The Scottish Government needs a delivery plan that clearly explains to the public how it will reform the NHS and address the pressures on services.
Despite increasing funding and staffing, the NHS in Scotland is still seeing fewer patients than before the Covid-19 pandemic.
Auditors found that:
commitments to reducing waiting lists and times have not been met
the number of people remaining in hospital because their discharge has been delayed is the highest on record
and NHS initiatives to improve productivity and patient outcomes have yet to have an impact and lack clear progress reporting.
Health accounts for about 40 per cent of the Scottish budget. Funding grew again in 2023/24 but has mostly been used to cover pay commitments and inflation. Costs are forecast to continue rising and making savings remains challenging. Work to build new healthcare facilities also remains paused.
The Scottish Government’s restated vision for health and social care is not clear on how these operational pressures on the NHS will be addressed or how reform will be prioritised. It needs to work with NHS staff, partners and the public to set out a clear delivery plan and make tough decisions about how it may change or potentially even stop some services.
Stephen Boyle, Auditor General for Scotland, said: “To safeguard the NHS, a fundamental change in how services are provided remains urgent. The Scottish Government needs to set out clearly to the public and the health service how it will deliver reform, including how progress will be measured and monitored.
“Difficult decisions are needed about making services more efficient or, potentially, withdrawing those services with more limited clinical value to allow funding to be re-directed. Taking those steps will require greater leadership from Scottish Government and NHS leaders than we’ve seen to date.”
Funding to help practices retain and recruit key staff
An additional £13.6 million will be invested in General Practice this financial year to support GPs to retain and recruit key staff, Health Secretary Neil Gray has announced.
Speaking at the annual conference of BMA Scotland’s Local Medical Committees, Mr Gray confirmed the immediate funding for 2024-25 will address known financial pressures, support staff costs and enable GPs to take on partners and salaried GP staff.
Mr Gray said: “I recognise the significant financial and workload challenges facing both the NHS as a whole and General Practice, especially during this period of high demand, and understand the significant strain this places on GPs.
“My focus remains firmly on finding ways to recruit more GPs, even within the constraints of the current financial climate, and that is why I am allocating an additional £13.6 million for General Practice this financial year to support staff costs. This additional funding will help GPs to underpin business decisions and provide high-quality patient care.
“Sustainable reform of the NHS means we must look to shift more care to primary and community care with a relentless focus on better outcomes for people.
The Scottish Government reform programme will develop the means to credibly restore, and further increase GP and wider primary care spend, within the overall health budget.
“This will be a long-term endeavour but this strategic shift is crucial. Our reform plans over the next period will look to explore this in partnership with key stakeholders including the GP profession.”
Addressing the separate issue of next year’s UK National Insurance contribution increases, Mr Gray added: “The UK Government’s decision to increase national insurance contributions will have a major financial impact on GPs.
“I have been very clear that this is completely unacceptable and the UK Government must fully cover the costs. Scotland’s GPs should not be paying the price for UK Government decisions.”
The Scottish Budget for 2025-26 will be published on 4 December.
Health and Social Care Secretary will outline how government and NHS leaders have a duty to patients and taxpayers to get the system working well
Wes Streeting to reveal package of reforms and announce new league table of NHS England providers, with top talent attracted to most challenging areas and persistently failing managers to be sacked
Turn around teams sent into struggling hospitals, while best performers given greater freedoms over funding to modernise technology and equipment
No more rewards for failure, with reforms to ensure every penny of extra investment into NHS is well spent and waiting times for patients slashed
NHS league tables will be introduced to help tackle the NHS crisis and ensure there are ‘no more rewards for failure’, as part of a tough package of reforms to be announced by the Health and Social Care Secretary Wes Streeting today (Wednesday 13 November).
Addressing the nation’s health leaders at the NHS Providers’ annual conference in Liverpool, he will outline how government and NHS leaders have a duty to patients and taxpayers to get the system working well and get better value for money.
NHS England will carry out a no holds barred sweeping review of NHS performance across the entire country, with providers to be placed into a league table. This will be made public and regularly updated to ensure leaders, policy-makers and patients know which improvements need to be prioritised.
Persistently failing managers will be replaced and turn around teams of expert leaders will be deployed to help providers which are running big deficits or poor services for patients, offering them urgent, effective support so they can improve their service.
High-performing providers will be given greater freedom over funding and flexibility. There is little incentive across the system to run budget surpluses as providers can’t benefit from it. The reforms today will reward top-performing providers and give them more capital and greater control over where to invest it in modernising their buildings, equipment and technology.
The government will deliver a health service fit for the future, fixing the foundations while delivering change with investment and reform to deliver growth, get the NHS back on its feet, and rebuild Britain.
Health and Social Care Secretary Wes Streeting said: “The Budget showed this government prioritises the NHS, providing the investment needed to rebuild the health service. Today we are announcing the reforms to make sure every penny of extra investment is well spent and cuts waiting times for patients.
“There’ll be no more turning a blind eye to failure. We will drive the health service to improve, so patients get more out of it for what taxpayers put in.
“Our health service must attract top talent, be far more transparent to the public who pay for it, and run as efficiently as global businesses.
“With the combination of investment and reform, we will turn the NHS around and cut waiting times from 18 months to 18 weeks.”
Amanda Pritchard, NHS chief executive said: “While NHS leaders welcome accountability, it is critical that responsibility comes with the necessary support and development.
“The extensive package of reforms, developed together with government, will empower all leaders working in the NHS and it will give them the tools they need to provide the best possible services for our patients.”
The NHS Oversight Framework which sets out how trusts and integrated care boards are best monitored – will be updated by the next financial year to ensure performance is properly scrutinised.
Deep dives into poorly performing trusts will be carried out by the government and NHS England to identify the most pressing issues and how they can be resolved.
Louise Ansari, Chief Executive of Healthwatch England: “People value the hard work of NHS staff, but it’s frustrating when services fail to operate effectively. So, a fresh approach to improving NHS performance is welcome.
“Currently, living in an area with either an outstanding or poorly performing NHS trust feels like a postcode lottery. When a service is underperforming, it often takes far too long for patients to see the necessary improvements.
“This is because the current system focuses on evaluating service performance based on the number of tasks it completes and it does not do enough to measure patients’ overall outcomes and experiences.
“Establishing a better system that encourages NHS managers to focus on delivering the best care as efficiently as possible, and leads to quicker changes at struggling trusts, would be good news for everyone.”
NHS senior managers who fail to make progress will also be ineligible for pay increases. There will be financial implications for Very Senior Managers (VSMs) such as Chief Executives if they are failing to improve their trust’s performance, or letting patients down with poor levels of care.
A new pay framework for VSMs will be published before April 2025. Senior leaders who are successfully improving performance will be rewarded, to ensure the NHS continues to develop and attract the best talent to the top positions.
The changes are made in response to Lord Darzi’s investigation into the NHS, which found that: “The only criteria by which trust chief executive pay is set is the turnover of the organisation. Neither the timeliness of access nor the quality of care are routinely factored into pay. This encourages organisations to grow their revenue rather than to improve operational performance.”
The cost to the health service of hiring temporary workers sits at a staggering £3 billion a year. Under joint plans to be put forward for consultation in the coming weeks, NHS trusts could be banned from using agencies to hire temporary entry level workers in band 2 and 3, such as healthcare assistants and domestic support workers. The consultation will also include a proposal to stop NHS staff resigning and then immediately offering their services back to the health service through a recruitment agency.
Rachel Power, Chief Executive, Patients Association: “We welcome today’s commitment to improving NHS performance and accountability. These reforms signal an important drive for positive change in our health system. The focus on tackling poor performance and rewarding excellence sends a clear message about raising standards across the NHS.
“At the same time, we know from the experience of patients, that real transformation comes through genuine partnership with patients. We look forward to working with NHS England to ensure patient voices help shape how any league tables are developed and how success is measured.
“The proposed support teams for struggling trusts could be particularly effective if they include patient representatives and focus on building a culture of patient partnership. This is an opportunity to combine better management with deeper patient involvement – creating an NHS that is both more efficient and more responsive to people’s needs.
“We hope trusts who receive greater funding freedom will use this money wisely – to cut waiting times, make the waiting experience better for patients, and strengthen the ways they work with patients to improve services. These are the things that matter most to people using the NHS.”
Lord Darzi’s investigation into the NHS found that hospital productivity has ‘nosedived’ in the past five years. During that time resources have increased by 20%, but the number of patients treated has only increased by 3%.
This comes a month after the Health and Social Care Secretary kicked off the biggest national conversation about the future of the NHS since its birth, calling on the entire country to share their experiences of our health service and help shape the government’s 10 Year Health Plan.
Members of the public, as well as NHS staff and experts, are sharing their experiences, views and ideas for fixing the NHS via the Change NHS online platform, which will be live until the start of next year, and available via the NHS App.
Alarm Bells: Alan Milburn joins the Department of Health and Social Care’s board to ‘support the government’s ambitious plans for reform’
Alan Milburn has been appointed Lead Non-Executive Member to the board of the Department of Health and Social Care.
Mr Milburn ‘brings experience at the highest levels to help transform the health and care system‘
This (Labour) government is determined to work with experts who can provide the best advice to help rebuild an NHS fit for the future
Alan Milburn has been appointed Lead Non-Executive Member to the board of the Department of Health and Social Care.
The former New Labour Health Secretary has a ‘proven track record of reducing waiting lists and improving satisfaction in the NHS’.
Milburn is also a strong advocate of private healthcare involvement in the NHS. Back in 2015, Milburn intervened in the British election campaign to criticise Labour’s health plans, which would limit private sector involvement in the NHS. Milburn was criticised for doing so while having a personal financial interest in the private health sector.
The current Labour government says the NHS is broken and it is the mission of this government to fix it and make the health service fit for the future. As part of this national mission, experts are being brought in to help develop policy, and NHS staff and patients have been invited to share their experience and ideas to change the NHS at Change.NHS.gov.uk.
Members of the department board provide independent advice and expertise to inform the department’s strategy, performance and governance and the Lead Non-Executive Member provides additional support to the Secretary of State for Health and Social Care in his role as Chair of the board.
The Labour government says that, as a former Secretary of State, Alan brings experience at the highest levels of helping transform the health and care system – but health trade unions will be very wary of Milburn’s appointment.
Health and Social Care Secretary Wes Streeting said: “As Secretary of State, Alan made the reforms which helped deliver the shortest waiting times and highest patient satisfaction in the history of the NHS.
“This government has inherited a broken health service with some of the longest waiting times and lowest patient satisfaction in history. I am delighted to welcome Alan to the department board, where he will offer advice on turning the NHS around once again.
“His unique expertise and experience will be invaluable and he has an outstanding track record of delivering better care for patients.”
Lead Non-Executive Director Alan Milburn said: “I am delighted to be appointed to this role.
“Having spent three decades working in health policy, I have never seen the NHS in a worse state. Big reforms will be needed to make it fit for the future.
“I am confident this government has the right plans in place to transform the health service and the health of the nation. I’m looking forward to working with them to achieve that mission.”
Due to ‘the requirements of the role and the unique expertise and experience Alan Milburn brings’, he was appointed directly by the Secretary of State on following consultation with the Commissioner for Public Appointments, and in compliance with the Governance Code on Public Appointments.
The Department of Health and Social Care would like to thank Samantha Jones for all her work and support as non-executive director since February 2023.
An awareness campaign is underway to ensure people know the best place to access healthcare this winter.
Right Care Right Place helps the public decide the most appropriate service for their healthcare needs – whether they should contact their GP or pharmacy, call NHS 24 on 111 or use self-help guides on the NHS Inform website. Hospital emergency departments should only be visited for critical emergencies.
The campaign features targeted advertising on television, radio and online and aims to help alleviate pressures on the NHS and social care ahead of an expected seasonal increase in demand.
Health Secretary Neil Gray visited East Lothian Community Hospital to hear about work being undertaken to address delayed discharges. The hospital supports patients leaving acute hospitals who require intermediate care before returning home.
Mr Gray said: “We have been working closely with colleagues across the NHS and social care to make sure we are as prepared as possible ahead of winter.
“Public information and awareness of the treatment options and how to access them when needed is key to ensuring services are directed where they are most needed.
“This will help everyone to get the right care, in the right place as quickly as possible while helping alleviate pressures on the rest of the NHS. People can also help by making sure they receive their Respiratory Syncytial Virus (RSV), Covid-19 and flu vaccinations if eligible.”
Self-help guides can be found on NHS inform and include advice on the most common winter illnesses.
‘We have detected a single confirmed human case of Clade Ib mpox. This is the first detection of this Clade of mpox in the UK, the wider risk to the UK population remains low’.
The UK Health Security Agency (UKHSA) has detected a single confirmed human case of Clade Ib mpox. The risk to the UK population remains low.
This is the first detection of this Clade of mpox in the UK. It is different from mpox Clade II that has been circulating at low levels in the UK since 2022, primarily among gay, bisexual and other men-who-have-sex-with-men (GBMSM).
UKHSA, the NHS and partner organisations have well tested capabilities to detect, contain and treat novel infectious diseases, and while this is the first confirmed case of mpox Clade Ib in the UK, there has been extensive planning underway to ensure healthcare professionals are equipped and prepared to respond to any confirmed cases.
The case was detected in London and the individual has been transferred to the Royal Free Hospital High Consequence Infectious Diseases unit. They had recently travelled to countries in Africa that are seeing community cases of Clade Ib mpox. The UKHSA and NHS will not be disclosing any further details about the individual.
Close contacts of the case are being followed up by UKHSA and partner organisations. Any contacts will be offered testing and vaccination as needed and advised on any necessary further care if they have symptoms or test positive.
UKHSA is working closely with the NHS and academic partners to determine the characteristics of the pathogen and further assess the risk to human health.
While the existing evidence suggests mpox Clade Ib causes more severe disease than Clade II, we will continue to monitor and learn more about the severity, transmission and control measures. We will initially manage Clade Ib as a high consequence infectious disease (HCID) whilst we are learning more about the virus.
Professor Susan Hopkins, Chief Medical Adviser at UKHSA, said: “It is thanks to our surveillance that we have been able to detect this virus. This is the first time we have detected this Clade of mpox in the UK, though other cases have been confirmed abroad.
“The risk to the UK population remains low, and we are working rapidly to trace close contacts and reduce the risk of any potential spread. In accordance with established protocols, investigations are underway to learn how the individual acquired the infection and to assess whether there are any further associated cases.”
Health and Social Care Secretary Wes Streeting, said: “I am extremely grateful to the healthcare professionals who are carrying out incredible work to support and care for the patient affected.
“The overall risk to the UK population currently remains low and the government is working alongside UKHSA and the NHS to protect the public and prevent transmission.
“This includes securing vaccines and equipping healthcare professionals with the guidance and tools they need to respond to cases safely.
“We are also working with our international partners to support affected countries to prevent further outbreaks.”
Steve Russell, NHS national director for vaccination and screening, said: “The NHS is fully prepared to respond to the first confirmed case of this clade of mpox.
“Since mpox first became present in England, local services have pulled out all the stops to vaccinate those eligible, with tens of thousands in priority groups having already come forward to get protected, and while the risk of catching mpox in the UK remains low, if required the NHS has plans in place to expand the roll out of vaccines quickly in line with supply.”
Clade Ib mpox has been widely circulating in the Democratic Republic of Congo (DRC) in recent months and there have been cases reported in Burundi, Rwanda, Uganda, Kenya, Sweden, India and Germany.
Clade Ib mpox was detected by UKHSA using polymerase chain reaction (PCR) testing.
Common symptoms of mpox include a skin rash or pus-filled lesions which can last 2 to 4 weeks. It can also cause fever, headaches, muscle aches, back pain, low energy and swollen lymph nodes.
The infection can be passed on through close person-to-person contact with someone who has the infection or with infected animals and through contact with contaminated materials. Anyone with symptoms should continue to avoid contact with other people while symptoms persist.
The UK has an existing stock of mpox vaccines and last month announced further vaccines are being procured to support a routine immunisation programme to provide additional resilience in the UK. This is in line with more recent independent JCVI advice.
Working alongside international partners, UKHSA has been monitoring Clade Ib mpox closely since the outbreak in DRC first emerged, publishing regular risk assessment updates.
The wider risk to the UK population remains low.
UKHSA has published its first technical briefing on clade I mpox which provides further information on the current situation and UK preparedness and response.
Ensuring Scotland is prepared as mpox cases increase in Central and Eastern Africa
With the World Health Organization declaring a recent rise in mpox cases in Central and Eastern Africa a Public Health Emergency of International Concern, Dr Kirsty Roy and Dr Kate Smith, Consultants in Public Health at PHS, explain more about the current international situation and what is being done to prepare for any cases seen in Scotland:
The recent rise of mpox cases in Central and Eastern Africa is of global concern due to the potential for the virus to spread beyond the affected countries. It’s therefore important that we’re prepared in the event a case is identified in Scotland.
Mpox is an uncommon viral infection compared to viruses like influenza or COVID-19.
It typically causes a blistering rash which can last 2 to 4 weeks and can be accompanied by fever, headaches, muscle and back aches, tiredness and swollen lymph nodes.
There are two main types of mpox – clade 1 and clade 2 that are then further divided into clade 1a, clade 1b and clade 2b. Each type can differ in who they affect, how they spread, and the severity of the outcomes.
Clade 1 mpox is more serious than clade 2, as it can be passed on more easily, can make people more severely ill, and has a higher fatality rate. This is why clade 1 is classified as a high consequence infectious disease (HCID). HCIDs are rare in the UK, and established protocols and guidance are in place to manage these.
What’s the current global situation?
Historically, clade 1 mpox has been associated with Central Africa and linked with more severe disease and higher death rates. Recently, a new type (clade 1b) has emerged and is circulating, particularly in sexual networks in the Democratic Republic of Congo (DRC) and neighboring countries.
It was the emergence and rapid spread of clade 1b that prompted the World Health Organization to declare the outbreak as a Public Health Emergency of International Concern (PHEIC) in August 2024.
Although most cases are currently confined to Central and Eastern Africa, there is the potential for the virus to spread out with the continent to other countries, as we saw with the global outbreak of mpox clade 2 in 2022.
It’s therefore important to be aware of the above symptoms. Anyone with these should stay at home, avoid close contact with others and get medical help by phone. More information can be found on NHS inform.
How is mpox passed on?
Mpox is not passed on very easily between people. However, you can get it from close contact with an infected person, including during sex or by contact with contaminated materials (for example bedding or towels).
It’s possible that mpox may also be passed on through close and prolonged contact that can include talking, breathing, coughing or sneezing. There is currently limited evidence around this, and information will be updated when new evidence becomes available.
What’s the current situation in Scotland?
Currently, no cases of clade 1 mpox have been confirmed in Scotland. The UK Health Security Agency (UKHSA) confirmed it had detected the first case of mpox clade 1b in England on 30 October, however, the risk to the UK population is still considered low.
PHS is working closely with public health partners across the UK, as well as NHS boards, to monitor the situation and prepare for any cases of clade 1 mpox in Scotland.
As part of this, we have rapidly put testing in place to ensure suspected cases can be quickly tested in Scotland at the Edinburgh Specialist Virology Centre (SVC) and the West of Scotland Specialist Virology Centre (WoSSVC) Glasgow.
What’s the travel advice?
Currently the risk to most travellers is small. A list of countries where cases of Clade 1 mpox have been identified can be found on the UK Government website
Anyone travelling to an affected country is encouraged to take precautions, such as minimising physical or sexual contact – especially with individuals showing signs of a rash – to reduce the risk of infection.
Working in partnership with Scottish airports, we have ensured that information about the clade 1b international situation is visible to travellers in Scottish Airports. These signpost to key information on affected countries and how to access healthcare services in Scotland if an individual develops mpox symptoms.
Is there a vaccine to protect against mpox?
Mpox belongs to a family of viruses that includes smallpox and a vaccine that was developed to protect against smallpox is also considered effective against mpox.
This vaccine was used as part of the response to the 2022 outbreak of clade 2 mpox, which mainly affected gay, bisexual or other men who have sex with men (GBMSM), and Scotland continues to offer mpox vaccination to those at greatest risk.
On behalf of Scotland, and other devolved nations, the UK Government has procured more mpox vaccine doses to strengthen the UK preparedness against clade 1 mpox. More information about vaccine eligibility can be found on NHS inform.
Scotland has a robust public health intelligence system, is now able to rapidly identify and test potential cases and has a supply of effective vaccines. There is also public health information available to ensure people are prepared if they are visiting an area of higher risk. These should all ensure Scotland is prepared should cases emerge within the country.
A university project, which is raising awareness of the shocking rise of osteoporosis in adults across the UK, is to provide specialist education for care home workers and community champions.
On World Osteoporosis Day (20th October ‘24) Queen Margaret University (QMU), Edinburgh announced that it is expanding its vital work to ensure osteoporosis is viewed as a public health priority.
The University team will be encouraging staff from care homes, and people living with the condition, to become better educated about the common bone disease which affects over 3 million people in the UK.
Osteoporosis is a common bone disease that weakens bones, making them fragile and more likely to break. Developing slowly over several years, it’s often only diagnosed when a fall or sudden impact causes a bone to fracture.
Affecting over 250,000 in Scotland and accounting for around 527,000 fractures per year in the UK, QMU’s Lydia Osteoporosis Project is passionate about raising awareness to help halt the rising numbers of people affected by the condition.
Although it is frequently perceived as a condition primarily affecting postmenopausal women (affecting 1 in 2 women over 50), evidence indicates that osteoporosis affects approximately 1 in 5 men over the age of 50.
Given its often ‘silent’ progression until fractures occur, it frequently evades diagnosis until it reaches an advanced stage.
Dr Karen Matthews, who leads the Lydia Osteoporosis Project at QMU, explained: “Osteoporosis silently undermines bone strength over time. Often, it remains undetected until a simple fall or sudden impact results in a debilitating fracture.
“Typically, individuals with osteoporosis experience fractures in their wrists, hips, or spinal bones. It can even lead to a broken rib or partial spinal bone collapse triggered by a mere cough or sneeze.
“Older people can develop the characteristic stooped posture as their spinal bones weaken and are unable to bear their body weight.”
Due to our increasing aging population, osteoporosis is now increasingly prevalent, with a high incidence of people with the condition living in a care home setting, as well as in the community.
Dr Matthews explained: “It is not always obvious that someone has osteoporosis, as it can essentially be a hidden disease. But it is critical that staff in care homes and health care settings develop a better understanding of the condition so they can prevent any unnecessary bone fractures when moving or handling patients.
“Care homes workers who may be moving people in and out of beds, chairs, wheelchairs etc., or even helping them wash or change, need to be aware of the condition, to avoid handling which may cause people’s weakened bones to fracture accidentally.
“Staff in care homes, healthcare professions and the public can all benefit from improved knowledge about preventing osteoporosis through lifestyle choices, physical activity, and a balanced, bone-healthy diet, as well as how to prevent unnecessary fractures.”
Dr Matthews emphasised: “We cannot underestimate the importance of care home staff when it comes to the care and welfare of our elderly population. We must invest in their education and professional development so they are equipped with the skills and knowledge to give the best care to their residents.
“That’s why Queen Margaret University will be offering a number of free modules as scholarships to individuals working in the care home sector. We want to develop a community of Lydia Osteoporosis Champions who can help to raise awareness of this important condition within the sector.”
The QMU team is also keen to develop champions in the community who can work to reduce the incidence of osteoporosis within the population by promoting good bone health and preventative behaviours such as weight bearing exercise and healthy eating.
Dr Matthews concluded: “Osteoporosis is now such a significant health problem in today’s society that it needs to be viewed and addressed as a public health priority.
“Education and research are key to raising awareness. That’s why we are ensuring it’s taught as part of our undergraduate and postgraduate healthcare professional courses at QMU, and in our PgDip Advancing Care Home Practice (Person-Centred Practice).
“But we also need to reach people who are already in healthcare roles to spread awareness of knowledge across healthcare settings. Partnerships with staff in care homes and other healthcare settings are going to be crucial to our development of Lydia Osteoporosis Champions.
“Ultimately this will improve person-centred care of people living with osteoporosis across our care home sector, and reduce the prevalence of this worrying condition in Scotland and the UK.”
Letters for new eye clinic appointments will begin “landing on doorsteps” in Lothian in two weeks’ time
NHS Lothian said it was making progress with plans for the continued delivery of services normally housed at the Princes Alexandra Eye Pavilion, while the facility is closed for urgent repair work.
It comes after the health board announced two weeks ago that the specialist eye hospital would have to be temporarily vacated for around six months to allow for extensive work.
All appointments scheduled to take place from October 28 are being moved in the interim to other NHS Lothian facilities while the work on the plumbing system is carried out.
Services will be distributed across five locations in NHS Lothian – St John’s Hospital, Livingston, the Royal Hospital for Children and Young People, Department of Clinical Neurosciences, East Lothian Community Hospital and the Lauriston Building which is adjacent to the Eye Pavilion.
Inpatient services and day surgery appointments will be located at St John’s, while referrals for emergency ophthalmology cases will be treated at the Lauriston Building, a major outpatient centre which will also serve as temporary home to many of the Eye Pavilion’s clinics.
Jim Crombie, Deputy Chief Executive, NHS Lothian, said great care was being taken to keep disruption to a minimum, but said there is likely to be some knock-on impact of such a busy facility being relocated.
He added: “We are devising a plan that allows us to vacate the PAEP building during this essential work, while ensuring that patients can continue to be seen and treated throughout.
“So far, we have identified five locations with the necessary clinically appropriate facilities where we can relocate outpatient clinics, however we are still working through the complex logistics this will involve.
“Patient and staff safety are always our chief consideration, and our teams are working hard to minimise disruption. Please be assured, patients will be given the details of their new appointment with updated times and locations as soon as we can, and we expect that to be within the next fortnight. They can expect to receive physical letters or electronic letters on the e-comms portal.
“However, the PAEP was our busiest location for outpatient appointments, with up to 1,600 slots every week, as well as more than 130 inpatient appointments. There is likely to be an impact on waiting times in ophthalmology, but also in other specialties where the new clinics are being relocated.
“Our migration plan has tried to spread the numbers evenly across our facilities and our clinical teams are working to prioritise patients with the most urgent need for treatment soonest.
“I would like to thank our patients for their understanding and patience and our teams at the Eye Pavilion and in other services which will also be affected for their hard work and co-operation. Moving a hospital is a massive logistical exercise and I want to acknowledge that this is a whole system effort that reaches far beyond ophthalmology.”
The extensive work will begin at the end of October and will involve the removal of two waste pipes as well as asbestos material from a sealed cavity where the pipework is located.
Contractors have advised that the work can be carried out more quickly and safely if the building is vacant for the duration.
The vast majority of patients due to be seen at the PAEP between now and Friday October 26are unaffected.
A small number of appointments due to take place before then will also need to be rescheduled in order to begin preparations for the temporary closure of the Eye Pavilion. These patients will be contacted individually by their clinical teams at least two weeks in advance, and do not need to do anything.
Those who already have appointments booked for dates from Monday October 28 will be contacted by letter, text or both in good time to arrange their new appointments, starting with patients who have appointments in the week beginning October 28.
This Challenge Poverty Week, Public Health Scotland’s CEO, Paul Johnston explains how PHS are advocating for a Scotland where everyone has access to an adequate income to enable a healthy standard of living:
Living in poverty is detrimental to health and one of the main causes of poor health and health inequalities, with negative consequences for children and adults. Policy changes which impact on the drivers of poverty (income from employment, income from social security and the cost of living) have the potential to impact on population health and health inequalities.
Since 2010 a series of changes have been implemented to the UK (reserved) social security system. An intention of The Welfare Reform Act 2012 which triggered these changes was to help people into work and reduce poverty for adults and children, which in turn would lead to improvements in health.
Policies included reduced financial support to low-income families with three or more children and increased conditionality for lone parents. These are families who already have an increased risk of living in poverty.
Since 2013, Public Health in Scotland (PHS) has been monitoring the economic and health trends associated with Welfare Reform. Our latest report Improving Lives? highlights that the anticipated improvements to income and health from Welfare Reform have not been realised for people in Scotland.
Aspects of health have worsened or remained unchanged since 2010 and importantly, many of these trends pre-date the COVID-19 pandemic. These trends were also observed for the rest of the UK. A forthcoming PHS systematic review found that for people exposed to the changes, UK Welfare Reform made mental health worse, and had no positive effect on physical health.
This is concerning, especially as our report shows that population groups most likely to be affected by these changes are the groups who are already more likely to be at risk of or experiencing poverty. We know from 2013 that the relative child poverty rates in Scotland increased after a period of decline.
Evidence also tells us that mental health problems became more prevalent, especially after 2015, while health inequalities have risen. The period also saw stalled improvement or worsening trends in financial insecurity and long-term sickness.
This Challenge Poverty Week, we are advocating for a Scotland where everyone has access to an adequate income to enable a healthy standard of living. This will help to create a Scotland where everybody thrives.
A number of changes are needed to make this happen. These include promoting quality employment which supports good health. Almost 19% of employees in Scotland aged 18-55 are in poor quality work, and most working-age adults and children in poverty live in a household where someone works.
We also need to ensure our social security system protects people’s mental health and wellbeing. This could include an Essentials Guarantee to protect people from hardship, supported by 72% of the population.
During 1997–2010 policy choices by the UK government directed financial support at children and pensioners and as a result poverty fell for both of these groups. This period also saw increased employment rates translate into improved mental health for lone parents. This proves that we can make a difference to people’s lives through social security and employment policies.
In Scotland, child poverty rates are lower than many other UK nations. In Scotland, we are doing things differently to tackle child poverty.
Scotland is delivering a strengthened employment offer to parents, to provide holistic support and address specific barriers to enable more parents to gain and progress in work. This along with focussed action to create a Fair Work Nation, which includes supporting more employers to pay the living wage, provides a platform to build on, to support more parents to escape poverty.
Learning and evidence from past UK policy approaches and Scotland’s actions to tackle child poverty should be used to inform further policy changes to address poverty and improve health.
It is imperative that providing an effective social security safety net for when families need it and creating high quality, flexible employment opportunities for parents, will be central to the UK’s child poverty strategy going forward.
A public health levy on alcohol and tobacco retailers is a crucial step to supporting frontline recovery services, says Scottish Green MSP Lorna Slater.
Ms Slater’s comments come as new Scottish Government stats show that 1,277 people in Scotland died in 2023 from alcohol misuse, with 163 of those deaths in the City of Edinburgh.
In the Scottish Parliament Lorna Slater pushed Scottish Government Minister Jenni Minto to reconsider the reintroduction of this levy as a surcharge on the non-domestic rates for large retailers selling alcohol and tobacco.
Currently retailers keep the additional revenue raised from minimum unit pricing. A recent report by the Fraser of Allander Institute for Alcohol Focus Scotland showed that a levy on retailers with a licence to sell alcohol and tobacco, set at 13p per pound, could raise £57 million a year for support services.
The majority of the funds raised would come from big national supermarket chains, who they say would make up 86% of all revenues.
The Scottish Government has committed to exploring the potential for the introduction of a levy as a result of budget negotiations with the Scottish Greens.
Ms Slater said: “Every one of these lost lives is a tragedy, and there will be people missing them and mourning them. We clearly need to change Scotland’s relationship with alcohol.
“We urgently need to tackle the root causes of alcohol misuse and ensure that we are funding recovery services to support people and communities that need it.
“Minimum unit pricing has been an important step forward, but the money made from it is staying with the supermarkets rather than being used to support people and families who are on the frontline of the crisis.
“If retailers are profiting from the sale of products that are damaging public health, like alcohol and tobacco, then they should also pay towards mitigating the health and social costs that they cause.
“This is something that I hope MSPs from all parties can agree on and work together to deliver. With a budget due later this year, I hope that the Scottish Government will apply a public health levy to ensure that we are supporting frontline recovery services.”
