NHS Greater Glasgow and Clyde emergency department review: response
Response to Healthcare Improvement Scotland's review of safety and quality of care at the main A&E departments in the NHS Greater Glasgow and Clyde area.
Response to recommendations
Healthcare Improvement Scotland' s report makes 41 recommendations, including 11 strategic/national recommendations for the Scottish Government. Our response to the national recommendations (31 to 41) follows.
Recommendation 31: national approach needed for safe urgent care standards to eliminate non-standard care areas (accept)
Recommendation: Scottish Government should commission Healthcare Improvement Scotland to lead the development of a national approach to improving the quality and safety of urgent and unscheduled care in NHS Scotland, consistent with the Quality Management System, including the development of national standards in partnership with a range of agencies including the Royal Colleges. This will build on work already commenced by The Centre for Sustainable Delivery and include urgent work needed to work towards eliminating the unacceptable use of non-standard care areas given the risks to patients and the impact on staff. This will require significant national focus and support.
Response: accept
The current position is that Centre for Sustainably Delivery (CfSD) have a well-established programme of urgent and unscheduled care (UUC) improvement and are working with Boards on bespoke plans and on standardisation of patient pathways. They will continue to work with Boards and partners such as HIS, to further build and integrate services that are fit for the future. However, further work will be required nationally along with partners around the quality and safety aspect of non standard pathways. The Scottish Government will work with HIS and partners to understand where there are gaps in the current approach to improving quality and safety of urgent and unscheduled care to ensure alignment with the new commission which will be undertaken by the relevant organisation.
Recommendation 32: patient feedback essential to improve emergency care experiences and future service design (accept)
Recommendation: Scottish Government should explore with Healthcare Improvement Scotland how best to gather patient views about experiences of accessing urgent and unscheduled care services and waiting in emergency departments to inform more detailed national recommendations on how to improve the patient experience and shape services for the future.
Response: accept
The Scottish Government will discuss with HIS-CE (HIS Community Engagement) how these topics could be covered in a future Citizens Panel. We will engage with Scottish Government policy leads to determine how best to gather patient views about their experience in an integrated way.
Recommendation 33: review needed of national escalation guidance to ensure robust whole-system emergency response (accept)
Recommendation: Scottish Government should engage with relevant national agencies to commission a review of the national guidance for specific health and care demand, capacity escalation and business continuity, which recognises the need to ensure a credible, robust and practical whole system response. This is essential and complementary to the current Multi Agency Major Incident Guidance.
Response: accept
Work is ongoing with Health Boards, led by the National Centre for Sustainable Delivery, to introduce an Operational Pressures Escalation Levels (OPEL) system across NHS Scotland Health Boards. This system utilises critical-level metrics and indicators to support the detection and assessment of ED operating pressures in the pre-incident space and will bring consistency to local and system escalation.
Framework to be in place by Winter 2025.
Recommendation 34: refresh professional advisory committee guidance to enhance transparency and safety reporting in NHS boards (partially accept)
Recommendation: Scottish Government should engage with relevant national agencies to commission a review of the professional advisory committee arrangements in NHS boards to ensure they have a transparent, independent and objective mechanism for the board to consider matters of safety and concern. There is an opportunity to refresh the previous national guidance and make these arrangements clearer and more open for all professions to understand.
Response: partially accept
Partially accepted on the basis that the professional advisory structures which exist in Boards are not the primary board structures for considering safety and concern, this is for Staff and Clinical Governance with Boards. However, we will consider a refresh / reminder of guidance to Boards, that their Clinical and Staff Governance assurance and oversight should include being satisfied that there are appropriate routes to raise concerns and monitor that these are being responded to and closed down, through reports to the committees. This could include reference to the role of the professional advisory structure. Decision around reminder to boards to be made by end June 2025.
Recommendation 35: develop comprehensive datasets through Public Health Scotland to improve urgent care system flow (accept)
Recommendation: Reliable and comparable whole-system datasets are essential to support improvement in urgent and unscheduled care and optimise flow through the health and social care system. Public Health Scotland (PHS) should be commissioned by Scottish Government to work with other national and local partners with the aim of progressing existing work and further developing datasets that are designed with, and available to NHS boards to support continuous improvement.
Response: accept
The Scottish Government will discuss with PHS whether the existing analytical products and development work planned for 2025/26 need to be adapted in light of this recommendation. This will involve engagement with HIS to understand further the intent behind this recommendation.
Recommendation 36: Centre for Sustainable Delivery must work with NHS boards to reduce variation, improve access equity, and ensure clinical leadership drives local improvements (accept)
Recommendation: The Centre for Sustainable Delivery (CfSD should strengthen its collaboration with territorial and national NHS boards to engage in improvement activities aimed at:
- reducing unwarranted variation in urgent and unscheduled care performance to enhance the quality and experience of care, as well as patient outcomes.
- rethinking access to urgent and unscheduled care to ensure equity and that individuals are treated in the right place, the first time.
- ensuring appropriate representation, including clinical leaders, in the recently formed Strategic Delivery Groups to drive improvement, set standards, and deliver change.
- participating in the acute hospital site visit process to ensure that change is driven by clinical teams and tailored to meet the needs of local communities.
Response: accept
The Scottish Government will work with CfSD to understand if work planned for 2025 to 2026 needs strengthened in light of this recommendation.
Recommendation 37: expand NHS leadership development programmes to foster multidisciplinary innovation and patient safety improvements (accept)
Recommendation: NHS Education for Scotland should strengthen and further develop structured development programmes to identify and support clinical and non-clinical leaders in NHS Scotland. These programmes will enable NHS boards to focus on developing whole system multidisciplinary working and relationships which foster innovation, improvement and inclusivity in decisions that explicitly benefit quality of care and patient safety.
Response: accept
The Scottish Government is working with NHS Education for Scotland (NES) as strategic delivery partners to support the identification and development of leaders in NHS Scotland. This includes:
- a national programme to support executive level talent development, talent management and succession planning, and an aligned approach to support identification of operational level leaders to go live in Summer 2025
- a range of interventions, under the banner of ‘Leading to Change’ to support the development of senior systems leaders across organisational, system and professional boundaries. This includes a current offer of ‘Adaptive Learning Sets’ for systems leaders from health, social care and social work backgrounds, as well as exploration of how best to continue to support alumni from a range of national, strategic, leadership interventions, to better enable them to support national, strategic, cross systems working
The Scottish Government, in partnership with NES, will continue to explore and progress additional opportunities for leadership development.
Recommendation 38: support transition to whole time equivalent medical trainee recruitment to strengthen workforce sustainability (partially accept)
Recommendation: NHS Education for Scotland should be supported by Scottish Government to explore the implications, and work towards the shift to whole time equivalent medical trainee recruitment in order to strengthen the learning experience, reduce gaps in service and build a more sustainable, effective medical workforce for the future
Response: partially accept
The Scottish Government recognises the impact of Less Than Full Time (LTFT) training and has, through the annual review of medical training establishments process, funded a number of additional posts in impacted specialties to work towards addressing this. With a pattern of increasing LTFT training across multiple specialty groupings, there is a recognition of the need for a more strategic and holistic approach to respond to this changing pattern of working to take into account trainees’ preferences while ensuring workforce sustainability. Given the significant implications of LFTF training for future workforce planning and current service delivery, we intend for future work to be taken forward jointly with NES (hence partial acceptance). To this end, the Scottish Government is currently working with NES to undertake a detailed review of training establishments to understand the impact and explore sustainable solutions through future workforce planning taking account of current service and training need, supervision and future trained workforce requirements.
Recommendation 39: evaluate and improve induction support for NHS Non-Executive Board Members to enhance governance effectiveness (accept)
Recommendation: The review has highlighted the critical role of effective and supportive leadership by the NHS Board. It is recommended that the Scottish Government commission NHS Education for Scotland to evaluate the current national and local induction and support arrangements for NHS Non-Executive Board Members. This evaluation should aim to identify and implement any necessary improvements to ensure that Non-executive Board Members can perform their roles as effectively as possible, and consistent with the requirements set out in the NHS Scotland Blueprint for Good Governance.
Response: accept
The Scottish Government commissions and oversees the work of the Board Development Team at NES who support and develop learning and development materials for Board Members. This includes a standardised approach to national and local induction for Board Members supported by a suite of e-learning materials on Board Specific topics and policy overview/relationship with the Scottish Government. The approach has been in place for several years now and NES monitor participation and collect feedback.
We will conduct a review of the materials in collaboration with NES, NHS Board Chairs and the Commissioner for Ethical Standards who regulate public appointments. The evaluation will be led by the Scottish Government, involving NES and others. We will build this into our commission to NES for the work programme for the year starting in April 2025.
We have commissioned the NES Board Development Team to undertake the review. They are putting together a short life working group which comprises of a range of stakeholders, including an independent perspective via the Commissioner’s office.
Recommendation 40: develop robust staffing tools for emergency departments to ensure safe care in current context (accept)
Recommendation: The review has identified that the tools for appropriate staffing levels with regard to emergency departments are not sufficiently robust. Healthcare Improvement Scotland’s Healthcare Staffing Programme should prioritise the development of new tools which reflect the current operating context and multi-disciplinary working to ensure safe and effective care.
Response: accept
The Staffing Level Tools (SLTs) are fully owned, monitored and updated by HIS. Scottish Government officials work closely with colleagues from HIS and have been advised that there are already plans for work to begin on updating this tool from 2027 and completed in 2028. HIS have confirmed that in order to ensure that this tool is contemporary, reflecting current practice and fulfils HIS' duty to consider multiprofessional tool developments it is acknowledged that this will be a complex build.
HIS have informed Scottish Government officials of their interim plans for the current tool, while the review is carried out.
Recommendation 41: develop clear whistleblowing guidance to improve staff awareness of reporting channels (accept)
Recommendation: Healthcare Improvement Scotland should collaborate with the Independent National Whistleblowing Officer, and other relevant bodies, to develop clear and unambiguous guidance for staff in NHS Boards on the national routes for staff to raise concerns under Whistleblowing and the Public Interest Disclosure Act. This will enable NHS Boards to ensure that they have effective arrangements in place and improve staff awareness and understanding.
Response: accept
Ministers will be kept informed of progress of the HIS RTC Action Plan and, once complete, processes for staff raising concerns will be described in the Scottish Government/HIS Operating Framework and on the HIS and other NHS Board websites, intranets and wider communication and engagement channels.
Any joint guidance developed would need to reflect the requirements of the Whistleblowing Standards, developed by INWO, which are underpinned by legislation.
It should be noted that escalation of concerns to INWO or HIS are where other systems and processes have not addressed the concerns. Boards must ensure that all colleagues are clear on how to raise concerns through a range of management, professional and confidential channels and to ensure these are functioning effectively, as outlined in the NHSScotland Whistleblowing Policy and Whistleblowing Standards.
See: NHS Greater Glasgow & Clyde Emergency Department Review: March 2025.