21.03.12: NHS Lothian waiting times
The report of the external review of NHS Lothian’s waiting times management details practices that are “completely unacceptable”, Health Secretary Nicola Sturgeon said in a statement to parliament.
The review, which was conducted by PricewaterhouseCoopers, followed reports in October last year about NHS Lothian patients being offered treatment in England at short notice. If patients refused to travel to England they were recorded as being unavailable and so did not appear in the health board’s published waiting time figures as breaching waiting time guarantees. An initial investigation and report by the board’s waiting times management group concluded that the practice had not been used intentionally to manipulate waiting times.
However, Sturgeon said the report also made reference to administrative practices that she considered needed further, independent, investigation.
“ The key finding of the PWC report, which examined the period from April to December 2011, is that NHS Lothian has been applying periods of unavailability to some patients inappropriately, to reduce artificially the number of patients who would otherwise have been reported as breaching waiting time guarantees. That has been done, in the main, by retrospectively adjusting the patient’s waiting time record,” Sturgeon explained.
Sturgeon said her reaction to the report is one of “disappointment and considerable anger”, adding: “ Waiting time guarantees matter. Patients value them and staff work hard to deliver them. I will not tolerate the manipulation of them.” NHS Lothian has already instigated disciplinary proceedings relating to the conduct of certain staff members, she said. However, she added that another “very serious concern” is the suggestion in the report that the management culture in NHS Lothian contributed to the situation.
“ The report states that staff were under pressure to find tactical solutions to waiting times rather than to tackle the root causes of the delays. It says that the culture actively discouraged people from accurately recording the facts and prevented full disclosure of waiting times from progressing up through the NHS Lothian management chain and governance framework to the board. That is completely unacceptable.” Sturgeon said she has instructed the chair to commission an investigation into the extent of such a culture in the board, and she expects to see the outcome by the end of April.
Labour’s shadow health secretary, Jackie Baillie, said the findings of the report are “quite shocking” and accused Sturgeon of choosing budget day for the statement as “a good day on which to bury bad news.” Baillie called for a Scotland-wide inquiry: “ We do so on the basis that the figures for patients who are unavailable for treatment for social reasons, and who are therefore dropped from waiting lists, have risen dramatically. In March 2008, for in-patient and day cases, it was 4,967. By December 2011, it had risen to 15,824, which is more than three times higher. There is a similar story for out-patient cases. It would therefore appear that the problem of creative reporting is not to be found in NHS Lothian alone.” Sturgeon said she has made it clear that she expects all boards to carry out a “rigorous audit” and said she has “no objection” should Audit Scotland or anybody else choose to look into the issue.
29.03.12: Donated breast milk
Mark McDonald (SNP) asked what steps the Scottish Government is taking to increase the availability of donated breast milk in neo-natal units.
Public Health Minister Michael Matheson replied: “The Scottish Government is aware that breast milk is the recommended form of enteral nutrition for all infants, especially those born pre-term and we recognise the valuable service that donor milk banks provide. The Scottish Emergency Rider Volunteer Service (ScotsERVS) now supports the transportation of processed donor milk to requesting units and provides a local ongoing and sustainable service across the NHS Greater Glasgow and Clyde Board area and into neighbouring health boards. NHS Greater Glasgow and Clyde is currently exploring options to provide equitable access to donor breast milk across all of Scotland.”.
29.03.12: Vitamin D
SNP MSP Bill Kidd asked, during Scottish Executive Question Time, what progress has been made with using vitamin D supplements or additives to tackle long-term health issues.
The Minister for Public Health Michael Matheson replied: “All four United Kingdom chief medical officers recently wrote to health professionals to reiterate the current advice on vitamin D supplementation for at-risk groups. That followed a Scottish awareness-raising leaflet that was aimed at the general public and which was distributed widely in 2011. In recent years, a wide variety of reports have linked vitamin D to various different conditions. The Scientific Advisory Committee on Nutrition is considering all the relevant evidence in its current review of recommended supplementation levels.” Kidd said that greater levels of vitamin D intake may prove beneficial in relation to the incidence of a number of illnesses and diseases, in particular, multiple sclerosis, and praised the success of the Shine on Scotland campaign for drawing attention to this issue.
Matheson responded: “I recognise the widespread interest in vitamin D. As I said, the Scientific Advisory Committee on Nutrition is currently reviewing the recommendations on vitamin D supplementation. Some of the evidence that links vitamin D with MS to which the member referred is conflicting and some of it is disputed, which is why the advisory committee process is vigorous. It will allow us to consider the evidence in detail before we consider any change to the current arrangements. The committee’s report is expected to be completed by 2014, at which time, in accordance with the committee’s findings, we will reconsider the current recommendations on vitamin D. Given that the research and surveillance data show that inadequate awareness and intake in at-risk groups is a key issue, our primary focus at this stage is to ensure that we encourage compliance with the current guidelines.”