I will make a brief statement, if that is acceptable.
I appreciate being given the opportunity to appear before the committee today. We take accident and emergency performance very seriously, which is why I have asked a number of senior colleagues to accompany me to bring their expertise to bear on different aspects of the issue.
The helpful evidence that the committee has taken from the Auditor General and—last week—from NHS Scotland senior leaders and clinicians has emphasised the complexity of the system within which unscheduled care operates. That complexity is not unique to Scotland. Unscheduled care performance was affected during winter 2012-13 in other parts of the United Kingdom and in similar health systems across the world.
Our approach in Scotland to tackling the issues related to unscheduled care is set within our overall vision that, by 2020, more people will be living longer, healthier lives at home or in a homely setting, so we want to do all that we can to ensure that, when people attend A and E departments, they get the right care, from the right person, within the standards that we set. That already happens in many cases, but we want it to happen consistently.
Sometimes it will be better for people to get the care that they need elsewhere—for example, in a minor injuries unit, via an out-of-hours primary care service or through telephone advice. Again, that is happening in some cases, but there is best practice that we can spread further, which will provide improved outcomes for patients and reduce costs.
I thought that it would be helpful to comment briefly on the phrase “A and E waits”. What we are measuring is progress against the target that, by September of this year, 95 per cent of patients will be seen and, as appropriate, treated or discharged within four hours of arrival at A and E. We are not measuring whether patients wait for four hours; we are measuring whether they get out of A and E, with all clinically appropriate actions taken, within four hours.
As I have made clear in earlier correspondence, I welcome the recommendations in Audit Scotland’s report, which was published in May of this year. We are progressing those through our unscheduled care action plan, which is supported by the local unscheduled care action plans that the boards prepare annually.
I will briefly mention some of the key actions that have been taken in the first year of the action plan. We have established the flow programme to improve the way in which patients move through the system and to cut out unnecessary delays. We have recruited an additional 18 emergency department consultants, put in additional bed capacity and issued signposting guidance to help direct patients to the most appropriate treatment point. In addition, we have a number of new initiatives to prevent frail elderly patients from going into hospital unnecessarily in NHS Forth Valley and NHS Ayrshire and Arran; we have introduced discharge hubs in NHS Fife, NHS Lothian and NHS Ayrshire and Arran; and we have invested in theatres in NHS Grampian, beds in NHS Lothian and staffing in NHS Lanarkshire.
Over the period November 2013 to March 2014, NHS Scotland recorded a performance level of 93.1 per cent for patients being discharged or admitted within four hours, which compares with 91.4 per cent over the same period in the previous year, and the figure of 94 per cent has been quoted in relation to published data for June. However, I fully accept that we are not at the standard that we have set, and I want to ensure that patients who attend A and E can leave A and E safely within that standard. That is the commitment that we have made and, despite the complexities, it is the one that we are continuing to strive for.
We have also reduced significantly the number of people who wait for more than eight and 12 hours to be discharged or admitted. We want to eliminate that, as far as possible; we do not believe that people should have to wait that long to be admitted or discharged. That should happen only in very few cases. Fewer than 1 per cent of all patients remained in A and E for longer than eight hours, but we owe it to patients to make further improvements, where we can.
I assure the committee that we are well aware that the context in which we are seeking to deliver the commitments is challenging. I am not here to provide a set of emollient statements about how it is all absolutely fine; there are places where it is not.
We have an ageing population, increases in the number of patients presenting with more than one condition—often referred to as multimorbidity—and recruitment pressures. Those issues are not unique to Scotland; nevertheless, we are committed to doing all that we can for the people who are served by NHS Scotland to provide timely treatment so that they experience safe, person-centred and effective care and enjoy good health outcomes.
I am happy to answer the committee’s questions. If we do not have the data immediately to hand, we will undertake to provide it as quickly as possible. I know that you have had a lot of detailed information; we want to ensure that any responses that we give in that context are accurate, so if we do not have the data today, we will provide it as soon as we can.
Thank you for allowing me to make a statement.