« Previous | Contents | Next »
Listen
Partnership for Care: Scotland's Health White Paper
CHAPTER ONE INTRODUCTION
1. This Health White Paper is about the promotion of health in the broadest possible sense and the creation of a health service that is fit for the 21st century. It builds on
Our National Health: A plan for action, a plan for change, published two years ago, but moves on to develop certain key issues. In particular, it sees patients and national standards as key drivers of change in the health service and frontline staff as leaders of the change process; it outlines ways in which the redesign, integration and quality of services can be systematically progressed; and it seeks a step change in our approach to health improvement as an essential complement to the modernised, patient-focused services of the 21st century.
2. We describe the kind of action we believe is required in order to achieve an improvement in Scotland's health. This cannot be done by the Health Department or the health service alone so we are working in new ways across the Scottish Executive. Partnership at national and local level with Local Authorities, the voluntary sector and local communities is also crucial.
3. Scotland's health is improving but remains poor compared to the rest of Europe, with an unacceptable health gap between the richest and the poorest communities. Action to close that gap pervades the health improvement strategy, which we outline in
Chapter 2.
4. Looking at services from a patient's point of view underpins everything that we are seeking to do in the health service. Patients are concerned about the quality of care; treatment at the right time and in the right place; being treated with dignity and respect; having their say in decision-making; having their feedback taken into account; and getting clear explanations at every stage. All this amounts to a massive culture change in the health service compared to the first fifty years of its history.
5. In
Chapter 3 we describe this culture change and how we intend to bring it about, building on some of the excellent work that is already taking place. We start from the assumption that patients must be seen as partners in their own healthcare. The health service must engage with patients, their carers and families, and listen to them in order to be more responsive to their needs. The Health Service must recognise the diversity of the population it serves. This is at the heart of improving quality and redesigning services from a patient's point of view.
6. The drive to define national standards for healthcare is still a relatively new feature of the health service and is now being taken forward in a more integrated way by
NHS Quality Improvement Scotland.
National standards are being set, performance is being independently inspected and the findings are being reported publicly for the first time. This will be backed up by effective intervention by the Executive, where necessary, to ensure that standards are met. Standards must include clinically-driven waiting times and critical patient issues such as cleaning in hospitals and infection control. Scotland is a pioneer in some of this work through the development of clinical guidelines and evidence-based care. The challenge now is to stay ahead and to build patients and their carers into the process in a more central way. We describe this broad quality and standards agenda in
Chapter 4.
7. Our model of a modern health service in Scotland lays strong emphasis on partnership, integration and redesign.
Chapter 5 describes how those principles will manifest themselves. It foresees a central role for primary care teams in new Community Health Partnerships, working with hospital services - for example in Managed Clinical Networks - and in new relationships at community level between NHSScotland and Local Authorities. Instead of the fragmentation of the market, which characterised the health service for much of the 1990s, we are seeking to bridge the gap between primary and secondary care and between health and social care. In this way, we will enable health and social care professionals to look at the whole picture of care from a patient's point of view. We believe this is essential for achieving shifts in the balance of care and for developing the new models of care that meet patients' needs.
8. If patients and national standards are the key drivers of change, then the key agents for delivering that change are frontline staff, especially clinicians. Staff are the health service and it is only through supporting and empowering them that services can be improved in ways that patients need. Central to this are healthcare teams working together and learning from each other in new ways.
9. In this White Paper we explicitly reject a command and control management approach, whether from St Andrew's House or local NHS Board headquarters. Instead we describe ways in which the centre can support staff by giving them the tools and the freedom to redesign services and lead change, in partnership with patients. The centre also has a vital role, neglected in the past, in workforce planning and in ensuring that workforce development is at the heart of health policy. All of this is described in
Chapter 6.
10. In creating a healthcare system fit for the 21st century we are not interested in change for change's sake and are inclined to distrust structural change as a distraction from the key issues and challenges. The new emphasis on integration, and on clinicians and patients working together to find better ways of doing things, will nevertheless have organisational implications. We describe these in
Chapter 7; they are a consequence of our new approach rather than the starting point for it.
11. Everyone has a part to play if we are to raise standards of health in Scotland. In the
final Chapter we concentrate on these roles and responsibilities: of the Executive, of managers; of health service staff including clinicians; and of the wider public. In particular, we make a clear commitment as a Scottish Executive to lead the new agenda in a supportive, facilitating and empowering manner, working alongside patients and healthcare teams to create a modernised health service fit for the 21st century.
« Previous | Contents | Next »