Chamber and committees

The Scottish Government is not aware of data that suggests doctors are retiring before reaching the state pension age due to overwork.

However we know that Annual and Lifetime Allowances, and particularly the Annual Allowance taper, are a serious issue for affected NHS senior clinicians and are impacting on service delivery across NHS Scotland. From 1 December 2019, an interim policy will give eligible NHS staff who opt out of the pensions scheme the option to get their employer pension contributions paid to them as part of their basic pay. This new temporary policy will provide eligible staff with an alternative option to restricting their hours in order to reduce financial penalties and will ensure crucial services are maintained as demand on the health service continues to increase. It will run until the end of the current financial year 31 March 2020.

We welcome the UK Government's commitment to review the operation of the tapered Annual Allowance across the public service, and urge HM Treasury to proceed urgently on this review.

We are aware of the pressures that doctors face with an increase in demand on health and social care, and the impact this can have on those delivering frontline services.

The new GP contract will ensure GPs can spend more time with patients and less time on bureaucracy. It will help cut doctors’ workload and make general practice an even more attractive career choice for young doctors.

The Scottish Government's priority is the wider development of the multi-disciplinary team to free up GPs' workload. This is being carried out over a 3 year transitional period from 2018-21.

Our commitment is to increasing the number of GPs by at least 800 over ten years to ensure a sustainable service that meets increasing demand on our services.

The Scottish Government advocates the use of the Scottish Therapeutics Utility to assist clinicians with identification of possibly non-adherent patients in order to prioritise them for a medication review. At review, clinicians are strongly advised to discuss medication options with patients as part of an honest and holistic conversation, and talking about medication adherence is an important element of this.

We will shortly be publishing Scotland’s first National Action Plan on Neurological Conditions; through this we will work with others to make information on neurological conditions more readily available and improve access to resources that promote self-management.

Scottish universities have sole responsibility over the courses they make available and the admissions process and criteria applied to them. However, the latest UCAS statistics which show the overall UK Higher Education Institutions application and acceptance rates and placed applicant numbers for general engineering in 2018 were;

Each institution is allocated a number of full time equivalent funded placements and it is for the universities themselves to decide; how to distribute the places between faculties, the courses they offer, how many of the total funded places they make available and the admissions criteria for each course. This includes the credits attributed to both Scottish and UK wide qualifications.

The University of Strathclyde have outlined their entry requirements for the engineering faculty within their 2020-21 prospectus. As an autonomous institution, this is a matter for the University of Strathclyde to answer directly.

Vaccination policy in Scotland, as with the rest of the UK, is based on recommendations from the Joint Committee on Vaccination and Immunisation (JCVI). The JCVI is an independent, expert group which considers a full range of available evidence before providing advice on all aspects of vaccination.

In line with the Committee’s recommendation, this year, individuals aged 65 years and over will receive either the adjuvanted Trivalent Inactivated Vaccine (aTIV) (Fluad ®) or the cell based Quadrivalent Inactivated Vaccine (QIVc) (Flucelvax Tetra®). The aTIV vaccine contains an adjuvant and protects against three strains. The QIVc vaccine protects against four strains without an adjuvant. On the basis of the available evidence on vaccine effectiveness the JCVI considers both these vaccines to be equally effective in those aged 65 and over. In line with this, Health Protection Scotland worked with Immunisation Coordinators within each of the NHS Boards on the distribution of both flu vaccines.

The incidence for cancer of the oral cavity by NHS board over the previous five years is shown in the following table.

Table 1. Caner of the Oral Cavity – Number of Registrations

Survival data from ISD (2007-2011) show the 5 year survival for Oral Cavity cancers is 57.2%.

To ensure progress is made the Scottish Government launched £42 million Detect Cancer Early Programme demonstrating commitment to early detection. The ‘Survivors’ campaign was on air in September which aims to reduce fear of cancer, which we know remains a key barrier to people presenting early and encourage those with any unusual or persistent changes to their body to visit their GP practice.

To support earliest referral the Scottish Referral Guidelines for Suspected Cancer were clinically reviewed and published on 22 January 2019. Specifically to support dissemination and use of the guidelines education events have taken place across NHS Scotland and officials are in discussion with NHS National Education Scotland to develop further online learning resources to ensure that the guidelines are being utilised consistently.

We also published the Oral Health Improvement Plan in January 2018, an ambitious programme of work, which sets the direction of travel for NHS dentistry for the next generation of patients. The focus of the Plan is to introduce a more preventive-based system of oral health care, including an Oral Health Assessment (OHA) for adult patients. Patients will receive tailored advice on how to manage and look after their oral health, including lifestyle factors such as drinking and smoking, which are clear risk factors associated with oral cancer.

The Oral Health Improvement Plan identified a range of actions, some of which have been completed. The current programme of work comprises two key highlights.

The introduction of new arrangements for dentists to provide enhanced domiciliary care in care homes. A second cohort of dentists are currently in training and the intention is for further cohorts to be rolled out next calendar year.

We have also launched an Oral Health Community Challenge Fund for Third Sector organisations to work with families living in areas of multiple deprivation to design and lead oral health improvement initiatives. The Fund comprises 22 projects throughout Scotland running from 1 July 2019 to 31 March 2022.

a) Shona Robison, the former Cabinet Secretary for Health and Sport, met with the Caithness Health Action Team (CHAT) on 7 February last year to discuss health services in Caithness, and the Chief Medical Officer also visited Caithness to discuss the issues they raised. I am pleased to note that CHAT continues to engage with NHS Highland and will of course consider any request for a meeting with health services user representatives.

b) It is vital that all pregnant women in Scotland receive safe, high quality service and care. The decision to change the status of the Caithness Maternity Unit from an obstetric unit to a midwife-led unit was made on the basis of safety following a report conducted by Hugo Van Woerden, Director of Public Health at NHS Highland, available via the following link: https://www.nhshighland.scot.nhs.uk/News/PublicConsultation
/CaithnessRedesign/Documents/Caithness%20Report.pdf .

There are a range of reasons why patients may be inappropriately admitted to hospital. This can include admissions due to a lack of suitable community support to keep an older, vulnerable patient safe in their own home. Delays in hospital discharge, and the assessment of long-term care needs within an acute ward are also an inappropriate use of hospital services, and a poor outcome for the individuals concerned.

The Day of Care Survey is carried out twice yearly and identifies the number of patients who do not meet criteria for continuing care in an acute or community bed. The last survey in May 2019 identified 21% patients in an acute bed and 39% in a community bed could be cared for in an alternative setting or discharged home.