Acute Services Review Report
Contents		NB Some of the illustrative charts are missing from this document: these will be added as soon as possible
SECTION 1 INTRODUCTION
Chapter 1	Introduction
			Guiding Principles
			Context for the Review
			Remit
			Way of Working
			Steering Group
			Sub-Groups
			Remit of Sub-Groups
			Rationale for selection of topics for Sub-Group working
			Areas not reviewed
			Evidence taken by the Steering Group
			Contribution of Open Meetings
			Evidence presented to the Chief Medical Officer
			Publicity, dissemination of information
			Public involvement
			Working assumptions
			Compilation of Review Report
SECTION 2: KEY THEMES
Chapter 2	Equity of Access
Chapter 3	Models of Service Delivery
			Hub and Spoke Arrangements
			Clinical Networking
			Managed Clinical Networks and Primary Care
			The Development of Managed Clinical Networks
Chapter 4	Prediction of Need and the Organisation of Services
			End Stage Renal Disease
			Renal Service Implications
			Current provision in Scotland Resource issues if the need for haemodialysis were to increase Increased rates of renal transplantation
			Coronary Heart Disease
Chapter 5	Organisational Issues
			Designed to Care
			Replacement of Internal Market Strategic Roles Service Roles
			National Professional Advisory Structures
Chapter 6	Relationship between Volume of Clinical Activity and Outcomes of Care
			Clinical Quality
			Patient Access
			Economies of Scale
			Other Pressures for Concentration of Services
			Conclusion
Chapter 7	Designed and Seamless Health Care
			Business Process Re-engineering
			Approaches to Designed Health Care
			Organisation of Multidisciplinary Services and Rehabilitation
			Ambulatory Care
			Designed Care and Information Flows
			Telemedicine
			Components of Telemedicine Current applications Technological tidal wave Costs, benefits and limitations Development of telemedicine
			Conclusions
Chapter 8	Quality Assurance and Accreditation
			The importance of accreditation
			Present Position
			Key Principles
			Key elements of accreditation system
			Setting standards Assessing performance Agreeing and implementing action
			Way Forward
Chapter 9	Data Collection
			National Acute Sector Database
Chapter 10	Emergency Pressures
			Care of Medical Emergencies
			Separation of diagnostic risks and dependency risk Development of joint protocols and guidelines by primary care and secondary care Improved management of medical emergencies Focus on peri-acute care
			Care of Surgical Emergencies
			Accident and Emergency Services
			Primary Care and the management of emergencies A&E departments Trauma services
			Transport of the Critically Ill
			Generalists versus Specialists and Emergency Care
			Conclusions
Chapter 11	Specialisation and Specialist Services
			High technology-small volume specialties
			Subspecialisation
			Specialisation and the separation of elective and emergency services
			Specialisation and training programmes
			Specialisation, workloads and Quality
			Capital allocation, expensive equipment and new treatments
Chapter 12	Services for Children
			Some Issues related specifically to the acute care of children
			Primary care and the community Accidents and emergencies Acute medical admissions Surgical specialties Medical specialties Professions Allied to Medicine Neonatal care Ambulatory care Community paediatric services
Chapter 13	Services for Remote Communities
			Concerns regarding acute health care for rural and remote areas
			Access to health care and clinical networks
			Access to primary care services
			The role of community hospitals
			Emergency Care and acute hospitals in rural areas
			Access to outreach services
			Critical mass for viable and sustainable services
			Recruitment and retention of doctors
			Recruitment and retention of other professional staff
			Service integration
			A resource centre for the Highland and Islands
Chapter 14	Diagnostic and Support Services
Chapter 15	Workforce Issues
			Multidisciplinarity and Skill Mix
			Professions Allied to Medicine
			Nursing and Midwifery
			Planning the Workforce Skill mix and multi-skilling Education and training Cost and clinical effectiveness
			Medical Workforce
			Hospital Medical staff UK and European context Retention of medical graduates in Scotland Supply Demand Flexibility Fitness for purpose Changes in consultant contract Separation of service and training Skillmix and the medical workforce Demonstration sites Tailored training Conclusion
SECTION 3: RECOMMENDATIONS AND IMPLEMENTATION
Chapter 16	Recommendations of the Acute Services Review
			NHS Priority Areas Managed Clinical Networks Services for Children Needs of Remote Communities Appraisal of Specific Services Service Design and Delivery Interface between Primary and Secondary Care Emergency Pressures Clinical Quality Assurance and Accreditation Workforce Issues Diagnostic and Support Services Capital spending, expensive equipment and drugs Research and Development Data collection and processing Communication and information flow Advice to The Scottish Office Department of Health
Chapter 17	Implementation of Recommendations
			Strategic Planning for Acute Services
			National Services Supraregional, regional and Trust services
			Implementation Plan
Annex 1	Steering Group Membership
Annex 2	Sub-Group Membership
Annex 3	Working Group Membership
Annex 4	Summary of Evidence of Volume/Quality Relationship from Best Quality Studies (York)