Hansard

I am delighted to have the opportunity to share with members the many successful initiatives that are being rolled out to continue to improve patient safety in Scotland. I thank all staff who are involved in that very important work.

When we launched the Scottish patient safety programme, it was ambitious. It was also unique to the world, because no country had ever decided to tackle patient safety head-on in that way. That is still true eight years on—we remain the only country with the level of ambition that I will describe today to strive for zero harm across our national health service and social care settings.

Don Berwick, president emeritus and senior fellow of the Institute for Healthcare Improvement, recently said:

“What I love about what Scotland has done, is it has done it scientifically. It has done it through developing the capabilities of the country to be a learning nation, to actually improve things. That’s how you’ve done brilliant work in patient safety.”

Our initial focus—understandably—was on acute hospitals, with the aim to reduce mortality by the end of 2012. The work has expanded to include safety improvement programmes across six strands: adult hospitals; healthcare associated infections; maternity and children; medicines; mental health; and primary care.

This morning, I visited the public dental service centre in Glenrothes, which is one of the practices participating in the Scottish patient safety in dentistry pilot. The aim of the dentistry programme is to improve quality and safety in general dental practice through a collaborative approach. Dental teams now see many more patients who are on high-risk medications, such as antiplatelet drugs or anticoagulants, and the work has focused on reducing the potential impact of dental treatment on that group of patients. I am delighted that Healthcare Improvement Scotland is further investing in dentistry, extending the testing phase and developing a plan to spread the learning.

The expansion of the work to dentistry, community pharmacy and nursing homes means that we have SPSP work in all healthcare settings, from our largest hospital in Glasgow displaying real-time safety data in each ward to small general practices in Fife discussing patient safety at staff meetings.

The Scottish Government’s position on patient safety is clear. It is—and will continue to be—of paramount importance in the daily work in healthcare settings throughout Scotland. Today, the Care Quality Commission down south announced a clear need for change in the NHS in England, including the need for safety to remain of central importance, with many trusts failing to learn when things go wrong.

The position that is taken in Scotland is why its unique national patient safety programme is internationally renowned and has made patient safety in Scotland the global benchmark for safe care. Since its launch in 2008, the SPSP has contributed to a significant reduction in harm and mortality through a national collaboration to improve the quality and safety of care.

A number of factors have been key to that improvement. We have built capacity and capability in clinical and non-clinical roles to develop and to apply quality improvement methodology through testing of focused safety interventions to understand and to deliver reliable, evidence-based processes. We have used data to support improvement, shared through national and local forums and networks—those data are on the walls in our healthcare facilities for all to see. We have tested and implemented leadership activities, providing strong organisational support for safety, such as executive safety walkabouts.

Taking all those measures has helped to create a culture in care that is more transparent, learns from success—and failure—and continuously improves. Crucially, in that culture, individuals and teams have risen to the challenge and continually work to improve safety.

The programme has sought to engage front-line staff in improvement work by promoting the application of a common set of tested, evidence-based interventions. That comes from a common improvement model based on the Institute for Healthcare Improvement model.

However, we recognise that, in order to meet the increasing demands that are being placed on our health service, we must reform as well as invest and work to accelerate the shifting balance of care. Consequently, we have committed to introducing a national and regional workforce planning system across the NHS in Scotland. The national plan will look to strengthen and harmonise workforce planning practice, take full account of the future demand for safe and high-quality services for Scotland’s people, accurately identify gaps in supply and help to deliver the vision that is set out in the national clinical strategy.

The plan, which is currently being consulted upon and will be published in the spring of this year, will take full account of the many demographic and other influences on our NHS workforce and enable us to continue to deliver a safe and sustainable NHS.

We have also committed to enshrine safe staffing in law by placing the nursing and midwifery workforce planning tools on a statutory footing. The work on legislation for safe and effective staffing is progressing, and the consultation will begin in early spring of this year.

A crucial element of the programme is that the changes are led by the staff who are directly involved in caring for patients. They can monitor and see the improvements through the collection of real-time data at the individual unit or ward level.

Many countries around the world—including Norway, Denmark, Sweden, Australia, Mexico, Chile and Tanzania—have looked at the Scottish model with envy. They are keen to emulate what we have been able to achieve for the people of Scotland through the Scottish patient safety programme, and many have begun to do so. This month, people from Singapore are visiting to learn from our approach.

The Scottish surgical checklist, which has been introduced under the safety programme, has been praised internationally, including by renowned experts such as Atul Gawande. That simple but powerful technique has been adopted across Scotland. It uses techniques that were developed in the airline industry to ensure that the safety of every surgical procedure is checked and assured every time.

We continue to strive to improve. This week, the chief medical officer’s annual report, “Realising Realistic Medicine: Chief Medical Officer’s Annual Report 2015-16”, was published. It sets out an ambition to put the person who receives health and social care at the centre of decision making and it encourages a personalised approach to their care. Its aims of reducing harm and waste, tackling unwarranted variation in care, managing clinical risk and innovating to improve are essential to a well-functioning and sustainable NHS.

In response, Sir Muir Gray, who is the director of the national knowledge service and chief knowledge officer to the NHS in England, tweeted:

“NHS Scotland is the future of healthcare”.

That is good praise indeed. We will take that.

Patient safety goes beyond the programme. Our diabetes improvement plan includes actions to improve the quality of care for people living with diabetes who are admitted to non-diabetes wards in hospital by improving their glucose management and reducing the risk of complications, such as foot ulcers. Only this week, we have written to the chief executives of NHS boards to begin the national adoption of two important diabetes initiatives. To support that, the Scottish Government will fund 1,000 hypo boxes, which are to be made available to acute wards across Scotland. That will ensure a standardised and improved approach to the management of low blood glucose and will improve patient care.

It is important to share with members some of the specific improvements that have been achieved throughout Scotland. The primary care programme, which was launched in March 2013, has been successful in improving the care that is delivered by health and social care partnerships. That includes general and dental practices, community pharmacies and care homes. One programme aim was for 95 per cent of primary care clinical teams to be developing their safety culture and achieving reliability in three high-risk areas by 2016.

An increasing number of mental health wards and units are showing improvements. Those include a 78 per cent reduction in violence, a 57 per cent reduction in the use of restraint and a 70 per cent reduction in self-harming. Speaking about the identification of physical conditions for people in Scotland with mental illness, Frances Simpson, the chief executive officer of Support in Mind Scotland said recently:

“Among the most supportive has been the Scottish Patient Safety Programme … team, whose staff have opened up access to hundreds of health professionals across the country for the Equally Fit message.”