THE ROLE OF HEALTH BOARDS
In our interim report we observed that it was Health Boards in Scotland who had responsibility for delivering health care for all the people within their particular area, including out-of-hours - despite the fact that throughout 2003 and 2004 NHS 24 had tended to give the impression that this responsibility lay with them. The point was well taken by Health Boards. Since the interim report we have had in-depth discussions with every Health Board and we have been very encouraged in listening to outline strategies and witnessing obvious commitment. There is now a clear recognition, on all sides, that NHS 24 (like the Scottish Ambulance Service) is a valuable service provider for Health Boards within the NHS in Scotland. There is now also recognition - at least at very senior levels across the NHS - that all of these parties are inter-dependent: NHS 24 cannot on its own guarantee to cater for all of the needs of the population - particularly at weekends and public holidays - at least in the foreseeable future. Health Boards cannot be passive partners on those occasions; Health Boards must be prepared, when necessary, to step into the breach and actually take responsibility for people who are seeking advice and/or care at times when the sheer volume of call traffic means that NHS 24 has difficulty in coping.
The words, the assurances, the promises and the clear commitment of all Health Boards have been extremely encouraging. But now action is needed in practice on the ground.
While we have been impressed by the corporate approach to NHS 24's problems by Health Boards at the most senior levels, that does not mean to say that this will automatically be reflected at middle management levels - either within NHS 24 or some Health Boards. A degree of mutual resentment has built up over the last year or so and that has to be dealt with. It is not enough for Boards to prepare a well thought out strategy for out-of-hours collaborative working and then effectively close the file. The need for really joined-up collaborative and co-operative working among all 15 Health Boards, the Scottish Ambulance Service and NHS 24 is increasingly important not least for unscheduled OOH primary care. We apologise for spelling out the obvious but it is important that basic partnership-working organisational principles and governance structures are agreed and understood. There must be clarity of objectives - both respective and common; there must be clear understanding of shared and individual responsibilities, of relevant resources, of funding etc. There must be agreed key performance indicators and agreed means of monitoring those. Above all, everyone involved in all of the organisations, at least in handling calls for help and advice from "NHSScotland", must accept the corporate commitment to share problems - and share solutions. Care for callers and patients within the community out-of-hours should not be regarded as a new and separate responsibility of Health Boards. It is now a core element of primary care and should be designed and planned as such.
Professor Kerr's report "Building a Health Service Fit for the Future" describes at length the need for this type of collaborative working within the NHSScotland of the future. The challenges now being faced by NHS 24 may provide a real opportunity for the framework for change developed in that report to be rehearsed in reality on the ground. Out-of-hours care can be recognised simply as an important and integral part of primary care. The fairly new Community Health Partnerships can really begin to make their mark. There will be real scope for innovative and lateral thinking which will benefit primary care as a whole - and the people in the community when they need that primary care. The development of a single system for the delivery of unscheduled care will enable actual delivery of the long planned 'seamless journey of care'.