Health Secretary Nicola Sturgeon
Speech to the British Medical Association (BMA)
July 8, 2008
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Thank you for that kind introduction and thanks to all of you for inviting me to speak at this special event.
Over the past week or so we have been celebrating the 60th anniversary of the NHS in Scotland.
It's focused our attention once again on the support that the founding principles of the NHS continue to enjoy across Scotland and given us the time to stand back from the daily business of operating a critically important and complex service to recognise the contribution that the people who work for the NHS have made to care, to research and to Scottish society more generally.
It's given us the chance to reflect on the fact that Scottish doctors strongly supported the development of the NHS from the very start, and to recognise the continuing importance of working with the clinical community to ensure that the service remains fit for the next 60 years.
Darzi Report
The past week has also seen the publication of High Quality Care for All, the report by Lord Darzi into the future of the health service in England. In some respects, the Darzi report echoes the vision that we set out in Better Health Better Care last December. For example, it shares our determination to ensure high quality care centred on the needs of patients, commits itself to an NHS that helps people to stay healthy rather than concentrating exclusively on the treatment of the sick; and recognises the need for empowering front life staff to lead the changes that will deliver improvements in quality.
However, there are some quite fundamental differences in the paths that Scotland and England have chosen for reform. As we stand 60 years from the launch of the service, there is - I think - a real battle of ideas going on between different parts of the UK about the future direction of healthcare. It is a battle between the values of the market, of internal competition and contestability on the one hand, and the values of public ownership, of cooperation and collaboration on the other.
In Scotland, we have set out our stall with absolute clarity. NHS Scotland is, and in my view always should be, a service that is publicly owned and delivered. Its unified structure embraces patients and the public as co-owners of the service rather than consumers in a competitive marketplace. The absence in Scotland of an internal market puts a focus instead on collaboration and co-operation. It is, of course, not for me to tell other parts of the UK how to organise their health services but I believe that our model is the best way of meeting our healthcare needs. Our outcomes - which are, after all, what matter to patients - also suggest that it works.
There is also a very strong opposition in Scotland to privatisation.
Apart from at the margins, there is no significant private sector delivery of NHS care in Scotland - and that is how the SNP government intends it to stay.
Indeed, a few years ago, a private hospital in Scotland was brought back into the NHS and is now a valued part of the service, helping in our efforts to reduce waiting times in a way that England has used the private sector to do.
The decision of the SNP government recently to fund the new £842 million Southern General hospital in Glasgow entirely from public capital also illustrates our move away from PFI.
I also want to acknowledge today the concern that many of you have about the commercialisation of General Practice that is being promoted elsewhere in the UK. While there is no appetite for this in Scotland, the state of the law as we inherited it does mean that it is a legal possibility. I can therefore confirm to you today that we will legislate to close that legal loophole. The Scottish Government is committed to an NHS rooted firmly in the public sector. It is important that we underpin that commitment in relation to General Practice and make clear the importance of primary care services being delivered from within the NHS family, including the traditional model of General Practice.
Better Health Better Care
Better Health, Better Care - our new national strategy for health in Scotland - sets out in detail our vision of a more mutual NHS.
A mutual NHS is one in which patients, the public and staff are seen as co-owners of the NHS, with the rights and responsibilities that go with that status.
The policies that will bring it to life are many and varied - the firm commitment to public service that I have just been talking about, pilot elections to NHS boards; a new Patients Rights Act; strengthened partnership working at local and national level, to name just a few.
Key Priorities
But of course, the key test of our approach lies in our ability to demonstrate that we can drive and sustain change. Just as we did 60 years ago, we need to take decisions and actions now that will stand the test of time.
The coming year is one in which I want to see us build for the future.
Health Improvement
We must keep up the incredible momentum we have already achieved on health improvement. To do that we're:
- Promoting the vision of a health improving health service in which every contact is regarded as an opportunity to promote health
- developing bold new proposals to tackle alcohol misuse, including the introduction of minimum retail pricing, raising the minimum purchase age to 21 for off sales and introducing a social responsibility fee for alcohol retailers
- and introducing a nationwide programme to immunise 12-year-old girls across Scotland to protect against Human Papilloma Virus
Health Inequalities
The Scottish Government is absolutely committed to a new national effort to tackle health inequalities. It is a real national disgrace that in the city I represent, male life expectancy in deprived areas is 10 years less than it is in Glasgow's more affluent suburbs. In equality is really unacceptable, but it also holds us back as a nation.We want to build on the publication of Equally Well, the report of the Ministerial Taskforce on health inequalities and seek to realise the benefits that can flow from greater investment in early years; improving mental health and wellbeing; tackling the big killer diseases; and combating the linked problems of drugs, alcohol and violence. It is a long term challenge - there will be few of the short term headlines that politicians like. But it is challenge we will not duck.
Quality of Care
Improving health and tackling inequalities are clear priorities for Scottish Government. But of course we also need to ensure that over the next 12 months we work together to improve the quality of healthcare in all its dimensions. Care that reflects the needs of patients, that is equitable, effective and efficient, that is delivered in a timely fashion with continuing improvements in waiting times as we deliver our target of an 18 weeks waiting time from GP referral to treatment by 2011.
Scotland is the first country in the world to have a national system-wide approach to safety and we need to build on the momentum, enthusiasm and commitment that have been generated by the Scottish Patient Safety Alliance. Leading the world in patient safety depends on the kind of collaborative and integrated approach that lies at the heart of a mutual NHS. The systematic application of key interventions requires us to reach out to international expertise and ensure effective multidisciplinary learning here at home. It means new behaviours, greater empowerment, more collaboration, more transparency and less defensiveness. It means a focus on improving the patient experience and making changes at the front line.
E Health
We also need to invest in the technology that underpins our service. Two weeks ago we launched our new e health strategy for Scotland which sets out the ways in which we intend to harness the opportunities of new technology to enhance patient care. It's a strategy that avoids the trap of putting all our eggs in the basket of a single, complex, centrally prescribed IT system and instead takes a pragmatic approach, building on what is already working well and making targeted investments that fill the gaps and ensure a joined up approach.
Amongst other things the strategy will, over the next three years, see us:
- Ensure the integration and interoperability of core systems
- Begin the development of a clinical portal with a single "sign on" to different sources of patient information
- And establish an e health fund to support improvements in primary and community settings that will enable us to modernise GP systems, support community services delivered by nurses, midwives and allied health professionals and support data sharing with partner agencies
Taken together, these actions will build the platform for an electronic patient record that will, in due course, support the patient and improve their experience of care throughout their journey.
Over the past 60 years, the NHS has secured its place at the heart of Scottish society. We have set out a hugely ambitious agenda to keep it there, striving for:
- A mutual NHS that promotes health and tackles inequality
- A mutual NHS that leads the world in patient safety
- A mutual NHS with the confidence and opportunity to invest in the future of its services
Above all, a mutual NHS that draws both the inspiration and the mechanisms for change from the people it serves and the people, such as those in the audience today, who work, day in and day out, to make it a success.
I would like to take this opportunity to thank the BMA for its continuing support in taking forward this agenda and wish you all a very successful meeting.