Chamber and committees

The Scottish Government has two Cancer Waiting Times (CWT) standards that apply to adults over 16 years, these are:

• a 31-day target from decision to treat until first treatment for new cancers regardless of the route of referral
• a 62-day target from urgent referral with suspicion of cancer, including referrals from national cancer screening programmes, and direct to A&E until first treatment.

a) The Cancer Waiting Times (CWT) Team within NHS ISD monitors and publishes performance on the following most common cancer types:

• Breast
• Colorectal
• Head & Neck
• Lung
• Lymphoma
• Ovarian
• Melanoma
• Upper Gastro-Intestinal (hepato-pancreato-biliary (HPB) and oesophago-gastric (OG))
• Urological (prostate, bladder, other)
• Cervical

b) The following cancer types are not currently monitored:

• Bone & Connective Tissue
• Neurological
• Leukaemias
• Multiple Myeloma
• Female Genital Organs (excluding ovarian and cervical)
• Testes
• Penis

A rolling programme of short term audits has been taken forward by ISD and are monitored for management and information purposes only, these are:

• Endometrial (2012)
• Neurological Cancers (2013)
• Sarcoma (2014)
• Subsequent Radiotherapy (2015-2016)
• Multiple myeloma (2017)
• Mesothelioma (2018)
  

Further information can be accessed via the ISD website https://isdscotland.scot.nhs.uk/Health-Topics/Waiting-Times/Cancer/

The Scottish Government has two Cancer Waiting Times (CWT) standards that apply to the most common cancers, these are:

• a 31-day target from decision to treat until first treatment for new cancers regardless of the route of referral
• a 62-day target from urgent referral with suspicion of cancer, including referrals from national cancer screening programmes, and direct to A&E until first treatment.

A rolling programme of short term audits on tumour types not included in the current CWT standards has been taken forward by ISD and are monitored for management and information purposes only, these are:

• Endometrial (2012)
• Neurological Cancers (2013)
• Sarcoma (2014)
• Subsequent Radiotherapy (2015-2016)
• Multiple myeloma (2017)
• Mesothelioma (2018)

The recommendations from the Clinical Review of Cancer Waiting Times (CWT) Standards in Scotland was published on 2 May 2018. These included recommendations to review the tumour types monitored through CWT standards. An implementation group is in the process of being formed to drive these recommendations forward, to ensure the Cancer Waiting Times Standards best meet the needs of patients and the NHS for the future.

The use of mesh to treat hernia repair is accepted practice across the UK and there is presently no medical evidence to suggest it should not be used. The Scottish Government therefore has no plans to carry out a review into its use.

Following consultation in 2008 with patients, voluntary sector, clinicians and individuals within NHS Boards, the scope of cancer waiting times targets in Scotland was extended from 2010 as announced in Better Cancer Care: An Action Plan (2008). The views of clinicians were integral to this review – equally the comments from patients and the public influenced the new definitions as there was an extensive consultation process during implementation. A new 31-day target was introduced at this time. The 62-day target was changed to focus on those patients who were referred urgently with a suspicion of cancer – and those referred via national screening programmes.

The Cancer Waiting Times (CWT) Standards are applicable to adult (over 16 at date of diagnosis) NHSScotland patients with a newly diagnosed primary cancer against ten major cancer types.

Further information can be accessed via the ISD website https://isdscotland.scot.nhs.uk/Health-Topics/Waiting-Times/Cancer/Historical-Data/

There are currently no plans to restrict the use of mesh in hernia repair.

The Scottish Government has agreed to offer HIV Scotland £231,000 over the next three years. This funding will support the organisation to move to a sustainable financial position. The Scottish Government’s grant offer to HIV Scotland brings the total financial support for third sector organisations working in organisations working to address the issues associated with sexual health and blood borne viruses in Scotland to £2.13 million in the period 2018-21.

NHS Projections are published at national level, broken down by main staff group and NHS Board. No further breakdown of staff groups is available.

Over the next four years we are investing £35 million to recruit 800 additional mental health workers in key settings including A&Es, GP practices, every police station custody suite, and prisons.

The single most important driver of quality in a child’s Out of School Care experience is a dedicated, highly skilled, and well-qualified workforce. Initial and continued training enables managers and staff to fulfil their own potential, and support our children to do the same. Graduate level qualifications, collectively recognised through the Childhood Practice award and based on the benchmark Standard for Childhood Practice , are one of the first work-based awards in Scotland where entry is based on practice qualifications and experience gained in role. Revised in 2015, the award is offered through a variety of flexible options, and designed to be completed in post with support from employers to facilitate continued earning.

The recorded rise in Acute Kidney Injury has been the subject of a number of detailed audits at individual patient level across Health Boards in Scotland. The reason for the recorded rise is thought to be multi-factorial and the reasons include the following:

• Pre-operative factors such as medication and co-morbidities
• Changes in coding practice over the observed time period
• Lack of a common definition for what represents Renal Failure
• Changes to anaesthetic protocols
• Reduced administration of intravenous fluids in the perioperative period.
• Changes to antibiotic protocols to antibiotics that are potentially more toxic to the kidneys.
• An increased number of patients on drugs for hypertension and other conditions that have an effect on renal function (case complexity).
• Changes to the Urological management of benign prostatic hypertrophy in men (more drug treatment and less surgical treatment) which may result in increased rates of post-operative urinary retention.
• NHS patients whose surgery is undertaken in the private sector are not consistently recorded in the national dataset; they may represent the fitter patients for surgery.

The local audits also show that the deteriorations in renal function was small and rapidly corrected in the vast majority of cases. There is no requirement for renal replacement therapy. The length of stay in patients who developed acute kidney injury was increased, but there was no increase in 30 day mortality or readmissions. Also many patients were admitted on drugs –to treat other conditions – that are known to affect renal function as well as some patients who are already known to have chronic renal failure.

There are improvements that have been made in the peri-operative care of patients to minimise the risk of acute kidney injury. These include the management of neprotoxic drugs and fluid balance, early identification of urinary retention, flexibility in enhanced recovery protocols to allow for the multiply co-morbidity of at risk patients. The Orthopaedic and Anaesthetic Community with help from the Scottish Arthroplasty Projects continues to monitored this closely and ensure that good practice is shared nationally.

The Directors of Planning Thrombectomy Advisory Group are progressing development of a National Planning Framework for the provision of thrombectomy for stroke in Scotland. It is anticipated the framework will be completed by spring 2019.

The framework will be presented to the National Planning Board (NPB) and follow due process for the planning of NHS Scotland services.