Malcolm shares his thoughts on improving quality of service in NHSScotland

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Debate on the Healthcare Quality Strategy for NHSScotland Malcolm Chisholm (Edinburgh North and Leith) (Lab):
I want to talk about the quality strategy because for many years I have believed that the quality agenda needs to be described in detail to the public and the media, but first I will make a couple of points about funding, which is clearly relevant to the subject under discussion.

Yesterday, Theresa Fyffe, who is the director of the Royal College of Nursing Scotland, said:

"Recruitment freezes, cutting support for frontline staff and replacing registered nurses with non-registered support staff are guaranteed ways to damage patient care."

It is clear that we face a funding challenge, but that means that there is all the more reason to ensure that genuine, high-impact efficiency and productivity approaches are implemented rather than cuts to front-line staff. We must take a hard and clear view of that distinction.

Joe FitzPatrick:
Is the member aware that the number of NHS staff has risen by 10,000 since the SNP came into government?

Malcolm Chisholm (Edinburgh North and Leith) (Lab):
I will take the member's word for that. I am not here to rubbish that point; I am here to talk about what is happening now.

As I said at question time - so I will not spend a lot of time on the point - it is far more important now than in the high-growth past that we ensure that NHS boards get the funding share to which they are entitled. It is self-evident that when there were big increases in the past, it did not matter if a board was not getting its share. When the boards are getting smaller, and presumably even smaller increases, it will matter a great deal. The gap between what Lothian gets and what it is entitled to is £69 million this year, which is £5 million more than last year. It is by far the biggest gap in Scotland. If that is not addressed, we will have particular problems in Lothian. I should point out that 700 jobs are already going.

Turning to the quality strategy, I particularly like the phrase about not

"pulling the plant up by the roots",

because the quality plant has been growing over a period of many years. I pay tribute to the whole health care team for all the work that the staff have done over the years and to NHS Quality Improvement Scotland. For many years I have been a great admirer of that body and I have followed the way in which its work has evolved. It is regrettable that most people in Scotland know very little of what it does.

A good example was at the recent reception that I hosted for the Neurological Alliance, when the new neurological standards were introduced. The lead clinician described how the work of NHS QIS had evolved and now, as he pointed out, it was going to work with clinicians on an on-going basis to improve the standards. That is typical of the work that NHS QIS is doing and we should pay tribute to it.

I also like the quote from Don Berwick on page 17 of the document. As far as I am concerned, and I think that Dr Richard Simpson agrees with me, he is the number one health care improvement person in the world and I was privileged to meet him on one occasion. It is great that his institute for health care improvement is closely involved with our patient safety programme, which began under the previous Administration and was pioneered successfully by NHS Tayside.

I could go on about continuity, but I want to give three other examples. First, there is the whole issue of patient experience, which others have referred to. There is an important patient experience programme called better together, which is mentioned and described in the document; it was started under the previous Administration, along with related work. Using the experience of patients in a meaningful way is absolutely central to quality improvement. I believe - I am sure that the Government believes, too - that it needs to go a great deal further. I was a little concerned that only one of the 12 quality outcome measures listed on pages 37 and 38 of the document is a patient measure. To be fair, the document says that a second one will be developed in due course.

Ross Finnie gave a very good example of patients feeding into quality improvement. Breakthrough Breast Cancer has had that service pledge over the past few months. As far as I know, it is an excellent and successful initiative whereby patients are central in forming an improvement pledge for each breast cancer unit in the country.

Since we are talking of cancer, I should also mention, as I have done before, the outstanding work of the cancer care research centre at the University of Stirling, which has done an enormous amount of work on patient experience and, in my view, has been the Scottish leader in that field. It was led by Professor Nora Kearney, who has now moved to Dundee.

The second example is the quality and outcomes framework of the, often and wrongly maligned, GP contract. That has led to enormous improvements in primary care, which many patients are probably not aware of. Issues such as heart disease and stroke have been greatly helped by the new requirements on GPs that are part of that framework. I was pleased to see in the document that the Government is committed to building on the principles of the quality and outcomes framework to maximise quality in other service areas.

My last example is anticipatory care. That, too, was started by the previous Administration but the strategy document talks about introducing and sharing anticipatory care plans for the 5 per cent of the population who are most at risk of hospital admission. That seems a really important development. For many years, we have been talking about the need to reduce emergency admissions but they are still going up, for whatever reason. Clearly, more anticipatory care that is targeted on the group most at risk of those admissions would be very helpful.

There are many positive features in the quality framework. It has to be seen in the light of the funding issues that many have described. In particular, we must emphasise the role and importance of front-line staff in delivering the quality improvements. At the end of the day, the front-line clinicians will do that and they must be at the centre of the quality agenda. We need to empower them to make the quality improvements that we all want. I hope that we can all be united in that objective. May 13th 2010 (Column 26247-50)