Chamber and committees

Clinical Nurse Specialist (CNS) data has been published on the ISD website available here: https://www.isdscotland.org/Health-Topics/Workforce/Publications/2018-12-04/Clinical_Nurse_Specialists_S2018.xls .

Due to data quality concerns, the following nine NHS Boards (NHS Ayrshire & Arran, NHS Borders, NHS Fife, NHS Greater Glasgow & Clyde, NHS Highland, NHS Lanarkshire, NHS Lothian, NHS Tayside and State Hospital) have indicated their data for September 2018 is not fit for release and so it is omitted from published data.

The CNS specialty categories used nationally were historically agreed by the Scottish Government and NHS Boards. At present there is no specific category for Paediatric Cardiology. Please note that the CNS definition, role and specialty categories are currently under review to improve future workforce planning. ISD will continue to work with Scottish Government and NHS Boards to ensure improved recording going forward.

Further notes:

Further information on the statistics, including information on how the data are collected and notes to aid interpretation, is given in the 'FAQs' section of the Workforce Statistics website at http://www.isdscotland.org/workforce/

The aim of Health and Care (Staffing) Bill is to provide a statutory basis for the provision of appropriate staffing in health and care service settings, enabling safe and high quality care and improved outcomes for service users. The Bill requires Health Boards to follow a common staffing method when determining staffing in specified health care settings, this includes the use of staffing level and professional judgement tools and takes into account local context and clinical advice to identify the workload required to meet the needs of patients. The Bill will also require Boards to have real-time staffing assessment and risk escalation processes in place. The sum effect of these provisions is that the Health Boards will generate evidence of workload, staffing decisions and risk mitigation which will be available, alongside information on quality of care, to HIS when an inspection is carried out.

Health Improvement Scotland (HIS) have asked NHS Grampian to submit an updated action plan by the 10th April as per the HIS process. They will then review what progress has been made in addressing the issues identified and determine what future actions will be taken, including the need to do a follow up inspection.

The paediatric cardiac nurse in NHS Grampian currently has a caseload of 180 patients and has made contact with more than 350 patients since taking up post. Each patient has a variety of clinical needs and therefore in some instances no more than one contact is required.

Paediatric cardiac surgery is a highly specialised service and NHS Grampian patients, along with those from across Scotland, are referred to the National Paediatric Cardiac Service based at the Royal Hospital for Children in Glasgow. In addition, Scottish patients are treated at the cardiology centre at the Royal Hospital for Sick Children in Edinburgh. Therefore the required infrastructure to support paediatric cardiac patients is concentrated at these two specialist centres.

Outreach services are provided by cardiologists from Glasgow and Edinburgh to NHS Boards, including NHS Grampian. NHS Grampian patients requiring paediatric cardiology services are also seen in Aberdeen by a paediatric cardiologist from Edinburgh and supported by two general paediatricians with a special interest in cardiology.

NHS Grampian is currently developing a business case which if approved will ensure paediatric cardiac nurse support to the children of the Grampian region.

One of the key priorities for the Scottish Government is that all NHS Health Boards across Scotland must sustainably deliver against the emergency access standard. This means 95% of all patients attending accident and emergency should be seen, treated, admitted or discharged within four hours.

During the week ending 10 February 2019 NHS Grampian reported a weekly average performance of 86.9% as you have highlighted. In the most recent published week (week ending 24 February) performance in NHS Grampian remains similar. We recognise this falls short of the 95% target and are working closely with the health board to support sustainable improvements.

The winter period puts additional pressure on all NHS staff, the hospital system and is a particularly demanding time for Health Boards across Scotland therefore we can expect some variability in performance. Nationally the level of attendances in corresponding week were almost 11% higher when compared to the average of the equivalent weeks over the last three years; NHS Grampian experienced a 18.7% increase in attendances and 8.0% in the latest published week.

The most recently published monthly figures for January 2019 for NHS Grampian, published on 5 March 2019 do show that NHS Grampians core performance was 90.4% and 92.7% for the year to January 2019.

We are determined no-one should wait longer than necessary, and we are working closely with hospitals who need it to help deliver improved performance. The Scottish Government is working with hospitals across Scotland to deliver enhance working practices to ensure optimal care through the six essential actions improvement programme.

As specialist cardiac services are based in central Scotland, NHS Grampian have advised that before the existing cardiac paediatric nurse was appointed there was limited local infrastructure and expertise to support a locally based cardiac paediatric nurse.

NHS Grampian is currently developing a business case, which if approved, will ensure that children with cardiac care needs in NHS Grampian receive the necessary care and support of a community paediatric cardiac nurse.

In response to a Press and Journal article of 21 February 2019 regarding the Older People in Acute Hospitals inspection report at Aberdeen Royal Infirmary, a Scottish Government spokesperson said: We welcome the positive progress NHS Grampian has demonstrated in this area. It is vitally important that our elderly and most vulnerable patients receive the best care available .

These inspections, together with the staffing legislation we will introduce, aim to directly support and continue to improve the treatment of older people in our services. The national standards describe what NHS Boards should do to ensure care is person-centred, safe and effective.

We are investing in the development of a care improvement and assurance, framework, Excellence in Care, to support nurses to understand the quality of care they are providing and to take any necessary action to ensure patient care is of the highest standard.”

Healthcare Improvement Scotland (HIS), on behalf of the Scottish Government, carry out a programme of unannounced inspections. They measure NHS boards against a range of standards, best practice statements and other national documents relevant to the care of older people in acute hospitals, including the Care of Older People in Hospital Standards. One of the areas assessed is screening and initial assessment.

As a result of the inspection at Aberdeen Royal Infirmary, HIS received an improvement action plan from NHS Grampian which is In line with HIS processes. HIS will check progress against the plan after 16 weeks and will continue to monitor action with the board, and if required, carry out a follow up inspection.

The exact information requested is not centrally available.

Information on the headcount and whole time equivalent of nursing and midwifery staff by specialty, including paediatrics, broken down by NHS Board can be found on the workforce statistics site at: https://www.isdscotland.org/health-topics/Workforce/publications/2018-12-04/Nursing-and-Midwifery.asp

Information about clinical nurse specialists is incomplete and only available for Paediatric and Cardiology but not both combined. A breakdown by NHS Board can be found on the workforce statistics site at: https://www.isdscotland.org/Health-Topics/Workforce/Publications/2018-12-04/Clinical_Nurse_Specialists_S2018.xls

The Scottish Government is committed to tackling the gender gap in enterprise through supporting the Scottish Framework and Action Plan for Women in Enterprise, and welcomes FSB Scotland’s contribution to the literature on the role of women-led businesses in the economy.

The Scottish Government itself does not hold official estimates for business Gross Value Added broken down by the gender of the business owner or management team. The source for official estimates of business employment and economic indicators is the Inter-Departmental Business Register (IDBR), which is maintained by the office for National Statistics and is an administrative database of all Value Added Tax and Pay As You Earn registered businesses. The IDBR does not include information on the characteristics of business owners, as this information is not collected via tax returns.