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CHAPTER ONE. INTRODUCTION
1.1 Since the publication of ' Our National Health - A Plan for Action, a Plan for Change' (2000), the NHS in Scotland has undergone a substantive change in the organisation and delivery of its services. The changes to service delivery bring an emphasis on ensuring that people get the right service at the right time in the right place.
1.2 These changes are essentially modernising the NHS in Scotland introducing a range of approaches, identified in policy objectives, to ensure that there is an increase in patient focus and public involvement, access, responsiveness and improvement in service delivery
1.3 In 2000 a survey was conducted on behalf of the Scottish Executive Health Department (SEHD) to examine public attitudes to the NHS in Scotland. This research informed development of 'Our National Health - A Plan for Action, A Plan for Change', essentially setting out the modernising agenda for the NHS in Scotland. Since the publication of 'Our National Health', various changes have been made to the provision of NHS services, and in order to inform further policy development and identify areas in which more work might be needed, the SEHD commissioned NOP Social and Political to undertake a new survey in the spring of 2004.
1.4 The 2004 survey was commissioned to ensure that the implementation of the Health Plan and the proposals in the White Paper and Partnership Agreement reflect and draw upon the Scottish public's experiences of and aspirations for the NHS, by assessing the awareness and attitudes of a representative sample of the Scottish population towards health services provided by the NHS in Scotland. The survey was based on the perceptions and where appropriate, the experiences of the Scottish public as patients and carers, and provides an indication of how well the public in general perceives the NHS to be achieving its aims which will inform the further development and implementation of healthcare policy.
1.5 The new study covers some of the same ground as the survey conducted in 2000 but it also reflects some fundamental changes in the landscape of health services since ' Our National Health' was published - for example, enhanced public involvement in healthcare policy, planning and delivery (as highlighted in ' Patient Focus and Public Involvement' and 'Fair for All' in 2001) and changes to increase access and choice in health services (e.g. ' Partnership for Care' in 2003). The survey is intended to establish a new baseline against which change can be measured every two years, starting in 2006.
1.6 At the heart of the policy and practice initiatives that have been developed and introduced since the publication of 'Our National Health' in 2000 is a commitment to patient focus and public involvement, and the principle that the NHS needs to respond more effectively to the views and preferences of those who use its services. These changes form the basis of a fundamental change in the way that the NHS involves and engages with those whom it serves.
1.7 The modernisation process has also involved a further movement towards partnership working and public involvement following a major reorganisation of the NHS and other related services. This is reflected in terminology: for example, services are now provided by the Primary Health Care Team rather than by GP's, health visitors or district nurses with the aim of making Primary Care services more flexible and responsive. In addition, the distinctions between primary and community and acute based care are now more fluid in order to make services more responsive to patient needs.
1.8 Alongside these changes, there has been a strong drive to promote improved access to healthcare services. This has involved both the primary and the acute sectors. The reorganisation of the NHS has redefined health services and what is meant by access. As well as ensuring better physical access, in particular for groups with specific needs, the aim is to improve access to services in local communities which were previously only available in hospital settings. This improved access to medical advice includes telephone consultation as well as appointments to see various health professionals in the surgery setting. Some professional boundaries are also changing, allowing patients to access healthcare through a range of professionals other than GPs and hospital doctors, with the intention of reducing waiting times and extending choice for patients.
1.9 Closely linked to access, the key concept of choice underlies many recent initiatives. A broad definition of choice has been adopted which reflects the patient focus and public involvement initiatives. An example of this is the move towards giving patients a voice in choosing appointment times, who they consult and where, to fit into their circumstances and lifestyle. 'The Outpatient Action Plan' launched in June 2003 aims to deliver improved access and choice to patients in the bid to reduce waiting times. Other changes designed to increase patient choice and access include the introduction of NHS 24, a service which provides 24-hour access to health advice and healthcare services by telephone from trained health professionals, and the development of the role of community pharmacists in order to allow them to prescribe a broader range of medicines, conduct medication reviews and monitor certain treatments.
1.10 The specific objectives of the survey reflect the diversity and scope of the modernisation agenda:
- To assess people's awareness and understanding of the range of health services available to them and the arrangements for their provision
- Where relevant, to assess service users' satisfaction with the quality of service provided across the full range of NHS services
- To examine service users' views and experience on issues of access to services
- To explore people's experience and perceptions of choice in health service provision
- To examine people's views on public involvement in the design and delivery of services
- To assess, where appropriate, service users' views on and experience of the responsiveness of NHS and related services to the patient perspective
- And to explore people's aspirations for improvement of the NHS and related services
1.11 The report is structured around the survey objectives, examining awareness, satisfaction, access, choice, public involvement, responsiveness and aspirations for improvement. As well as outlining the overall findings in each section, the report presents significant findings for each of the key service areas (e.g. Out-of-hours, telephone consultation, Primary Health Care Team, home visiting, inpatient and Outpatients) where relevant. Hence, the reader can look at the results for individual services as well as across NHS provision as a whole. Findings are presented in the policy context in order to make clear the implications and conclusions of the survey.
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