NHS

NewsBulletin from inside the Health Directorates February 2010

MESSAGE FROM THE SECRETARY Inside this

issue:

Our NHS. Winter Performance

Making Quality Count. Tobacco Bill

Equally Well At the beginning of February, I visited Drumchapel Health Centre Taskforce where I learned how staff and patients have been working together and listening to each other in order to share responsibility for improving the Dignity at Work quality of healthcare services provided. This was the perfect setting to Nicola Sturgeon reaffirm the ambition of the Quality Strategy, which recognises that the MSP, Deputy First Anthrax Outbreak and Cabinet patients’ experience of the NHS is about more than speedy treatment – Secretary for Health & it is the quality of care they get that matters most to them. Wellbeing Medical Revalidation While developing the Quality Strategy, we have listened carefully to you as staff, patients, Roadshows carers and the people delivering the healthcare services across NHSScotland. You have told us that you want a compassionate health service; you want to see real partnership between clinicians, patients and others; you want services to be provided in a clean and safe care environment, with continuity right though their journey and of course you want to have confidence in the quality and effectiveness of any treatment.

The Quality Strategy can achieve all of these things and will give the people of Scotland a new confidence in their NHS. For the first time we are developing ways in which the quality of care provided by the NHS can be measured and the information used to drive up standards, and over the coming months all NHS Boards will be expected to identify steps they can take to improve the quality of care they give. Shona Robison MSP Minister for Public Health By identifying what already works, by finding new and innovative ways of improving and Sport healthcare, and by spreading these examples of good practice across NHSScotland we can improve the quality of care we give to everyone.

For patients, the Quality Strategy means that for the first time, their experience of care and the outcomes they report will be collected nationally and systematically and then used to improve the quality of care. Decisions about care will be shared decisions – taken in a relationship of equal partnership between the person and their clinical team

For staff, it will give a renewed focus on issues fundamental to the professional and clinical values you hold, such as clinical excellence, empathy and compassion.

We also need to make sure that all of us - from those working in Government, those providing healthcare services as part of or with NHSScotland, and every patient and carer in Scotland - understands the role we play in achieving the ambition of putting quality healthcare at the heart of our NHS and making quality count.

Page 1

Winter Performance

NHS Boards have been working closely with the Emergency Access Delivery Team in preparing for this winter and performance management information shows that the Boards have performed well, so far, in response to this year’s pressures. We have seen the most severe weather for 30 years, which resulted in a significant increase in A&E attendances due to falls and fractures and difficulties in staff travelling to work. During this period, there have been numerous examples of NHS staff going the extra mile to ensure that patient safety remained a priority and that vital services were maintained, particularly within NHS Borders and NHS Grampian which bore the brunt of the severe weather.

The Scottish Ambulance Service also performed well, despite the difficult conditions they were operating under and managed to maintain their emergency response service and patient transport services for high priority cases by working in partnership with NHS Boards and Third Sector organisations, such as the British Red Cross and St Andrews Ambulance Association.

This winter has demonstrated the importance of sharing performance information in helping to predict and plan for winter pressures, and in helping the Scottish Government and NHS Boards to respond effectively to pressures as they develop. Equally important, is keeping patients and the public up to date with information about services which are affected due to the winter pressures.

I would like to thank you all for your hard work and commitment in delivering services over this busy period.

Date for the Diary

Online registration for the event will open in April. For more information about this, the event and exhibiting, visit: www.nhsscotlandevent.com

Page 2

Organ Donation Teaching Pack for Children

On 12 January 2010, at Clydebank High School, I launched the updated version of the Organ Donation Teaching Resource Pack which has been issued to all Scottish secondary schools. The original pack, which was issued in 2003, has been widely used across a number of subjects and has been recognised as a highly valued teaching resource.

Since 2003, a number of significant developments have taken place, such as the introduction of the Human Tissue Scotland (2006) Act, and two reports published in 2008 by the UK Organ Donation Taskforce. The revised version reflects the work in implementing the 14 recommendations in the original Taskforce report, as well as the thinking on the relative merits of opting out contained in the second report.

Representatives from the NHS, and pupils and teachers in secondary education in Scotland, have worked with representatives from the Scottish Government Health Directorates to completely redesign the pack for ease of use by teachers, and it is in line with the Curriculum for Excellence approach of allowing teachers maximum flexibility in planning lessons. It is aimed at S2-S6 pupils and provides teachers with lesson plans and resources covering the science behind transplants and organ donation to give young people enough material to help them make informed, educated choices about the issue. It includes a short film with case studies of 3 families telling their organ donation stories and, in keeping with the pack’s use in schools, Example photography children feature prominently in these studies. from the Teaching Pack

The Warden family, with their son David who is a pupil at Clydebank High School, participated in the film, and were on hand at the launch. Their daughter Rachel donated her organs for transplant after she died of a brain haemorrhage aged 11. Aaron Gray, aged 13, who also features in the film, came along with his parents and his brother. Aaron received a small bowel and liver transplant when he was only three years old.

Clydebank High School pupils participated in a question and answer session on organ donation and had the opportunity to get “hands on” with a life size human torso complete with organs.

Page 3

Shona Robison Minister for Public Health & Sport

One Step Closer to Smoke-free Scotland

The Tobacco and Primary Medical Services (Scotland) Bill was passed by an overwhelming majority in the on 27 January this year. The Bill will see new measures being introduced over the next few years to reduce the attractiveness and availability of tobacco to children and young people. The Bill also ensures that all contractors for Primary Medical Services have a direct involvement in patient care, supporting our public health priorities and our aim of a mutual NHS.

Whilst there have been encouraging trends in recent times, smoking remains one of the principal preventable causes of illness and premature death in Scotland. This places a heavy burden on our health services.

The tobacco industry recruits 15,000 new smokers every year in Scotland. A young person who starts smoking at 15 is estimated to be three times more likely to die of cancer than someone who starts in their twenties. It is clear; we need to help today’s children not to become tomorrow’s smokers.

Scotland’s Future is Smoke-Free¸ our five year smoking prevention action plan, is the next step and this Bill is an integral part of the action plan. The Bill bans tobacco displays, the last remaining marketing tool of the tobacco industry, and tobacco vending machines. Children and young people under 18 will be held accountable for trying to buy tobacco as will adults trying to buy tobacco for under 18s. But we acknowledge that retailers also need to act more responsibly and have therefore introduced tougher sentences for those found to be breaking the law.

I acknowledge that to see our goal achieved, it will require further hard work on all of our parts. As we stand at the beginning of a new decade, let’s look to the future and strive together to make Scotland smoke free.

Page 4

Equally Well

Equally Well is the joint Scottish Government and COSLA approach to the reduction of health inequalities in Scotland. The plan includes action for all – across all portfolios in central government and across all community planning partners.

Our Ministerial Task Force reconvened on 12 January 2010 to start reviewing progress to date. This will allow us to update action needed to give impetus to the vision for tackling inequalities set out in Equally Well and the linked social policy frameworks on early years and tackling poverty. We aim to agree a report for publication in the summer.

The Task Force meeting was very positive and we are absolutely committed to this agenda. Financial pressure is, of course, a key factor for public services, but we agreed the need to maintain a focus on prevention activities and to promote an investment approach to the best use of public sector resources. Often the best chance of positive change can emerge in a time of challenge.

We have to look at what changes in public services 8 test sites working across can be achieved within existing resources, with a Scotland: view to reducing the key health inequalities in the • Glasgow City – longer term. This is what our Equally Well test sites health and the built are about. environment • SE Glasgow –

neighbourhood approach in The test sites will also provide evidence for future Govanhill • West Dunbartonshire – spending decisions, both nationally and locally, to tobacco use in Whitecrook redesign public services and shift the emphasis from • Lanarkshire – dealing with consequences of health inequalities to employability and health • East & Mid Lothian – preventing them in the first place. early years • Perth & Kinross – complex needs in Rattray The test sites are all addressing really complex • Fife – problems, but trying to keep their approach simple young people and alcohol in Templehall and experimental. The overall test site approach is • Dundee – about working in new ways across partners, mental wellbeing in challenging traditional models of working, where Stobswell area complex hierarchies may act as barriers.

Support for the test sites and the wider health inequalities learning network, is provided and resourced by the Scottish Government.

To find out more about the test sites visit: http://equallywell.ning.com and http://openscotland.gov.uk/Topics/Health/health/Inequalities/inequalitiestaskforce

Page 5

Personal Child Health Record (Red Book)

On 13 January, I was very pleased to launch the new Scottish National Personal Child Health Record (commonly referred to as ‘the Red Book’ due to the colour of its cover). For the first time, all NHS Boards in Scotland will now be issuing the same version of the Red Book which should encourage professionals to use it more, especially when families move from one area to another, as well as when a child is referred to tertiary services.

Parents/carers are encouraged to take the Red Book to every health appointment, and parents and professionals are also encouraged to make entries into the Red Book to ensure it becomes a complete record of a child’s health.

A Chief Executive Letter CEL 49 (2009) was issued on 14 December 2009, informing NHS Boards that the new Red Book should be used for all babies born on or after 1 January 2010 – this coincided with the introduction of the new WHO Growth Charts across Scotland which are contained within the Red Book.

The Red Book should be issued by the relevant health professional, e.g. Health Visitor/Public Health Nurse or midwife, on or around the 10th day after a baby’s birth. Guidance for health professionals on the use of the new Red Book was also issued.

The Red Book will only be available in English, as it is mainly completed by health professionals, but an accompanying letter, to be given to parents/carers as appropriate, has been translated into the standard Scottish Government languages of Urdu, Punjabi, Bengali, Arabic, Chinese/Cantonese, Hindi, Polish and Gaelic.

NHS Boards should continue to purchase Red Books from Harlow Printing.

The Red Book can be viewed at: http://shop.healthforallchildren.co.uk/pro.epl?SHOP=HFAC4&do=userpage&page=d ec09

The CEL, guidance and translations can be found at: www.sehd.scot.nhs.uk/details.asp?PublicationID=3132

Page 6

Kevin Woods Director General Health and Chief

Executive, NHSScotland

Scotland Performs

NHSScotland has become the first public body in Scotland to report its performance through the Scotland Performs website: the single gateway for reporting government performance in Scotland. The website measures and reports on progress towards the Government’s Purpose of creating a more successful country, with opportunities for all to flourish, through increasing sustainable economic growth and against its 15 long-term National Outcomes.

The Scottish Government’s move to focus on delivery of outcomes calls for open and accessible performance information by which progress can be monitored and people in Scotland can judge how government is performing for themselves. Since its launch, Scotland Performs has been established as a dependable and credible way to track progress through ‘real-time’ performance updates, improving accountability and, in the longer term, driving improvement.

Progress against the HEAT targets due for delivery in 2009/10 and 2010/11 is reported at both national and NHS Board level, with links provided for further information on related policy or statistics. These pages bring all the information together in one place, making it easier for the public to access information on NHSScotland performance. They will also be refreshed throughout the year following publication of updated statistics, ensuring that the most up-to-date information is always readily available.

At a national level, one of the strongest stories which Scotland Performs is telling is of the progress made towards the National Outcome ‘we live longer healthier lives’, where clear and incremental progress can be seen. Life expectancy and healthy life expectancy in Scotland are increasing and there have been reductions in premature mortality rates from Scotland’s “big 3” killer diseases: cancer, coronary heart disease and strokes. This progress will have a contributory effect on several other National Outcomes, for example ‘tackling the significant inequalities in Scottish society’, and on the ‘cohesion’ and ‘participation’ Purpose Targets.

See the Scotland Performs website for more information: www.scotland.gov.uk/About/scotPerforms

Key Health National Outcomes

• We have tackled the significant inequalities in Scottish society • Our children have the best start in life and are ready to succeed • We have improved the life chances for children, young people and families at risk • We live longer, healthier lives • Our public services are high quality, continually improving, efficient and responsive to local people's needs

Page 7

Dignity at Work Toolkit Launch

The NHSScotland Dignity at Work (DAW) Project, commissioned by the Scottish Government in late 2008, is an important piece of work which exists to promote a positive culture and behaviours in the workplace. It seeks to establish current activity being undertaken across NHSScotland and then to share best practice and promote the most effective methods of reinforcing positive behaviours.

Work by the DAW Project Group included an extensive literature review, analysis of the 2006 & 2008 staff survey results, structured interviews with nominated contacts in NHSScotland employers and partner organisations such as trade unions and professional bodies. A number of focus groups and open events to explore Dignity at Work issues, such as bullying and harassment, were held with a range of staff from organisations across Scotland.

The project group was responsible for producing a practical toolkit to further Dignity at Work. NHSScotland employers will receive a Dignity Toolkit this month (February) and will be able to use the resources provided in a flexible way to support the staff governance action plans.

For further information please visit: www.staffgovernance.scot.nhs.uk or contact [email protected]

eHealth Helping the Armed Forces

The eHealth Strategy Board has approved recommendations on how eHealth can help improve healthcare for the Armed Forces in Scotland. A scoping project was undertaken by the eHealth Strategy Division over 2009 which included meetings and workshops with members of the Armed Forces. Findings included:

• The need for Armed Forces to have access to electronic pathology laboratory results. • The need to create CHI numbers for non Scottish Armed Forces personnel based in Scotland. • The need to proactively help those leaving the Armed Forces to register with a Scottish GP. • The need to flag veteran status on NHS IT national systems.

To address these issues a detailed action plan will be developed to implement the following recommendations:

• All serving Armed Forces personnel, based in Scotland, should be provided with a CHI number. • The Defence Medical Service Primary Care Medical Centres should include the CHI number in all communications with NHSScotland. This universal provision of CHI numbers will in turn enable the Defence Medical Service Primary Care Medical Centres in Scotland to access SCI Store (Scottish Care Information) for electronic lab results and use the electronic referral process. • Make changes to the MODs current pre-retirement processes, to assist in finding a GP Practice within the area that personnel, leaving the armed forces, plan to live. • Develop a tick box on SCI Gateway for veteran status and provide advice to all Scottish health boards about records flagging.

For further information please contact: karen.o’[email protected]

Page 8

Harry Burns

Chief Medical Officer

Anthrax Outbreak in Drug Users in Scotland

An outbreak of anthrax infection among heroin taking drug users has occurred in Scotland over the last month. Initially, an Outbreak Control Team (OCT) based in Glasgow managed the outbreak with support from local microbiologists, Strathclyde Police, Health Protection Scotland, and the HPA SPRU (Special Pathogens Reference Unit) (Porton Down). Over the following weeks, further suspected cases were reported and investigated in other Scottish NHS Board areas. As a result, the outbreak investigation is now managed by a National Outbreak Control Team, coordinated by Health Protection Scotland. The team includes representatives of Scottish Drugs Forum and National Forum on Drug Related Deaths. Further investigations are underway to try to trace the supply network.

Information was released advising the drug using community of the additional risk associated with taking heroin and that they should seek urgent medical advice if they developed an infection. Subsequently specific information leaflets and posters have been developed in collaboration with the Scottish Drugs Forum. Due to the potential risk of inhalational anthrax from smoking (or snorting) heroin, and the potential risk from injecting anthrax spores, addiction services and pharmacies were alerted to the fact that no ’safe’ route of administration of heroin could be advocated.

The key harm reduction advice message is of avoiding the use of heroin if possible and seeking alternatives via drug treatment services, highlighting awareness of the symptoms and signs of infection. General practitioners, hospital departments, and microbiology departments have also been alerted. A letter was issued on 11 January and cascaded across all NHS Boards in Scotland, to health and other professionals, and to specialist community addiction services.

On 13 January, the OCT was informed of a confirmed death from anthrax of a drug user in Germany (which occurred in December) although no direct links with any Scottish case has been made so far. We have no confirmed explanation for the outbreak as yet and the source of the contamination has not been identified despite ongoing investigations.

As of 29 January 2010, a total of 18 confirmed cases of anthrax infection in Scotland had undergone treatment of whom nine have died. All cases reported a history of taking heroin by intramuscular, intravenous or subcutaneous injection and/or by other routes including smoking or snorting.

The National Outbreak Control Team continues to liaise closely with colleagues in other parts of the UK, the European Union, and with experts from the Centre for Disease Control in Atlanta, which has considerable experience in dealing with anthrax.

For more information on the outbreak, the Health Protection Scotland microsite on its website carries daily updates and will issue press releases to report on any significant developments.

Visit: www.hps.scot.nhs.uk/anthrax/index.aspx

Page 9

Ros Moore Chief Nursing Officer

Medical Revalidation Roadshows

From 16 November 2009 any doctor who wants to practise medicine in the UK will not only have to be registered with the General Medical Council (GMC), but will also have to hold a licence to practise. Some 18,870 doctors in Scotland are now registered with a licence.

All the professional activities that were previously restricted by law to doctors who were registered with the GMC are now restricted to doctors who are registered and hold a licence. These activities include, but are not limited to, prescribing, signing death and cremation certificates, and holding certain medical posts in the NHS and the independent sector. All doctors who hold a licence to practise will be required to participate in revalidation.

Revalidation is the process by which doctors will have to demonstrate to the GMC, normally every five years, that they are up to date and fit to practise and complying with the relevant professional standards.

The Scottish Government Health Directorates are planning to hold three regional roadshows regarding Medical Revalidation during March 2010. These roadshows are to be held in Aberdeen on 4 March 2010, Glasgow on 18 March 2010 and Edinburgh on 25 March 2010. The roadshows are aimed at doctors and their employers who have not yet had the opportunity to engage directly with the GMC or the Scottish Government on the reforms to the regulation of doctors. Presentations are to include talks from the GMC, Scottish Government Health Directorates and others.

The roadshows will also provide the opportunity to introduce Mr Ian Finlay, Consultant Surgeon and Clinical Director in NHS Greater Glasgow & Clyde, who, from February 2010, takes over responsibility for supporting the medical revalidation agenda in Scotland on behalf of the Scottish Government.

For further information on any of the events visit: www.shsceventsbookings.co.uk

Page 10

Jacqui Lunday

Chief Health Professions Officer

Update from the Health Professions Office

Allied Health Professionals in Mental Health

The allied health professionals in mental health (arts therapies, dietitians, occupational therapy, physiotherapy and speech and language therapy) are in the process of writing a three year action plan outlining their contribution to support Delivering for Mental Health (2006) and its later refresh.

The action plan is being written by allied health professions in collaboration with carers and service users in Scotland. The plan will focus on their role in self management, psychological therapies, physical health and wellbeing, and vocational rehabilitation. The action plan will be launched by the Scottish Government at the first National AHP conference in Mental Health in Scotland on the 24 March 2010.

For further information, contact Elaine Hunter: [email protected]

Draft Guidance on Partnership Working Between Allied Health Professions and Education

In the December issue of NHS Bulletin, I announced the publication of a consultation on national guidance on allied health professionals and education working practice. This draft guidance has been written to help school staff and allied health professionals to work more effectively as partners in supporting children and young people, and was developed following extensive engagement with stakeholders.

The consultation is now closed and I would like to thank everyone who contributed. This feedback together with views expressed at a number of focus groups held over the same period, will be collated to inform the final development of the guidance.

An accompanying website will be developed to illustrate exemplars of good practice in partnership working between AHPs and education with final publication and launch of the guidance in June 2010.

For further information, contact Nicola Robinson: [email protected]

Modernising Scientific Careers

Modernising Scientific Careers: The UK Way Forward is a UK initiative which has been developed in partnership with the four UK countries. I have contributed significantly to the development of these proposals to ensure they align with Scotland's action plan for Healthcare Science, Safe, Accurate and Effective. The Policy Document will be published in the near future.

For further information, contact me at: [email protected]

Page 11

Professor Sir John Savill

Chief Scientist

Investing in Research/Improving Health

In December the Cabinet Secretary launched the Scottish Government’s new strategy for health and healthcare - Investing in Research / Improving Health. The strategy sets out the support and direction for health research over the next five years and will be implemented by the Chief Scientist Office. The Office was established in 1973 with its main mission to identify, encourage, promote and support research for the benefit of NHSScotland; a responsibility that has stood the test of time and remains key to the new strategy.

In Scotland, our clinical and healthcare researchers have achieved international recognition for the excellence of their science. Investing in Research / Improving Health sets out the aims and ambitions we have to sustain and build upon current success. Indeed it is only by continuing to invest in our outstanding research talent that we can generate the sound evidence and exciting innovations upon which improvements to healthcare are based.

It is against that background that Investing in Research / Improving Health sets an ambitious vision to place Scotland at the international forefront of clinical translational research and the development of systems medicine. Its four broad aims are: securing benefits to patients and the population at large; improving population health; valuing and investing in NHS research to ensure that the NHS provides high quality efficient structures to support clinical research; and building and sustaining skills.

The new strategy will also help to drive economic development by fostering Scotland’s efforts to develop a world-leading biomedical R&D cluster comprising the NHS, universities and industry. Central to these developments is the unstinting support shown for clinical research by patients and the public in Scotland, for which we should all be very grateful.

The strategy can be downloaded from: www.cso.scot.nhs.uk/Publications/research.pdf

Page 12