Around 50 members attended the meeting at the Hilton Dunblane Hydro. 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. Opinions expressed within the notes are those of Forum members and have been included for completeness. This does not necessarily mean I agree with them.
The meeting on the evening of 22nd January was fairly informal and was intended to get initial reactions to 'Our National Health' - the Scottish Health Plan. Gerry Marr also wanted to know what they should be thinking about for the implementation and what each organisation on the Modernisation Forum considered should be on the table.
The first of the health plan roadshows took place earlier today. These roadshows are intended to be for a cross-section of staff - not just senior managers. It is important to note that the plan is about policy development AND implementation.
The next three documents to be produced will be
1. Rebuilding the NHS - consisting of three parts -
The first draft of this document should appear in February, be finalised by April and possibly implemented by October.
2. Public and patient involvement - making a reality of some of the detailed commitments in the plan.
3. Redesign of the patients journey
Members of the forum were told to forget about the unified health boards for the moment and get on with the job in hand - winter pressures.
Some of the Reactions to 'Our National Health'
The meeting started with all participants asked to consider what barriers and what enablers they could see from their personal point of view and that of their organisation. These points were then written on flip charts positioned around the room with various headings such as 'staff', 'trusts' and 'boards'. Once that had been completed, everyone was asked to select the five most important points they considered would affect implementation of the plan.
The participants were then asked to divide up into 6 groups, each considering a particular question. The questions were
1. Rebuilding the NHS
SEHD - identify policy, national targets, overall accountability
UHB - facilitate implementation
Providers - all the groups involved
The providers and the professionals must be involved and must feel they are involved. Such inclusion might not lead to them getting their own way, but it will increase their ownership of the solutions.
Disincentives do not work. Taking money away from providers only results in a poorer service for the patients.
What is the future for the LHCCs? It must be described and the expected links must also be detailed. The LHCC is involved with the local community and must be involved with the strategies devised by the unified Health Boards. LHCCs have engaged with local communities and organisations, and the service must not risk these contacts being lost.
2. Working in partnership with staff
Start with the patient. Work out their needs then redesign the service around that and decide on the most appropriate staff to carry out each part of it
Make flexible working simpler, acceptable and encouraged. It is currently seen as complicated to have people job share or be part time. With current manpower crises this type of working must become more widespread.
Allow roles/jobs to change with no financial disincentives. Allow those near retirement age to work part time or job share without it having any detriment to their pension entitlement.
Encourage more discussion among disciplines at local and central levels. Better understanding of roles and responsibilities allows better appreciation of other staff and how they can assist each other. This could be started during training.
Share responsibility. Doctors have a major problem with this. Their perception is that they are solely responsible to the patient for all their care. If some of the work is moved to other professionals, the responsibility must also be transferred. The other professions must be aware of their particular responsibilities when they take on extended roles, as must the doctors. Resources also need to follow changes in responsibility. Proper remuneration must reflect the increase role of the member of staff. There is a difficulty in identifying how this can be done within the current pay structures and on a single pay spine. It is also important to note that training another professional to take on a role does not effect a substitution. This may be the case for a short time, but after that they build up their own workload.
Lack of investment in education and training. There is also a problem in giving staff time to develop these additional responsibilities. There is no sign that 'Learning Together' has made any difference in this area. The service is so tight that it is impossible to take people out of the system to do this.
Demonstrate that the NHS cares about the welfare of staff.
Eliminate the blame culture.
Ask staff about the running of the service.
3. The patients journey
There should be direct access to all members of the Primary Care team. Professional barriers should be eliminated where they exist, and there should be adequate staff numbers. What is the point of referring a patient to another healthcare professional when the patients could refer themselves? Often this procedure is used as a safety net for professionals. Basically doctors have to indemnify other professionals to do their job. However there is also the aspects of professional ethics and self-protection, where it is used to keep some control over workload.
There need to be better links between GPs and specialists employed in the Trusts. What is the role of the LHCC?
There should be some monitoring of the patient's journey through secondary care by primary care. GPs in the past regularly visited any of their patients who were in hospital, but this is rarely done today.
IT should be used effectively. The system should be user friendly and secondary and primary care systems should communicate with each other.
4. Role of the Health Department as an enabler
The purpose of the Health Dept. (SEHD) is basically to advise and give effect to political will. Major obstacles to implementing 'ONH' are -
If SEHD prioritises too many initiatives, then there are few priorities!
It came as a surprise to most of the participants to learn just how small SEHD actually is. With only about 200 staff, it is considerably smaller than the Education Dept. Their workload has massively increased with MSP parliamentary questions. There is a need for more staff. However, there is also a question about how many of the functions currently carried out by SEHD could be done by the new unified Health Boards. There was a suggestion that secondments to SEHD from the service could be increased.
5. Involving patients and staff
£14m has been earmarked over the next three years to facilitate consulting and informing the public. This needs to be done at various levels -
There is a need to use the media more effectively than hitherto, and develop a continuing dialogue with them, providing information and possible consequences.
Staff should also be used as an information cascade to patients.
Some of the money should be spent at LHCC level, providing a liaison/information officer to liaise with the local communities. Some areas have information shops in shopping arcades -staffed by local authority, LHCC and Health Board staff.
There could be a dedicated project officer in Trusts and/or the unified health boards to act as a conduit to local communities. It was stressed that the post should be dedicated, rather than the responsibility being added to an existing employee's already wide remit.
Staff should be more involved in implementing the plan. Every member of the NHS should have an email address. This will not work, though, unless every member of staff has access to the necessary computer equipment.
Trust and Health Board websites should be used and promoted. All should have feedback zones and links should be built to other sites. The NHS Scotland website should be promoted more than at present.
An independent advocacy service is essential although family and professional advocacy are also important. Part of the £14m should also be used to evaluate personal, spoken communication between patients and doctors / nurses / anyone else for those who are unable to read, are too ill to read or for whom English is not their first language, if spoken at all.
There is a need, after a patient leaves hospital, to collect information on their experiences.
Research is required on the best method(s) of consultation. Should a pack on "how to consult" be prepared centrally by SEHD, and distributed for use by the service?
It will also be necessary to spend some money to prepare communities to get involved.
6. Unified 'thinking'
How does the health plan fit in?
Resource allocation - does it help or hinder?
Find 'ways in'
Proactive versus reactive agenda
It is necessary to think across all groups, including the voluntary ones. It was noted that enterprise companies in smaller areas are making good links with local authorities and health boards. There needs to be collaborative work between all agencies and sectors at operational level as well as strategic and Scottish Executive level.
Future role of Modernisation Forum
The meeting finished with some discussion on the future role of the Modernisation Forum. It was argued that as a lot of the implementation is local and not central, it's life would necessarily be limited. A similar body at local level should replace it.
If the Modernisation Forum was to meet again, it should be to look at specific areas e.g. to consider suggested answers for implementing the plan. There is a structured relationship between SEHD and the Modernisation Forum. It was suggested that the next meeting should be after the three papers have been published.
Key Messages from the Modernisation Forum to SEHD
Secretary for Scotland
Guild of Healthcare Pharmacists