Chamber and committees

The Scottish Government published Part 1 of the National Health and Social Care Workforce Plan on 28 June 2017. This makes specific recommendations in key areas to strengthen national, regional and local improvements to NHS workforce planning.

Parts 2 and 3 of the Plan, respectively covering workforce planning in Social Care and Primary Care, will bring this together iteratively to enable different systems to make the right links. A further integrated Plan will be published in 2018.

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 proposals include reducing GP workload through the expansion of the primary care multidisciplinary team.

There will be significant new investment in expanded teams of health professionals in practices, widening patient choice and ensuring that GPs are able to focus on their expert medical generalist role. Additional health professionals will include pharmacy; nursing; Allied Health Professionals (physiotherapy, and paramedics and other urgent care practitioners); community mental health workers and non- clinical Support Workers (e.g. community Links workers).

The Chief Medical Officer’s reports, Realistic Medicine and Realising Realistic Medicine, seek to put the person receiving healthcare at the centre of decision-making and create a personalised approach to their care. Realistic medicine aims to reduce harm, waste and unwarranted variation, all while managing risks and innovating to improve.

One of the actions arising from the Health and Social Care Delivery Plan in support of this is to review the consent process for patients in Scotland with the General Medical Council and Academy of Medical Royal Colleges and make recommendations for implementation from 2018 onwards. This is a key element in supporting shared decision making and transforming the relationship between individuals and medical professionals.

In addition, our world-leading action plans on health literacy are working to build the skills, confidence, knowledge and understanding that people need to cope with the complex demands of the health and care system. This is vital to supporting people’s greater involvement in decisions about their care and treatment.

Funding allocations for the Health and Sport portfolio and for NHS Boards for future financial years is a matter for the relevant spending review. The Scottish Government will publish its draft budget for 2018-19 on 14 December 2017.

We are taking significant action to reduce waiting times, that is why I made an additional £50 million available to NHS Boards earlier this year.

I announced on 29 August the setting up of an expert group to reduce waiting times and improve the way elective care services are provided. The Elective Access Collaborative programme is bringing experts from the Scottish Government, NHSScotland and the Royal Colleges together in providing support to NHS Boards and will be crucial in bringing about sustained delivery of waiting times. This approach has seen us deliver improvements in unscheduled care. I will be making a further announcement on the early progress the collaborative has made in the coming weeks.

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

Unscheduled care is a key priority for Scottish Government and we want all hospitals across Scotland to sustainably achieve 95% of all patients attending A&E to been seen, treated and discharged or admitted with four hours. The latest weekly performance against the four hour A&E target for the w/e
29 October was 94.0%.

Since the launch of the six essential actions two years ago we have delivered significant improvements; Scotland is leading the way in the UK in terms of performance against the four hour A&E target, the number of patients waiting longer than four hours has reduced by 10% since 2012-13 compared to 180% increase in England.

Scotland’s performance in September was almost 8 percentage points better than England; more than 23 percentage points better that NI and almost 12 percentage points better than Wales (England 84.6%; Northern Ireland 69.4%, and Wales 80.6%); Scotland’s core site performance has been ahead of England for
31 consecutive months, to September 2017.

But we are not complacent. I recognise that more needs to be done to ensure a sustainable improvement in performance especially as we go in to the winter period. That is why I recently announced an additional £5 million to support winter resilience. This is over and above the £9 million, announced in May 2017, to support Unscheduled Care - total of £14 million for winter 2017, compared to £12 million the previous year.

The Scottish Government is committed to ensuring that NHSScotland delivers high quality services and improved outcomes for patients. The Modern Outpatient Programme and Scottish Access Collaborative will deliver sustainable improvements. We have adopted a collaborative approach for Unscheduled Care and Scotland’s A&E performance has been the best in the UK for the last 30 months.

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.