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New chapter for NHS - Health Minister

01/10/2001

The 15 new unified NHS Boards 'go live' across Scotland from today. They replace the previous decision-making structures of 43 separate boards and trusts.

Each of the 15 existing geographical Health Board areas will now have a single NHS Board with over-arching responsibility for improving health and health services across their local area.

Health Minister Susan Deacon said the new Boards are intended to reduce bureaucracy, improve decision-making, increase accountability, and foster greater integration and partnership working. Their creation marks an end to the fragmentation and division left over from the NHS internal market, a key pledge made in the Scottish Health Plan published last December.

Ms Deacon stressed that changes in decision-making structures, while 'necessary', were not sufficient on their own to deliver a step change in how the NHS responds to the need of patients. She challenged the Boards to work to drive forward changes to culture and practice throughout the NHS, to improve communication, reduce waiting and delays, and ensure that services are designed and organised around the needs of patients.

The Minister announced the introduction of a tough new national Performance Assessment Framework for NHSScotland. This will set clear priorities and standards against which the performance of local NHS Boards will be measured.

She also announced plans for the creation of a national group of experts to provide support and advice to local NHS Boards as they develop plans for changes to local health services. The group will help share experience across Scotland to ensure local plans are robust and that local communities have been effectively involved in the decision-making process.

Ms Deacon said:

"This is the start of a new chapter for NHSScotland. Today, just nine months after announcing their creation in the Scottish Health Plan, I am delighted to announce that 15 new unified NHS Boards are up and running. This is another major step forward in the removal of the bureaucracy, confusion and division which came from the internal market.

"Each NHS Board will be accountable for the delivery of effective health services across their local area, and will work with local authorities, communities and others to improve the health of local populations.

"New Chairs have been appointed and each Board brings together around the same table a range of organisations and interests - including NHS staff and local authorities. Each Board will be expected to agree 'joined up' policies that deliver the best way forward for health and health services in their local area, and to do so in dialogue with local communities.

"In the last week I have met, face to face, with the leaders of the new Boards. They, like me and many thousands of staff and patients across Scotland, believe passionately in the NHS. But they are under no illusion of the scale of the task or the size of the challenge ahead. This can only be achieved if we work in partnership - government, the NHS, staff and patients - working together to support and develop our nation's biggest and most important public service.

"I have made clear to the new NHS Boards that I expect them to communicate better with NHS staff and patients at all levels. Staff, patients and the public have a right to know how the NHS works and what is happening within it. The strengths and successes of the NHS deserve to be championed and the efforts of staff valued and recognised. In turn, where problems exist or improvement is needed, these issues must not be 'swept under the carpet'.

"Most importantly, I expect the new NHS Boards to work to deliver better, modern, more patient-centred services. Increased investment must move through the system quickly and effectively. Hospitals, GPs and other local family health services must work more closely together. Modern technology and improved ways of working must be harnessed and developed.

"The new Boards will be responsible for shaping the overall strategy for their local NHS system and for developing a health plan for their area. But they must not become preoccupied with plans and processes as an end in themselves. The new Boards are not an exercise in centralisation, they are about building effective leadership and supporting effective staff teams.

"Already many parts of NHS Scotland are demonstrating improvement. Better teamwork is resulting in better services. I want to see this become the norm in all parts of NHSScotland. Change will not happen overnight but it is happening. The steps I have outlined today are another significant milestone in that process."

Ms Deacon explained how the Executive will hold the NHS to account for its performance, and extra support for them in working to deliver changes to local services.

She said:

"The new Performance Assessment Framework (PAF), to which all NHS Boards will work from the outset, will help ensure that national priorities are met and are seen to be met. National priorities which really matter to patients - like shorter waiting times, cleaner hospitals, better services for children and older people, and improved communication.

"This system is not a straitjacket for new Boards or their management. We want to encourage initiative and harness enthusiasm. We will not hold back those who want to drive forward improvements. But there will be no hiding place for those who tolerate poor practices or who resist a partnership approach.

"Some of the decisions which lie ahead for NHS Boards will not be easy. Making changes to the way health services are organised, redesigning or even closing outdated facilities, shifting the balance of care from hospitals to people's own homes - these are all sensitive and complex issues.

"If we are to have a truly modern, patient-centred NHS then change must be embraced. That is why I have asked the NHS Boards to be clear about how and when decisions will be taken and about why they are being made. Protracted review and prolonged uncertainty can cause great anxiety to staff and patients alike.

"I am also announcing today the creation of a new, high level national Expert Group to support NHS Scotland in this work. Its members will be drawn from among Scotland's leading experts in health and health services to support and advise the NHS Boards and to give an independent assessment of their proposals for change - a 'sounding board' to ensure that ideas are thought through and that the best possible outcome is achieved for patients and local communities.

"Hand in hand with this new Expert Group will be the inclusion of real and meaningful public involvement as a 'core' priority for the new Boards. We will hold new Boards to account for their performance in this area. But we will also back them in taking hard decisions when we are clear that these represent the right way forward."

BACKGROUND

1. The Boards, which have come on stream on schedule, and within just nine months of being announced in the Scottish Health Plan, will:

  • take over the strategic responsibility for improving health and delivering improved health services in their area
  • replace the 43 boardrooms of the 'old' NHS with 15 local 'powerhouse' bodies
  • significantly reduce the number of NHS appointments needed to govern the NHS
  • for the first time, bring universal frontline staff and elected local authority representation into every NHS boardroom in the country

2. The new Performance Assessment Framework (PAF) which will hold the NHS to account is based on measures directly related to the core chapter headings of the Scottish Health Plan, Our National Health - published last year. The PAF will cover:

  • improving health and reducing inequalities
  • fair access to healthcare services
  • clinical governance, quality and effectiveness of healthcare
  • patient's experience, including service quality
  • involving public and communities
  • staff governance
  • organisational and financial performance and efficiency

3. Leaders from the new NHS Boards will be held to account for the performance of all parts of the NHS in their local area - including what happens in local community health services as well as in our hospitals. For the first time, they will also be held to account for performance in improving health in the community and in reducing the health gap between rich and poor. Each Board will have to publish its performance against these criteria in an annual report.

4. Details of the membership and remit of the new Expert Group on service change will be announced shortly.

5. NHS Boards will provide strategic leadership and direction in each local NHS system, leaving the management team of each NHS Trust free to concentrate on delivering its operational responsibilities for health care services. Trust boards have been replaced by a Trust Management Team, more closely focused around delivery of services to patients. In the longer term, the Scottish Health Plan includes a commitment to a review of the management and decision-making structures appropriate for a post-devolution and post-internal market NHSScotland, which will provide a timely opportunity to examine the NHS landscape now that NHS Boards are in place. Any fundamental changes in the structures of NHSScotland resulting from the review will be the product of full and considered discussion, debate and consultation, and are likely to require primary legislation.

6. The Executive will work on an advertising campaign for future NHS appointments. The aim will be to increase the diversity of appointees across public bodies.