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Partnership for Care: Scotland's Health White Paper
CHAPTER
EIGHT ROLES AND RESPONSIBILITIES
1. With this White Paper, we have set out a framework for the NHS. Organisationally, we are consolidating around 15 NHS Boards, with minimal structural change and a large degree of devolution and delegation to frontline staff. We envisage a deepening relationship between NHS Boards and Local Authorities, as the Joint Future agenda yields ever increasing examples of practical co-operation on the ground. In particular, Community Health Partnerships and Local Authority social work services need to evolve around distinct local communities.
2. We expect increasing co-operation among NHS Boards, based around a stronger system of regional planning for services and around Managed Clinical Networks to redesign health services. We want to see a system of national standards, independently inspected, with performance subject to public reporting. We expect to see a sharing of good practice and sharp action to check poor performance. But above all, we expect to see a greater involvement of patients and the public at every stage in the design, delivery and review of health services.
3. The Scottish Executive will:
determine national objectives and policies for health protection, health improvement and health services, setting targets and offering guarantees on behalf of patients;
provide a clear statutory and financial framework for NHSScotland;
hold NHSScotland to account for its performance against national priorities and targets, and within the context of increased funding provided by the taxpayer; and
intervene when serious problem or deficiencies in service arise which are not being resolved quickly enough at local level.
4. Within the centre of NHSScotland there must also be a capacity to:
develop strategic plans with NHS Boards, setting clear criteria for success and measures of performance to implement national objectives and policies;
initiate policy or service reviews that require attention at a regional level and support NHS Boards in carrying them out; and
deliver certain national services for NHSScotland.
5. We will now place increased emphasis on:
promoting a culture of patient focus and public involvement;
joining up Executive policies which are relevant to improving health;
planning and developing the workforce in far more effective ways; and
setting clearer targets and monitoring NHS Board performance to ensure that services are delivered effectively.
6. What we reject however, is a command and control culture that assumes the Health Service can be transformed from either St Andrew's House or NHS Board headquarters. One of the key messages of this White Paper is that it is frontline staff and clinicians in particular who will lead the change process that will deliver improvements in performance for patients funded by increased public investment in the NHS. We are determined to support and empower them to deliver results in the interests of patients.
7. However, support and empowerment bring responsibilities. Clinicians must practise in accordance with agreed standards and within the limits of their professional competence, maintaining those standards by life-long learning and personal development. They must involve patients and be responsive to patients - for some, a culture change from the past. Clinicians must work with managers to ensure that services are provided efficiently and effectively.
8. One of the problems in the Health Service over many years has been distrust between clinicians and managers. The step changes in performance that patients - and we - want to see will require managers and clinicians to work together with mutual respect, since each has a vital role to play.
9. As we move beyond NHS Trusts as the key operational units, there will be an even more important role for operational management, ensuring the best possible service in matters that go beyond standards of clinical care. We value that role. Managers must work in partnership with clinicians and other staff to develop a culture that responds to patients and involves the wider public.
10. Because of their particular responsibilities, the performance of senior managers should be rigorously scrutinised by NHS Boards. The Scottish Executive will work in partnership with senior managers and will offer support and assistance where there are management difficulties. But where these are not being adequately addressed, the Health Department will act swiftly and fairly to ensure the interests of patients are protected.
11. Patients and the wider public have responsibilities too. In relation to health improvement, there is self-evidently a key element of personal responsibility. For the Health Service we have been working with the Scottish Consumer Council on developing a Statement of Entitlements and Responsibilities. Ensuring that appointments are kept is one obvious aspect of those responsibilities.
12. We are not interested, however, in a culture of blame but in a culture of improvement. As a Scottish Executive, we make a commitment at the end of this White Paper to lead the programme of change and improvement that we have outlined, recognising the central new role for patients and staff. We are determined to work in a renewed spirit of partnership with them to bring about the changes which are urgently required.
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