The second in a series from the Wealthy Nation Healthy Nation paper edited by Malcolm Offord
This chapter was by Prof A McNeill. Contributing authors: Mr C Winstanley, Dr A Gregor CBE, Dr G Boyd, Prof A Cumming, Dr A Dunlop, Dr B Hacking, Prof C Robertson
Financial, structural and cultural change
HEALTHCARE outcomes in Scotland are deteriorating relative to many other countries that spend a similar amount or less on healthcare. This should persuade us that the current model of healthcare in NHS Scotland (NHSS) is outdated and unable to quickly adopt changes that benefit the population it is there to serve.
There is an urgent need for politicians to publicly accept that additional spending cannot and does not serve as a cure-all, and that without truly significant reform NHSS will remain unable to meet the challenges it faces.
Whilst the initiatives outlined in the Scottish Government’s Operational Improvement Plan are welcome, the plan does not properly address the financial, structural and cultural changes that are needed to preserve the NHS in Scotland. Therefore, unless significant reform occurs that improves the efficiency and productivity currently delivered by NHSS, it seems very unlikely that we will benefit from greater spending on healthcare.
The Scottish Government should acknowledge that NHSS is currently unable to deal with many of the challenges it faces and that an honest debate with the public about urgent reorganisation and reform of finances, structure and culture is necessary.
“No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.”
Aneurin Bevan
Prevention
There is a need to improve the general health of the population to reduce demand on a stretched healthcare system.
We face an ageing population burdened by increasing chronic diseases such as obesity, diabetes, certain cancers, cardiovascular disease and dementia. Most of these diseases are overwhelmingly associated with diet, lifestyle and poverty.
Addressing these issues must be an intermediate and long-term goal that goes hand in hand with improving the economic outlook and education of the population of Scotland.
RECOMMENDATIONS
To protect the future of NHSS from the short-termism of the political cycle, the Scottish Government needs to convene a commission of independent senior experts and business leaders, without political affiliation, that can consider:
The modernisation of healthcare provision, through:
- A focus on patient outcomes and experience, which must be the priority for everyone in healthcare and involves extending patient choice as essential to ensuring high standards;
- Decentralisation of funding and control to local bodies;
- Transparency of funding, with money following the patient more directly;
- Re-establishment of a medical hierarchical system that is based on experience and ability, with a Head of Department setting standards, nurturing, developing, and supporting younger colleagues. Managers focussed entirely on the delivery of excellent patient outcomes;
- A new constitution for the NHS in Scotland so that patients know what they can expect from the service;
- Recruitment into healthcare and measures to ensure retention of staff up to the state retirement age; and,
- A capital fund dedicated to ensuring the estate and infrastructure in the Scottish Health Service underpins the objectives set out in the constitution.
Conclusion
All of these changes could be implemented within the term of the next Scottish Parliament if the political will is there to do so. We believe they will substantially improve the performance of NHSS, allowing us to preserve a high quality easily accessed NHS, which is now a matter of urgency.
As well as looking at how these immediate changes to the NHSS are implemented, a great advantage of the Scottish Government setting up the Independent Commission, as we recommend is that it can look at further reform. Our health system needs to strive for constant improvement and the further lessons we can learn from other healthcare models such as those in Sweden and Germany. Such reform may well be more long-term and seem radical, but it is important that new ideas are given due consideration if we are to make NHSS the best healthcare system in the world, which must be our aim.
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For the full paper visit Wealthy Nation Healthy Nation.
Professor Alan McNeill FRCS(Urol), FRCP(Ed), FFSTEd was, until recently, an NHS Consultant at NHS Lothian University Hospitals in Edinburgh, where he worked for 24 years. He now works with NHS Fife and holds honorary Professor posts at both the University of Edinburgh and Heriot Watt University.
