DESIGNED TO CARE

Renewing the National Health Service in Scotland

Foreword by the Secretary of State

The Government were elected on a manifesto which committed us to a fundamental aim: to restore the National Health Service as a public service working co-operatively for patients, not a commercial business driven by competition. This White Paper, Designed to Care, sets out our vision for the NHS in Scotland and explains how we will fulfil the manifesto commitment.

We will ensure that the NHS remains true to the historic principle that if you are ill or injured there will be a national health service there to help, with access based on need and need alone, not on your ability to pay, or on who your GP happens to be, or on where you live. We will do this through our commitment to raise spending on the NHS in real terms every year, and put that money towards better patient care.

Our objective is a patient-centred health service. We will harness new technologies to improve the reliability and effectiveness of patient care. Our commitment to clinical effectiveness is designed to ensure that wherever patients make use of the services of the NHS they receive the highest quality care. We will create a seamless service which gives patients continuity of care from GP through hospital to rehabilitation.

The White Paper sets out clearly the system which will replace the internal market in healthcare. We are not advocating a return to top-down management. The strategic role and the service role are distinct functions, and will remain so. Health Improvement Programmes, which we introduced in August, are designed to promote an overview of the health needs of our communities. They are the common agenda that will act as a catalyst for co-operation and collaboration amongst all those concerned with health care.

In recent years GPs have gained opportunities on behalf of their patients. We support this. But the cost under the internal market has been fragmentation, a burgeoning of bureaucracy and the potential development of a two-tier service. The White Paper honours our commitment to retain the central role for primary care while removing the disadvantages of the previous system. We will do this by giving strong organisational support to primary care through the creation of Primary Care Trusts, which will allow GPs and other health professionals to take the lead in combining locally to organise health services for all the patients in their area.

Trusts will retain their autonomy over day-to-day operational activity. The White Paper re-focuses Trusts on improving the design of services to patients by giving clinicians and those who use these services a bigger say in their management. We are committed to fewer Trusts, and the health service is already discussing locally how to achieve this. We do not intend to impose an inflexible blueprint, and will leave plenty of scope to respond to local needs and circumstances.

Designed to Care is an important step in fulfilling our manifesto commitments, and does so without creating a disruptive 'big bang'. It sets out solutions suited to Scottish needs and lays the foundations for the work of the Scottish Parliament in continuing to improve the health of the people of Scotland. The NHS in Scotland has served the people of Scotland well for nearly 50 years. I believe the proposals in this paper will enable it to prosper well into the next century.