Thank you for the opportunity to update the committee on the Healthcare Improvement Scotland review of services at NHS Lanarkshire. In addition to what Ian Ross and Iain Wallace said earlier, I would like to provide some details of the work that has already taken place and of the improvements that have been made in NHS Lanarkshire following work undertaken by the board since the HIS report. We last spoke on 4 February 2014, and I am pleased to report that I am satisfied that there has been substantial progress since then and that I am reassured by the energy, commitment and focus that have been shown by the board and by all the staff at NHS Lanarkshire to ensure that those changes are embraced and bedded in sustainably.
Patient and public confidence in NHS Lanarkshire is critical, and I believe that the action that has been taken since the HIS report and the work that is still to come will allow us to rebuild that confidence in high-quality, safe services. In a moment, I will outline my plans for ensuring that that remains the case. You have heard from Ian Ross, the chief executive, and from Iain Wallace, the director of medical services, and I am grateful to them for updating the committee on the progress that has been made to date. They both also set out the further work that is in train, and I am grateful to them for doing that. Some of the issues that were identified in the HIS report need longer than three months to embed organisational change completely, so there is more work to be done on governance and accountability; the board acknowledges that, as I do.
The committee will be aware that, in August last year, I commissioned Healthcare Improvement Scotland to conduct a review of the quality and safety of care for adult acute patients in NHS Lanarkshire. That followed routine monitoring of hospital standardised mortality ratios through the Scottish patient safety programme, which indicated that, although there had been a fall in HSMR figures over the past five years in all three hospitals in Lanarkshire, Monklands hospital had not progressed sufficiently.
HIS provided me with the report and its findings in December and I then appointed a governance and improvement support team to engage with the board, providing challenge and support for its actions to address the recommendations that had been made by HIS. I thank the members of the GIS team—Jeane Freeman, chair of the Golden Jubilee national hospital; Malcolm Wright, chief executive of NHS Education for Scotland; and Professor Sir Lewis Ritchie, director of public health at NHS Grampian—for their significant hard work in assisting NHS Lanarkshire.
The HIS report made recommendations for improvement, and it was agreed that NHS Lanarkshire would provide weekly progress reports on action. More detailed monthly reports have also been provided. Many of the actions taken by the board have already been effective in addressing the concerns that were raised in the HIS report. For example, the board has reviewed its processes for collecting patient and carer experience data, to ensure that patients and carers feel able to provide honest feedback that reflects both positive and negative aspects of care and can be used to further improve care. It has rerun the workload tools with occupancy levels reflective of wards’ actual activity, so the additional £3.1 million that the committee has heard about this morning is being invested in acute nursing services, leading to the appointment of an additional 150 or so full-time equivalent nurses, prioritised for the wards and units that have the most significant gaps against the assessed level of need.
The board is ensuring that a further review of nurse numbers and of the skill mix is addressed in conjunction with wider work on vacancies, bank use, rostering and admin support. It is also ensuring that there is a clear focus on embedding patient safety throughout the organisation, and the creation of a dedicated patient safety team led by an experienced head of patient safety is key to that. It is delivering swiftly on the simplification and strengthening of acute management structures, centred on the appointment of three new hospital directors, one for each site, along with a lead nurse and lead clinician for each site.
To ensure that we build on these successes, the board has reviewed its clinical governance structures, which will ensure clarity and transparency, and accountability for the safety and quality of care. That is welcome work in progress, and I have asked my officials to continue to work with the board to ensure that the new structure is clear and effective and builds the confidence of clinical staff through a strong engagement process.
I am assured that the board understands how critical it is that it receives and reviews reliable, timely and meaningful information regarding quality and safety, to enable it to perform its crucial leadership role, which involves support, challenge and accountability. I have asked my officials to continue to engage with the board on that important agenda.
To ensure that we take appropriate stock of the sustained nature of the progress, I confirm that follow-up meetings will be held with NHS Lanarkshire, the Scottish Government and the governance and improvement support team in June and September this year to review progress, and that the GIS team will continue to be available to provide the board with support whenever it may be needed. I also confirm that Paul Gray, director general of health and social care and chief executive of NHS Scotland, will meet the senior representatives of the three medical staff associations in Lanarkshire on 25 April. That provides another chance to hear at first hand the views and contributions of the local medical community on the changes that are being made, and to ensure that their on-going engagement and ideas for further improvement remain central to sustainable change in which everyone can have confidence.
The board of NHS Lanarkshire is fully behind the improvements and I wish to acknowledge its enthusiasm and commitment to respond positively to HIS’s recommendations in the review report. I have been clear with the board—and publicly—that the problems identified in the HIS report were not acceptable and that rapid and sustained improvements were essential. I am pleased that the board, supported by all its staff, has taken responsibility and made a real step change in its focus on quality and safety of care as a result of the HIS report recommendations. I am confident that the improvements will be maintained, embedded and built upon where necessary.
However, as you would expect, I consider these issues sufficiently important that I will seek clear, on-going assurances that the improvements are sustained—personally, from the board, and through the follow-up discussions between the board and my officials.
Thank you, convener, for allowing me to provide you with this update. My team and I would be happy to provide you with further details and to answer any questions that you may have.