Our National Health
A plan for action, a plan for change
As spending on the NHS in Scotland rises from £4.9 billion in 1999/2000 to £6.7 billion in 2003/2004, Our National Health sets out a radical programme of investment and reform designed to:
The Plan builds on previous work and also looks to the future. It is not an end in itself, but the start of a process. It brings together a fragmented NHS, signals new partnerships with Local Authorities and other organisations, and sets out new ways of ensuring that national standards of care will be delivered locally. It marks a real change in the way the NHS is run, and a real opportunity to make a difference to the health of our nation.
2. improving health
Scotland’s health record is poor by European standards, and within Scotland there is great inequality between the health of richer and poorer communities. Poverty, poor housing, and lack of employment and of educational opportunities all contribute. So improving health is a long-term commitment. Many services and agencies must work together to improve health and to empower individuals and communities to build better health. The Plan sets out a wide range of detailed proposals, including:
This year, we have announced a new Public Health Institute for Scotland to provide research support, and we are planning a major Healthy Scotland convention in 2001 to raise awareness and drive forward change.
Our health demonstration projects on children’s health, sexual health and the prevention of cancer and coronary heart disease have now been launched. Lessons learned will be rolled out across Scotland.
3. rebuilding our National Health Service
We can be proud of our NHS, its record of service, and the skill and dedication of its 136,000 staff. But the way it is run now still reflects some of the wasteful and competitive practices of the internal market, with the work of Boards and Trusts being planned, managed and monitored separately. Standards of care are uneven, with a ‘postcode lottery’ of care across Scotland. So a new approach to managing the NHS will:
As part of our streamlining of bureaucracy, the new NHS Boards will be responsible for the whole system in their area, from strategic planning, through resource allocation and financial management to performance review. Boards will be structured to ensure strong Local Authority and staff input. NHS trusts will retain their operational responsibilities but will have fewer non-executive directors.
Allied to these simplifying measures, we will perform a review of NHS financial systems, introduce a new performance management framework and launch a national communications programme.
4. improving the patient’s journey
Too many people wait too long for treatment and care, and sometimes it seems that the interests of the service come before the needs of the patient. But there are many examples of excellent service – where the patient, the patient’s experience and the improvement of that experience are first and foremost. Investment and reform, together with a change in the culture of the NHS, will ensure that best practice becomes common practice, with:
5. involving people
Our National Health Service belongs to the people of Scotland and serves them throughout their lives. So patients, staff and communities have a right to be involved in decisions which affect them. Again, there is good practice – in listening, in keeping people and communities informed, and in consulting them to improve the NHS locally. So to make such good practice universal:
6. a lifetime of care
For most of us, for most of the time, the NHS is simply a reassuring presence – there if we need it. But we all need it most at the beginning of life and when we grow older. To reflect these needs:
7. meeting specific needs
Coronary heart disease, cancer and mental health are the three agreed clinical priorities identified for special action by the NHS in Scotland – common serious problems that blight and shorten many lives. There is sound knowledge of what needs to be done, both for prevention and to help those already affected. The challenge now is to ensure such knowledge is applied systematically to reduce illness and improve patient care. So:
The Plan also covers learning disability, physical disability and chronic conditions such as diabetes.
We remain alert to the health needs of excluded groups such as homeless people, and the Plan seeks to set out new ways to address their problems.
8. working in partnership with staff
The public values NHS staff, and the NHS must do the same. With a workforce of 136,000 people, it is the biggest employer in Scotland. To improve patient care, the NHS must now explore new ways of working to deliver high-quality and cost-effective care right across Scotland. To achieve this:
We aim to address low pay issues and to consider rewards for length and quality of service. An important element of our review of GP practice will be our initiative to develop alternative contractual options.
9. to make this work, we must work together
Our National Health: A plan for action, a plan for change brings together the results of a year’s consultation with patients, public, NHS staff, and representatives of many different groups and agencies. All of them will again be involved as we move on – to action and to change. With devolution, decisions can be made closer to the people that they affect. With substantial new resources too, we can make a real difference – improving Scotland’s health and rebuilding our NHS.
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