DESIGNED TO CARE

Renewing the National Health Service in Scotland

1. Patients look to all those involved in the National Health Service - Health Boards, NHS Trusts, primary care practitioners and others - to work together to provide them with effective care, delivered efficiently, and to put their interests first. To help achieve these aims Health Boards, Trusts and General Practitioners are working together to produce a Health Improvement Programme for the people of each Health Board area. Health Boards are leading the preparation of these Programmes, but with the active engagement of Trusts and General Practitioners. Clinicians are involved in the development of these Programmes. All parties involved will be committed to the successful implementation of the Programmes. Health Board and Trust Chairmen are expected to take personal responsibility for ensuring that the Programmes are agreed.

2. The necessary first steps in the preparation of Health Improvement Programmes are open discussions between Health Boards and Trusts to share and agree all relevant information in the light of existing service strategies including financial baselines. Having agreed the baseline information, these discussions will identify the mutually supportive objectives and action to be taken by each organisation over the coming years to improve the health of the population. The extent to which the Programmes serve the greater good of the population and secure health gain is a key criterion by which Boards and Trusts will be held accountable. The principal agenda for Trusts is the implementation of relevant Health Improvement Programmes. Collaboration and co-operation will help to improve quality. It is important to emphasise the need to focus on health gain and improved outcomes for local populations.

3. Health Improvement Programmes should:

• build on existing Health Board service and financial plans and Trust plans;
• cover a period of 5 years;
• include firm plans for the forthcoming year 1998/99 and provisional plans for later years which should nevertheless be as firm as possible; and
• be open to public scrutiny, recognising the role of the Local Health Council.

4. Each Health Improvement Programme should set out:

• proposals to protect the public health, including emergency planning;
• proposals to promote health;
• proposals to analyse and tackle health inequalities;
• service changes and developments, including those involving primary care;
• a rolling programme for the implementation of evidence-based clinical guidelines and clinically effective practice, to be monitored through clinical audit;
• resource assumptions including locally generated efficiencies;
• human resource strategies;
• how efficiency in the use of existing assets will be maximised; proposed capital investments; and changes in the National Health Service's estate; and
• Information Management and Technology strategies.

5. Health Boards which secure a significant level of service from Trusts outwith their areas should involve these Trusts as appropriate in preparing Health Improvement Programmes. Health Boards should also involve the Scottish Ambulance Service in discussions. Health Improvement Programmes will be prepared annually, rolling forward the previous year's 5 year Programme to firm up plans for the following year and to include a new Year 5. Health Boards will continue to agree annual Corporate Contracts with the Management Executive.

6. NHS Trusts should prepare an Implementation Plan consistent with the Health Improvement Programme. These should be agreed with the host Health Board to ensure they support delivery of Health Improvement Programmes and that resource assumptions are consistent. For Trusts which deliver a significant level of service to people from more than one Health Board area it will be appropriate to discuss their Implementation Plans with each of the relevant Health Boards.

7. Health Improvement Programmes are described in the Priorities and Planning Guidance, which provides the overall policy context for the planning and delivery of health services, and targets the NHS in Scotland on the most important national priorities. It sets out, amongst other things, the Service's clinical priorities. These are:

• mental health;
• coronary heart disease and stroke; and
• cancer.

These clinical priorities are kept under review and may therefore be subject to change over time.