Scottish Patient Safety Programme

Part of the debate – in the Scottish Parliament on 2nd March 2017.

Alert me about debates like this

Photo of Alison Johnstone Alison Johnstone Green

The Government’s motion acknowledges the success of the Scottish patient safety programme and it acknowledges the significant challenges that the NHS faces. Given the scale of those challenges, we must take stock of approaches that work, learn from them and build on opportunities to expand them.

The amendments that have been lodged all—rightly—address workforce shortages, which undermine the efforts of our NHS staff to provide the best possible care. Appropriate staffing levels are essential to patient safety, and demand is often outstripping supply. The latest Information Services Division figures show that many patients are facing unacceptable waits for diagnostic tests and treatment. I am worried that, although our health service is delivering very high standards of safe care to most patients, many others are being left for too long without the care that they need.

The Government points to its long-term strategy, but we need urgent action to improve access to care for patients who need it today. We have been promised a new national workforce plan, but I am not encouraged by recent actions such as the modest uplift in student nurse numbers. An increase of 142 in the number of student nurses is not ambitious enough when 28 per cent of nursing posts in the care home sector are vacant. Bliss Scotland’s report on our maternity and neonatal services found that many of our neonatal units do not have enough nurses in post and that most struggle to ensure that nurses get appropriate specialist training.

Training and support are essential. We know that, when staff are well supported and their experience is valued, they can achieve fantastic results for patients. The patient safety programme has delivered some of the best examples of improvements in our healthcare system, and that is because it gives staff the opportunity to drive change themselves, as we have heard. Learning from that approach can help to make our hospitals and community health services more attractive places in which to work.

Sometimes NHS targets are criticised for creating perverse incentives, contributing to a tick-box culture and putting processes, not patients, first. However, the patient safety programme set ambitious goals and has surpassed many of them. In its briefing for us last November, the Royal College of Nursing said:

“There have been real improvements in the way health services are delivered in Scotland over the last 10 years, for example, the patient safety programme.”

Colleagues have mentioned the 16 per cent reduction in hospital mortality, the 18 per cent reduction in stillbirth rates and the 21 per cent reduction in mortality from sepsis, which are clear and significant improvements. They have all been achieved by staff working together to review their practice, question their normal processes and develop safer alternatives. That is brave work, and I thank all the staff who have been involved in the pilots, collaboratives and improvement projects across Scotland.

I am glad that the patient safety programme is moving into care homes. Its target of reducing harm from pressure ulcers by 50 per cent in hospitals and care homes by December this year will greatly improve many people’s quality of life. We need to ensure high standards of safety as health and social care is integrated, and this is the kind of approach that we need.

I want the programme’s successes to reach even further—not just to care homes but to those who are cared for at home and in our communities. People often feel that a frail elderly relative would be safer in hospital and that that would be the best place for their relatives, because they are more confident that risks will be minimised there. However, we also need to use the patient safety programme’s rigorous approach to improve the safety of vulnerable people who are cared for at home. That poses clear challenges because, at the moment, social care staff do not have much chance to lead improvements in care services. They often have to work in relative isolation, under pressure and with few opportunities for training and development.

One strand of the patient safety programme is its highly regarded fellowship programme, which allows clinicians to develop their leadership skills, strengthen collaborations and learn directly from international experts. It is crucial that we invest in our future clinical leaders. In the long term, we have to develop equivalent mentoring, training and expert support for our social care staff.

Back in our hospitals, there are concerns about consultants’ ability to teach up-and-coming medical students. That, too, has implications for patient safety, and it leads to the perception that Scotland is a 9:1 country. That is the very reason that has been cited by consultants who are not attracted to practising medicine here, and it impacts on consultants’ contribution to the NHS.