NHS70 Souvenir edition published by Canongate Communications
RAISING THE STANDARD THE NHS AT 70
Inside: the women who shaped Scotland’s National Health Service
Contents EDITOR
Kevin O’Sullivan 0131 357 4472 kevin@futurescot.com
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William Peakin 0141 465 7652 will@futurescot.com
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Andrew Ritchie 0131 357 4474 andrew@canongate.org Harry Dickinson 0131 357 4473 harry@canongate.org Katrina Merrilees 0141 465 7652 katrina.merrilees@canongate.org
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TYPOGRAPHY
7 16
4 Great NHS Menu revealed
Celebrating NHS@70
6 NHS Scotland 8 Paul Daisley Trust 9 British Heart Foundation
Women who trailblazed the way
12
Acta by Dino Dos Santos DSType Foundry www.dstype.com Flama by Mario Feliciano www.felicianotypefoundry.com
Stratified Medicine Scotland & Royal Pharmaceutical Society
13 Wright, Johnston & Mackenzie LLP 14 NHS History
Cover picture: Nurses at Gartnavel Royal Hospital in Glasgow hoist a flag to mark the beginning of the NHS in Scotland on July 5, 1948. Picture courtesy NHS Greater Glasgow and Clyde.
NHS@70 is an independent publication by Canongate Communications distributed in The Times Scotland. All rights reserved. Neither this publication or part of it may be stored, reproduced or transmitted, electronically, photocopied or recorded without prior permission of the Publisher. NHS@70 is published and exclusively distributed in The Times Scotland. We verify information to the best of our ability but do not accept responsibility for any loss for reliance on any content published. If you wish to contact us, please include your full name and address with a contact telephone number.
16 NHS People 18 NHS Innovation 20 From the archives
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Scotland’s global breakthroughs
24 Health and Social Care 25 Scottish Qualifications Authority 26 Chest, Heart and Stroke Scotland 28 Scottish Genomes Partnership 29 UNISON 30 Golden Jubilee National Hospital 31 MSD 32 NHS Research Scotland & Scottish Health Innovations Ltd 34 Ieso NHS70 | SUMMER 2018 | 3
5 July Celebrations
Founding principles ‘as Celebrations for a ‘treasured institution’ were held across Scotland this month BY WILLIAM PEAKIN
A
deline Reid MBE, a retired nurse and midwife from Keith, began her career in 1958 and in her 44 years with the NHS worked in a variety of roles throughout
Scotland. She trained as a Registered General Nurse at Dr Gray’s Hospital in Elgin, became a certified midwife at Rottenrow Glasgow, worked as a Queen’s District Nurse and District Midwife in Glasgow and was a midwife at Seafield Hospi-
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tal in Buckie. Adeline also studied at Robert Gordon University, to become a practical work teacher at Keith Health Centre and took a course to become a nurse prescriber. “From an early age my ambition was always to be a nurse and working for the NHS has been the most wonderful experience for me. It has given me a wealth of skills and the opportunity to meet loads of amazing people – both fellow staff and patients,” said Adeline. “I cannot praise the NHS highly enough for everything it does. Indeed, I have also experienced the NHS as a user, and owe a debt of gratitude for the screening programme which identified my breast cancer, the surgery and radiotherapy which followed, and the follow-up care since. “The first-rate healthcare and compas-
sionate service is something we as a country should be very proud of. I am hugely grateful for everything the NHS has done for me and given to me throughout my life. It gives me great pride to have been part of one of our nation’s most treasured institutions, and in its 70th year, to see it continuing to impact hundreds of thousands of lives every day.” All around Scotland this month the nation celebrated this ‘treasured institution’. First Minister Nicola Sturgeon reasserted a commitment to an NHS free at the point of need as she celebrated the 70th anniversary with patients and staff in Glasgow. She was joined by Health Secretary Jeane Freeman at the Royal Hospital for Children. They took part in 1940s games with children in the hospital’s atrium before meeting patients,
Some of the celebrations across Scotland this month. Clockwise from above; Fife, Raigmore Hospital in Inverness, Forth Valley and in Glasgow with the First Minister
strong as ever’ family members and staff on the wards. “Our NHS has gone from strength to strength over the past 70 years, and this anniversary is an opportunity to appreciate the vital role the service plays in all our lives. It is also a time to reaffirm our commitment to the founding principles of the NHS – that healthcare should be provided free at the point of need,” said Sturgeon. “This commitment remains as strong as ever and is just as relevant today as it was in 1948, which is why we are investing record-high real terms health funding and have delivered an all-time high in NHS staff numbers. I’d like to take this opportunity to thank everyone who has contributed to the health service over the last 70 years, and all those who continue to work and volunteer across the NHS today.” n
“It gives me great pride to have been part of one of our nation’s most treasured institutions, and in its 70th year to see it continuing to impact hundreds of thousands of lives every day” Adeline Reid MBE Adeline Reid MBE began her career in 1958
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NHSScotland
There for you The NHS is all about you, whoever you are, and wherever you are
BY PAUL GRAY
T
o be Chief Executive of NHS Scotland as it celebrates its 70th anniversary is an enormous and humbling privilege – and a very real responsibility. NHS Scotland is one of our best loved institutions, available to touch all of our lives at some point. It’s there for us when we’re born and at every stage of our lives, always striving to provide the highest standards of care when we need it most. Since 1948, the NHS has been on a journey of improvement and innovation, to meet the changing needs of the people we are
here to serve. But what hasn’t changed is the dedication and compassion of our staff and volunteers. They make NHS Scotland what it is today. Every day I see examples of personal commitment and dedication which go far beyond words, but I also know that patients, families and carers are quick to express their gratitude in a myriad of ways. We remain committed to delivering safe, person-centred and effective care. We remain committed to learning from the best examples, nationally and internationally. And we remain committed to ensuring that more people are able to live longer, healthier lives at home or in a homely setting. But I’d never claim that it is all plain sailing. The changing needs of Scotland’s population do present challenges. The demand for services that can support people with multiple and complex health conditions is increasing. We still have serious health inequalities in some areas of Scotland. And we don’t always get everything right. So, transformation is not just desirable – it’s essential. The models of health and care delivery that served us well in the past are changing to reflect the needs of the future, and to take full advantage of advances in technology, medicines and practices. In this, the Year of Young People, we owe it to future generations to deliver the transformation that will meet their needs.
Our partners in delivering health and care should also be recognised, as we celebrate this important birthday. Without the help of local government, the third sector, our friends in the blue light services, volunteer first responders and local volunteers, and many others day in and day out, we would be much less than we are. I hope that during this year of the 70th anniversary of the NHS, we can reflect on how far we’ve come in Scotland - and look towards the future. That future is one where we can continue on the journey which has seen some of the world’s greatest achievements in health improvement and healthcare. But ultimately, the NHS is all about people. The people we serve and care for – the patients, their families and their carers. The people who work in the NHS, with their unfailing professionalism and kindness, sometimes in the face of pressing need, sometimes in difficult circumstances, sometimes with little thanks at the end of the day. The people who work with us across public services and beyond, the volunteers, and the individuals who give us feedback, or simply say a word of thanks. The NHS is all about you, whoever you are, and wherever you are. Paul Gray is Director-General, Health and Social Care, and Chief Executive, NHSScotland.
The NHS is a ‘gift’ that we must hand to future generations Committing to the hard work needed
BY JEANE FREEMAN
runs through the heart of the health service workforce, from porters through to our surgeons and specialist clinicians, is remarkable and should never be taken for granted. In Scotland we have so much to be proud of – pioneering medical developments, world-leading research produced in our hospitals and universities – all changing the lives of patients not only here, but right across the world. We live in a time where these ground-breaking advances mean people in Scotland are living longer than at any point in our history. That success also brings challenges that mean we need to work hard to make sure we continue to adapt our NHS to meet these evolving needs head on.
ver the years, many of my family, including me, have worked for the NHS. And, like very many, we have benefitted from it too. So, I have real and deep admiration for everyone who day after day, gives their skill and energy and compassion to our national health service. The compassion, care and commitment that
Investment in delivering services is necessary, but it must also be twinned with reform. That’s why I am so committed to continuing our drive to invest in the successful integration of health and social care, delivering one of the most ambitious reform programmes our NHS has seen. Health and social care integration will see more people
O
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treated closer to home where possible, and that means implementing a joined-up system of care to make sure people get the right care, in the right place, at the right time. Of course, patient safety will always remain paramount and our Scottish Patient Safety programme is a global benchmark. We know change of this scale will take time, but our commitment to delivering an NHS that continues to serve the people of Scotland free at the point of delivery is unwavering and I’m proud to be part of that journey. Our NHS is precious to us and we must guard it and develop it. This anniversary is not only an opportunity for all of us to celebrate all that the NHS in Scotland has achieved over the past seven decades and to give our sincere thanks to everyone who makes our NHS what it is, it is also our opportunity to commit ourselves to the hard work needed so we hand on this gift to future generations, as it has been handed to us. Jeane Freeman is Cabinet Secretary for Health & Sport.
Dawn of a New Era
‘Invalid fruit tart’ and ‘fish custard’: The Great NHS Menu revealed How hospitals, healthcare – and nutrition – have changed since Nye Bevan’s Appointed Day BY DR LOUISE WILLIAMS
L
othian Health Services Archive (LHSA) is the archive of NHS Lothian, based in the Centre for Research Collections in the Main Library of the University of Edinburgh. LHSA looks after more than 3,000 shelves of archive material, dating from 1594 up to the present day. With collections documenting patient lives, hospital histories and staff stories through text, images and objects, we’re one of the largest medical archives in the UK. I’ve been NHS Lothian’s Archivist for more than four years now, but the sheer size and variety of the collections that I look after means that I’m always coming across items that I’ve read about in our catalogues but have never seen ‘in the flesh’. Rarely a day goes by when I don’t learn something new about how people were cared for in Scotland. We’re always adding to our holdings: we take in material from NHS Lothian hospitals (mostly when important records are no longer in active use and need to be preserved permanently) and archives from the general public and non-NHS organisations that reflect our local health history. Our current exhibition, Dawn of a New Era, runs to 15 August this year, on the 6th floor of the Main Library, and celebrates the 70th anniversary of the NHS in Edinburgh and the Lothians. Looking back through pre-1948 experiments in state healthcare, celebrating NHS medical breakthroughs, marking public health campaigns and charting growing patient power, Dawn of a New Era outlines how hospitals, healthcare and communities have changed in our region since Nye Bevan’s Appointed Day. The regional nature of the exhibition we’ve put together is important: 5 July 1948 did not create one monolithic NHS, but a service for England and Wales and another for Scotland, with a slightly different structure and a different chain of accountability. Scotland was also used to state responsibility for healthcare in a way that England, for example, was not, making the transition to the new service arguably a smoother one. Experiments in
The exhibition’s title reflects a graphic on the back page of the final annual report of the Royal Infirmary of Edinburgh’s League of Subscribers
The Royal Infirmary was a leading light in hospital nutrition, having founded the UK’s first Department of Dietetics in 1924
state healthcare in the Highlands and Islands Medical Service as far back as 1913 (when government directly funded medical staff to serve poor and remote areas) were a case in point. Furthermore, when the British Medical Association (BMA) scuffled with Bevan over conditions of service in the new Health Service in the late 1940s, the final BMA ballot on proposals saw the majority of Scottish doctors, unlike their counterparts south of the border, vote for the new arrangements. The exhibition’s title reflects a graphic on the back page of the final annual report of the Royal Infirmary of Edinburgh’s League of Subscribers. Founded in 1729, the Royal Infirmary was the first voluntary hospital in Scotland, funded by charitable contributions from across Edinburgh’s social spectrum. The League came into being in 1918 to raise and manage public donations – but with the introduction of the National Health Service in 1948, central funding for hospital care meant that its function was effectively redundant and the League was disbanded in March 1949. The ‘Dawn of a New Era’ graphic on the final page of the report reflected hope for a brighter future (indeed, the graphic was a rising sun over an idyllic horizon) whist its surrounding text expressed gratitude for all that the generosity of Edinburgh’s public had built.
One display case in the exhibition focuses on hospital food: the Royal Infirmary was a leading light in hospital nutrition, having founded the UK’s first Department of Dietetics in 1924. The department formulated special diets to aid patient recovery and to benefit certain conditions. We have a bundle of small recipe sheets showing food that would have been cooked up by the department in the 1950s – from fish custard (essentially fish in white sauce with the fish taken out before serving!) to an ‘invalid fruit tart’: a kind of apple sponge pudding. Food seems to be something that has really caught the public imagination in this NHS anniversary year: so much so that part of a special series of The Great British Menu was filmed at LHSA, due to air later this summer. Being part of celebrations like this, bringing hospital heritage into people’s living rooms, has been really exciting, and a chance to show how much we can learn from the lives, stories and achievements that make our NHS. n Dr Louise Williams is the LHSA Archivist You can learn more about LHSA through our website (http://www.lhsa.lib.ed.ac.uk), and we always welcome queries by email (lhsa@ed.ac.uk) or telephone 0131 650 3392.
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Bowel cancer, also known as colorectal cancer, is the 4th most common type of cancer in the UK and is the 2nd most common cause of cancer death after lung cancer. It is one of the most treatable of cancers with early diagnosis. Each year, more than 41,000 people in the UK - 4,000 in Scotland - are diagnosed with bowel cancer: 23,000 men and 18,000 women, and someone dies from bowel cancer every half hour. Research shows that 9 out of 10 people whose bowel cancer is detected early will survive the disease, but currently 50% of bowel cancers are diagnosed at a late stage. The most common route to diagnosing bowel cancer is referral from the GP. Screening is the route with the highest proportion of cases diagnosed at an early stage. Survival rates have doubled over the last 40 years and are continuing to improve due to increased awareness, earlier diagnosis, improved treatments and screening. Treatments are most successful in the 60-69 age group, probably due to screening. 54% of cases of bowel cancer are preventable. Some potentially avoidable life style factors are alcohol – 6%, smoking – 7%, eating processed meat – 13%, overweight and obese – 11%, eating too little fibre – 28%, and too little physical activity – 5%. Regular bowel cancer screening has been shown to reduce the risk of dying from bowel cancer by 16%. The NHS Bowel Cancer Screening Programme offers routine screening to those aged 50-74 in Scotland and 60-74 in the rest of the UK. In Scotland alone, that’s over half a million people doing their bowel screening test each year. For more information contact your helpline: Scotland – 0800 012 1833. Figures refer to UK. Primary sources CRUK and National Cancer Intelligence Network.
020 8968 4340 pdaisleytrust@aol.com The Paul Daisley Trust, 11 Montrose Avenue, London NW6 6LE Reg charity: 1103457 – The Paul Daisley Trust, set up in 2003 after the untimely death of Paul Daisley MP, is run entirely by volunteers
Proud to support the NHS in Scotland
Raising awareness of bowel cancer – the importance of screening
British Heart Foundation
Innovation
A focus on population impact, data and improving patients’ lives British Heart Foundation is innovating to the core of healthcare delivery BY KEVIN O’SULLIVAN
W
ith a rich history of driving scientific progress, the British Heart Foundation (BHF) has for almost 60 years of its existence been at the forefront of turning cutting-edge research into real-life applications which have transformed people’s lives. That focus continues unremittingly in the modern era and in addition to its long-standing public-facing role, with a nationwide chain of 750 retail stores, the organisation now stands on the cusp of its own digital transformation which is changing the way it develops and delivers services, from the remote monitoring of people with heart-related risk factors, to retinal scans, or genetic testing to predict future cardiac events. Since BHF’s founding in 1961, the charity has long regarded Scotland – in terms of its size, geography, clinical expertise and ability to gather data from a relatively small collection of NHS health boards (14 in total) – as the ‘perfect test bed’ for many of its pilot programmes; indeed, 54 per cent of the organisation’s annual £70m research budget is spent, per capita, on services and research north of the Border. The organisation is proud of the fact that two of its ‘world-class’ Centres of Research Excellence are in Scotland, located at The University of Edinburgh and The University of Glasgow. This has led to the development of such initiatives as a remote blood pressure monitoring service, which has been rolled out - in partnership with NHS 24’s Scottish Centre for Telehealth and Telecare, and the Scottish Government’s Technology Enabled Care Programme - across NHS Lanarkshire, NHS Lothian and NHS Western Isles. Creating front-line applications which address pressing societal challenges, such as helping the near estimated 30 per cent of Scotland’s adult population who have high blood pressure to live better and longer lives,
goes to the heart of a recent strategic shift which seeks to place patient data in their own hands. Jacob West, a former health policy adviser to Tony Blair and Gordon Brown, is the man charged with leading the organisation into this new data-driven era; as Director of Healthcare Innovation he wants to drive the digital agenda but above all to demonstrate the value proposition for BHF in a 21st Century health and social care model, with ever closer service integration shaping new interactions between clinicians and patients. “I think one of the things that we are particularly going to focus on is how we demonstrate our impact to patients and the
“I think one of the things that we are particularly going to focus on is how we demonstrate our impact to patients and the public that we are really making a difference” Jacob West
public that we are really making a difference,” he says. “If you look over the history of the British Heart Foundation, it has played a pivotal role in cardiovascular breakthroughs, whether for clot-busting drugs or demonstrating the effects statins can have, to supporting the development of heart transplantation, we’ve been there on that journey. However, there’s often a very long lag time for the impact of research to be translated into services, so we want to be able to help people make that connection. That’s going to be a big theme for us as we move forward with the new strategy.” Healthcare is grappling with the challenges and opportunities of emerging data science and artificial intelligence techniques, or ‘machine learning’. The ability of clinicians to predict likely future cardiac events among specific population cohorts through sophisticated algorithmic processes may become the norm in the not-too-distant future; modelling will therefore enable clinicians to intervene in cardiac cases before acute hospital-based medicine is required, the current survival rates for which are lower in the UK than in other western European countries. For West, these kind of techniques could have primary benefit to not only patients, but to the health system as a whole. He wants BHF itself to be a ‘learning organisation’ – like some of the cutting-edge institutions he has observed in the US, such as the Mayo Clinic and the Geisinger Medical Center – and to be able to assist its partners like the NHS to better understand its own data and turn it into patient-focused solutions. “Organisations that are learning organisations, which use data, test and experiment, and try and continually improve are those that succeed the most; systems that take learning, data and improvement seriously at the organisational level, that’s where it’s really important for the improvement of healthcare. He adds: “But if data is going to be an important part of the solution it’s important that we bring people with us because, fundamentally, research that doesn’t turn into impact on the ground has got limited value; so a big part of our role is building on the BHF’s terrific research base and to try and translate that into practice with the NHS and other partners.” n
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British Heart Foundation
Scientific progress and compassionate care The British Heart Foundation has a shared history of discovery with the NHS
I
n the late 50s and early 60s, there was a recognition that action was needed to tackle the epidemic of heart and circulatory diseases, in particular coronary artery disease. The causes of heart and circulatory diseases were poorly understood and there were very few treatments. Heart and circulatory diseases accounted for more than half of all deaths in the UK. Dying of a heart attack was very common. Most people didn’t survive if they had one outside of hospital. If you did survive and made it to hospital, you would be given painkillers such as morphine and kept in bed for six weeks. But survival rates were low. Medical science had not yet understood that heart attacks were caused by blood clots. This population health challenge prompted a group of doctors to found the British Heart Foundation (BHF) in 1961. Thanks to the generous support of the public, the BHF has funded hundreds of millions of pounds of research, saving and improving lives worldwide, and has pioneered treatment ever since.
1960s: CORONARY CARE UNITS
The BHF helped set up the first coronary care unit, by funding equipment and nurses, and set a global standard. If you were admitted to hospital today, you’d expect to be placed on a specialist ward dedicated to your condition. But in the late fifties and early sixties, the coronary care unit was an unheard of concept. Heart patients were scattered around a hospital on general wards. If a patient went into cardiac arrest, there was often a lengthy delay before the right staff and equipment could be brought to the scene. These delays cost lives. Professor Desmond Julian at the Edinburgh Royal Infirmary had a better idea. Just a
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junior doctor in 1961, he sketched out a plan for a specialist coronary care unit. He wanted to keep all heart patients in the unit, monitor them continuously and have the right equipment – and the right staff – on standby for emergencies. In its first year the unit saved the lives of an extra seven out of every 100 patients admitted compared to the old method. Soon hospitals around the world were following the example set by the man who, in 1986, would serve as the BHF’s Medical Director until 1993.
1970s: HEART ATTACK TREATMENT
In 1976, BHF Professor Michael Davies proved that heart attacks are caused by a blood clot in a coronary artery, setting the stage for a revolution in treatment. Before the 1970s, heart attacks were poorly understood, and the best treatment doctors could offer was bed rest.
TREATING BABIES
Now, thanks to BHF-funded research, more than eight out of ten babies with congenital heart disease will reach adulthood. In 1961, less than half of children born with a heart defect lived to their first birthday. In 1974, the BHF started funding Professor Bob Anderson, who pioneered our understanding of anatomy of the heart and heart defects. Following his work, BHF surgeons, including Professor Sir Magdi Yacoub, pioneered new surgical techniques for repairing babies’ hearts that are now used worldwide.
1980s: CLOT-BUSTING DRUGS
In the 1980s, the BHF funded an international study led by Peter Sleight and Professor Rory Collins, which revealed the life saving potential of the clot-busting drug streptokinase, as well as aspirin, for treating heart attacks. Thanks to this pioneering research, 70% of people now survive a heart attack in the UK.
STATINS
In 1989, BHF Professor Stuart Cobbe led a trial which revealed that people with high
cholesterol could reduce their risk of having a first-time heart attack by around 25 per cent by taking statins. Today, statins, which work to lower the level of cholesterol in your blood, are the most commonly prescribed medicines in the UK.
HEART TRANSPLANTS
BHF Professor Sir Magdi Yacoub and Sir Terrence English helped make heart transplantation a success story. In 1985, six years after Professor English succeeded in getting government support for his heart transplant programme, a Department of Health study demonstrated that transplantation was ‘much more cost effective than any other procedures in medicine.’ As a result, the Department of Health began funding both Papworth and Harefield as centres of heart transplantation, with the Harefield team led by Professor Sir Magdi Yacoub. Now, thanks to the early work of Professor English and Professor Yacoub, around 200 heart transplants are carried out on adults in the UK each year.
1990s: STATINS
In 1994, BHF Professor Rory Collins launched a huge trial which showed that even people with ‘normal’ cholesterol could lower their risk of future heart attack or stroke by taking statins.
“The BHF and the NHS have a shared history: one of pioneering medical advances and compassionate care, all to improve and save lives. I’m immensely proud that, working alongside the NHS, the BHF has played a leading role in halving death rates from heart and circulatory diseases across the UK. Thanks to the public’s generous donations, fundraising and legacies, the life saving research we fund will continue to make an impact not just in the UK, but globally.” Simon Gillespie, Chief Executive, British Heart Foundation Statins are now the most commonly prescribed drug for those at risk of developing heart disease, saving around 7,000 lives in the UK each year alone.
GENES
In 1994, BHF Professors Stephen Ball and Sir Nilesh Samani set up the Family Heart Study, which led to the discovery of genes linked to heart and circulatory diseases. Genetic discoveries set the stage for new ways of preventing and treating heart disease.
HEART ATTACK
In 1999, BHF Professor Keith Fox, in Edinburgh, started an international research programme called the GRACE registry which is now used worldwide to help doctors predict a heart attack and give people the treatment that could save their life.
2000s: FAMILY HISTORY
Thanks to BHF-funded pioneering research and investment, genetic testing is available to search for the faulty genes responsible for familial hypercholesterolaemia (FH). BHF Professor Steve Humphries dedicated his career to finding the genes that cause FH, an inherited condition which puts people at risk of early heart attack. Since 2010, we’ve invested £2 million into an FH
Biggest independent funder of heart and circulatory disease research in Scotland. Since the BHF was established, the annual number of deaths from heart and circulatory diseases in Scotland has fallen by more than half.
genetic testing programme and funded 27 FH nurses across the UK, to help improve diagnosis and prevent families suffering heart attacks at a young age.
STEM CELLS
In 2015, BHF researcher Roger Pedersen showed that human stem cells develop normally once transplanted into an embryo. This is the strongest evidence yet that stem cells are safe to use in regenerative medicine, paving the way for healing damaged hearts in the future.
BHF TODAY IN THE UK:
800+ research projects More than 1,000 of the best scientists l Nearly £450 million in active research grants l 31 world leading BHF Professors l 6 BHF Centres of Research Excellence – including at the Universities of Glasgow and Edinburgh l 3 Centres of Regenerative Medicine – including at the University of Edinburgh l l
We have enabled thousands of people to have genetic tests, preventing many premature deaths from heart disease. BHF-funded research has led to statins being prescribed, saving lives every year in Scotland.
The BHF supports research to improve the prevention, diagnosis and treatment of heart diseases such as heart attacks and heart failure and circulatory diseases such as stroke and vascular dementia, and to minimise the impact of their risk factors such as diabetes. n
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Comment
Scotland’s world-class health data can unlock health improvements As valuable as oil in discovering new treatments BY DR DIANE HARBISON
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e all know that Scotland has a problem with chronic illness like liver disease, MS and cancer. However, there is a silver lining: the health data we have in Scotland is some of the very best in the world. It is even referred to as our new oil – because it could be so valuable to our nation in terms of improving health. Many of today’s healthcare innovations take advantage of big data. Scotland has incredibly well-mapped patient data, helped by the Community Health Index (CHI) number that is assigned to every Scot at birth. All of a patient’s medical data is associated with this number. Precision medicine involves developing treatments that are targeted to a person’s genetic makeup. Because people respond differently to medication depending on their genes, precision medicine will help get the
right treatment to the right person at the right time, resulting in better outcomes for patients. SMS-IC is an industry-led healthcare innovation hub in precision medicine. One of the projects we are currently working on, in collaboration with partners Eagle Genomics, the Universities of Edinburgh and Glasgow, and NHS Scotland, could help develop new tests and treatments for patients with non-
“Precision medicine will help get the right treatment to the right person at the right time”
alcoholic fatty liver disease (NAFLD), which is a leading cause of premature death. When it comes to discovering new treatments for this type of disease, our health data is indeed as valuable as oil. We’ll be using £1.7m of funding from Innovate UK to develop the world’s first data commons for NASH, the progressive form of NAFLD. This will share information from patients with NASH, which will help us understand which tests and treatments are most effective for each patient. Improper use of data has been topical recently, thanks to the Facebook scandal and GDPR, so people could be forgiven for feeling wary about the use of health data. But there is no need to worry – it is anonymised, and nobody can be identified from it. We collaborate with the NHS to ensure all data is used responsibly and appropriately. The future is exciting. Our world-class data might be rooted in our unfortunate chronic health problems, but it could also hold the keys to the solutions. Dr Diane Harbison is CEO of Stratified Medicine Scotland Innovation Centre. http://www.stratmed.co.uk/
Celebrating our NHS and our pharmacists at the forefront of healthcare Key partners in person-centred care BY ALEX MACKINNON
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am proud to mark the platinum jubilee of our most treasured public service – the NHS. Over the past 70 years pharmaceutical advances have significantly enhanced our health service. Pharmacists, as the experts in medicines and their safe and effective use, play an increasingly crucial role. The discovery of new medicines has resulted in more treatment options, making them one of the most important interventions. They can help avoid premature death, cure illness and significantly improve the individual’s quality of life. However, medicines can carry risks as well as benefits. The persistent focus on safety and personcentred outcomes is the hallmark of any pharmacist. Their impact is demonstrated by the difference they make to patients and our NHS. Working with colleagues across the multi-disciplinary team in health and social
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care, pharmacists ensure individuals get the most out of their medicines and help reduce avoidable hospital admissions. Community pharmacies provide some of the most accessible services within our NHS, and Scotland is starting to benefit from a ‘pharmacy first’ approach so that the public knows when it is best to see their pharmacist. They provide core NHS services and tailored advice on your medicines. Many
“Our NHS will see an increasingly visible pharmacy profession at the forefront of healthcare”
also offer other services, such as clinics focused on asthma, blood pressure, COPD, diabetes and travel health. Increasingly, pharmacists work in GP practices, enabling pharmaceutical care for more complex cases within the practicesetting. In hospital, pharmacists are on the ward advising patients and physicians on all aspects of medicines. With further advances in personalised medicines on the horizon, the public, fellow health professionals and our NHS will see an increasingly visible pharmacy profession at the forefront of healthcare. Alex MacKinnon FRPharmS, is Director of the Royal Pharmaceutical Society in Scotland @RPSScotland
Wright, Johnston & Mackenzie LLP
A call on doctors Legal expert underlines crisis in general practice BY WILLIAM PEAKIN
I
n Aberdeenshire, a local surgery is using a video promoting the local area to help recruit more doctors. Macduff Medical Practice is trying to encourage GPs to take up a new post in the town. The seven-minute video, which features the staff as well as a tour of the coastal community, was commissioned by the practice and shared online. “This is a great place to work,” said Dr Iain Brooker. “We don’t want to recruit just any doctor. We want to reach the best we can to be the family doctors for this area - now, and in the future.” The shortage is being experienced across Scotland and, as well as presenting problems for practices and their patients, it is putting a financial strain on health boards. Figures released under a Freedom of Information request revealed that NHS Orkney was paying up to £1,400 per day for locum cover, NHS Lanarkshire £1,132 per day and Ayrshire and Arran, £885. Scottish Government statistics showed 24%
of practices reported vacancies in 2017, compared with 22% in 2015 and only 9% in 2013. “It is a trend that has accelerated in the past few years,” said Colin Millar, healthcare specialist at Wright, Johnston & Mackenzie LLP. “We have reached a situation where GP numbers in many practices have fallen below critical mass and in some cases this has led to the inevitable consequence that they cannot continue and have had to hand their contract back to the local health board. With not enough doctors coming into general practice from university, practices are having to resort to the ‘sticking plaster’ strategy of employing locums and/or accepting increased workloads for existing GPs.” Over a similar period, a GP’s workload has increased by 16%. A recent survey of 208 Scottish GPs commissioned by the Royal College of General Practitioners (RCGP) Scotland found 22% struggled to cope due to stress at least once a week. RCGP Scotland said GP shortages and rising demand had left family doctors having to work harder and for longer hours. It said Scotland needs 856 extra full-time GPs by 2021. Now, nurses and other healthcare staff who want to retrain as doctors are to be offered university places in a bid to boost GP numbers. The Scottish Government will
Doctors are struggling to cope with workloads fund 85 additional places at universities to help to reach its aim of increasing the number of GPs by 800 over the next decade. Edinburgh University will offer places on a five-year course, said to be the first of its kind in Britain. It will be part-time and largely online for the first three years so that participants can continue working. Glasgow and Aberdeen will each offer places on new courses with a greater focus on general practice. “Training more people to be GPs,” added Millar, “and, potentially, looking at structural changes which make it less onerous to be a GP in a practice – for example, minimising the requirement to inject capital or the collective burden of owning and maintaining premises – it would be hoped could make an impact on the shortage.” n
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70 Years In Pictures
History: Scotland’s NHS
From hernias restrained by trusses to the first kidney transplant and MRI scans - the story of Scotland’s NHS on its 70th birthday BY KEVIN O’SULLIVAN
A
group of four nurses stand smiling as they prepare to hoist a standard depicting the sun rising – created as a symbol of optimism for the new National Health Service. Dated July 5, 1948, the picture, taken at Gartnavel Royal Hospital in Glasgow, is one of many thousands held by the Mitchell Library as part of the city’s NHS archives, which records for posterity: “During the first few weeks patients flooded into doctors’ surgeries – men with huge hernias restrained by trusses, women with prolapsed uteruses, thousands of near-deaf people without hearing aids, tens of thousands wearing second-hand spectacles. Anuerin Bevan had said that the NHS would ‘lift the shadow from millions of homes’. Now it was clear he had been right.” Edinburgh and Aberdeen hold similar archival collections, but this remarkable image may be the only surviving visual testimony bearing witness to the very day the new service came into being. This might seem astonishing 70 years on when barely a single event escapes capture by a smartphone for instant sharing to millions. There are plenty of written records held in
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the national collections, however, which chronicle the advent of a new service whose foundations were laid by Sir William Beveridge’s seminal ‘Social Insurance and Allied Services’ report in 1942. Beveridge, a Liberal, had called for the creation of an NHS, and the sense of solidarity invoked by the Second World War created the necessary social conditions for the Welfare State which flourished under Clement Attlee’s post-1945 Labour Government and finally the NHS, which was turned into a political reality by steely Minister for Health, Aneurin ‘Nye’ Bevan. By 1948, half of Scotland’s landmass was already covered by a state-funded health system serving the whole community and directly-run from Edinburgh. The Highlands and Islands Medical Service had been set up 35 years earlier with other state-run experiments in public healthcare including the Scottish National Blood Transfusion Association, set up in 1940, and Glasgow City Council’s own district medical service. In addition, the war years had seen a statefunded hospital building programme in Scotland on a scale unknown in Europe and this was incorporated into the new NHS. Scotland also had its own distinctive medical tradition – centred on its medical schools
rather than private practice. The 1936 Cathcart report in Scotland had also been influential in the way the NHS was formulated in the wider UK context. The Glasgow Herald, under the headline ‘New Health Service begins today’, explained some of the reasoning for nationalisation in an article ‘From Our Special Correspondent’, which said: ‘The arguments for State medicine as the Government rehearsed them, and the Department of Health developed them, were plain enough. Hospital organisation had grown up without plan or system. There was no co-ordination. There was unnecessary overlapping and competition on the one hand, and on the other a desperate lack of special services, as for orthopaedics, cancer, and neurosurgery. The panel doctor was available free of charge only to insured persons. The person who could not afford a fee could have access to consultant and specialist advice only through the out-patient departments of the voluntary hospitals.’
In numbers terms, the article pointed to something of a patchwork at the time, with ‘the State’ taking over more than 400 hospitals with 65,000 beds, with 80 percent of general practitioners to become ‘enrolled’, and the response of dentists and pharmacists, ‘not yet known’. The hospitals were to be administered by five Regional Hospital Boards and ‘85 Boards of Management’. Fifty-five local health authorities – County Councils and the Town Councils of Burghs – will ‘continue to be responsible for such matters as the care of mothers and young children, and will provide a number of additional services, including domiciliary midwifery, home nursing, and vaccination and immunisation,’ the report added. And the cost of Bevan’s vision, for Scotland at least? It was to be an estimated £25,000,000 per year, £4,000,000 of which would be provided for by the new ‘National Insurance Scheme’. During the 70th anniversary of the NHS, it is of course right that we look back at its foundation and the campaigns and breakthroughs which have marked its course in Scotland. There are too many achievements to mention, but the pioneering work of obstetrician Professor Ian Donald – along with engineer Tom Brown – which gave way to the first ultrasound scans in Glasgow in the late 1950s, Elsie Stephenson’s contribution to nursing studies in Edinburgh in 1956, the UK’s first successful kidney transplant carried out by Sir Michael Woodruff at Edinburgh Royal Infirmary in 1960, the world’s first MRI service launched in Aberdeen in 1980 and bioengineer David Gow’s ‘bionic hand’, in 2006, are among the standouts. But fast forward to 2018 and the service is a very different beast to the one conceived in 1948. The annual budget of the NHS in Scotland is now £12bn, with spending having risen as a proportion of gross domestic product (GDP) from just over 2% in the early years to 7% annually today, and supporting more than 300 hospitals, with 16,503 acute beds and 157,000 staff. With an A&E visit every 20 seconds and the proportion of over-75s estimated to grow by 25% in the next 10 years (this age group is more than 3.5 times likely to be admitted to hospital), thanks largely to the NHS’s own medical advances, the ‘free at the point of use’ concept is under greater threat than ever before. Dr Peter Bennie, a consultant psychiatrist from Paisley and Chairman of the British Medical Association (BMA) Scotland, did not mince his words recently when he said the service, which doctors themselves believe to be chronically under-staffed, is now “on the brink”. He says: “The NHS was a child of its time; my understanding is that there was a real fear and even an attempt to pre-educate the public that although treatment would be available if they needed it, it was really important that people effectively rationed themselves and didn’t all turn up on day
Nurses at Gartnavel Royal Hospital in Glasgow hoist a flag to mark the beginning of the NHS in Scotland on July 5, 1948
one demanding appointments and operations. People were used to rationing in the war, where everyone pulls together and it’s tempting to think that mentality helped to get it off the ground. But there’s not too many people still around who were adults when the NHS came into being; we’re used to that being an expectation, most people think of it almost as a right within the UK. Of course, you don’t need to move too far from the UK to recognise it’s not so much recognised as a right, it’s been a very clearly made political decision.” Despite it being founded on “clearly socialist principles”, unlike much of the rest of the country now, Dr Bennie says ➜
This leaflet was distributed to every household in Scotland and a diagram explained how the new health service would function
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70 years in pictures
Scotland’s NHS ➜ the NHS “clearly has the backing of the
public and has done throughout much of its lifetime”. As to whether the NHS’s core principle of being freely available will continue forever, Dr Bennie, concludes: “It’s so hard to know, and that’s writ large through medicine. What we can be reasonably certain about is that there will be substantial advances in various different fields of medicine over the next 30 years, which is a good number to pick because it takes us up to the centenary. But what we don’t know is where those advances will be, when they will be and what they will be.” Dr Bennie says a good way of looking at the future is to look to the past, and mentions his own city of Glasgow which is surrounded by “at least half a dozen hospitals” which, when they were built, were purely for the treatment of respiratory diseases, primarily TB, when the disease “killed” or “crippled” its sufferers. “All of those hospitals have of course now closed down, having gone through six or seven stages of doing different things. We haven’t needed specific TB hospitals with hundreds of beds for many, many years, because a treatment was developed.” He says: “The hope and expectation is that with various conditions which currently cause great stress to individuals and their families, and cause a huge burden to society, that we will be able to treat them, but we don’t know when. And it’s so hard to plan for that kind of thing.” One thing the government and local authorities are all planning for, though, and which has been described as this generation’s single biggest reform, is the integration of health and social care. Dr Bennie believes it is the right course of action but fears that unlike in the 1980s and 90s, when there was sufficient ‘bridging funding’ to allow the transition of services from hospital to community care, that there isn’t enough slack in the current system. It is, he says, a “real, real challenge”. “The key issue is people will often think if we can reduce the number of beds in a ward and therefore reduce the staffing a little that frees up significant amounts of money that we can then place in community care,” he says. “But actually the economies of scale are such that you don’t really make significant financial savings unless you’re at a position where it’s genuinely safe to close down whole units or whole hospitals. And two problems flow from that. One is that it’s a much bigger undertaking in the first place, so you’ve got to have the community facilities up and running and doing the job, and the other one is the local politics of shutting a local hospital. People will always see the closure of a hospital as a bad thing, but often it’s the appropriate thing to do, both in order to improve the quality of care in a hospital and in the community. But it’s almost impossible to manage that in a way that satisfies everybody.” n
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Trailblazing women who changed the status of their professions Elsie Stephenson and Maggie Myles leave a legacy that has shaped nursing and midwifery in Scotland and the world over PEOPLE BY KEVIN O’SULLIVAN
T
he idea of nursing as a subject fit for study at university level was first suggested in 1900 by Mrs Bedford Fenwick, a British nurse who campaigned for the profession’s first national certificate. It would take another 56 years for the subject to be
officially recognised as worthy of higher education attainment, when Elsie Stephenson – who reportedly wanted to become a nurse aged three after her father died in the 1919 influenza epidemic – became the first director of the Nursing Studies Unit at Edinburgh University. A trailblazer who prevailed against stuffy attitudes among some academics because she was ‘not a graduate’, Stephenson is one of the lesser-known figures within the NHS’s history in Scotland over the last 70 years, but whose contribution to education in the field helped set the standard for generations to come. Maggie Myles, an Aberdonian midwife, is another whose work in her her own discipline has become synonymous with setting the standards worldwide. First published in 1953, Myles’ ‘Textbook for Midwives’ remains the world’s most popular midwifery manual. It still sells in more than 75 countries and is
Nursing over the ages: Nurses in the dining room of the Western Infirmary in Glasgow in the 1960s; the photograph is one of many held by the NHS Greater Glasgow & Clyde Archives
Maggie Myles receiving an Honorary
Elsie Stephenson became the University
sity. Described in the Journal of Advanced Nursing as “Britain’s nursing messiah of the 20th century”, Elsie helped position Scotland as a world leader in nursing education and research. “In 1953 Margaret Myles, a midwife and pioneering educator from Aberdeen, published the revolutionary manual ‘Textbook for Midwives’. Now in its 16th edition and internationally recognised, ‘Textbook for Midwives’ is the world’s best-selling midwifery textbook. “These influential women have been instrumental in establishing the status of the nursing and midwifery profession today and we owe a debt of gratitude to all the nurses and midwives who have shaped the future for today’s nursing workforce.” Dr Mary Ross-Davie, Royal College of Midwives’ Director for Scotland, adds: ”Maggie Myles has had a huge impact on midwifery skills and practices, not just in Scotland but around the world; a textbook like Myles’s continues to be really crucial for student midwives all over the world and it’s amazing when you
go to places like Bangladesh, Nepal or Uganda and you see it in the classrooms there.” When asked how midwifery has changed since Myles’s first textbook, which she used to write after visiting between 20 and 40 maternity units to keep up to date on the latest techniques, Ross-Davie says: “I think there are some universal things that will remain the same and that will run through all of the Myles textbooks over the years and will never change; so for example, around physical skills helping a woman during labour but also about that emotional support and communication.” Interestingly, Ross-Davie says that the key shift that occurred in the 1960s and 1970s, when increasingly women went from home births to a hospital setting, may be slowly changing back. The RCM’s recent Best Start policy guidance bases itself on evidence that refutes previously held ideas about the hospital as being a ‘safer’ birthing environment. New guidance is all about giving women the choice between home births, hospital and new ‘community maternity units’, which are attached to hospitals but not part of a consultant-led labour ward, one of which has recently opened in Wishaw and another is due to open at Forth Valley Royal Hospital. “Best Start is seeing midwives doing that whole role which Maggie Myles would have been familiar with, where you are part of the community and you are providing care for women through the whole journey,” says Ross-Davie. So, back to Call the Midwife, then? “Yes, that’s right, back to Call the Midwife.” n
Fellowship of the Royal Obstetrical Society in 1978 (Copyright The Scotsman).
regarded by many in the profession as ‘The Bible’. Remarkably Myles, who was born in 1892, started writing the book after her retirement in 1952 and saw 10 editions published in her lifetime, including 20 reprints into five different languages. Material held in the Lothian Health Services Archive bears witness to the fact that she remained active well into the 1960s and 70s, at one point flying to the Arctic Circle in Canada to lecture Eskimos on the importance of maternity care. She also undertook 35 flights in six months as part of a global lecture series, and her work included setting up a midwifery school in Ethiopia. She received an Honorary Fellowship of the Royal Obstetrical Society in 1978, having previously turned down an MBE on two occasions because she did not want to be seen to ‘covet’ such an award. Both women, who died in 1967 and 1988 respectively, are subject of a tribute in this landmark year from Theresa Fyffe, Royal College of Nursing (Scotland) Director, who says: “The NHS has changed significantly in its 70 years, but one thing that has never changed is the difference that nurses and midwives make to peoples’ lives. Inspirational women have always been at the heart of the NHS but arguably have often been overlooked in the history books. Two decorated women who paved the way for the health care industry are Elsie Stephenson and Maggie Myles. “Elsie Stephenson became the University of Edinburgh’s first Director of the Nursing Studies Unit in 1956, which was the first nursing department in a European univer-
“These influential women have been instrumental in establishing the status of the nursing and midwifery profession today” Theresa Fyffe, Royal College of Nursing (Scotland) Director
of Edinburgh’s first Director of the Nursing Studies Unit in 1956. (Image courtesy of the Lothian Health Services Archive).
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70 Years In Pictures
Innovation
Polaroid cameras, which had become popular in the 1950s, were used to take the pictures in the first diagnostic ultrasound machines
Breakthroughs of global significance ULTRASOUND BY WILLIAM PEAKIN Today it is a common experience for parents to ‘see’ their baby before it is born, when the mother has a scan. This type of scan uses ultrasound, and the first such pictures of unborn babies were produced in the 1950s by Ian Donald, Regius Professor of Obstetrics and Gynaecology at Glasgow University. Professor Donald served as a Medical Officer in the RAF during the Second World War, when he was mentioned in dispatches and awarded an MBE for bravery. In 1951 he was appointed Reader in Obstetrics and Gynaecology at St Thomas Medical School, London, where he devised a respirator for new-born babies with breathing problems. During his time in the RAF, he had
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become interested in the possibilities of adapting radar and sonar technology for medical diagnosis. The medical application of ultrasound had first been suggested in the 1930s, but advances in sonar and electronics were necessary before it was possible for Professor Donald’s experiments, at engineering firm Babcock and Wilcox in Renfrew, to demonstrate the ability to probe the body with ultrasound waves. Professor Donald subsequently worked with Tom Brown, of the scientific instrument makers Kelvin & Hughes, to create the first diagnostic ultrasound machine, and in 1958, along with Brown and university colleague John MacVicar, they published their landmark findings in The Lancet. That first machine was refined by Dugald Cameron, a young industrial designer who later became head of the Glasgow School of Art, to make it less intimidating to expect-
The history of the NHS in Scotland is a story of innovation, as will be its future ant mothers. Polaroid cameras, which had become popular in the 1950s, were used to take the pictures. This early work was built on through the collaboration of doctors, engineers, physicists, and technicians in the UK, America, Japan, and Sweden. Today, scanners are capable of displaying moving pictures, even the flow of blood. Professor Donald was also the driving force behind the creation of a new maternity hospital; the Queen Mother’s Hospital at Yorkhill, or ‘Storkhill’ to some. He was an outspoken pro-life campaigner and as a result did not receive the official recognition that he might otherwise have received; as John Lenihan, Professor of Clinical Physics at Glasgow University and science correspondent for the Glasgow Herald put it: “Others have gone to the House of Lords for less”.
The device contains miniature cameras and a light source, and captures 400,000 images as it travels through the body
SCOTCAP
Professor
Donald seen scanning unborn grandchild. He had four daughters and 13 grandchildren, and was the driving force behind the creation of Yorkhill Maternity Hospital
This first
scanner was later refined by a future head of Glasgow School of Art, to make it less intimidating to expectant mothers
BIONICS The history of Touch Bionics begins with a programme of work conducted at the Princess Margaret Rose Hospital in Edinburgh from 1963, starting with research into developing prosthetic solutions for children affected by Thalidomide. In 1986 David Gow, a Mechanical Engineering graduate, joined the hospital’s Bioengineering Centre with responsibility for research and development - focussing on electronic arms, including shoulders, wrists, and hands. In 1998, he achieved international recognition with the fitting to a patient of the world’s first electrically powered shoulder. Supported by Scottish Health Innovations Ltd (SHIL), which works with NHS Scotland to identify, protect, develop, and commercialise healthcare innovations, Gow subsequently led a spin-out from the NHS in 2002, the first to do so, to create Touch Bionics. In 2007, the company launched the ‘i-limb’, the first powered prosthetic hand to incorporate articulating fingers that open and close around objects in a more natural and anatomically correct way than any previous hand prosthesis. The i-limb hand helped amputees across the world to improve their everyday lives with the
increased function offered by its independently articulating digits. The following year, it acquired an American company which developed lifelike prosthetic coverings for the i-limb hand. Since then, Touch Bionics has launched a series of enhancements to their technology including individual fingers, pulsing grip strength, Bluetooth enabled customisation, gesture control, and aesthetic and durability improvements. By the end of 2015, more than 5,000 patients had been fitted with Touch Bionics i-limb and i-digits products. In 2016, Touch Bionics was acquired by Össur, a global leader in non-invasive orthopaedics “that help people live a life without limitations”. On being awarded the CBE in 2014, Gow said: “I feel lucky to have been fortunate to work alongside skilled teams of engineers, clinicians and entrepreneurs.”
From 1998, the ‘Limb of the Future’
It is the stuff of science fiction; a miniature camera navigating its way through your body, transmitting images which are then screened by specialist medical staff for signs of lifethreatening diseases, such as bowel cancer. Except, it is happening now – in Scotland. A ground-breaking trial of the technology is being run by the Digital Health & Care Institute (DHI), part of the Scottish Funding Council’s Innovation Centre Programme, in collaboration with NHS Highland. The device, containing two miniature cameras and a light source, is sent to patients in the post, negating the need for a hospital appointment. Before the process they are guided by a nurse, usually via video conference. Swallowed like a tablet – it is the size of large vitamin pill - the device takes the same route through the body as food. Around 400,000 images are recorded on a reader worn by the patient. The images are then reviewed by specialists at Raigmore Hospital in Inverness. If abnormalities are spotted the patient will be called in for colonoscopy, so that a tissue sample can be taken for further analysis. So far, 56 patients have benefitted from the procedure. As the database of images grows, algorithms can be written to accelerate image assessment and artificial intelligence used to better recognise tissue that would subsequently test positive or negative for disease. The trial team is also exploring the possibility of using specific frequencies of light or special dyes that have the potential to highlight cancerous tissue. In the future, the device could be remotely controlled by clinicians to inspect specific areas of the body and use infrared or ultrasound, as well as video. Existing processes for investigating potential problems are often time and resource intensive for both patients and the NHS. Between 2008 - 2016 there was a 104% increase in new attendances for gastroenterology services. SCOTCAP, as the project is known, could significantly reduce pressure on services, as well as discomfort and disruption caused to patients, at the same time as improving diagnosis. “If we can demonstrate a Scottish model that delivers results that are as good as, if not better than traditional colonoscopies, it will be transformative,” said Professor George Crooks, chief executive of the DHI. n
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70 Years In Pictures
From the archives
STUDENT NURSES AT STOBHILL HOSPITAL, 1956 Professor Ian Donald, the developer of ultrasound, with the Queen Mother at the opening of the Queen Mother’s Hospital in Glasgow.
Goodbye matron, eradicating TB, and the first ‘iron lung’
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Among the many changes in nursing since 1948, the departure of matrons from our hospitals is one which was pioneered in Glasgow. In the 1960s Miss Anne CourtBrown, Matron of the Royal Infirmary, introduced the first pilot scheme under which grades, related to actual duties carried out,
replaced the old hierarchy with matron at the top. As health care has become ever more scientific and technical, the work of nurses has changed enormously. So, nurse training based on ‘hands-on’ experience in the hospitals has gradually been replaced by theoretical nurse education based in universities. An important early experiment in nurse education was carried out in Glasgow.
BIRTH OF THE NHS, 5 JULY 1948
In 1957, Miss Edith Manners launched the Royal Infirmary experimental course of training for nurses. The experiment achieved many of its objectives. For example, the ‘drop-out’ rate was reduced, and the scheme succeeded in attracting high-scoring school leavers. Most importantly, the course provided valuable lessons on which latter developments were based.
“Last minute guessing about the scheme has touched on every question from how the gaps are to be filled to the probable rate of progress in those sections which are ready, more or less, for action. The most intelligent of it suggests that success or failure of the Service will depend on the family doctor. If the beneficiaries of State planning are to catch up with all of their rights he will have to be guide as well as philosopher and friend” – a report in The Glasgow Herald on the day the NHS was founded.
MOBILE X-RAY VANS IN GLASGOW, 1957 One of the great achievements of the NHS was to bring about an enormous reduction in levels of tuberculosis. During the 1950s, new drugs provided the opportunity to deal effectively with TB and in an an effort to identify all TB sufferers and treat them simultaneously (so as to prevent mutual reinfection) a massive chest x-ray campaign was conducted in Glasgow in 1957. Thirty-seven mobile X-ray vans screened 714,915 people over five weeks with 2,842 new TB cases identified and treated. The campaign was a triumph of medical science and of organisation and record-keeping.
FIRST ‘IRON LUNG’ IN BRITAIN, 1955 Epidemics of poliomyelitis occurred across Europe in the years following the Second World War. Polio could cause temporary paralysis of the chest muscles and diaphragm, weakening patients’ breathing to the point where they died from lack of oxygen. In Copenhagen, where there had been a serious epidemic, clinicians organised teams of medical students to hand pump oxygen for polio patients suffering from paralysis of both the chest and throat. Imitating the rhythm of normal breathing, they were able to save many victims lives. Dr Peter McKenzie, Physician Superintendent at Belvidere Infectious Diseases Hospital in the east end of Glasgow, heard of the Danes’
success and commissioned equipment that could imitate breathing. The first intermittent positive pressure ventilator in Britain was built by Aga, the makers of cooking ranges, and installed at Belvidere Hospital in 1955. The method of treatment and nursing attention required by these patients provided one of the practical experiences from which present-day intensive care units trace their origins.
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70 years in pictures
From the archives
Groundbreaking campaigns, world-class training
The Scottish air ambulance service began using aircraft to transport patients from remote Scottish islands to the mainland in the 1960s.
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NURSE TRAINING, 1879 In 1879 Rebecca Strong was appointed matron at Glasgow Royal Infirmary, the largest voluntary hospital in Scotland. When she arrived, she was shocked to find how backward the Infirmary appeared in relation to its nurses. She devoted her energies to improving nurse education and training and working conditions. With the support of Glasgow surgeon Sir William Macewen, Strong initiated the ‘block apprenticeship’ training programme, later adopted worldwide. Short periods of instruction in the hospital school were followed by periods of practice on the wards. This was a great improvement on previous nurse instruction whereby nurses were expected to attend lectures and study while still working long hours on the wards.
Volunteers position sandbags around Glasgow Royal Infirmary in 1939, as the Second World War breaks out.
PIONEERING PUBLIC ENGAGEMENT, 1950S ONWARDS Health campaigns figure strongly in the history of NHS Lothian including, as an early example, urging people to have their chest x-rayed. Most prominently, however, its pioneering campaign around HIV, launched in collaboration with Lothian Regional Council, set the tone for progressive approaches to wellbeing. Edinburgh’s first case of HIV was diagnosed in 1983. As the decade went on, the city’s high infection rate, nearly seven times the national average, meant that the region was at the forefront of the battle against the spread of the virus. The most effective of the initiatives undertaken was the ‘Take Care’ campaign, launched
in 1989. Where campaigns in the wider UK used negative images, such as tombstones, ‘Take Care’ broke with the past with its frank and fun approach, telling people how they could ‘take care of the one you love’ through making the right choices and recognising when they could be at risk from HIV and AIDS. ‘Take Care’ spread the message that HIV and AIDS could affect anyone, and its main focus was sexual transmission of the disease. As the ‘Take Care’ campaign progressed into the 1990s, needle exchange services, antenatal screening, blood testing and contact tracing evolved as further ways to prevent
people being at risk from HIV. Edinburgh’s early collaborative approach to fighting HIV and AIDS makes the city stand out in national public health policies. Page 20-23 pictures courtesy of Lothian Health Services Archive and NHS Greater Glasgow and Clyde. Main picture, top, copyright The Scotsman
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Health and Social Care
Digital dividend Technology is at the heart of Scotland’s strategy to improve health and social care BY WILLIAM PEAKIN
S
cotland has a new digital health and social care strategy that sets out how technology can support person-centred care and sustain and improve services for the future. Announced earlier this year by the then Cabinet Secretary Shona Robison at FutureScot’s Health and Social Care Digital Leaders’ Summit, it highlights progress and challenges to date, and sets out to maximise the opportunities of digital technology to help improve the health and wellbeing outcomes for people in Scotland. The new strategy has been developed over the past year, and its aims and priorities have been informed by widespread engagement with members of the public and health and social care front-line staff. An independent panel of world-leading UK and international experts was also established to make recommendations to inform the development of the strategy and was chaired by the acclaimed Professor David Bates of Harvard School of Public Health. The strategy has also been informed by the evidence presented to the Scottish Parliament’s Health and Sport Committee, which reported earlier this year on technology and innovation in health and social care. Chair of the external expert panel, Professor David Bates MD MSc, Professor of Medicine at Harvard Business School, welcomed the new strategy. “Scotland is already an international leader in integrating health and social care services and is well positioned to seize the opportunities offered by digital. “It has already seen a number of key successes in specific areas. Our panel was impressed by the commitment of those tasked with developing and improving Scotland’s health and care services through the use of technology. “The challenge now will be to build on these specific areas and ensure that digital technology and data science become mainstream in health and social care to reshape equip services for the future and further empower those using the services. “The new digital health and care strategy for Scotland is a key element in achieving that success, setting out the key priorities and objectives for this shared endeavour. I urge all those with an interest in positioning Scotland as a digital leader to get involved.” Professor Andrew Morris, Professor of Medicine, Director of the Usher Institute of Population Health Sciences and Informatics, and Vice Principal Data Science, University of Edinburgh, co-chaired the strategic oversight group
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“Digital means we will be able to tailor health and care systems to deliver greater value to the public, with scrutiny and governance ensuring that any research we do is ethical and to the public good” Professor Andrew Morris that developed the strategy and its priorities. “Scotland is already a world leader, for example, in diabetes care where analysing anonymised data has helped reduce blindness, heart disease and amputations,” he said. “Digital technology with appropriate privacy structures in place can enable us to develop new treatments, and services that are personalised, precise, participatory, and preventative. Digital means we will be able to tailor health and care systems to deliver greater value to the public, with scrutiny and governance ensuring that any research we do is ethical and to the public good.” A dedicated website (http://www. digihealthcare.scot/) explains the strategy’s approach, supported by case study examples, blogs and video, and stakeholders are asked to follow the Twitter feed @ DigiCare4Scot for further information and to keep up to date with developments. The strategy sets out six key areas that will be prioritised in order to achieve the intended benefits of digital technology: l National direction – establishing a joint decision-making board from national and local government and the NHS, supported and advised by industry, academia and the third sector to make national decisions for investment, priorities and policy, and achieve greater consistency, clarity and accountability. l Information governance, assurance and cyber security – ensuring appropriate
safeguards are in place for the management of data and ensuring consistency in decision-making about sharing data and understanding about data protection requirements. l Service transformation – a clear, national approach to service redesign and the scaled up adoption of successful models such as home and mobile health and care monitoring. l Workforce capability – recognition that leadership and workforce development in digital skills and capability underpin successful uptake and use of digital technology, with the establishment of a joint approach between NHS Education for Scotland, the Local Government Digital Office (working with COSLA and Integrated Joint Boards) and the Scottish Social Services Council. l National digital platform – commitment to the interoperability of systems by developing a national Health and Social Care services digital platform through which real-time data and information from health and care records is available to those who need it, when they need it, wherever they are, in a secure and safe way. l Transition process – a recognition of the need to improve and upgrade existing systems to contribute to future developments, with a joint approach required between NHS National Services Scotland and the Local Government Digital Office to ensure that existing systems continue to work effectively. n
SQA supports the NHS in Scotland celebrating its 70th anniversary The NHS has turned 70, and throughout the UK members of the public have been celebrating that milestone and offering their thanks to the thousands of doctors, nurses, and other healthcare professionals and healthcare support workers, who have dedicated their careers to a national institution that touches the lives of millions of people across the country. The commitment and dedication of staff throughout the NHS has underpinned the service ever since it was launched in 1948. But with so many changes throughout society over the past seven decades, the service has had to constantly evolve to meet the demands of the communities it serves and continually improve the patient-centred care it offers. The Scottish Qualifications Authority (SQA) has worked with the NHS in Scotland to ensure staff across the service have opportunities for further training and career progression, and are also well placed to prepare for and adapt to future healthcare challenges. Of the courses, awards, and qualifications offered by SQA, many have been developed in partnership with key stakeholders within the NHS including individual health boards, NHS Education for Scotland, as well as those outwith the NHS, such as Scotland’s colleges, and universities. SQA qualifications enable individual NHS boards to meet workforce planning challenges, and help staff – particularly Healthcare Support Workers (HCSWs), and assistant practitioners – to upskill and access career progression, or broaden their knowledge and experience to allow for wider deployment to meet particular strategic needs. One of the highlights of this partnership approach has been SQA’s Higher National Certificate (HNC) in Care and Administrative Practice. Designed together with NHS Greater Glasgow and Clyde and other stakeholders, the HNC in Care and Administrative Practice provides a route for HCSWs and administrators to prepare for future roles, either within the NHS, or other public services.
The qualification is useful to those staff seeking senior HCSW roles either in a clinical, or non-clinical setting, but is also useful to those people keen to begin a career with the health service. SQA has also developed a number of vocational qualifications that reflect the changing needs of NHS staff, and allow them to deliver care to patients across the community. SQA is currently working with NHS Lothian and Borders on a new award that will support HCSWs to deliver care in community settings. And while new qualifications are explored and developed, long-standing awards such as the Professional Development Award in Telehealthcare are being reviewed to ensure they remain up-to-date, and continue to meet the needs of the sector. SQA’s portfolio of qualifications offer opportunities for staff across most sectors within the NHS in Scotland, including HCSWs, and staff in business and administration teams, estates and facilities services, pharmacy services, and in health and social care roles. Louise Gaddi, Qualifications Manager at SQA, says: “The range of qualifications SQA provides the NHS in Scotland is as broad as the number of services available to patients who rely on the NHS every day. Our successful partnership with the NHS ensures that the staff across the service have the opportunity to access robust, valuable qualifications, and the skills and knowledge they develop will help them to deliver high-quality, safe, effective and patient-centred care for years to come.” For more information on SQA’s portfolio of NHS qualifications, visit www.sqa.org.uk/nhs
Chest, Heart and Stroke Scotland
Health & Social Care Jane-Claire Judson, Chief Executive of CHSS, at the launch of No Life Half Lived
Keeping the wagons rolling on public health work that began in 1899 26 | NHS70 | SUMMER 2018
‘No Life Half Lived’ is the latest in a long line of campaigns from Chest Heart & Stroke Scotland (CHSS) BY KEVIN O’SULLIVAN
I
meet Jane-Claire Judson just before the official launch of her organisation’s new strategy. Chest Heart & Stroke Scotland (CHSS) has provided much-needed support for people for approaching 120 years, and the ‘No Life Half Lived’ campaign is the latest iteration in a long line of the charity’s ever-evolving public health work. Born in 1899, CHSS was initially set up to combat the big killer in Scotland at the time - tuberculosis, or ‘consumption’ as it was more commonly known then, which claimed 7,000 lives every year. Fast forward through two centuries and
A touring horse and cart exhibition on the dangers of TB is the earliest record of a public health campaign held by CHSS
many different health campaigns on the way - including 1950s public chest X-ray vans - and the picture is very different. TB has ceased to be a threat and thankfully the survival rates for the vast array of chest and heart diseases are now better than they’ve ever been. But with the improvement in acute treatment comes the inevitable poser: how best to support people as they leave the hospital setting and assimilate back into the community, albeit with conditions that can seriously restrict quality of life. Resource limitations means the NHS cannot, on its own, provide what patients need to manage a range of chronic longterm conditions, whether it’s heart disease, the effects of a stroke or chronic obstructive pulmonary disease (COPD). Whilst these people are in receipt of the vital medical devices and drugs they need through the NHS, it’s the softer-focus social, community and rehabilitation support that can prove to be more difficult to source. What can start off being a straightforward
medical diagnosis then risks falling into many other pathologies: mental health, social isolation, disability, the list goes on. ‘No Life Half Lived’ has been conceived by CHSS as a campaign which directly reflects that challenge, which is only set to become more pressing if Scotland is to adequately provide services for an ageing population. “We’re going to double the number of people we reach,” says Jane-Claire, with an air of determination. “There will be bumps along the way but that’s the biggest challenge for us - it’s just not acceptable that people live half a life; people are being restricted in terms of what they can achieve, from the very simple dayto-day things like putting your socks on in the morning, to doing things with your grandkids or even doing your job. Twenty-five per cent of people who have a stroke are of working age and they still want to be economically productive, but we’re not enabling them because the rehabilitation support is not there.” In terms of how CHSS is going to deliver on its strategy, Judson says: “We’re going to be bolder and more courageous about what we want to see for people with chest, heart and stroke. It’s not just that it ‘could happen’, we’re now saying it ‘will happen’. Yes, it’s a challenge, we’re not going to deny that but the key issue is that there is so much that you can do with those conditions and it’s our job to make sure that those services are in the right place at the right time.” Judson pledges that the charity will also look to double the number of its volunteers, from 1,500 to 3,000; it is essential to the delivery of a joined-up network of services, which can easily be mapped out across the country. She argues that current statutory facilities are patchy and inconsistent, and that needs to change. “In certain places you just can’t get access; it’s not even that it’s a six or 18-week waiting time, it’s just not there. Pulmonary rehab, for example, only 8.4% of patients have access to that in Scotland.” As well as supporting new services it is a big personal challenge for Judson. She joined the organisation just six months ago, from her previous role as Director (Scotland) for Diabetes UK. It’s her first CEO role and
clearly she is already well-liked by her staff, one of whom mentions that she’s a “keeper” before my time is up. She is also a committed feminist (see Twitter feed) and doesn’t mince her words when it comes to striking an equal gender balance in the charity sector (“we have to be more bold and radical”), to a refreshing honesty about the demands on her as a female CEO (“I’m a woman with a small child”); she is also not afraid to put her argument across to the NHS that it needs to invest in social and community support to prevent people being readmitted unnecessarily to hospital (“part of our job as a charity is to hold the NHS to account”). Her broad remit also links through to other areas of policy, whether it’s transport or environmental, or even food standards, all of which, if considered advisedly, have the potential to deliver substantial ‘upstream’ benefits to the the health and wealth of the nation. As with the the charity’s own history, those benefits will – hopefully – become obvious in later years. n
#NOLIFEHALFLIVED FACTFILE: l Around 488,000 people in Scotland are living with Asthma and COPD. l Around 230,000 people in Scotland are living with Coronary Heart Disease. l Around 124,000 people in Scotland are living in with the impact of a Stroke. l Around 48,000 people in Scotland are living with Heart Failure. l Up to two thirds of people in Scotland living with COPD are either undiagnosed or have an incorrect diagnosis. l An estimated one third of people with Atrial Fibrillation are undiagnosed, a leading cause of stroke and one of the most common forms of abnormal heart rhythm. l Almost one-third of people in Scotland have hypertension – high blood pressure – increasing their risk of heart attack, stroke, and heart failure. l There are over 1 million people in Scotland, that’s 1 in 5 of the population, living with the effects of serious chest and heart conditions and stroke.
NHS70 | SUMMER 2018 | 27
Scottish Genomes Partnership
Genomics central to medicine’s advance DNA tests could transform healthcare’s next 70 years
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atients in Scotland could benefit from a revolution in personalised healthcare, thanks to major investments in gene sequencing technology. Researchers say pioneering techniques that can sequence a person’s entire genetic make-up in under three days have the potential to transform patient care in the coming decades. The establishment of two cutting-edge centres for genome sequencing, in Edinburgh and Glasgow, and the contribution of NHS staff from across Scotland, have laid the foundations. Work carried out by the Scottish Genomes Partnership, a collaboration led by the universities of Edinburgh, Glasgow,
Delivering precise molecular information could ultimately enable prevention of diseases Aberdeen and Dundee, and NHS Scotland, has given researchers unprecedented access to sequencing technologies. Findings from the project are already helping to improve diagnoses of patients in the Scottish NHS, as well as advancing the understanding of rare and common diseases including cancer. More than 400 NHS Scotland
patients and their families have now had their genetic make-up decoded under the scheme. “This technology offers one of the biggest opportunities in today’s NHS, delivering precise molecular information that is changing the management of diseases,” said Professor Tim Aitman, director of the Centre of Genomic and Experimental Medicine at Edinburgh University, and co-chair of the Scottish Genomes Partnership (SGP). “It could also ultimately enable prevention of diseases.” Professor Andrew Biankin, Director of the Wolfson Wohl Cancer Research Centre at the Glasgow University and the SGP’s co-chair, added: “Genomic testing allows us to start predicting which therapies will work best for an individual cancer patient, improving outcomes whilst minimising side-effects and cost.” The SGP has received funding from NHS Scotland, the Scottish Government, and the UK Medical Research Council. Professor Zosia Miedzybrodzka, of Aberdeen University and lead clinical geneticist for the SGP, said: “NHS Scotland scientists and clinicians will be working over the next year to turn the complex DNA sequence data we have collected into test results that can make a real difference to the lives of patients and their families.” Fiona Murphy, director of the NHS National Services Division, added: “Innovation has driven huge changes in the NHS over the past 70 years with new technologies bringing benefits to all patients. Genomics will be central to future medical advances.” n
Glasgow Clyde College would like to congratulate the NHS Scotland on their 70th Anniversary. Glasgow Clyde College has been a close and trusted partner of the NHS for many years, both in our legacy colleges and in the vibrant new college we have become today. Working collaboratively, we have helped make Glasgow Clyde College the leading training provider for the NHS workforce and helped change many lives by growing countless careers in Scotland. Over the years we have celebrated countless awardwinning achievements, both old and new, that have only been made possible by longstanding trust and friendship. Our proudest moments include: l Writing and co-developing the HNC in Care and Administrative Practice, now the national standard for care support workers in Scotland. l Creating and delivering the HNC in Occupational Therapy Support, now the only undergraduate OT programme in the UK and celebrating its
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25th year of delivery.
l Designing and creating the
first entirely online qualification for Prosthetic and Orthotic technicians in the UK, our PDA in Rehabilitation Technology. l Offering over 125 places a year in our enormously successful SWAP Access to Nursing and Medical Sciences programmes, which send our most excluded adult returners into guaranteed degree places at Scotland’s best universities. l Training 50 lab technicians a year in our new HND in Biomedical Science. l Managing the largest Modern Apprenticeship programme in Scotland for NHS Greater Glasgow and Clyde, training over 100 young apprentices. l Becoming the first deliverer of Foundation Apprenticeships in both Health and Social Services to school pupils in Glasgow. l Designing a bespoke GP Practice training programme hosting an annual skills
conference for the last 10 years. l Writing the brand-new PDA in Midwifery to help meet the skills gap in this much needed specialism. l Boasting the most qualified and credible educators in the sector in our outstanding Health and Life Sciences team, so many recruited from or
still working in your ranks. Here’s to another 70 years of saving and changing lives together.
glasgowclyde.ac.uk
UNISON
Time for a new social revolution Let’s build an NHS that can be celebrated for the next 70 years, says Matt McLaughlin
“T
he NHS will last as long as there’s folk with faith left to fight for it.” These words are attributed to the architect of the NHS, Anuerin Bevan. And whilst the last 70 years is well worthy of a celebration, fight for it we must if we are to celebrate the next 70 years. The NHS is the matriarch of our welfare state. A beacon for universal services, free at the point of use, envied worldwide and the very expression: that all citizens are created the same and entitled to be treated equally, underlined the socialist principles which led to its birth. Her birth was not an easy one. Labour’s post war manifesto promised a revolution in healthcare but Bevan faced furious opposition from doctors, the voluntary sector, the Tories, and even some in the Labour Party as he fought to realise his dream that every citizen in the UK could access free, high quality healthcare, paid for from general taxation. Of course, the NHS has changed in 70 years; much of it a direct consequence of its own success and the hard work of staff. Polio, mumps and measles are no longer prevalent or as critical, and industrial-based causes of ill health have reduced as our economy has moved from heavy industry to services. Life expectancy has increased by decades in some communities, although we still see the impact of poverty and inequality. And while generation after generation live longer, we are not necessarily living healthier lives. The NHS now must deal with more degenerative disease like diabetes, dementia and cancers. UNISON is proud to represent the whole team of staff who work in the NHS and we believe that everyone, whatever their job, plays a vital role in patient care. Positive initiatives like the Scottish Health Awards, of which UNISON is a major sponsor, or government visits and announcements - consistently talk up the unfaltering commitment of NHS staff, are of course the welcome. The commitment and amazing work staff do should be celebrated alongside the NHS itself. But as the biggest and most diverse union in the NHS we are well aware of the unprecedented pressures staff are under. They face ever-increasing demand as patients (rightly) expect more and their leaders demand they deliver more and more with less resources and fewer staff. We have crippling PFI debt and a spiralling drugs bill. And patterns of illness and disease are changing, raising big questions about how we fund social care and support an ageing population.
The NHS, its workforce and the people of Scotland need a NHS new deal
“Our members also tire of the constant bickering amongst our elected representatives who are more inclined to fight over and not – as Bevan asked - for our NHS” Our members also tire of the constant bickering amongst our elected representatives who are more inclined to fight over and not – as Bevan asked - for our NHS. The NHS, its workforce and the people of Scotland need a NHS new deal, based on a political consensus, driven by enthusiasm and based on core values which have stood the test of time: comprehensive care, free
at the point of use, delivered on the basis of need rather than the ability to pay. We must reject the private sector, zero-hours contracts, and low pay models. Seventy years ago, health services were delivered by local authorities and the voluntary sector. And here we are 70 years later and that battle continues as integrated health and social care boards argue over delivery models and the allocation of funds. UNISON fully supports the principle of better community services, leading to shorter and fewer hospital admissions, but the current model is not delivering and remains stagnating in a silo. We will continue to resist a culture of ‘cheapest is best’. In short, our politicians and civic leaders need to get to grips with our changing health needs and lead a new social revolution with health and wellbeing firmly at its centre. They should challenge established thinking and restrictive professional interests that have been with us 70 years. And build an NHS that can be celebrated for the next 70 years. n Matt McLaughlin is UNISON Scotland’s head of health
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A Patient’s Story
‘The gift of life, my gift of time’ Born three weeks before the NHS, Andrew Nelson wanted to give something back
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ust before his 40th birthday, Andrew Nelson suffered a major heart attack resulting in triple bypass surgery. When his health became steadily worse over the next 10 years, it was apparent that he urgently needed a heart transplant - which he subsequently underwent at Glasgow’s Royal Infirmary. When adult heart and lung services moved to the Golden Jubilee National Hospital 10 years ago, Andrew’s care
transferred also and it was then he decided to ‘give something back to the NHS’ by offering his services as a Peer Support Volunteer. “My birthday is three weeks prior to the anniversary of the NHS service starting; if it wasn’t for NHS Scotland, and the marvellous transplant team, I wouldn’t be here today,” said Andrew, a grandfather of three, and a former Ministry of Defence police sergeant, from Helensburgh. “Prior to my heart attack I’d never been ill. I was always athletic, had a very demanding job, always on the go and interested in sport and going about my day with absolute ease. “When I fell ill, the NHS was there for me. They were super-efficient, helpful, and extremely compassionate and I have nothing but the highest praise for the brilliant staff of our national service.” Andrew now offers his time delivering support and advice to transplant patients. Mark Duddy, 48, a caretaker from
“If it wasn’t for NHSScotland, and the marvellous transplant team, I wouldn’t be here today” Andrew Nelson
Play is essential for our optimal health and wellbeing Research reflecting on the transformation of play over the last 30 years in Scotland (Professor J McKendrick 2017) highlighted current trends, like the: l demise of outdoor play l children’s retreat from the wider neighbourhood l the rise of screen-based play l less play with friends l less informal play spaces l less playtime throughout the year l more restrictive play With the decreasing access to the outdoors environment and lack of free outdoor play, research into children’s mental health has also shown a link between restrictions on children’s access to challenging unsupervised play and rising levels of stress and mental health problems. Prof. R Winston (BBC’s Child of Our Time) Scotland’s Play Strategy values play as a life enhancing daily
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experience for all our children, and the UN General Comment 17 on Article 31 clarifies that governments have obligations to ‘respect, protect and fulfil’ children’s right to play to ensure their optimal health and wellbeing. “Communities, schools and parents need to strategically plan for everyday play opportunities to support the optimal health and wellbeing of our children and young people,” said Marguerite Hunter Blair, Chief Executive, Play Scotland. Let’s plan to give our children more permission, time, space and independence to develop their own spontaneous and self-initiated play-it’s one of the best things we can do to improve children’s health and wellbeing in Scotland! For more information contact info@ playscotland.org and visit www.playscotland.org
Andrew Nelson, centre, with Golden Jubilee National Hospital staff Uddingston, who received a heart transplant at the Golden Jubilee last winter, is deeply grateful for his life-saving care, as well as the support and friendship received from Andrew. “Sometimes when you’re feeling unhappy and you’re thinking ‘why did this happen to me’,” said Mark, “Andrew is there to give you advice and support that just lifts your spirits. “Although your family visit regularly, they really can’t appreciate the challenges you are facing on a daily basis but Andrew has been through the same and I’m very grateful he was there for me, and for what the NHS has done for me.” n
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Innovation
Scientific invention to meet the healthcare challenges of today MSD is inventing for life for our patients, through our partnerships and with our people.
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SD is a global biopharmaceutical company at the forefront of some of the world’s most urgent global population health challenges such as oncology, hepatitis C, antibiotic resistance, Alzheimer’s and Ebola and has been researching, developing and manufacturing medicines in the UK for over 80 years. John McNeill is the Country Manager for MSD in Scotland, a role specifically created three years ago out of recognition that Scotland’s distinctiveness as a healtheconomy required a dedicated business focus. Outside of the UK’s London, Cambridge, Oxford so-called ‘scientific triangle’, Scotland is viewed as the second biggest centre for cutting-edge academic research on medicines, vaccines and healthcare technology, and it is important to MSD to be a part of that. As a company that puts scientific innovation at the heart of everything it does, MSD has a strong focus on its ‘inventing for life’ programme, which not only aims to develop innovative medicines and vaccines for patients who have “unmet clinical needs” in diseases and conditions as wide-ranging as Ebola and Alzheimer’s but also to go beyond the pill to invest in harnessing innovative solutions and technology to help address health challenges now and in the future. This is reflected in MSD’s work in Scotland across three key areas for the UK organisation, which it views as priorities: NHS collaboration and partnerships, investment in innovative medicines and technologies, and utilising data and digital tools. “We’ve got a great team of very entrepreneurial and innovative people, whether it’s healthcare innovations or medicines for patients and populations that we serve,” says McNeill. “For us over the next five to 10 years, the focus will be on how do we partner with the NHS, with non-profit organisations and everyone who’s involved in the life sciences and healthcare industry, which includes academia, healthcare professionals and the Scottish research base to ensure that we continue to invent the next vaccines or medicines which help to extend life or
MSD’s work in Scotland is part of the organisation’s global life sciences reach
improve its quality. Those are the aspirations of the organisation for us here in Scotland.” In terms of research, MSD currently works with over 11 hospitals and 14 investigator sites in Scotland across its clinical and pre-clinical trials programme. The MSD Life Sciences Fund, a three-year £3m programme developed in 2012, has paved the way for undergraduate, PhD and research post support across a range of life sciences activities including pioneering International Genetically-engineered machines (iGEM) and laboratory placements. In the digital space, MSD is at the forefront of the new national SPIRE (Scottish Primary Care Information Resource) programme, developed by NHS National Services Scotland (NSS). MSD was selected through a rigorous procurement programme to provide the software which will securely streamline the way data is collected and shared by GP practices across the NHS. For MSD, this work is a key plank of its drive towards digital innovation and partnership. This ‘additionality’ is part of the way healthcare is engaging with ‘disruptive innovation’ by new technologies and aims to improve the way patient data is collected and disseminated within the NHS in Scotland and is central to MSD’s future mission.
“We have been working in the digital space for around 15 years in Scotland; it was MSD who partnered with NHS Scotland on GP contracts, through the QOF (Quality Outcomes Framework), providing the software and analytics for the NHS, so there’s quite a history in that space of working with health boards, government, NHS NSS, and the other associated agencies with SPIRE being another example of continuing to build on that work.” MSD recognises that no single organisation has everything it takes to deliver complete healthcare. The organisation is proudly exploring partnerships projects in Scotland in collaboration with the Pharmaceutical Industry Alliance (PIA) and Greater Glasgow & Clyde Health Board, and working with NHS Fife Diabetes Centre, SCI-Diabetes (the Scottish National Diabetes System) and the Scottish Ambulance Service to support patients who experience severe hypoglycaemia (low blood sugar) with the aim of improving patient care and reducing emergency admissions. MSD has also taken a role in the Life Sciences Scotland Industry Leadership Group whose aim is, in collaboration, to transform the life sciences sector in Scotland into a world leading industry that contributes £8bn to the Scottish economy by 2025. John McNeill co-leads one of four work streams designed to help achieve this target. He says: “This is all about the industry having one voice and MSD is excited to be part of that cross-sectoral work.” n
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Research & Innovation
Transforming Patient Care
Keyhole surgery, first conducted at Ninewells Hospital in Dundee, has since revolutionised most disciplines of surgery as well as the patient experience.
A proud history, an exciting future The accomplishments, innovations and breakthroughs made in the NHS over the last 70 years have completely transformed modern medicine BY WILLIAM PEAKIN
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cotland’s reputation as a pioneer of medical and pharmaceutical research is well earned. The discovery of Penicillin, the beta blocker, the hypodermic syringe; the first use of diagnostic ultrasound, the full body MRI scanner and the establishment of the world’s first radiology department – all these things happened in Scotland, and over the last 70 years have completely transformed modern medicine.
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We live in a health technological age that was unimaginable back in 1948; MRI scanners, ultrasound, transplantation and antibody therapies, to name just a few. The pace of these medical advances is somewhat amazing. The first ever full body scan took place in Aberdeen in 1989 establishing a revolutionary procedure that is now a cornerstone of modern medicine. The opening of Glasgow’s £32m Imaging Centre of Excellence (ICE), in spring 2017, featuring the world’s most powerful MRI scanners is testament to the advancement. Sitting proudly, as part of the largest acute hospital in Western Europe – the Queen Elizabeth University Hospital – the facility combines world-class facilities with leading expertise in brain, stroke and cardiovascular disease imaging allowing researchers to see detail in the brain as tiny as a grain of sand. On a smaller scale, but no less important, laparoscopic surgery, commonly known
as keyhole surgery, was first conducted in Scotland at Ninewells Hospital in Dundee with the removal of a patient’s gall bladder. It has since revolutionised most disciplines of surgery as well as the patient experience and is now in routine use across a range of surgical procedures. It is a proud history, transforming the lives of patients not only in Scotland but around the world. But that cycle of innovation never stops and services must always evolve to meet new patterns of care, increased demand and technological advances. Continual investment and valuing innovation from both within and outside the NHS is at the heart of rising to this challenge, creating a service that is modern, sustainable, adaptable and at the forefront of medical advances. Within Scotland, two national bodies are helping to harness the collective power of the NHS across Scotland to translate research and innovation into excellent individual healthcare.
NHS RESEARCH SCOTLAND (NRS)
NHS Research Scotland (NRS), a partnership of Scottish NHS Boards and the Chief Scientist Office (CSO) of Scottish Government, helps ensure NHS Scotland provides the best environment to support research. It co-ordinates access to worldclass facilities and leading expertise across all therapy areas, underpinning NHS Scotland as a base for trials of the most advanced healthcare treatments, diagnostics and medical technologies and bringing them to patients faster. Over the last year more than 30,000 patients have participated in research in Scotland and the top 20 pharma companies have trials in Scotland. Attracted by Scotland’s unified health service, stable population and some of the best health data in the world, it allows research across all disease areas to be delivered. This covers everything from cancer, cardiovascular disease, diabetes, stroke and dementia with a total of 28 therapy areas which bring together leading clinicians and academics with patients and carers. This collaborative environment enables ambitious research projects to be conducted ultimately leading to improved treatment options and better outcomes for patients. This ability to undertake high-quality research at pace is critical to broader life science objectives. Not only is Scotland working to make people better and healthier but it is building economic growth and supporting the nation’s vision to be the location of choice for businesses, researchers, healthcare professionals, and investors. www.nrs.org.uk / @NHSResearchScot
GROUND-BREAKING RESEARCH IN ACTION
As the second biggest killer worldwide, research into the prevention and treatment of stroke has the potential to drive lifesaving benefits and improve the quality of life in patients following stroke. A broad range of research studies are conducted within the NHS. For example, arm mobility is a major problem and is associated with poor quality of life in patients who have had a stroke. It is estimated to affect about 75% of all patients in the early months and remains a permanent issue for about half of patients so new treatments are urgently required. The NRS Stroke Network partnered with Microtransponder Inc® - an innovative clinical technology company – to trial the Vivistim® System for treatment of post-stroke upper limb mobility. The medical device surgically implanted just below the collar bone, delivers electrical stimulation to the vagus nerve. The stimulation, which is given in conjunction with rehabilitation physiotherapy, is believed to cause the brain to be more receptive to the recovery training exercises delivered after stroke. www.nrs.org.uk/resources
SCOTTISH HEALTH INNOVATIONS LTD (SHIL)
With more than 160,000 staff working across NHS Scotland, it is a rich resource of ideas and innovations from within the health service. Scottish Health Innovations Ltd (SHIL) work in partnership with NHS Scotland to identify, protect, develop and commercialise healthcare innovations to improve patient care. The multidisciplinary team use specialised knowledge to help bring new ideas and innovations from healthcare professionals to life. This includes intellectual property advice and protection, project management, idea incubation, funding advice, development and commercialisation, and postcommercialisation monitoring. Over the last 15 years SHIL have been able to harnesses the entrepreneurial talent of all NHS staff, whether that be front-line clinicians, researchers, nurses, pharmacists, specialists, managers, or support staff, to turn a range of ideas into viable products and services to improve patient care.
INNOVATIVE PRODUCTS
From pre-hospital emergency anaesthesia to nosebleeds to rehabilitation after stroke, SHIL has worked closely with health professionals across Scotland to develop and commercialise a range of products to improve patient care. The most recent launch in collaboration with the Scottish Ambulance Service and Air Paramedic Paul Swinton is SCRAM 2.0 – an emergency airway bag. Inspired by Paul’s experience working with the air-ambulance attending accidents and emergencies in the pre-hospital setting, the bag is designed to form a system of advanced preparation and organisation of equipment and drugs; promoting the delivery of safe, timely, and well-governed pre-hospital emergency anaesthesia. “The effectiveness and speed of potentially lifesaving pre-hospital airway management can significantly impact the outcome of critically ill or injured patients,” said Paul Swinton, Air Ambulance paramedic with the Scottish Ambulance Service and co-inventor. Using the insight and experiences of health professionals alongside the expert services of SHIL is a strong model in developing products that really do make a difference to patients and health professionals. Other products include Prism Glasses™ - an innovative solution to rehabilitation and phantom limb pain; Rhinopinch – a simple but highly effective clip to staunch nose bleeds and the Ambulance Child Restraint, an innovative system for the safe and effective handling of young patients being transported in ambulances which is now widely adopted by Ambulance Services across the UK. n
SPIN-OUT’S INVENTION GOES GLOBAL SHIL also has a strong record in producing spin-out companies on behalf of NHS Scotland. If a product is thought to have the scope for more than one iteration, or if the NHS innovator has ideas for multiple products in the same field, a spin-out company helps establish a brand for their products and raise capital from a wide range of sources. Clear Surgical, a 2013 spin-out, develops innovative solutions to surgical problems. Starting life as a small, wafer thin light dreamt up by NHS Ayrshire staff it is set to transform surgical lighting in hospitals across the globe. Measuring just 4mm thick and 5.5cm long, the cartridge adheres to surgical instruments and lights up the operating cavity from the inside so that surgeons can see more clearly. SHIL took the initial idea from concept design stage through to fully-approved product; and following successful trials at hospitals in Edinburgh and Ayrshire, the light was launched at the world’s largest medical trade show Medica, attracting orders from hospitals in the USA, Canada, Germany, Portugal, Italy, Australia and Saudi Arabia. Graham Watson, SHIL’s Executive Chair, said: “Oplight is the first major advancement in surgical lighting in many years and we believe the market is going to be huge. It’s an extremely versatile product with a wide range of surgical applications, from cardiac and spinal to bowel and breast, at a fraction of the cost of current lighting options. To date more than £1.3 million has been invested in the company, showing there’s a high level of confidence in the power of this invention to transform surgical lighting across the globe.” Actively supporting healthcare professionals to turn ideas into reality helps capitalise on the talent, entrepreneurism and commitment of staff and uncover transformational ideas throughout NHS Scotland. Scotland has a proud history of shaping health and patient care through research, science and innovation and is set to continue to transform the world of modern medicine. www.shil.co.uk/browse
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Ieso Digital Health
Help at your fingertips Improving access to evidence-based mental health therapy
A unique way of providing online therapy through written conversation. Picture by kaitlynbaker.co
N
ick Martin has lived with anxiety and depression for many years. “My natural instinct is to worry about everything,” he said. “Even the simplest of decisions are a struggle.” But then Nick’s GP offered him a series on online therapy sessions; a typed conversation with a therapist he would never meet. “It’s quite strange getting started,” said Nick in a recent interview with the BBC. “You write something; how you are feeling, what you are thinking. And then there’s a pause, while the therapist responds. [But] just writing something down, which I had never done before – I was scared to do so – it had quite a profound effect, for me personally. I found it liberating; it gave me a way to cope with what I was thinking.” Mental illness is the single biggest cause of disability with over 12.5 million working days lost each year representing a cost of £26bn to UK businesses. In 2017 NHS England spent £9.7bn alone on mental health. For sufferers of depression and their families, the cost to their wellbeing is beyond monetary measure. “When you put a computer between an experienced therapist and a patient, it opens up all kinds of possibilities,” said Sarah Bateup, Chief Clinical Officer at Ieso Digital Health. “In a traditional therapy setting, initial problem statements can take some time to get to. But here we see that occurring in the first session. That’s really important because once you know what the problem is you can start the treatment.” Ieso is a world-leading digital health company specialising in internet-enabled evidence-based psychological therapies. This unique method of providing online therapy through written conversation, along with strict adherence to disorderspecific treatment protocols, means that Ieso can ensure patients are experiencing the best possible evidence-based cognitive behavioural therapy (CBT) for their needs.
“Digital mental healthcare pathways are delivering game-changing outcomes in the treatment of depression” Rob Brougham, UK MD, Ieso Digital Health 34 | NHS70 | SUMMER 2018
IESO’S VISION Imagine capturing the collective knowledge of the world’s leading and most effective therapists – every therapeutic interaction – and being able to visualise what works in an extremely nuanced way for each patient. Imagine taking that collective
knowledge, and by using deep learning techniques, natural language processing engines and sophisticated artificial intelligence practices, being able to make every therapist better: the sum of the whole now being greater than its individual parts.
Using the company’s proprietary technology, Ieso is developing artificial intelligence techniques using natural language processing to provide personalised training and real-time support for Ieso therapists, in order to generate higher recovery rates for patients. Since 2013, the company has treated more than 26,000 patients and conducted 100,000-plus hours of therapy. Patient recovery rates have improved incrementally year on year. Ieso focuses on patient experience; offering appointments at a time and location convenient to the patient. This particularly helps people with social anxiety, those who are embarrassed to attend a clinic, people who live in remote locations or those who require unusual appointment times. Recently released figures by Ieso using NHS IAPT data show that: 66% of all Ieso therapy sessions now take place out of standard 9-to-5 office hours and at weekends, 48% more patients complete Ieso’s therapy compared with the national average for treatment, and greater flexibility of online therapy sessions offered by Ieso is reducing appointment no-shows by 31% compared with average national figures for traditional therapy.
Imagine that those learnings are translated into real time, in-the-moment, clinical practice guidance tools that provide patient personalised guidance to therapists, to make them better and as a result, their patients better, faster.
“These figures provide more evidence that demonstrates how Ieso’s digital care pathway is giving patients with anxiety and depression disorders a much better experience,” said Rob Brougham, UK MD of Ieso Digital Health. “Ieso is connecting patients to clinicians in real-time, beyond 9-to-5 hours – enabling them to have high quality care, quickly and conveniently, without having to adapt their life to their condition.” Brougham added: “Digital mental healthcare pathways are delivering game-changing outcomes in the treatment of depression. Many people seeking therapy for mild to moderate depression with the NHS, still face long waiting times, with one in 10 having to wait more than a year to be seen leading to minor problems becoming major ones. “Nearly two-thirds of people with a known mental condition never seek help from a health professional, and yet most of them carry a mobile phone around with them every day. By combining digital technology with the knowledge and experience of qualified expert clinicians we are seeing the real-world impact of how Ieso is redefining mental health, removing barriers and stigma by meeting patients where they are; on their mobiles and on PC.” n
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