NHS Scotland Forum Meeting
27 September 2002

Don Page, for GHP Scotland

I attended this meeting on behalf of Colin Rodden, Scottish Secretary to the Guild of Healthcare Pharmacists in Scotland. The meeting was attended by about fifty representatives of the Health Service and related interested agencies, including Local Authorities, Social Workers and voluntary sector bodies. The venue was the St James Thistle Hotel, and a room was used that could comfortably seat 40. The only other pharmacist present was David Thompson, Trust Chief Pharmacist for Greater Glasgow PCT. representing the Trust Chief Pharmacists and RPSGB Scotland.

The meeting was addressed by Malcolm Chisholm MSP, Scottish Minister for Health, followed by Trevor Jones, the Chief Executive for NHS Scotland. The minister posed two questions:

He referred to a debate within the Scottish Parliament two days previously on Primary Care services, where the issues of `Integration and De-centralisation' were raised, as well as the concept of `Care without walls'. He also referred to the recently launched guidelines on the management of Coronary Heart Disease and Stroke, and noted that funding was being made available through Managed Clinical Networks.

Trevor Jones followed up with a presentation on the Health Agenda. (Participants were promised a printout of the slides, but these have yet to appear.) The points made were that the aims would be to:

The `great themes' included:

He then looked at the delivery of health care:

It was noted that demography is going against us, and that the situation will be dynamic. He noted that there is a Health White Paper due for publication in February 2003. The title is likely to be `Joint Futures: Our National Health'.

He then looked at delivery of care:

The recognised barriers would include:

He mentioned the Wanless report, which included comments on:

There were recognised competing demands:

The message must be that the `Status quo is not an option. Reform is essential'.

The current tiers of delivery are:

Noting that there are current barriers between the three tiers, are these sustainable? How does the patient view the delivery of service? He noted the current ascending pathway:

Hospital (DGH)
Tertiary Care (Hospital)

The expectation would be that as one ascended the ladder (or descends the list) that the level of care would increase. There is a case for re-defining care pathways.

The last section of the `pep' talk looked at the framework for modernisation. This included:

He also looked at new working practices, with delivery of care being devolved to the most appropriate member of the team, noting the extension of roles.

The aim would be to attempt to `square the circle', looking at:

The model of care would include the `patient local hospital, which could variously deliver:

He referred to changes in the hospital of the future, of which more will come in the white paper.


The presentation did not include very much that was new or surprising. It all sounded very good. The snag is delivering all of this.

The meeting then split into five groups to consider six questions. Each group had to tackle question 1, and then each group considered one of the remainder.

1 The patient's journey seems to cross the interface between primary & secondary care many times: what can we do to improve the interface between primary & secondary care, to integrate services in a way, which will really deliver benefits to patients and users?
2 Our staff are our most vital resource: how can we invest in and work in partnership with staff to develop and provide new, improved, services in the most appropriate settings, developing clinical and non-clinical roles in a flexible way to deliver the highest standard of care?<
3 Health is not just about NHS Scotland: how can the health service plan and work with other organisations and partners, other departments, local authorities, voluntary organisations and patient groups by way of example to achieve the best effect?
4 Gaining the views and opinions of the public is critical to the development of improved health services: how can we ensure we are getting a range of views and opinions, which reflect the general public's view in a country as diverse as Scotland? Do we need to focus on anyone in particular?
5 The best laid plans of mice & men: the size and complexity if the change agenda will require sustained and focused action by a wide range of people. Where should our energy and attention be directed to lead and manage the changes required to realise the type of service that we seek to deliver?
6 Service improvements are all too often met by scepticism and distrust: what must be done to create mutual understanding and commitment to new or different ways to deliver improved care?

Report back

This landed up as a `free for all' focus group session, which was not very satisfactory. There were two official minute-takers present, who will probably have had prolonged sessions trying to make sense of what came over.

The meeting was of interest for hearing other viewpoints, but the voluntary sector representative on our table did not seem to understand the concept of letting others have an equal say. It was interesting to hear the viewpoints of people from outside the managed service. There was little pharmacy content, but we did have a discussion on the content of patient notes for question 1, and who should have the right to read them, and to write in them.

The feeling was that the session was probably half an hour too long in a poorly ventilated room.


Don Page
Guild of Healthcare Pharmacists

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