The Scottish Government

Deputy First Minister and Cabinet Secretary for Health and Wellbeing

Nicola Sturgeon

Statement on Health and Wellbeing at the Scottish Parliament, Holyrood, Edinburgh

December 12, 2007

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I'm delighted today to publish our new Action Plan for Health and Wellbeing.

Better Health, Better Care sets out a clear vision for the NHS in Scotland. It outlines the actions we will take over the lifetime of this parliament to improve health, tackle health inequalities and enhance the quality of our healthcare services.

Better Health, Better Care builds on the strong foundations of the NHS Scotland. We will retain what is working well but we are determined to add fresh impetus and new momentum to our efforts to improve health and deliver healthcare that is truly patient-centred.

Our Action Plan has at its heart a strong commitment to participation and involvement: to the participation of patients as partners in their own care; and to the involvement of patients, the public and staff in the design and delivery of health services in the future.

The Action Plan has developed out of one of the most thorough and wide reaching consultation processes ever seen in Scotland. More than 2000 people took part in face to face discussions and we received around 600 written responses. I am grateful that so many people - and so many organisations - took the time and trouble to give us their views and I want to place on record my thanks to all of them.

Presiding Officer, the consultation process demonstrated the passion of people in Scotland for the NHS. I brought to this job a firm belief that this passion should be viewed as a strength to be harnessed, as a powerful driver of change in the NHS, not as an obstacle that NHS Boards need to get around.

My experience over the past few months has served only to reinforce that view.

I have been impressed time and again with the commitment of patients, the public and staff to use their experiences to drive change and improvement in the way in which services are delivered.

But I have also been left in no doubt that their voices must be heard and listened to even more.

That is why this Action Plan represents a new era for patient and public participation in our NHS. It represents a step change in the power, influence and voice that the Scottish public will have in our NHS. It recognises the public not just as consumers with rights, but as owners of the NHS, with rights and responsibilities. It represents a radical shift towards an NHS that is truly publicly owned.

The Action Plan sets out a clear vision of a mutual NHS where ownership and accountability is shared with the public and with NHS staff.

This concept of mutuality does not mean a change in the financial or structural arrangements of NHS Scotland. But it does mean gathering the people of Scotland, our voluntary and community sectors, all of our partner organisations and the staff of the NHS around the common purpose of building a healthier Scotland. A common purpose that will be delivered through integrated care and co-operation. It involves a genuinely collaborative approach to healthcare that builds on the founding values of the NHS and rejects the market-based model favoured elsewhere in the UK.

Over the next three years, we will take a number of steps towards a more mutual NHS in which patients, the public and staff are treated as partners in health and as co-owners of the NHS.

For example:

• We will launch a public consultation on the possible content of a Patients' Rights Bill by May 2008. This will cover waiting time guarantees and the right of patients to be treated as partners in their own care
• We will produce proposals for independent scrutiny of major service change by April 2008, building on our experiences of the independent scrutiny panels already established in Ayrshire & Arran, Lanarkshire, and Greater Glasgow & Clyde
• Following public consultation, we will by next summer introduce a Local Healthcare Bill that will include proposals for direct elections to NHS Boards
• We will develop a Participation Standard for all NHS Boards to reflect the needs of our diverse population and incorporate assessment against this standard into NHS Scotland's performance management system by 2009
• We will produce and distribute an annual "ownership report" to every household in Scotland. This will set out the rights and responsibilities of patients and their carers alongside information on how to access local services and raise issues or complaints

This is a step change. It will take time to fully embed this new mutual approach, but I believe that these steps set us firmly on the right path.

Presiding Officer, let me turn now to the twin challenges of improving health and tackling health inequalities. Last month, the Chief Medical Officer for Scotland published his Annual Report on the state of our nation's health. He recognised that our health is improving, but that it is improving faster in the wealthiest sections of our society than it is in the poorest. As a result, health inequalities are widening.

Presiding Officer, this government is clear that, in a country as rich as ours, that is simply not acceptable.

That is why we have made tackling health inequalities our top health priority.

The Ministerial Task Force on Health Inequalities led by Scotland's first ever Minister for Public Health will report to Cabinet by May 2008 on a range of cross-Government recommendations to tackle our most significant and widening health inequalities. The discussion around Better Health, Better Care has informed the work of the taskforce and this action plan sets out some of the early measures that we will take to add real momentum to our shared, national drive to improve the health of people living in our most disadvantaged communities:

For example:

• We will abolish prescription charges by April 2011, and in so doing remove a tax on ill health and a significant barrier to self management of chronic conditions
• We will develop new approaches to anticipatory care, building on the early success of the Keep Well programme and introduce "Life Begins" health checks
• We will roll out simple but effective interventions to promote good health in acute hospitals
• We will implement a systematic approach to assessing the impact of policies and strategies on health and health inequalities
• We will ensure that the NHS uses its considerable influence as Scotland's largest employer to promote good health and take the lead in getting people into work through innovative employment schemes that offer pre-employment training and first destination work opportunities for those on benefits

Presiding Officer, it is not the job of the NHS alone to improve health and tackle inequalities, but there is no doubt that the NHS has a leading role to play.

That is why our new plan puts greater emphasis than ever before on the unique contribution that the NHS can make, working with its partners, to enable people to improve and sustain their health.

We recognise of course that health improvement requires a long term effort. The full value of the work we do to support children may not become apparent until that child has become a parent or a grandparent.

But there is action that the NHS can take now to create the conditions in which people have the confidence, motivation and ability to make healthy choices.

That is why:

• We will invest an additional £3 million a year in new measures to prevent smoking and set a target for NHS Boards to increase the numbers of people they support through smoking cessation services
• We will invest an additional £85 million over the next three years to tackle alcohol related harm with a greater focus on changing behaviour through brief interventions delivered by GPs and other professionals in primary care
• We will invest a total of £94 million to allow NHS Boards to increase drug treatment and rehabilitation services
• We will invest an additional £11.5 million to tackle the rising tide of obesity in our country and set a new target for completion of programmes that support healthy weight management

In other words, we will focus the NHS on activity that has a real, practical effect - while leaving plenty of scope for Boards and highly professional staff to use their own initiative and judgement to achieve the best outcomes.

Presiding Officer, we recognise that good health requires more than the absence of disease. It also requires good mental health. Scotland is recognised internationally for some of its work around mental health legislation and services. However we will do more to address stigma, prejudice and discrimination, particularly for those with a diagnosis of psychosis. We will roll out the Mental Health First Aid Programme so that more key workers are mental health and wellbeing literate.

We will also do more to deliver better outcomes for people suffering from depression by matching appropriate therapies to the specific needs of individuals. While antidepressants will offer the most appropriate help for some, for many more a range of other interventions will be more effective. That is why we will target NHS Boards to reduce the annual increase in anti-depressant prescribing to zero by 2009/10 and by 10% in the years thereafter.

Presiding Officer, let me turn now to where we can and must make the biggest difference in the long term - by giving our children the best possible start in life.

Work emerging from across the world shows that the circumstances in which a child is brought into the world can have a major impact on physical and mental health.

It is therefore critical that we give our children the best possible start, by supporting good health choices and behaviours that will enable them to sustain good health throughout their lives. The key to this approach will be the development by Autumn 2008 of a cross-government Early Years Strategy. That will provide the framework within which we will work with our partners to deliver effective early years support for children and young people.

But this Action Plan also outlines a range of steps that we will take now to improve the life chances of our young people and break the link between early life adversity and adult disease.

For example:

• We will focus intensive support on children identified as being particularly vulnerable
• We will expect each NHS Board to identify a lead maternity care professional to help mothers quit smoking and drinking during pregnancy
• We will challenge Boards to improve breastfeeding rates
• We will extend entitlement to free school meals
• We will increase nursing and other healthcare support in schools
• We will roll out a new schools based preventative dental service and ensure that 80 per cent of all 3-5 year old are registered with a dentist by 2010/11

Presiding Officer, let me turn now to how we will make our health service better, more local and faster. Firstly, let me acknowledge progress that has already been made. Waiting times are shorter and outcomes for patients are improving.

I want to pay tribute to all NHS staff. It is their hard work that has delivered this success.

Our challenge now is to accelerate the pace of improvement.

Better quality care has a number of dimensions. It must be patient-centred, safe, effective, efficient, equitable, and timely.

It must also be designed for the future as well as the present. The challenges that we face - an ageing population, a rise in long term conditions and growing inequalities - require us to further shift the balance of care towards community and anticipatory services that are effective. That means developing primary care services that are more accessible and flexible.

We were told repeatedly by members of the public in the consultation that improved access to primary care was important. The current contract for GPs defines their opening hours as 8am to 6:30pm, Monday to Friday. However routine appointments are usually scheduled between 9 am and 5:30 pm, with very few GP practices offering early morning, evening or even lunchtime appointments.

No-one expects GP services to be available 24 hours a day, seven days a week. But many patients - including those in some hard to reach groups - both want and would benefit from being able to see a GP before or after work or at the weekend.

That is why we will work with professional bodies, NHS Boards and individual GP practices to provide a more accessible service which fits in with the lives of patients.

This will involve more flexible access during existing contract hours as well as some extended hours opening.

We will use the framework of patient experience surveys to develop a robust evidence base to support this drive towards improving access and patients' experience of care.

Another issue of concern to patients in some areas is their inability to book appointments in advance or with a GP or member of the primary care team of their choice. We will therefore work with the profession to secure guaranteed access to an appropriate member of the practice team within 48 hours, and more flexible advance booking arrangements.

Of course, improving access to primary care should not be just about "more of the same". We will also develop innovative methods of accessing services such as more effective use of telephone consultations and email communication.

We will also enhance the role of community pharmacy. Community pharmacies offer convenient access to primary care in High Streets and other community settings.

That is why, by March next year, we will establish pilot projects in five of our largest health board areas - Grampian, Greater Glasgow and Clyde, Lanarkshire, Lothian and Tayside - to provide walk-in access to a range of primary care services via community pharmacies.

These pilots will be located at main commuter points, major shopping centres, and inner city areas.

They will provide extended hours walk-in access to a wide range of services, including nurse led minor injury treatments; sexual health screening; simple diagnostic tests; and some adult immunisations.

Presiding Officer, this ambitious package of improvements to our system of primary care - more flexible GP access; a development of the Keep Well model of anticipatory care; and easy, walk in access to a range of primary care services will start to deliver the local and more preventive health service that we need to develop for the future.

Presiding Officer, let me turn now to the important issue of patient safety.

Let me firstly assure the public that NHS Scotland is safe by international standards.

But there is no room for complacency. I want NHS Scotland to be a world leader in patient safety.

The Scottish Patient Safety Alliance has been established to achieve significant, measurable improvements in patient outcomes through the implementation of specific evidence based interventions.

This work will ensure that robust quality improvement methodologies are implemented and embed a culture of patient safety in all of our NHS hospitals.

One of the key aspects of patient safety is our work to tackle Hospital Acquired Infections. The prevalence of infection in our hospitals and other healthcare settings is understandably a matter of considerable public concern.

That is why we will introduce a range of new measures to tackle Healthcare Associated Infection and invest more than £50 million to support their implementation through the HAI taskforce. These measures will include the introduction of a national MRSA screening programme, tougher hospital cleaning standards and a more rigorous approach to hand hygiene.

Presiding Officer, let me deal now with the issue of timeliness.

The benefits of national waiting times for patients are clear - earlier diagnosis and better outcomes; less unnecessary worry and upheaval; and less post-code variation.

Shorter waits benefit the NHS too by reducing the need to manage complex queues and backlogs for treatment.

That is why, by 2011, this government will deliver a maximum wait for treatment of 18 weeks from GP referral to treatment.

This target differs from previous waiting time targets. It does not focus on a single stage of care - instead it will apply to the whole patient journey.

Achieving this ambitious target will demand new ways of working in the NHS.

That is why by Spring 2008 we will publish a national framework for the delivery of the 18 week target and support its implementation with £270 million of new resources.

Presiding Officer, this commitment represents the biggest step change in waiting times in the history of NHS Scotland and will transform the experience of patients.

Presiding Officer, I have been able to touch on a just few of the areas covered by Better Health, Better Care. Today's publication will, of course, be followed up with detailed implementation guidance to the service.

However, I would like now to touch on a key issue - how we will hold NHS Boards to account, and how parliament will hold the government to account, for the delivery of this ambitious programme.

Better Health Better Care sets out new annual performance targets and measures for NHS Boards across Scotland. It describes a framework that:

• Identifies and drives the contribution of NHS Scotland to the overall strategic objectives of the Scottish Government
• Links closely with the new accountability and performance arrangements that will apply to local government
• Demonstrates a clear alignment between short term operational targets and our longer term direction of travel

The new performance framework represents a better balance than ever before in terms of the impact that the NHS can make on the health of the people of Scotland. It puts a greater emphasis on health improvement, mental health, efficiency and anticipatory care and reduces the number of targets around waiting times.

It also includes new targets focussed on:

• the unique contribution that NHS Boards can play within our overall approach to health improvement
• our manifesto commitment to make dementia a national priority and achieve agreed improvements in early diagnosis and management of patients with dementia
• The reduction of hospital admissions for patients with a primary diagnosis of COPD, asthma, diabetes or coronary heart disease
• The delivery of clear milestones towards the 18 week whole journey time waiting time

Over the next few months, NHS Boards will be expected to produce local delivery plans showing how they will meet or make progress towards these targets over the next year. Boards will track their own progress against plans, taking action where necessary to bring performance back into line. And the Health Directorates will performance-manage Boards to ensure that planned levels of achievement are delivered.

This performance management approach provides a sound basis for outcome agreements established jointly with other service delivery partners. It also provides the basis on which I will report NHS Scotland's progress to the public and be held to account by parliament.

This Action Plan is published at a highly significant time. Next year, the NHS will celebrate its 60th birthday. That is an occasion to reflect on what the NHS has achieved and to ask questions about its future direction.

With this Action Plan we show how the NHS in Scotland will answer those questions. We set out a plan for a National Health Service based on the values of collaboration and cooperation, not the whims of the market. We affirm a unified structure in which decisions are made in the interests of the people we serve and not to meet the demands of internal competition. A public service, used by the public, paid for by the public and owned by the public.

Better Health Better Care sets out a vision for a National Health Service that is not only true to its founding principles, but has the confidence to extend those principles through a commitment to involving the public, patients and staff in shaping its future direction. It delivers a national health service for the Scottish nation - a truly Scottish Health Service.

I hope that our Action Plan will have the support of the chamber.