Modernisation Forum Meeting
13th September 2000



30-40 out of the 88 (at the last count) members attended the meeting at the Scottish Health Service Centre in Edinburgh. This report is compiled from notes taken during the meeting, is for information only and does not constitute formal minutes. Consequently, I take no responsibility for any inaccuracies, errors or omissions.

Gerry Marr opened the meeting with a short introduction on the Modernisation Board (MB) and the hopes for the Modernisation Forum (MF)

The Modernisation Board is not a representative body. It's 15 members were appointed by the Minister for their abilities. It is envisioned that the MF will feed issues into the MB, and also feed into policy development.

A lot of work has already been done which can contribute to the NHS Plan for Scotland (NHSPS). The network groups are trying to identify all the different groups that exist, get information on what they are working on and ensure reinventing wheels is not on their agendas. They will also ensure the work can be evaluated and fed into the MF and MB. Annex A, circulated with the papers for the meeting, showed only some of the groups which were currently in existence. It was noted that information on the groups and what they were investigating is something which the MF would need. Few people had heard of the Joint Futures Group, for instance, which was looking at barriers and the integration of health and social care.

The timescale for the production of the NHSPS is short and the next 5-6 weeks is really the only time during which proposals can be included. The plan will be written in October and issued on 30th November. Unfortunately, the timescale was not of the Scottish Executive Health Department's (SEHD) choice, but a Government decision. The SEHD is intending to write to various organisations and Colleges to allow them to feed into the plan directly, and there will also be public consultation. He pointed out that SEHD was in discussions with System Three on the best way to get a genuine, stratified, statistically valid sample of the population. The public will be asked about their concerns and expectations of the NHS in an attempt to get a clear view of what the real issues are. Interestingly, some initial consultation had shown a generational split on attitudes to the NHS. There was also concern over a loss of caring in the service. Staff too will be consulted.

There were considerable discussions on the purpose of the group and all agreed that some clarity was required on -

  • the remit and terms of reference of the group
  • how the MF can input into the NHS Plan for Scotland (NHSPS) and
  • it's relationship with the MB
  • what information comes into the group from other groups, including the MB?
  • what is the lifespan of the group?
  • what role is the group supposed to perform.?

Gerry Marr explained that he considered that the MF was at the start of a relationship with the SEHD, and that the relationship is not defined or clear at the moment. There is also the relationship with the Health and Community Care Committee of the Scottish Parliament. This is another group that the MF and MB will have to work with, and a lot of thought will be required to work out how. SEHD have no preconceived notion of how the MF should work and would like advice from the MF on how it could be most effective. There is not a good track record for proper consultation in the past, but there is now a willingness to be different and develop the relationship over the next 6 months to 2 years.

The group raised concerns as to whether the NHSPS is going to be a starting point or a finished product like the NHS Plan for England (NHSPE). He maintained that the NHSPS will be markedly different from the NHSPE. There is a need to examine and evaluate the NHSPE, but also a need to grapple with the essential differences between Scotland and England. Many of the priorities would be similar, since the basis for the plans had been the joint Ministerial meetings which took place in Glasgow, London and Cardiff. The starting point is improving health. Whereas this had appeared as chapter 13 in the NHSPE, it would be chapter 1 in the NHSPS. The NHSPE was very prescriptive and focused on inputs. The NHSPS would be accessible and understandable to the people of Scotland and concentrate more on outcomes. It has to look, feel and be very different from the NHSPE.

It is intended that the NHSPS will be more signposting than prescriptive, and a lot of work will spawn from it. The MF will be involved with the implementation as well as ideas for the Plan. It is not the case that the group will have 6 weeks to influence the next 10 years. There is not a blank piece of paper. The majority of the plan will be built around work that is already in place. SEHD want to use the MF and MB to evaluate some of the work that has already been done. The network groups consist of around 5 people trying to ascertain what work is being done and then bring it all into the equation.

He stated that there is a programme of modernisation in Scotland looking at -

  • patients' perception and public involvement (Patients Project)
  • improving health
  • improving service delivery
  • improving the flow of funds
  • governance, performance and accountability issues and
  • workforce issues

Taking, for example, the workforce issue - it would be impossible to design a blueprint for the workforce before 30th November. The current shape and demographic of the workforce will not sustain the service over the next 25 years, and the NHSPS will acknowledge this. Learning Together and multiskilling will continue to erode professional barriers. The question is whether the current piecemeal approach should be replaced with a programmed and systematic one. SEHD want people to be working at a level where they are carrying out tasks near the top of their job specification, rather than the lowest common denominator, where they are routinely carrying out duties that should be delegated to a lower grade.

A different performance framework is required too. It won't be there by the end of November. The NHSPS might say that by April a consultative process on this would be undertaken. He stressed that there is no plan already in existence and the MF will not close down on 30th November. It is envisioned that they will provide a short term input into the plan but also sustained input and support to the Board during the implementation.

Health issues in Scotland are different. Access is an issue. There are different levels of investment in the work force and the workforce is ready to work with the SEHD.

Members of the group were concerned over whether the MF was a real relationship or merely window dressing. Gerry Marr's answer was that it was a genuine start to a different way of deciding policy, but made the point that although the Minister may listen, she will also decide. It was also pointed out by the group that some inputs would be essential to take this forward.

The Government wants a balance between "top-down" instructions and partnership. However that balance is tricky. The Scottish Partnership Forum (SPF) have been frustrated with the guidance on family friendly policies, for example, where Trusts have a choice in what to implement. Here, there may need to be a top-down instruction.

Worry was expressed that the plan will change the current direction of the NHS. Gerry Marr said this was unlikely to be a major change and probably it will be the same direction that people are comfortable with.

Several people raised issues on how to ensure proper consultation with members, and pointed out that proper consultation and short timescales were incompatible. It was recognised by SEHD that it might have to be representation in its broadest sense, as there may be issues where no organisation policy exists; occasions where members will be talking as individuals or broadly representing their profession; and occasions where it is not possible to consult members.

There was a fear that the MF would be no more than a protective umbrella for the NHSPS, and that they would get the blame if the plan did not contain what they thought it should. It was suggested that the plan should carry no indication that it has been endorsed by the MF, so that the group could criticise the contents and act as a sounding board for the longer term.

Questions

Q. To what extent will the NHSPS be constrained by the NHSPE?

A. Very little constraint on looking at public health. While the NHSPE is intended to get Alan Milburn through the next general election, the NHSPS will be viewed over the next two years.

Q. Ownership of the proposals is important. Could the MF work with the other groups to jointly own the proposals and then the MB would have a quality assurance role?

A. It is a possibility. It is not known how a lot of the groups came together originally, so if the MF could provide a consistent approach to the setting up and the representation on groups, this might be a useful way forward.

The way forward

It is planned to set up a 1.5 day meeting in October to examine and evaluate the components of the NHPS in place at that time. It is not impossible to input proposals for this meeting, even on the day. Gerry Marr is confident that there will be very few nasty surprises. There is likely to be little dispute over the main themes - the disputes will be about how to achieve them. The current Government administration are adamant of the need to build and restore public confidence in the NHS, so there is a significant emphasis on healthcare as well as health.

It might also be that the meeting in October is used to shape the future agenda of the MF.

A pack of information on the various network and other groups will be sent out to members by the end of the week. It was not possible to do this for this meeting since the work is only being done at the moment. The pack would identify groups and key people / organisations / bodies that they need to liaise with, since it is important to build on successes.

Comment by Secretary for Scotland

The meeting was not particularly coherent. The presentation by Gerry Marr on the NHSPS towards the end of the meeting would have been more useful at the start, before the meeting split into groups to discuss the remit and terms of reference of the MF. Consequently, much of the discussion centred on what role the MF was supposed to fulfil, what timescales we were supposed to work to, what could be done within the timescale for the NHSPS and what would be done after itís publication. Hopefully, future meetings will be more productive.

 

COLIN RODDEN
Secretary for Scotland
Guild of Healthcare Pharmacists
13.9.00

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