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FAIR TO ALL, PERSONAL TO EACH The next steps for NHSScotland

Chapter 1: Executive Summary

This paper reiterates the fundamental principles of healthcare in Scotland; outlines progress to date in key areas; and introduces specific plans to tackle waiting. The paper also points to further work on specialised NHS services, on clean hospitals, and on performance management of the NHS.

1.1 Healthcare and health are vital to Scotland as a nation and to the opportunities we enjoy now and will enjoy in the future. People in Scotland now live longer and enjoy better health than in previous generations, and clear progress has been made, for example, in reducing infant mortality and premature deaths from heart disease and cancer. But in comparison to our European neighbours the health of our people is not as good as it should be.

1.2 While health is improving for the vast majority of Scotland's people, it is improving fastest for those who are most affluent. This means that, even though things are getting better across the board, the health gap is not closing. So, for example, the most affluent of us enjoy life expectancy which is comparable to the rest of Europe, but the most deprived of us have a life expectancy that is still too low. Tackling health inequalities matters. We all want to stay healthy longer, and we should all have the chance to do so.

1.3 The Executive accepts its responsibility to help promote healthier lifestyles. Our intention to legislate for a ban on smoking in public places demonstrates our commitment to improving population health, continuing the direction set by, for example, our actions on diet and exercise.

1.4 But key decisions affecting our health lie in our own hands. The Government can't make us eat more healthily or give up smoking. Each of us needs to take responsibility for our own health by choosing a healthier lifestyle and the Government can help by providing appropriate opportunities and ensuring services are accessible and available.

1.5 Prevention is better than cure, and the NHS helps people sort out health problems early, spotting potentially serious health issues when effective treatment can be given quickly and easily. But the NHS also supports people in managing chronic and long-term conditions. And when people do become acutely ill or suffer an injury, it is the NHS that is there for us, caring and saving lives, and keeping families together for longer.

1.6 It follows that maintaining and improving NHS services is central to our commitment to high quality public services in Scotland. The founding principles and core concepts of the NHS - comprehensive services, available to all according to clinical need, and free at the point of use - are a part of our national fabric. These principles are strongly supported by the vast majority of people in Scotland.

1.7 These are our values. And we are committed to supporting and improving the NHS for the benefit of patients, and to helping the Service overcome the challenges which it faces as health technology advances and expectations and demands on services increase.

1.8 Our vision for the NHS is to apply its founding principles with vigour to meet the needs of the 21st century. Patients should be at the centre of the delivery of responsive care and treatment, with more convenient services delivered more quickly at each stage. Services should be as local as possible, and as specialised as necessary.

1.9 For the vast majority of us, our contact with the NHS starts and finishes in the GP surgery and local pharmacy. For some of us, contact will continue to diagnostic tests and investigations, to seeing a specialist at an outpatient clinic, and getting inpatient or day case treatment where that is necessary. Every step of that way should be safer, quicker and more accessible. We cannot begin to meet individual needs when people are waiting too long for their diagnosis or their treatment. When someone waits 18 months for an operation or a first outpatient appointment that someone else is getting in 18 weeks in another part of the country, the system isn't equal or fair.

1.10 The principal focus of this paper is on that crucial measure of the delivery of NHS services, waiting times. Driving down waiting times for inpatients, day cases and outpatients is the critical next step to improve clinical outcomes and give better quality of care and service to patients. We also intend to move on and tackle those conditions which affect the quality of life for so many people and deal with other issues of immediate concern to people in Scotland. Where their health services are, and the cleanliness of our hospitals are of critical importance to them. This paper points to the further action we are taking on these.

Quicker, better care

1.11 We are continuing to respond to the increasing demand for healthcare and to public priorities by boosting investment in the NHS. We have invested record sums since 1999, increasing financial investment by 63% in 5 years and continuing the trend for the next 3 years. This sustained investment means more staff, providing more services, using more modern equipment in more suitable buildings. It has laid the foundation for further progress and for better, quicker services for patients.

1.12 But investment must deliver results. In the 2003 Partnership Agreement, we pledged to ensure that no-one with a guarantee waited more than nine months for hospital treatment by the end of 2003, and more than six months by the end of 2005. We are keeping this pledge for nine months, and the annual trend shows that we are on course to meet the six month pledge. Our recent pledges on heart treatment are also being met.

1.13 It is important to remember too that the majority of people using the NHS in Scotland don't wait at all.

1.14 There have been big falls over the last year in the number of patients with a guarantee waiting over 6 months for hospital treatment in a number of specialities:

• 38% for general surgery;

• 40% for ophthalmology; and

• 46% for cataracts.

For coronary heart disease, our targets of 12 weeks (soon reducing to 8) for angiography and 18 weeks for angioplasty/coronary artery bypass graft have led the way across the UK.

1.15 This context is important - we are building on success. But we are dissatisfied and intend not just to go further and faster, but to work in a new way.

1.16 So to ensure that patients get the best and quickest treatment possible from the NHS, we are setting the following new targets:

1.17 These are radical improvements to the time required for the patient's journey through the system. In addition, for the first time we will set new standards for patients waiting for diagnostic tests and procedures, and we will announce these in spring 2005.

1.18 We are also changing how waiting times are defined and measured to make them clearer, more consistent, and fairer to patients. The new definitions will balance the responsibility of the NHS to provide care and treatment quickly with patients' responsibility to make sure they attend for appointments.

1.19 We will achieve this unprecedented improvement in waiting by:

1.20 Combined with changes already happening such as new contracts of employment for NHS staff, these approaches will help the NHS to move towards the point where waiting times will no longer be a source of dissatisfaction for users of NHS services in Scotland.

Services as local as possible, as specialised as necessary

1.21 Shorter waits and greater convenience for patients are an important part of the future of healthcare. But this is not the whole story. People rightly want reassurance that services are being delivered safely and sustainably. Communities want to know that services will be available locally wherever possible. Patients requiring highly skilled interventions need to be reassured that services will be as specialised as they need to be to deliver quality care and the best possible clinical outcomes. Clinical teams that often undertake a complex procedure will get better results than clinicians who see and treat such cases infrequently.

1.22 Scottish Ministers have asked a group led by Professor David Kerr to look closely at these issues, and to involve the public, patients and staff of the NHS in a debate on a National Framework for Service Change. This will report in 2005. Its conclusions will be important in shaping the future pattern of healthcare services in Scotland, but they will not avoid the need for hard decisions in the interests of better healthcare.

1.23 The public and patients also want to know that hospitals in which they are treated will provide a clean and safe environment for healthcare. Scotland is leading the UK, with good progress already made - cleaning services standards are in place and a national cleaning services specification has been issued to all NHS Boards. But there is more to do, and there will be a further announcement in the new year.

1.24 The improvements in services and shorter waits described in this paper will require effective performance management across the NHS, on which we will make further announcements. Lead responsibility for this, and for achieving value for money and better services for patients through increased investment, lies with the Chairs of NHS Boards. The Executive will make sure that Boards have clearly understood targets aimed at better patient care, that there is a clear commitment from each Board to deliver these, and that all necessary actions are being taken to achieve them. Ministers will chair annual accountability review meetings, in public, to review and report on progress. Boards will be in no doubt what is expected of them: that increased resources must be matched by increased results. They will have the support of the Executive in delivering on these expectations for patients.

Conclusion

1.25 These are unprecedented measures for NHSScotland. Shorter waiting times targets, new standards for diagnostic waits, better and more complete definitions of waiting, and the investment and reform that we are taking forward to help ensure delivery add up to a major package of change, the next steps on the way to a twenty-first century health service, fair to all and personal to each.

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