The Scottish Government

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FOREWORD

Andy Kerr, MSP

Dear Minister,

When Malcolm Chisholm asked me just over a year ago to chair the work of the National Framework Advisory Group, I was delighted to accept. It seemed to me to be an ideal time to consider the future shape of the NHS in Scotland and I am grateful to you for providing the opportunity to do this work. I hope we have provided you with a set of proposals that you will find helpful in delivering your vision for a modern NHS in Scotland.

One of the most important components of our work was to give voice to the public and healthcare professionals working in the clinical front line so that we could understand more fully the dominant issues that were causing concern. These tended to converge around:

This sets an enormous agenda to be framed by this twenty year plan for the NHS, and one which could only be met by the Advisory Group members (appendix 1) chairing a series of action teams, drawn from multidisciplinary teams of healthcare professionals and members of the public, each of which dealt in detail with work-streams which serve to illustrate how the NHS should respond to and contextualise these concerns. We have been busy and lateral in our thinking and I would commend the two hundred or so members of our action teams (appendix 2), the two thousand or so members of the public and NHS staff who attended our ten open, "town hall" and "front line forum" meetings and our colleagues in the media who have given us fair hearing. One of us has estimated that the sum of this activity approximates to ten thousand man hours of heated debate and discussion.

First the good news - I did not doubt for a moment that Scotland had anything other than a highly trained and committed staff, capable of delivering health care on a par with anywhere in the world. Our medical and nursing schools produce eager and enthusiastic graduates who grace medical communities all over the globe, we support areas of research which are truly internationally competitive and we live through a time of record investment in the Service. Outstanding progress has been made in tackling some of Scotland's killer diseases. And yet, we find ourselves still suffering in comparison over a range of health indicators with our neighbours. We find health to be Scotland's touchstone issue, with over 250,000 folk signing petitions to "save our health service" although quite from what remains a matter of uncertainty. Given the extraordinary health pressures that we face from a rapidly ageing population, dwindling birth rate, imposed working time directives from Europe, changes in working patterns, evolving technology and an ever expanding health gap between rich and poor, it should be obvious to all that the status quo definitely cannot be an option.

This is the moment, then, for all of us to transform the NHS with a series of bold initiatives which will provide a framework to deliver safe, quick and sustainable health care for the future. We need to establish and empower systems for national and regional planning to create strong, cohesive health communities. Rather than restructure Boards, I would rather build on this well of human resource, improve their culture of leadership, collectivism and engagement with both the public and clinicians to lead implementation of the key recommendations which stem from our report. The health debate in Scotland has polarized, or disconnected several communities and it is clear that we need to win back public confidence and build bridges between several constituents, including the Royal Colleges, Boards, Health Department and NHS staff.

At risk of seeming overly sentimental, I believe that a more truly Scottish model of healthcare would be to take a collective approach in which we generate strength from integration and transformation through unity of purpose. Patient choice is important, but the people of Scotland sent us a strong message that certainty carries greater weight - if we make a commitment to see or treat a patient on a specific date, we must honour this, and ensure the quality of care delivered.

In practical terms, this implies investment in patient pathways that span primary and secondary care, networks of rural hospitals linked to and supported by the major teaching hospitals, rational distribution of services between neighbouring hospitals and national planning of complex service frameworks like neurosurgery and specialised children's services. I believe that Scotland is better suited to health improvement through collaboration and internal cohesion, making us externally competitive.

We can start to map the route that will incentivise the Service to collaborate to enhance quality of care; managed care pathways that describe the patient's pathway from the community through to specialised care; joint consultant appointments, that increase the potential to keep services local; evolving technology such as telemedicine that can link ambulance paramedics in a patient's home to teaching hospital consultants; an IT solution that connects all aspects of clinical care, across boundaries of primary and secondary health provision, throughout the Service to enhance the timeliness and quality of diagnosis, treatment and research. We make a series of recommendations, evidence based as far as possible, which will make our NHS safer, faster, fitter for purpose and more capable of sustaining care in remote communities. When the evidence supporting the recommended policy change is incomplete, we will ensure that there is sufficient prospective data collection to support or refute the direction of travel. We will ascribe roles for these recommendations to the organisations charged with their delivery, namely the Health Department, Regional Planning Groups, Boards, Community Health Partnerships so that we may hold them accountable.

In closing, I would like to touch on a general impression which I gained particularly from our "town hall" events. Scotland's NHS, though criticised and maligned by some, is still seen as Government's greatest gift to its citizens, the vast majority of whom are well served by a dedicated staff. The health debate has touched many a raw nerve, but I sense that folk want to see the various protagonists, politicians, the media, clinicians, hospital campaign groups, etc put aside what is sometimes seen as narrow self interest and pull together to reconfigure Scotland's NHS to better serve our old, our infirm, our poor and our children's children so that at last we might cast off the label of the "sick man of Europe".

Let me thank the Advisory group who worked tirelessly and Derek Feeley and his team from the Scottish Executive Health Department who provided an inspired and thoughtful secretariat.

Professor David Kerr
CBE, MAMDDScFRCP ( Glas & Lon) FMedSci

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