Chamber and committees

Thank you for submitting the series of parliamentary questions in relation to NHS Forth Valley, with a specific focus on the External Review around Culture in the Emergency Department, Forth Valley Royal Hospital. I have responded to each of the questions in this one response.

Firstly, you asked about the number of people that were directed away from the A&E department at Forth Valley Royal Hospital without a correct clinical assessment during 2020 and from 1 January to 30 June 2021, we do not collate that level of data therefore I am unable to provide a response on this.

Regarding the findings of the External Review around Culture in the Emergency Department, this was an independent report commissioned by NHS Forth Valley and we are pleased that the Board took swift action after serious allegations were made by staff representatives.

The Scottish Government has noted the findings of the independent review and welcome that the Board has accepted the recommendations. We meet regularly with all Boards, including Forth Valley, and we will support the Board in taking forward these recommendations, seeking assurance that these are fully implemented.

We are also committed to supporting staff within the Board. All staff in our NHS must have the confidence to raise any concerns they have about patient care and not suffer any repercussions for doing so. The NHS Scotland Whistleblowing Policy requires boards to have an impartial, confidential contact that all staff can access to raise concerns should they feel that they cannot raise these concerns with their line manager or senior management.

In addition the confidential, Independent National Whistleblowing Officer (INWO) advice line provides information, support and signposting for those raising whistleblowing concerns, including former staff - the number of this service is 0800 008 6112. The INWO, which came into force in April 2021 and is the first of its kind in the UK, provides a mechanism for external review of how a Health Board, primary care or independent provider has handled a whistleblowing case.

Furthermore, staff working in health and social care can access support services available through the national wellbeing hub this can be accessed via www.promis.scot or by calling 0800 111 419. Both the INWO and wellbeing hub are available to current and former members of staff.

You have raised a number of issues including communication with patients in case of any subsequent legal or civil action. The decision on whether or not an action for damages is time-barred is a matter for the courts to determine. If there is any doubt as to when the limitation period should start to run, a court could hear arguments about when the pursuer became aware of his or her entitlement to pursue a claim, as part of the court’s application of the date of knowledge test.

The Scottish government and NHS Scotland have a shared vision for an open and learning culture and we want to learn when there has been dissatisfaction or harm and encourage organisations to identify improvements. Safety is at the heart of everything we do in NHS Scotland and it is vital to building a culture, which allows all frontline professionals time and safe spaces to learn, without fear of censure.

As part of our commitment to transparency, improving standards and learning lessons when something goes wrong, we have introduced a Statutory Organisational Duty of Candour. This makes it a legal requirement for all care providers, including Health Boards, to review certain types of adverse events, meet personally with those affected, and to publish an annual report to support openness and learning.

Part of that includes an organisational emphasis on staff support and training to ensure effective implementation of the organisational duty of candour. Staff must feel that they have the necessary skills and confidence if they are to be meaningfully involved in the delivery of the procedure and they are supported after an incident occurs. Being candid promotes accountability for safer systems, better engages staff in improvement efforts, and engenders greater trust in patients and service users.

The Scottish Government is clear that there should be robust site management in place across NHS Boards at all times, including access to senior decision makers, with operational overview of all emergency activity. Through our unscheduled care programme we continue to work closely with Boards, including NHS Forth Valley, with a specific focus on supporting the implementation of a series of improvements, including the workforce model in emergency departments, for example staffing levels, systems and processes as well as a nursing workforce review.

In terms of redirection, the Scottish Government policy is that patients may be referred to another service or provided with self-care advice once assessed by an appropriate clinician and deemed not to require emergency care. We are aware that during peak times of the pandemic some Boards had to take necessary measures to keep patients and staff safe by redirecting people following triage at the front door. We would expect any Board utilising this approach do so based on risk assessment.

During the summer months NHS Forth Valley, supported by the national programme for unscheduled care, have been working to explore the option of a care navigation area at the front-door to safely direct people to the onsite Minor Injury Unit and Urgent Care Centre if these areas are appropriately medically staffed.

In addition, the Scottish Government unscheduled care programme commissioned a Short Life Working Group, with representation including clinicians and managerial staff, during this year to review existing Redirection and Signposting Guidance to support Boards to implement best practice and ensure a consistent, coherent and safe approach to the right care in the right place. A key aim is to ensure people can be seen at services which better meet their healthcare requirements avoiding unnecessary exposure to a hospital environment. This will be published in September.