Partnership For Care

White Paper on Scotland's health

A blueprint to transform Scotland's health and its health services was outlined today.
Key points in the White Paper Partnership for Care include the abolition of NHS Trusts, and a new guarantee of treatment on time.

Health Minister Malcolm Chisholm said:
"Over the lifetime of the next Parliament, we plan to increase investment in health from 6.7 billion to 9.3 billion, an annual increase of 5.5% in real terms.

"That is high by historic standards but it will only deliver the necessary improvements if it is matched by a programme of modernisation that is based on the needs of patients.

"This White Paper is about the promotion of health in the broadest sense and the creation of a health service that is fit for the 21st century. At the heart of its vision is a culture of care that is developed and fostered by a new partnership between patients, staff and Government."

Key points are:
1. More local health care - a wider range of services delivered locally in communities. Stronger role for Local Health Care Co-ops, evolving into new Community Health Partnerships.
2. Abolition of NHS trusts and new requirements to devolve authority to frontline units and involve their professionals.
3. New guarantee of treatment on time, initially for certain heart surgery, but to be extended to services with national waiting time targets. New local targets for specialities.
4. Vigorous independent monitoring of services by NHS Quality Improvement Scotland (NHSQIS) to ensure highest standards of care and cleanliness. The Executive will take tough action where serious failings emerge.
5. A new Scottish Health Council, as part of NHSQIS, to involve the public in NHSScotland.
6. Patients to be partners in decision making - plans for an Integrated Care Record owned jointly by patients and their health care professionals. A new statement of patients' rights and responsibilities and new complaints procedure.
7. A new 26m fund for change and innovation to build a new model NHS designed not by centralised bureaucracy but by clinicians with patients in the driving seat and removing barriers between primary and hospital care.
8. More help for staff through professional development and training to encourage new skills and roles to meet the needs of the NHS. A new approach to workforce planning.

Mr Chisholm said:
"This is a genuine Scottish document to meet the needs of Scotland. It is part of an ongoing devolution process - devolving power and responsibility to clinicians and patients.

"We have talked for some time about patient-centred services but today we are signalling a step change so that looking at services from a patient's point of view becomes the key driver of change in the health service.

"This has specific outcomes such as a new complaints procedure, a Patient Information Initiative and a new statement of Patient Rights and Responsibilities but underlying these specific initiatives is a more fundamental culture change that involves patients at every stage as partners in care and key contributors to quality improvement.

"There is also a new emphasis on the role of staff, and frontline staff in particular, as leaders of change in the health service. We shall increase the capacity of the NHS workforce, develop new workforce planning arrangements, improve opportunities for continuing professional development and establish reformed pay systems. We shall also ensure that healthcare teams are given the support and the tools and the freedom to redesign services and improve patient care.

"One of the key themes of this White Paper is decentralisation of decision making and an end to traditional command and control approaches to reforming the health service. We shall ensure that there are schemes of decentralisation within each NHS Board and this will be backed up by legislation."

Existing Local Health Care Co-operatives will evolve into new Community Health Partnerships. These will have stronger roots in their local communities through local accountability and closer links with local authority social work services.

NHS Boards will be required to establish a Service Redesign Committee, with a strong involvement of clinicians and other health professionals, with representation from each Community Health Partnership.

An additional 26m will be allocated in the next financial year to NHS Boards to modernise services - based on robust plans supplied by the boards. They will also be supported by the Centre for Change and Innovation by funding pilot projects, supporting redesign and helping to share best practice.

The Minister continued:
"Our first priority in improving services must be to improve waiting times, because that is the first concern that we hear expressed by patients. A major national piece of work has been launched to reduce outpatient waiting through redesign and other changes.

"This process will be matched by increased investment in e-health or information technology and the appointment of a clinician as Director of Clinical Information in each NHS Board to take this forward.

"Our emphasis on integration and decentralisation has implications for the future of Trusts. The existence of separate NHS Trusts covering the same areas as NHS Boards has not yielded clear benefits, but has confused accountability and obstructed the integration of services. We shall therefore require NHS Boards to submit plans to dissolve Trusts and establish new decentralised operating units with a strong role for frontline staff.

"All these measures will ensure the improvement and modernisation of health services but we shall never achieve the health outcomes we want unless there is parallel progress on the broader health improvement agenda. This will require a sustained effort that involves, not just the Scottish Executive and NHSScotland, but local authorities, employers, trade unions, community planning partners and local communities.

"We will publish a Health Improvement Challenge shortly to set out in more detail how we will focus actions on four groups: children in early years, teenagers, people at work, and local communities. We are backing this with plans costing almost 250 million over the next three years on a range of measures to improve health.

"This White Paper signals a direction of travel, to enable us to go forward together. It takes a broad view of health. It puts the patient first. It recognises the importance of national standards of healthcare and independent inspection of performance. It sets out specific reforms to devolve power and to involve the health professionals, in order to modernise services, and so reduce waiting times.

"Of course the implementation of these measures, including the legislation, must be a matter for the next Parliament."
News Release: SEhd336/2003

The full document can be downloaded from here and the Executive Summary can be downloaded from here

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