in practice from individual clinicians, departments and NHS Boards that aim to reduce waste, reduce unwarranted variation and create a more personalised approach to care, as described in the Chief Medical Officer’s annual report Realising Realistic Medicine, and we encourage NHS Boards to share and adopt good practice.

There are two tools which although not specifically developed for Realistic Medicine, they are good examples of the type of approach that will assist clinicians to know whether they're practicing Realistic Medicine through patient feedback. A new measurement tool known as CollaboRATE has been developed and is intended for use to assess the quality of shared decision making in clinical encounters. A patient-reported measure of integration in care delivery is also being developed, known as IntegRATE. As Realistic Medicine becomes part of the way that we deliver care in Scotland, tools such as these will become very important in providing measures that will allow us to assess our ability to truly involve people in the decisions relating to their care. They will also help ensure that this is delivered in a joined up, integrated fashion between professionals, communicating and acting with clarity of role and mutual respect.

The Chief Medical Officer’s vision is that by 2025, all healthcare professionals will demonstrate realistic medicine principles and values through their professionalism.

The posters that have been developed and displayed by NHS Borders support one of the key principles of Realistic Medicine, which is to strengthen the relationships between healthcare professionals by encouraging people to ask their healthcare professionals questions that will support shared decision-making and giving people informed choices about their treatment and care.

The NHS Borders poster initiative is highlighted in the Chief Medical Officer’s annual report, Realising Realistic Medicine and NHS Dumfries and Galloway, NHS Lanarkshire and NHS Forth Valley are now piloting similar posters. We would encourage all NHS Boards to consider adopting this person centred approach.

The Scottish Government supports improvement of foot care service delivery through nationally produced tools and resources including the Traffic Light tool and CPR for feet.

We understand that, NHS Valley are at present piloting a fast track referral/triage system to improve service delivery in a standardised manner and reduce variation in practice within their Board. The results will be discussed with our Scottish Diabetes Foot Action Group so that best practice can be shared nationally.

I refer the member to the answer to question S5W-12337 on 20 November 2017. 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.

The Chief Medical Officer’s second annual report, Realising Realistic Medicine sets out the need to strengthen relationships between professionals and individuals, with the person at the centre of all decisions and the need to tackle unwarranted variation. The report can be accessed here: http://www.gov.scot/Publications/2017/02/3336/downloads#res-1

The Chief Medical Officer’s vision is that by 2025, all healthcare professionals will demonstrate realistic medicine principles and values through their professionalism.

Different types of variation exist within the health and care system. Variation in health practices and outcomes exist, as well as variation in the volume of procedures carried out. There is a range of work, either planned or under way, that aims to strengthen person centred approaches and shared decision making to help tackle unwarranted variation. The Health & Social Care Delivery Plan which contains a series of priority actions that will begin to help embed Realistic Medicine across Scotland. They include:

• Refreshing our Health Literacy Plan, to support everyone in Scotland to have the confidence, knowledge, understanding and skills we need to live well with any health condition;

• Reviewing the consent process for patients in Scotland with the General Medical Council and Academy of Medical Royal Colleges and make recommendations for implementation. This is a key element in transforming the relationship between individuals and medical professionals;

• Commissioning a collaborative training programme for clinicians to help them to reduce unwarranted variation. This will support a workforce that can find more effective and valued ways of delivering medicine;

• Incorporating the principles of realistic medicine as a core component of lifelong learning in medical education and mainstream the principles of realistic medicine into medical professionals’ working lives at an early stage.

• Developing a Single National Formulary to further tackle health inequalities by reducing inappropriate variation in medicine use and cost and reduce the overall cost of medicine.

We will report progress towards achieving these actions through regular updates to the Delivery Plan Programme Board.

There is already some evidence of change in practice from individual clinicians, departments and NHS Boards as described in the CMO’s annual report Realising Realistic Medicine and we encourage boards to share and adopt good practice.

The new GP contract which has now been agreed between the Scottish Government and the Scottish General Practitioners' committee (SGPC) is a critical part of our plans to transform primary care services in Scotland. The new contract aims to reinvigorate general practice and turn it into a positive career choice for existing and future GPs. GPs will have the opportunity to vote on the new contract at a special SLMC Conference in December.

The proposals include reducing GP workload through the expansion of the primary care multidisciplinary team and allowing GPs to focus on their role as expert medical generalists. This will give GPs a more fulfilling role, with more time to see and treat the patients that need them most.

There will be new investment in expanded teams of health professionals in practices, which may includes pharmacists, nurses, physiotherapists, paramedics, community mental health workers and non-clinical support workers for example community links workers.

More detail on the primary care workforce will be provided in the National Health and Social Care Workforce Plan: Part 3 Primary Care in 2018.

The new GP contract can be accessed here - http://www.gov.scot/Publications/2017/11/1343

An overall programme plan was agreed with the Delivery Plan National Programme Board in August 2017, mapping the work currently underway with detail on specific actions, targets, timescales and key milestones. This included a programme plan and regular monitoring and reporting on activity as result of the Delivery Plan. Work on a set of success criteria for the Delivery Plan as a whole and an underpinning set of performance indicators is being finalised for the end of this year. It will be supplemented by the work underway to model the performance and financial impacts of the Delivery Plan as a whole, which is being commissioned.