Chairman's letter to the Minister
When, 7 months ago, you asked me to head up the Independent Review Team I thought it would be a very challenging task. That was some understatement! As you recognised in your commissioning letter it is not possible to assess the performance of NHS 24 in a vacuum; it is essential to look at its impact on its main NHS partners - and theirs on it. That has taken us, albeit cursorily, into all 15 Health Boards, the Scottish Ambulance Service, remote and rural GP practices, the voluntary sector, NHS 24 itself of course - and many other areas involved with and interested in unscheduled primary care. We have learned a lot from the friendly, open and frank exchange of views.
So what picture do we have at the end of that fascinating journey? Well encouragingly we see NHS 24 recognises that it has a number of difficult challenges ahead but, under the current leadership, it seems determined to learn from the past in order to do much better in the future. We see Health Boards, capable of being parochially insular in the past, now convinced that the way ahead for NHSScotland is a corporate way, team working, inter-dependent, mutually supportive, recognising the patient as more important than the system.
The new NHS Utopia? Not quite - and certainly not yet. NHS 24 has a very important role in helping Health Boards meet their local health care obligations - particularly in out-of-hours periods. We are in no doubt that it has the potential to fulfil that role - but there are a lot of difficult challenges to be met along the way. In this report we list those challenges and we offer advice on how they might be overcome. We are encouraged by the fact that NHS 24 not only accepts the need for change, some of it radical, but has already begun to tackle that need. We are impressed by the recognition by all NHS Boards of the need for real partnership working right across unscheduled primary care. But we emphasise the importance of the basic requirements of actually working in partnership and all that involves. It is not always easy and there is a human tendency to retreat to defensive positions whenever things start to go wrong. There is obviously a role for the Scottish Executive Health Department here and it is clearly aware of the importance of that role.
We see continuing extensive, unplanned, difficult-to-manage use of call-back as the major battle to be won and we encourage NHS 24 to tackle that radically in a number of ways. We have a high regard for the front-line staff in NHS 24 and we think they are capable of even better performance if there is recognition of the further potential they have to offer.
This report is essentially about NHS 24 but in reality it is about much more. It is about recognising that doctors and nurses will likely continue to be scarce resources and that we need in future to move forward in 'team mode' using a whole range of clinical skills - doctor, nurse, paramedic and other allied health professionals. That is already being practised successfully in several parts of the country.
Finally, on a personal note, I pay warm tribute to every member of the review team. They all have demanding 'day' jobs but their commitment to this review has been massive. I am enormously indebted to each and every one of them for their support and for their hard work. I also want to thank very sincerely everyone in the performance management division of the Scottish Executive Health Department for the first class administrative and clerical help they have given.
Owen Clarke CBE
Chairman, Independent Review Team