The current situation in the Scottish NHS
The introduction of General Management with the purchaser/provider and mantra of Thatcherite policies was not well received in Scotland. General practice fundholding was also not widely popular. In some circumstances, previously good relations with hospital consultants became strained.
With the advent of the Scottish parliament in 1999 came devolved health powers which provided the impetus and the opportunity to abolish this unpopular business plan in the provision of health services.
A White Paper “ Partnership for Care “ was published. This proposed the abolition of the purchaser/ provider relationship, and this was finally concluded with the passing of the National Health Service Reform Act (Scotland) 2004. This saw the dissolution of NHS trusts and the establishment of Community Health Partnerships, with these having the responsibility of providing health services at a local level involving NHS boards, local councils, and voluntary organisations. This model has taken some time to establish itself but now seems to be bedding down well in most areas. The Act also placed a duty on health boards to co-operate with each other in the interests of developing more effective regional planning of health services, and extended ministerial powers to intervene to secure the quality of health care services.
The previous Labour Scottish Executive had embarked on a programme of hospital closures and centralisation of services which proved to be extremely unpopular with local communities and several of the five main rural hospitals in Scotland were under threat of closure.
In Lanarkshire and Ayrshire there were proposals to close accident and emergency units with the substitution of minor injury units .In the West of Scotland, a major district general hospital has been threatened with closure of its acute medical receiving unit.
There was a widespread belief amongst the general public that Health Board documents produced to support these closures/mergers were severely flawed, and that many of the consultative processes had been shams. In the case of Lanarkshire , there was also a strong suspicion that the excessive repayment costs of two PFI/ PPP build hospitals in the health board’s area was a major factor in the decision to close the A.& E. unit and downgrade this hospital.
In May 2007 a Scottish Nationalist Party minority government was elected .In her first speech to the parliament as Cabinet Secretary for Health and Well-being, Nicola Sturgeon announced the reversal of the proposed closure of the accident and emergency units in Lanarkshire and Ayrshire.
She appointed two Independent Scrutiny Panels to re-examine health board’s proposals. The Lanarkshire and Ayrshire panels were chaired by a senior lecturer in health economics, and comprised an A&E consultant, the director of the Scottish Consumer Council, and the head of the Chartered Institute of Public Finance and Accountancy in Scotland.
The very recently published outcomes of the deliberations of the panels have supported the views that the reasoning and consultative processes which the Health Boards originally undertook were indeed flawed and misleading, and the health boards concerned have been forced to produced revised proposals to maintain the accident and emergency functions of these two hospitals.
An innovative Integrated Care Model which had been proposed to support another more peripheral West of Scotland district general hospital, and which involved a combination of consultant/general practice cover was rejected by the local health board on grounds of ”safety”.
Another Independent Scrutiny Panel deemed this model to be worthy of exploration, and the Cabinet secretary has asked the board to re-examine its decision. The outcome of this process is awaited
Also announced was the phased abolition of prescription charges in Scotland along the lines already being pursued in Wales.
In the previous session of the Scottish parliament a bill had been proposed to democratise health boards by the direct election of members of the public to health boards.
On behalf of the Scottish Health Campaigns Network I had the opportunity to give evidence supporting this proposal to the Health Committee of the parliament. Although the majority of the committee were in favour of the bill, it was later rejected by a full session of the parliament.
The new Scottish Government now intends to reintroduce such a bill and the proposal is at present out to consultation.
It also consulting on the introduction of scrutiny panels to examine proposals for major changes in health service provision before health boards put these out to public consultation.
Last summer the Scottish Government published a consultation document “ Better Health, Better Care”. This was based on Professor David Kerr’s Report “ Building a Health Service Fit for the Future”. Arising from this, a much more focussed Action Plan is now in the process of implementation.
The debate about locally provided generalised services versus centralisation has been reopened, and much greater emphasis is being placed on meaningful consultation.
Interestingly, the Royal Academy of Royal Colleges in Scotland has recently supported the view that bigger is not necessarily better where remote and rural communities are concerned, and a report for NHS Scotland prepared under the auspices of Highland Health Board clears the way for consultants to be specifically trained to staff these hospitals.
The new government is also examining other means of financing capital projects other than the PPP route. A form of not for profit trust is one proposal, but detailed information on what the final model will be is awaited.
Sir John Tooke’s report has also been put out to consultation. In this respect it is essential that there is a U.K. consensus on the future training of doctors.
I think it is fair to say that the Scottish Health Campaigns Network which acts as an umbrella organisation for groups in Scotland with health concerns, has established a degree of credibility on health politics in Scotland. In particular the Cabinet Secretary has expressed a willingness to a continuing dialogue with the organisation.
We are most grateful to the NHSCA for the initial financial support of the organisation when it was founded almost four years ago.
As Dr Tudor Hart indicated in the September 2007 NHSCA Newsletter, the more socialist Celtic fringes, with or without a capital ”s” continue to support the retention of the principles of the original NHS as it approaches its 60th birthday.
We are appalled at what is happening in England, but are still not complacent ,and are keeping a watching brief on any further potential privatisation of the health service in Scotland.
As I conclude this account of the current situation, in Scotland I am dismayed to read a report that Greater Glasgow and Clyde Health Board is looking at the possibility of employing Capita Health Solutions to run their occupational health service!
Consultant Haematologist and Chairman, Scottish Health Campaigns Network