This item was published during the term of a previous administration that ended in April 2007
Listen
Framework for the future of the NHS
25/05/2005
A framework for the future of the NHS in Scotland was
published today.
An expert group, led by international cancer specialist
Professor David Kerr, has produced a detailed set of
recommendations on how the health service could be shaped
over the coming decades. It represents the culmination of
14 months of investigation.
Health Minister Andy Kerr welcomed its publication.
Mr Kerr said: "We called for a bold and confident plan
and that is what I have been given.
"Patients expect their care to be personal, and to be
delivered to them as locally as possible. It also has to be
as specialised as necessary and of the highest quality.
"We want to continue to reduce health inequalities, cut
waiting times, and deliver the right services in the right
place through an efficient workforce and modern
facilities.
"The Kerr Group support these aims and their report
reflects the realities of today's health service - 90 per
cent of all care is delivered locally in a non-hospital
setting, through staff like health visitors, practice
nurses, physios, pharmacists and family doctors. That is
where we can make the biggest improvements to people's
health.
"There is no doubt that our response to the report will
change the way health care is delivered in the future.
Currently care can be reactive, hospital centred and geared
towards acute conditions. The future focus will be on
integrated, anticipatory care, embedded in communities and
geared towards long term conditions.
"The Kerr Group involved the public, patients and NHS
staff in developing these recommendations which I now want
to consider in detail. In the meantime though, there are
some elements of the report that we can start to implement
now.
"I want to see Boards get to work on identifying
patients with long term conditions who are most at risk of
hospitalisation. This will enable them to provide
proactive, co-ordinated care in the community.
"I also want priority given to care in deprived areas to
reduce health inequalities. This will mean taking a more
proactive approach to seeking out people who are most
likely to need care in the future and helping them to
access it earlier.
"I also share Professor Kerr's view on separating
emergency care from planned care, so that planned care can
be taken forward faster for patients and with fewer
cancellations for them because of emergencies. I want to
work with Boards to take this forward."
Professor Kerr said: "The NHS in Scotland has to change
because of changing health care needs and demands, and the
need to meet future challenges, such as an ageing
population and advances in treatment.
"However members of the public need to take
responsibility, for their own wellbeing at the same time as
accepting modernisation is necessary.
"Unless we are brave enough to challenge the status quo
together, we won't be able to build the right service.
Scotland's future health care needs to focus on providing
care for an older population with long term conditions.
That kind of care will be provided not in hospitals but by
proactive primary care.
"We need to focus on getting the right services out in
the community rather than on the bricks and mortar of
hospital buildings.
"We want to see much more regional planning for hospital
based services, with new networks of hospitals sharing the
responsibility for providing key elements of acute
care."
Key recommendations:
- All NHS Boards to put in place a systematic
approach to caring for people (especially older people)
with long term conditions with a view to managing their
care at home or in the community and, where possible,
without hospitalisation.
- Action in deprived areas, through anticipatory
care, to prevent future ill-health and reduce health
inequality.
- Manage demand for planned care to maximise use of
capacity and to inform patient choice by streaming it
from unscheduled care, treating day surgery as the norm
(rather than inpatient surgery), enabling better
community based access to diagnostics and developing
referral management services.
- Support and encouragement for patients and their
carers to manage their own health care needs and to
help others with similar conditions.
- Implement urgently a national single information
and communications technology system, including an
electronic patient record and the development of
tele-medicine, as a means to improve access, quality,
develop clinical evidence and connect up the NHS.
- Empower multi-disciplinary teams in local casualty
departments to provide the vast majority of
hospital-based unscheduled care - networked by
tele-medicine to consultant led emergency units.
- Concentrate specialised or complex care on fewer
sites to secure clinical benefit or manage clinical
risk.
- Develop networks of rural hospitals to ensure
continued access to key elements of acute care and
establish a Clinical School for Rural Health Care to
ensure workforce development.
- Accelerate the development of regional planning for
hospital based health services.
- Set a clear agenda for Community Health
Partnerships working across the boundaries between
primary and secondary care and with partners in social
care to shift the balance of care.
The Kerr report assesses the current state of the NHS,
and proposes a new model:
Current model - to - Proposed new model
- Geared towards acute conditions - to - Geared
towards long-term conditions
- Hospital centred - to - Locally responsive
- Doctor dependent - to - Team based
- Episodic care - to - Continuous care
- Disjointed care - to - Integrated care
- Reactive care - to - Preventative care
- Patient as passive recipient - to - Patient as
partner
- Self care infrequent - to - Self care encouraged
and facilitated
- Carers undervalued - to - Carers supported as
partners
- Low tech - to - High tech
The report represents the culmination of 14 months of
investigation and consideration by an expert team, drawn
from across the health service. Together the team travelled
the length and breadth of Scotland listening to the views
of the public and professionals.