NHS Scotland Forum Meeting
6 December 2002

Around 50 members attended the meeting at the Carlton Hotel, 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. 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.

Health Minister Malcolm Chisholm opened the meeting by thanking everyone for their input into the Health White Paper. An Advisory Board meeting that morning had received feedback from the sub-groups involved in the Review of Management and Decision Making in NHSScotland and this would form the basis of the afternoons presentation. However it was important to realise that this is only part of the picture. It was also important to realise that these were emerging proposals and that the meeting should challenge the recommendations and see if they are valid.

Dick Manson then presented the feedback/progress made so far.

In developing integrated care, patient experience was that the care was weak at the interfaces between

The sub-groups looking at LHCCs and health and social care had thought their work was so similar that they had put in joint outline proposals to

Why target the primary / secondary care divide? They had four reasons –

How should the primary / secondary care divide be taken forward?

The joint futures agenda should be taken forward by-

The sub-group looking at support services had made six recommendations –

The Leadership sub-group had recommended

The Accountabilities and Configurations sub-group had looked at the present system and recommended –

As far as the single-system working was concerned, there were six recommendations –

The question at the end of the presentation was whether people thought this could work.

Although the primary/secondary care interface was considered to be the main problem, was this true? Some considered the health/social care interface to be more of a problem and there was some doubt as to how feasible this would all be unless either social care was taken away from local authorities or local authority areas matched NHS Board areas. Local authority representatives thought it was working well as it is, at least in some areas, and should be allowed to evolve. Local authorities would be helped by single-system working, instead of having to deal with several different systems. There was a need for LHCCs to fulfil their potential.

More clarity was needed around the operating divisions. They were to ensure that care was properly planned and, therefore, should not be based on primary and secondary care otherwise they are perpetuating the divide. They should span both areas.

Experience with regional co-ordinators in other countries is not good, so this proposal concerned some participants. Planning is currently on a reactive basis in the majority of cases. What is needed is proactive planning, taking into account recruitment and retention difficulties and staff shortages. Why isn't it happening at the moment? Basically, because the NHS Board agenda is considerable and they don't have the time. This is why extra staff are required.

Devolved decision making is a welcome innovation as long as it is inclusive and involves front line staff.

There was concern that for some specialist services there needed to be a national perspective, but apparently SEHD are aware of this and have taken it into account.

It is not just a case of trying to remove Trusts from the political landscape. Proper devolved organisations must be in place before trusts are dissolved.

Attendees were then given a list of 12 questions to be asked at the group discussions and these were

  1. From your perspective, what difference will what has been proposed make?
  2. If Trusts are dissolved, how should services be managed and by whom?
  3. Will Managed Clinical Networks be the answer to managing and delivering services in the future?
  4. Will Managed Clinical Networks bridge the gap between primary and secondary care?
  5. How will members of Managed Clinical Networks be recruited and what are the incentives to ‘join’?
  6. Are Managed Clinical Networks ‘voluntary organisations’ like LHCCs?
  7. If patients and staff have difficulty in identifying with local Trusts, how will they identify with Managed Clinical Networks and LHCCs?
  8. Should staff have the choice to ‘opt in’ and ‘opt out’ of Managed Clinical Networks and LHCCs?
  9. Are LHCCs the building block of future community based health services?
  10. If yes, should these organisations remain voluntary?
  11. How can we really achieve decentralisation and delegation in local health systems?
  12. In a decentralised NHS, what is the role of the Health Department?

Should LHCCs be mandatory? One camp favoured this, but noted that instructions were often resisted on principle and that if organisations wished to work together they would find a way to do so.

Joint Futures processes are not as robust as they ought to be and as they are often quoted as being. This area was thought to be an ideal barometer as to whether progress was being made and partnership was a reality.

Some felt that an opportunity had been missed to reduce the NHS organisations further, when the 15 unified NHS Boards had been set up last year. Three might have been more realistic, given the population of Scotland. Although this might be true, there is the problem of how to input into such a large corporate body. It is difficult enough for patients and staff at the moment!

It was noted that change in any situation is difficult, not just in the Health Service.

There was some discussion about the present perception of the Health Department and what it should do in the future. It's role is poorly understood as are the routes of influence. It might help if officials left their offices more often and were seen around the service. It was thought that SEHD should set policy and support and manage performance.

It would be helpful if inappropriate political interference could be prevented and if clinical governance issues were properly explained to patients and the public - without undermining the existing service. There was a short debate about whether politicians should be more distant from Health, but some accountability is required. The challenge for them is to be responsible in how they engage in health issues.

There was disappointment from patient, carer and the voluntary sector representatives who questioned whether they were seen as part of the NHS, when there had been no mention of them or their role. They were the third side of a triangle with the NHS and Local authorities. Neither did the language used help them to engage properly. What were managed clinical networks (MCNs)? Outcomes should be the key to working out how to deliver them. Instead of one patient journey, there may be multiple journeys and so what the patient needed was a map and someone to help them read it.

There were a number of questions around MCNs, e.g. the definition, role and capacity of contributing NHS organisations. There needs to be a spectrum of networks from neighbourhood to area levels. Best practice should be disseminated.


Secretary for Scotland
Guild of Healthcare Pharmacists

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