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improving care for patientsBetter information
on the most effective treatments |
Improvements in recent years have provided the National Health Service in Scotland with an opportunity to focus its efforts where they will do most good. Better information on the most effective treatments means that the NHS can concentrate its efforts on improving health, and developing health services in the community and in delivering hospital services. To take advantage of this 3 National clinical priority areas were set in 1995/96.
These are
The whole of the NHS in Scotland, including Health Boards, NHS Trusts and GPs, have been working to improve the health of people in these 3 areas.
Mental Health
The focus of mental health care is to provide appropriate responses to assessed needs in community settings. Mental health remains a clinical priority for the NHS in Scotland. As provision for caring for people with a mental illness in community settings expands, there will be a need for fewer long stay beds. People with mental health problems living in the community, like everyone else need to have access to a range of care services and the focus has remained through 1998 and beyond to provide both hospital and community services that match assessed needs. The "Framework for Mental Health Services in Scotland" required all Health Boards to produce comprehensive mental health strategies which ensure that the full range of services, including hospital care is available for all those who need it, when they need it.
Review of the Mental Health (Scotland) Act 1984
The Mental Health (Scotland) Act 1984 is being comprehensively reviewed by a committee chaired by Bruce Milan, which was set up in February 1999. The Committee has the following terms of reference:
"In light of developments in the treatment and care of persons with mental disorders, to review the Mental Health (Scotland) Act 1984, taking account of issues relating to the rights of patients, their families and carers, and the public interest; and having particular regard to:
and to make recommendations"
In its Report, to be made to the Scottish Executive in Summer 2000, the Committee aims to establish and take account of the views on the scope and operation of mental health legislation of all those involved in mental health. The Committee's consultation paper was published and widely distributed in April 1999.
Coronary Heart Disease and Stroke
The Coronary Heart Disease (CHD) Task Force was established by the then Scottish Office Minister for Health in June 1998 in response to the Acute Services Review's call for a national initiative to help the NHS in Scotland tackle the burden of the disease, in particular by treating less advanced CHD and minimising delays that are leading to avoidable morbidity and mortality. It is chaired by Professor Ross Lorimer, Consultant Cardiologist at Glasgow Royal Infirmary.
The Task Force was asked to make its first priority an assessment of the additional capacity for coronary artery bypass grafts (CABGs) at the 4 cardiac surgery centres in Scotland. It concluded that an additional 484 CABGs could be carried out in existing centres by March 2000. That would produce a rate of 616 per million population (pmp) for Scotland as a whole, above the 600 target recommended by the British Cardiac Society and a year earlier than the target date set out in the most recent Priorities and Planning Guidance. Consideration of that recommendation prompted the announcement on 5 February 1999 of a further £7 million investment in all aspects of CHD, including the additional CABG activity. Health Boards were then asked to decide on their share of additional activity, based on their populations' needs.
The Task Force also engaged in a range of other work during the year, including a needs assessment of the level of coronary revascularisation (both cardiac surgery and angioplasty) appropriate to Scotland; investigating the creation of a national database founded on the routine management of patients in primary care; primary prevention, through "The Heart of Scotland" demonstration project; the management of patients on cardiac surgery waiting lists, including risk assessment techniques; and cardiac rehabilitation (with the Scottish Needs Assessment Programme (SNAP)).
Cancer Services
Cancer Managed Clinical Networks
The highest priorities for the newly constituted Scottish Cancer Group, which met for the first time in September 1998 - have been the establishment of cancer managed clinical networks and the development of a quality assurance system for cancer services based on open, collaborative prospective audit.
Significant efforts have been invested in facilitating the establishment of cancer managed clinical networks initially in breast, lung, colorectal and gynaecological cancers. The first of these - the West of Scotland Gynaecological Cancer Network - is up and running and it is hoped that breast, colorectal and lung networks will soon follow.
In the East of Scotland a lead Cancer Clinician provided strategic direction and focus to the overarching Lothian and South East Scotland Cancer Advisory Group, under whose aegis cancer managed clinical networks are developing in a similar fashion to those of the West of Scotland.
A number of issues remain to be resolved in co-ordinating managed clinical networks in North and North-East Scotland. However, the foundations exist on which such regional networks can be built.
Palliative care colleagues are developing a framework for cancer-related managed clinical networks. Links with primary care are an essential part of this development. There are a number of cross-cutting issues to be considered to identify how best to play into the overall cancer managed clinical networks, both regionally and across Scotland, but it is envisaged that the specialist aspects of palliative care might begin to be addressed by looking at the issues surrounding pain control in patients with cancer. This latter aspect will have as its basis the planned Scottish Intercollegiate Guidelines Network (SIGN) guideline on pain control in cancer.
Quality Assurance
The Scottish Cancer Therapy Network (SCTN) is liasing with Health Boards and NHS Trusts to assist with the establishment of systems of prospective audit for breast, colorectal, lung and gynaecological (ovarian) cancer. This nationwide initiative will underpin the cancer managed clinical networks by providing audit data to clinicians to assist them in continuously assessing and improving cancer services. Data will be collected using the relevant SIGN recommended minimum datasets where these exist or, in the case of ovarian cancer, a dataset drawn up under the auspices of the Scottish Programme for Clinical Effectiveness in Reproductive Health.
Link with the Clinical Standards Board for Scotland
Preparatory discussions have been held with Lord Patel who has been appointed as Chairman of the Clinical Standards Board for Scotland (CSBS). Further meetings with the Scottish Cancer Group will be held later with the aim of identifying key indicators against which CSBS might assess and accredit cancer services.
Cancer Genetics Services
The report Cancer Genetics Services in Scotland (published in November 1998) recommended the establishment of dedicated cancer genetic counselling and follow up for those individuals considered to be at significantly increased risk of developing breast, colorectal or ovarian cancer. Funding for dedicated Genetics Associate posts in each of the four Scottish Regional Centres was announced by the then Secretary of State for Scotland in October 1998 with the expectation that staff will be recruited in early 1999.
The Cancer Genetics Sub-Group of the Scottish Cancer Group is preparing guidance on referral criteria for those people presenting either to their General Practitioner or via specialist clinics. It is anticipated the guidance will be issued to the Service during 1999.
Clinical Effectiveness
Central to the quality of health care is the effectiveness of clinical care and treatment. Considerable effort has been devoted to the provision of guidance on best practice in the delivery of clinical services. The Clinical Resource and Audit Group (CRAG), under the chairmanship of the Chief Medical Officer, provides a focus for this work. This has resulted in:
Collaborative working with other agencies has remained central to CRAG's work, including the development of the Clinical Standards Board for Scotland and the preliminary planning of the Scottish Health Technology Assessment Centre.
Quality
The NHS Act amended NHS Trusts' statutory duties to make explicit their responsibility for quality of care. In addition, through a process of clinical governance, Trust boards will be held accountable for ensuring that quality of patient care is given the highest priority at every level in the organisations for which they are responsible. Following consultation with the NHS in Scotland, guidance on the implementation of Clinical Governance was issued in 1998.
Human Resources Strategy
The prominence which the White Paper "Designed to Care" gave to human resources and organisational development issues led to the publication in April 1998 of "Towards a New Way of Working", the first ever Human Resource Strategy for the NHS. At the heart of the strategy is the concept of partnership, and a commitment to fairness and consistency as the foundations for good human resource practice in the NHS in Scotland. During 1998/99 a shared commitment from professional bodies, NHS staff representative bodies, senior NHS managers and the Management Executive resulted in the establishment of the Scottish Partnership Forum (SPF). The Forum aims to promote fundamentally new ways of working, and has already made a major contribution to the development of more cohesive, practical human resource policies across the Health Service in Scotland. Throughout Scotland local partnerships agreements are being established and are making the concept of partnership working a reality in the NHS in Scotland.
One of the most significant challenges for the NHS in Scotland in 1998/99 was the major re-configuration from 47 to 28Trusts, and the selection of 28New Trust Chairmen and 135Non-Executive Trustees.
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