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Section four Making it happen
Delivery
The NHS in Scotland is accountable to the Minister for Health and to the Scottish Parliament. In practice, the Minister holds the leaders of NHS Boards to account for their performance in meeting the health needs of their area, and for the implementation of national policies, including the commitments in this national action plan.
We outlined plans in July 2005 to set up in the SEHD a new Delivery Group to support the Minister in this role, with a view to:
- ensuring a renewed and explicit focus on key objectives, targets and measures across the health portfolio
- strengthening performance management arrangements between each NHS Board and the Scottish Executive by introducing local delivery plans consisting of agreed, sharply focused, quantified local actions
- working with more timely and reliable management data, enabling accurate tracking of NHS Boards' performance against all the agreed local delivery plan targets
- making specific interventions to support and improve performance where the need arises.
In setting up the Delivery Group, we recognise that we need better long-term planning and a clearer approach to ensure that NHS Boards are able, and supported, to deliver on those plans. We have established within the SEHD a new Group for Healthcare Policy and Strategy to ensure we have the capacity for long-term planning. We have also established a Group for Primary and Community Care to ensure we can drive the strategic shift in favour of locally delivered services responsive to the growing level of long-term conditions.
We will issue guidance on local delivery plans for 2006/2007 shortly. The guidance will require local delivery plans to maintain a 'line of sight' from strategy through to delivery on the ground. It will describe how local delivery plans link to resource planning and change management.
NHS Boards will use local delivery plans to demonstrate how they will deliver key targets for all their patients within the resources available. By including clear performance milestones, these plans will help to set and track the pace of change and ensure the delivery of objectives is affordable and sustainable.
For some of the commitments in this national action plan, there will be performance measures in the local delivery plans (e.g. extent of day case surgery) that allow direct monitoring of their implementation. More generally, the new Delivery Group will monitor implementation of the full set of commitments in Delivering for Health, and will publish progress reports.
"Our aim is to improve the health of the people of Scotland . . . with a shift towards preventive medicine and more continuous care in the community. Our strategies, policies and actions are intended to support that key objective."
Culture, consensus and leadership
Reform of our planning and performance management processes will not be enough. If the changes we plan are to happen, we need to create a culture and climate for change. We need to recognise the nature and the scale of the health challenge which we face in Scotland, and to encourage the NHS to work with other bodies, especially local authorities, to tackle that challenge. In presenting his report, Professor Kerr was clear that the NHS needs to be transformed to meet the challenges of the future.
The huge consensus in support for the direction of change signalled in the National Framework provides us with an opportunity to build a commitment across the NHS for the practical measures set out in this plan. For that to happen, we need to put patients first and set aside professional differences. If people in Scotland want the high quality health care that is within our grasp, we all have to accept that change is required. We need to maintain consensus, requiring NHS Boards to engage in genuine dialogue with the patients and communities they serve.
We will therefore work with NHS Boards to ensure that there is a constant effort to ensure not only that the interests of patients are paramount in the redesign of services but that every reasonable effort is made to explain the impact of service changes for both patients and local populations, and to involve patients and the public in the consideration of options for change.
We will continue to give patients an influential voice in the future of the health service and in their own individual care. NHS Boards will be asked to demonstrate how they are working to achieve year-on-year improvements by involving the public in service delivery and in individual decisions about their personal health care. The new Scottish Health Council will have a central role, holding the NHS to account for its performance on patient and public involvement.
Our collective aim should be to implement the proposals in this plan by engaging with, and winning the support of, the people we serve.
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