A Scottish Parliament report published today raises concerns that “fundamental weaknesses in NHS management” may be influencing decisions on spending, budgeting and staff resources.

The Parliament’s Health and Sport Committee has completed its review of NHS board revenue allocations for 2010-11 and has raised questions over how budgets have been managed.

Read the Committee’s report

Committee Convener Christine Grahame MSP said: “More staff have seemingly been appointed without any comparable rise in productivity because of the way budgets have been managed in the past. This raises a number of questions, including what criteria are being used to approve new spending and what standard of evidence is expected to support a spending plan.

“The committee is concerned that mechanisms in place for holding NHS boards to account don’t adequately address efficiency within the service. We’re also concerned that reductions in budget growth, against a background of continuing rises in demand and inflationary pressures, will place the NHS under great strain.”

Other key findings of the report include:

• The need for NHS boards to inform and involve local stakeholders in increasingly contentious decisions about where savings can be achieved based on evidence they have gathered.

• A call for reassurance from NHS boards that savings can be made without damaging the quality of service.

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Exclusive: Kate Foster

30 May 2010

Patients will be assessed by nurses instead of consultants and spend less time in hospital under controversial cutbacks to meet waiting time targets in Scotland.

Many follow-up appointments will be scrapped altogether and patients could be discharged from hospital at weekends under the scheme.

The groundbreaking plans to “streamline” the NHS have been revealed as hospital managers prepare to meet an ambitious target that no patient should wait longer than 18 weeks from a GP referral to the date of their operation.

The move will allow thousands to be treated faster but last night doctors and politicians raised fears it could compromise patient care.

The sweeping changes have emerged in official advice to NHS managers from the Scottish Government’s 18-week Referral to Treatment Time Programme, staffed by doctors and health officials.

Key changes proposed by the experts, revealed in a briefing to health boards, include using specialist nurses and health professionals such as physiotherapists to “reduce consultant appointments” by assessing whether the patient needs a specialist or just requires advice.

Nurses will also be trained to carry out some follow-up appointments and many outpatients will be seen at weekends.

The advice also states day surgery should be “the norm” rather than traditional overnight stays and patients discharged “as soon as they are ready”, including weekends which previously hospitals have avoided due to scarce community services. Health boards are also told to eliminate unnecessary follow-up appointments by scrapping them or replacing them with phone calls.

The move applies across all specialties for non-urgent patients as part of a £230 million three-year scheme to improve NHS infrastructure.

Managers must consider making the changes to free up consultant appointments and hospital beds.

Follow the link to read more about plans to replace consultants with nurses in  NHS Scotland

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Helen Puttick, Health Correspondent

Published on 18 Mar 2010

Scottish doctors have published a damning critique of a report which claimed Scotland had the most expensive but poorest health service in the UK.

The British Medical Association (BMA) Scotland said the study by the Nuffield Trust did not make meaningful comparisons between the health services in Scotland, Wales, England and Northern Ireland. They asserted that the trust’s report focused on healthy policy priorities that exist in England, rather than considering the different aims of the devolved nations.

According to BMA Scotland, while the report attacked the devolved nations for failing to improve waiting times, data show the median wait for treatment for cataract surgery, bypass surgery, hip replacement, knee replacement and some heart procedures was lower in one or more of the devolved countries than in England. It also said the work of GPs was ignored and surgeries in the devolved countries had achieved higher scores than England in the GP performance-related pay scheme.

Click the link to read about BMA Scotland healthcare critique

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The study, which targeted nurses, nursing managers and chief nursing officers (CNO) across the U.S., was conducted in partnership with StatCom and Travel Nurse Solutions.  It was based upon an online survey of 2,439 nurses, and focuses on the 1,663 who work in hospital settings.

Nurses reported having to document patient care information in multiple locations, in addition to having to complete logs, checklists and other redundant paperwork that prevented them from having more time with their patients.  Beyond these paperwork redundancies, nurses reported significant time being wasted trying to secure needed equipment and supplies.

When asked for solutions to these challenges, nurses recommended a combination of ancillary staff support, hospital-wide communications technology and reductions in redundant regulatory requirements.

According to Jackson Healthcare Chief Marketing Officer, Bob Schlotman, the results reveal a concerning trend.  ”Nurses are being taken away from the patient’s bedside by non-patient activities.  Unfortunately, due to the regulatory nature of healthcare, we know that some of these redundancies won’t go away.  However, the good news is methodology, in the form of process improvements, and adaptive technology now exists to help minimize and manage these frustrations for our nurses.”

The survey found several significant differences between front line nurses and CNOs.  CNOs were more concerned with the coordination of patient care, whereas nurses felt overworked and in need of additional staff support.

The survey summary data is available at Jackson Healthcare.

SURVEY METHODOLOGY-Between October 22 and November 30, 2009, Jackson Healthcare conducted a web-based survey of 2,439 nurses.  Results reported in this press release focused on the 1,663 of those nurse respondents who work in hospital settings.  Jackson had a response rate of 4.45 percent from the 54,764 invitations distributed.  The survey has an error range of +/- 1.29 percent, at the 95 percent confidence level.

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herardscotland staff

Published on 23 Feb 2010

The number of patients waiting in Scottish hospitals beyond the end of treatment has increased in the past year.

There were 606 delayed discharges in January, an increase from 492 in the same month last year, according to NHS statisticians at ISD Scotland.

Of those, 83 patients waited more than six weeks to leave, up from 79 in January 2009.

The problem arises when patients have to wait for necessary care, support and accommodation arrangements to be put in place.

Although up over the past year, the recent figures showed a fall from a peak in October.

Click link to read more about delayed discharges

Read ISD’s latest update about delayed discharges

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Brian Currie and Helen Puttick

Published on 20 Jan 2010

A damning report today says Scotland has the worst-performing health service in the UK despite being better funded than England, Wales and Northern Ireland.

It finds that while Scotland has the highest levels of poor health, the country has more hospital doctors, GPs, and nurses per head of population, but productivity is the worst and inpatient admissions are the lowest.

Today’s report by the Nuffield Trust is the first to compare Scotland’s health record since devolution with regions of England, as well as the four nations as a whole. Even areas with a similar socio-economic profile to Scotland appear to do more with less money.

In 2006, Scotland spent 6% more than the north-east of England but treated fewer patients in hospital, according to the report, which says staff in the north-east had “far higher levels of crude productivity”.

The authors question whether, instead of addressing entrenched health problems, the extra money spent in Scotland allows health service staff to do less work.

The study, using figures from 2006/07, tracked performance against expenditure, staffing levels, outpatient appointments, inpatient admissions and day cases, waiting times and staff productivity.

It found that less money was spent in England, it had fewer doctors, ­nurses and managers per head of population than the devolved countries but was making better use of resources.

Trust director Dr Jennifer Dixon said: “A key question for the NHS in all four countries, especially in the current economic climate, must be whether or not value for money is being obtained.”

The report said that health services across the UK had enjoyed “massive increases in funding” since devolution but Scotland “appears to perform less well than anywhere else on almost every measure examined”.

Read the rest of this Scottish healthcare article here

The Main findings from the Nuffield Trust are below

The main findings are:

• Historically Scotland, Wales and Northern Ireland have had higher levels of funding per capita for NHS care than England. However, the research suggests the NHS in England spends less and has fewer doctors, nurses and managers per head of population than the health services in the devolved countries, but that it is making better use of the resources it has in terms of delivering higher levels of activity, crude productivity of its staff and lower waiting times.
• Scotland has the highest levels of poor health, the highest rates of expenditure, the highest rates of hospital doctors, GPs and nurses per capita, and yet it has the lowest rates of crude productivity of its staff and the lowest rates of inpatient admissions per head of population in 2006/7.
• In 2006, Wales had the lowest rate of day cases but the highest rate of outpatient attendances, while Northern Ireland had the lowest rate of outpatient attendances but the highest rate of inpatient admissions and day cases.
• The performance of Wales and Northern Ireland in key measures of waiting has been poor compared with England (Scotland’s waiting times could not be compared with those of England, Wales and Northern Ireland at the three time points because they were measured in a different way). By 2006, virtually no patients in England waited more than three months for an outpatient appointment, whereas in Wales and Northern Ireland 44 per cent and 61 per cent of patients did. By 2006, virtually all patients in England who needed inpatient or day case treatment were seen within six months, while in Wales and Northern Ireland 79 per cent and 84 per cent of patients waited longer than this.

Read the full report from the Nuffield Trust

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“This culture of excess must change and will change.”

He added that the government would use technological advances to make services more user-friendly and cheaper.

As an example, sending text messages to remind patients about GP appointments could help save up to £600m a year wasted on missed visits.

Read this report noticing the part healthcare technology can play here

Two companies offering solutions for this are Felltech and their Outbox SMS and iPlato with their GP messaging service

The technology is there and ready it is just down to the NHS to implement it.

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Local Delivery Plans set out a delivery agreement between the Scottish Government Health Department and each NHS Board, based on the key Ministerial targets. Local Delivery Plans reflect the HEAT Core Set – the key objectives, targets and measures that reflect Ministers’ priorities for the Health portfolio. The key objectives are as follows:

* Health Improvement for the people of Scotland – improving life expectancy and healthy life expectancy;
* Efficiency and Governance Improvements – continually improve the efficiency and effectiveness of the NHS;
* Access to Services – recognising patients’ need for quicker and easier use of NHS services; and
* Treatment Appropriate to Individuals – ensure patients receive high quality services that meet their needs.

Statistics that inform progress against the suite of HEAT targets are reported publicly throughout the year. Performance against all the HEAT targets are brought together in NHSScotland Chief Executive’s Annual Reports.

More information on the HEAT Targets

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By Lucy Adams

Published on 18 Oct 2009

Older people will use care homes only for specialist services and respite and will instead be supported by technology at home rather than being institutionalised, new Government proposals envision.

Public Health Minister Shona Robison believes that housing will have to be redesigned to allow services to help those living in “clusters” and that care homes will have to specialise in dementia or end-of-life care.

Speaking exclusively to the Sunday Herald, she explained that demographic challenges will make such changes necessary.

Her comments follow a week-long campaign by our sister newspaper, The Herald, to raise awareness of elderly abuse in Scotland and will fuel the forthcoming Re-shaping Scotland debate on how to manage the country’s ageing population.

There is growing concern that care homes – which currently house 38,000 older people in Scotland – would not be affordable because of growing numbers and a perception that they tend to “­disable rather than re-able”.

The number of people in Scotland over 65 is projected to be 21% greater in 2016 than in 2006 – and 63% greater by 2031.

Government figures estimate yearly costs for health and social-care services for older people will increase by £1.1 billion by 2016, and £3.5bn by 2031, if care continues the way it is now.

Read more about new care for elderly strategy

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