Chamber and committees

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.

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

Part 1 of the National Health and Social Care Workforce Plan, published on 28 June 2017, reflects Audit Scotland’s recommendation and is clear on the need to develop capacity to project future supply and demand. Further work is proceeding at local, regional and national levels via NHS Education for Scotland and other NHSScotland bodies to develop a scenario planning model which can be implemented nationally, regionally and locally.

The Scottish Government already requires NHS Boards to undertake an annual workforce planning and projections process, and factors the information provided by NHS Boards into its financial plans.

The national performance standard for cancer is 95 per cent of patients referred urgently with a suspicion of cancer are to begin treatment within 62 days of receipt of referral.

We know further work is needed to shorten waits for diagnostics and in September 2017 we formed a Ministerial Cancer Performance Delivery Group to drive forward service redesign and improvement, backed by £1 million investment on top of
£4.85 million already allocated to boards.

Among a series of actions the group will audit processes for managing patients with a suspected cancer, implement new scrutiny and monitoring processes for health boards struggling to meet the 62 day standard, and invest in the roll-out of new technology to assist with pressures on diagnostic services.

The Health and Social Care Delivery Plan, published 19 December 2016, affirms that there will be a shift in the balance of care from hospital to community care settings, and to individual homes when that is the best thing to do. By 2021-22 more than half of frontline NHS spending will be in community health services.

As part of this shift, in every year of this Parliament there will be an increase in the share of the frontline NHS budget dedicated to mental health and to primary, community, and social care. This will be supported by an increase in health resource funding of £2 billion over the life of this Parliament.

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.

Unlike local authorities and integration authorities, NHS Boards do not publish draft accounts. NHS Boards publish their annual accounts once the accounts have been audited and laid before the Scottish Parliament.

All NHS Boards received an unqualified audit opinion for their 2016-17 accounts.

In 2016-17, there were 978 incidents of domestic abuse recorded by the police in the Scottish Borders. This represents an increase of 47% from 665 incidents recorded in 2008-09. The rate of incidents recorded per 10,000 population in the Scottish Borders has increased from 59 in 2008-09 to 85 in 2016-17. However, this rate has been consistently below that of the Scottish average which in 2016-17 was 109 per 10,000 population.

The Scottish Government is investing almost £30 million (2017-20) from the Equalities portfolio to support a range of projects and initiatives – including support for a range of front line specialist services working with women and children who have experienced domestic abuse. Separately, we committed an additional dedicated £20 million over 2015-18 from Justice budgets to be invested in a range of measures to tackle all forms of violence against women and girls.

We are also implementing Equally Safe, Scotland’s strategy to tackle all forms of violence against women and girls. This aims to prevent violence from occurring in the first place, build the capability and capacity of mainstream and specialist services to support survivors and those at risk, and strengthen the Justice response to victims and perpetrators. A Delivery Plan for Equally Safe will be published by end 2017.

We are also improving the justice system response to domestic abuse. The Domestic Abuse (Scotland) Bill, which is currently before Parliament, will create a new offence criminalising a course of abusive behaviour towards a partner or ex-partner. The offence will help law enforcement agencies in dealing with domestic abuse with a law that reflects a modern understanding of domestic abuse and will cover all the types of behaviour that can constitute domestic abuse; crucially this includes psychological harm. This new offence will help our justice partners such as Police Scotland and the Crown Office to more effectively deal with domestic abusers.

As public bodies, Health Boards and Integration Authorities are required to publish a range of information, including all papers and agendas of their Board meetings. These papers are accessible online or can be requested directly from the relevant Health Board or Integration Authority.

As part of the approach to finance and performance, NHS Boards prepare plans over a medium term timescale and submit this information to the Scottish Government as part of their Local Delivery Plans.

The Budget Process Review Group was established by the Finance and Constitution Committee and the Scottish Government to carry out a fundamental review of the Scottish Parliament’s budget process. The Group published its Final Report on 30 June 2017, which included comment on spending reviews and multi-year budgets.

The Cabinet Secretary for Finance and the Constitution has responded to this Report.