Picking up a couple of issues that have arisen from what we have been talking about, I should say first of all that, for me, the question about rurality points towards the huge issue of rural sustainability, and I will give the committee two examples to illustrate what is already happening to help us with that.
The first is the community hospital that has been developed for the Western Isles. A range of clinicians and other NHS staff such as advanced nurse practitioners, paramedics, GPs in the overnight hours and a number of other colleagues has come together to provide that service. We know that GPs have exceptional patient assessment skills. As a result of introducing that new method of working and bringing that multidisciplinary team together, admissions to the Western Isles hospital have reduced by 17 per cent as evaluated. That reassures me that patients are getting good assessments, because a clinician with good experience sees them when they arrive at the hospital and they are pointed in the direction of the right kind of care. It also means that, instead of using the inelegant term “delayed discharge” to refer to people, we are talking about not having so many people going into hospital inappropriately in the first place.
We have talked a bit about the sustainability of the remote and rural workforce. A number of things are already happening in Scotland in that respect, but I will give you just one example. We have undertaken an initiative with colleagues in Fort William, where a couple of consultant posts had been vacant for some time. Unless there is interest from people who have particular lifestyle or clinical practice choices, those opportunities do not always generate a huge number of applicants.
Working with colleagues in NHS Lothian, we were able to put together an educational experience and support package in Fort William, as a result of which we went from having no applicants to having seven suitable and appointable ones. It is quite something to have that number of applicants for some of our vacancies. We were trying to ensure that people who were drawn to remote and rural practice did not feel that, in making that choice, they were abandoned to nothing but remote and rural practice. The approach is really innovative and is now starting to produce shoots across the piece.
Dennis Robertson mentioned the use of digital support. There is no doubt that we are doing more in that area, but we are also starting to see real benefits from, for example, the development of the Scottish specialist transport and retrieval service—or ScotSTAR—which gives us the ability to retrieve patients and take them to the place that best suits their needs. We will doubtless come back with further evidence on ScotSTAR’s effectiveness in due course, but it is already starting to show real clinical effectiveness.
As for Rhoda Grant’s point about variation over the week, there is no doubt that there is some variation and that we will, as another colleague mentioned earlier, negotiate terms and conditions in that respect in due course. We have made it very clear from the outset of our work that the service models and patient requirements will determine the shape of those negotiations. That is really important, partly because that is what we are here for and partly because every clinician I have met has wanted to come and work in the NHS and do a good job. They want to be able to play the fullest possible part, and we want to be able to give them a service model to which they can pin their professional coattails.
Some of the work that the task force has seen relates to RCN proposals about the extended role that nursing and midwifery staff could play. The committee has already heard—quite persuasively, I think—from our pharmacy colleagues, who have a huge role to play. A number of others will come together, not least the paramedic cohort of the Scottish Ambulance Service.
Examples of that sort of work can be found all over remote and rural Scotland, from Buckie to Fort William, including certain initiatives in the island communities and the Clackmannanshire model that the cabinet secretary has already described. For general information, that model has produced a facility with three GP surgeries, two in-patient beds and 24 additional services that are available through advanced nurse practice and some social care partners who provide psychiatry support and other such services. It is no longer just a kind of tube with a fence that you could not climb through, and that is really important.
The radiotherapy services in Glasgow have not been redesigned so much as reorganised. That has involved bringing together a group of disparate services, which means, quite frankly, that there is a bigger rota, so there is an opportunity to run those services and make diagnostic support available to people across a wider range of times than simply 9 to 5 from Monday to Friday. Again, it comes back to the convener’s point that we are considering not just the mortality stuff but the sheer effectiveness and efficiency that come together to produce a better patient outcome.