The Scottish Government

Future of Scotland's Health

First Minister Jack McConnell made a major speech on the Executive's health policy at Ninewells Hospital in Dundee on Tuesday, February 11, 2003.

Full text.

Ninewells is a hospital where the dedication and skill of everyone who works here makes a difference to the lives of patients and their families - every day.

And it is a hospital where the skill and determination of its staff - working alongside partners in the medical schools and research institutions, in primary care, in the community, in local authorities and with the local voluntary sector - removing the barriers to good health, and eradicating disease. Not only in Scotland - but for people across the world.

Can I thank Peter Bates and his Health Board colleagues for their help in making my visit possible.

Much more importantly, I want to thank them for the hard work they have put in to work alongside their health colleagues and community partners to tackle problems and drive up standards of care across Tayside. You have made a difference and there are lessons here for public services elsewhere in Scotland.

Fifty-five years ago we created the National Health Service. At that time Aneurin Bevan expected that demand would decline as the Service made its impact felt on the nation's health.

But advances in medical research and treatment have opened up the realistic possibilities of tackling disease and ill health on a scale unimaginable then. These advances keep more of us alive and for longer - creating new demands on health care provision.

But more than that, as citizens we have failed to take real responsibility for our own health.

Despite medical advances, despite the care and treatment available from a national health service - in Scotland we still have some of the worst health statistics in Europe. Statistics that show that we are still suffering and dying from the key killer diseases of cancer, heart disease and stroke. Statistics that show that our younger generations lead worryingly unhealthy lives.

It is our recognition of that which has lead to the renewed focus on health improvement - tackling Scotland's national health alongside our drive to improve our national health service.

Our health improvement campaign will not provide any kind of quick fix. We will not see overnight changes in eating habits or exercise.

And government on its own - no matter how many campaigns we run - will not deliver the changes needed.

Only you and I can do that. It is the right thing to do and we will commit long-term to the promotion of healthy eating and regular physical exercise.

But improving our health service is not onlyabout medical or social care - whether we find that in the GP surgery or the hospital or the community. It is also about improving the standards of social care, bringing services to where people are so that they can live more of their lives in their own homes or near to their families.

Reducing the number of people in hospital beds, caring for them in the community, or in local health facilities. Not just lengthening life - but improving the quality of life.

And we will continue to drive up national standards in cleanliness, workforce planning and patient care. We will continue to improve inspection and audit and invest in staff wages and conditions.

All of these areas - taking responsibility for the future health of Scotland, addressing the serious issues around quality of life and social care - all are vitally important. And we will continue to take national action for our National Health Service.

But, today I want to concentrate my remarks on acute and primary care.

In 1999, responsibility for Scotland's health service was devolved to the new Scottish Parliament. We have had some important successes in that time.

• Death rates from our key killer diseases, including cancer, heart and stroke have fallen - including a 25% drop in deaths from coronary heart disease

• We have delivered the largest ever hospital building programme - and upgraded GP surgeries, A&E facilities and local health centres

• We have targeted initiatives and investment to bring the facilities of the HCI hospital in Clydebank into NHS Scotland to tackle orthopaedic demand
• Our cancer strategy, backed by investment is making real inroads in our fight against this disease
• We have seen a four fold increase in the number of single visit centres where you receive a speedy consultation, tests, results, diagnosis and if appropriate, treatment - all in a single visit
• And, step by step, we are investing in the wages, career structures, training and conditions of the 136,000 people who work in our National Health Service

So we have made progress - but not enough and not fast enough.

Our health budget here in Scotland has increased in the 4 short years since devolution from 4.6 billion (1998/99) to 6.7 billion (2002/03). More than ever before, with real achievements delivered as a result.

But we all know that there is much more still to do.

That is why the UK government will increase National Insurance by 1 per cent in April - to fund a step change in health spending by 2007.

That investment is much needed and it starts to happen in just two months from now.

Scottish taxpayers and patients in our health service will rightly expect to see real change and real improvement. We need to meet their expectations.

We need reform to match investment - but we need reform to go with the grain of Scotland.

To put patients first we need to streamline management, cut out bureaucracy and support frontline health staff.

So I believe that it is time to change the structures inside the NHS nationally and locally. Not to disrupt the service, but to clarify responsibility and cut out unnecessary tiers of bureaucracy which do not drive up standards or improve quality. We must bring the decision-making closer to the patient and there must be no buck- passing in the face of poor performance.

I want to give primary care - local GPs and the health care staff who work with them - a stronger role. Responsibility in the redesigning of services and decisions on the best use of resources.

Malcolm Chisholm will bring forward proposals soon to streamline management and devolve decision making and budgets to local hospitals and local health care units.

Structures are important because they can be barriers to integrated care, to devolved decision making and to effective service delivery.

But patients are, and must be, at the centre of our ambitions.

On waiting times, we will honour our guarantees. What matters most is that those in pain or distress are treated within a reasonable time. Step by step, we are bringing down the longest waits for the key surgical procedures.

So our guarantee will make sure that you will get the operation you need. NHS paid for care, whether from the health service or the private sector, in Scotland or elsewhere in the UK, or Europe. You will get the operation you need - and you will get it on time.

Let me spell out the next steps.

From next month in cardiac surgery no one will wait more than 6 months from the point of diagnosis to surgery. And from 2004, we will extend that guarantee to 18 weeks or less from diagnosis to surgery.

For everyone with a nine month waiting target for surgery, we will turn that into a guarantee by December 2003.

And as we bring in the additional staff we need to build capacity into the service, we will systematically asses the situation for each specialism and incrementally reduce that nine month guarantee to six months for all by 2005 or earlier.

So we will deliver not just targets, but a real guarantee. Not a promise before an election, but a fundamental right for the future.

Making the money work for the patient, delivering what is required.

Now I know from my post-bag, my constituency surgery and my day to day experience that this is only part of the story.

In many cases the real delay is in the wait for that first outpatient appointment. The focus on both lower waiting lists by March 2002 and now lower waiting times, has led to delayed action on outpatient waiting.

That has to change.

Malcolm Chisholm and I agreed last year that it was time to address the delay in outpatient waiting and the real distress it causes. He instructed the new Centre for Change and Innovation to give priority to tackling this area, where action in Scotland is long overdue.

It was time to act - and today I can confirm that action is underway.

We have begun a major piece of work to shorten waiting times, increase patient choice and improve access to clinics.

The work is lead by the clinicians and staff themselves. It is they who will identify the solutions we need to bring down waiting times - using new technology to improve the booking system, better management of lists and more flexible use of professional staff to deliver treatment.

The result of their efforts will be published in the coming weeks and all Health Boards across Scotland will be required to implement their recommendations.For outpatients, we will take the following steps.

• We will accelerate by one year, the current target of 26 weeks for an outpatient consultation - to reach that 26 week target by 2005.

• And we will introduce a better and more accurate system of recording and monitoring the number of people waiting for an outpatient appointment to support this.

These are minimum targets and we will monitor and publicly report progress on each. And we will bring them down, one by one, as we build additional capacity and expertise into our health service.

These are three realistic and practical steps to put outpatients higher in our priorities than they have been until now.

I believe we face two major challenges which should guide our drive to improve Scotland's NHS.

• We need to deliver all services as near to where people live as is clinically appropriate

• And we need to deliver services quickly - not because that is more convenient or makes good headlines. But because the right diagnosis, treatment and care delivered quickly and well, improves lives and very often, saves lives.

This focus on what the patient needs lies at the heart of the White Paper we will publish in the coming weeks.

Take the patient who goes to the optician for a routine eye test and is told that they may be developing cataract problems. The optician has to write to the GP. The person has to go and see the GP. The GP has to write to the consultant and the person has to wait for the appointment to see the consultant. All of that to confirm what the optician spotted weeks before - and we still haven't got to the discussion on treatment yet.

Now I accept that this may be too simplistic a characterisation of the situation. But it is one that too many patients - and many health service staff will recognise as accurate.

We need a health service which across the country streamlines this process - takes the patient from diagnosis to treatment faster and more effectively. A system that makes best use of technology to move the information faster and move the patient around less.

In Lothians, Glasgow and here in Tayside we've taken the first steps for new diagnostic and treatment centres at a local level. These will speed up the patient's journey, bring down waiting times and deliver better health care. We are determined to see these facilities develop right across Scotland and I expect Health Boards to make them a priority.

Fifty-five years ago the National Health Service was created around three founding principles.

Universal in reach - available to anyone who wanted to use it.

High quality in provision - applying the latest knowledge and the highest professional standards.

Available on the basis of need, without regard for ability to pay.

I am as committed today to those founding principles as a generation of British people were to the NHS when it began in 1948.

But we are building a health service for this new century and it must be a health service that takes those principles and applies them to the demands that we face today.

Comprehensive in principle - but dynamic, flexible, individual and creative in its application. Delivering choice as well as clinical expertise - meeting the challenges of our modern society.

• A health service where the speed and the quality of your care will not depend on where you live or how much you can pay.

• A health service where, as a patient, you are involved and consulted about your treatment.

• A service where safety, cleanliness and quality are paramount.

• Where you are treated promptly and professionally and as close to your home and your family as your clinical needs permit.

• It will be a health service where staff can focus on using their professional skills - not on filling out forms or following a regime they had no part in designing.

• A health service where everyone who works in it, is consulted and valued and allowed to get on with the job they are trained to do. And where technology and management supports them to do that.

That health service is more than good facilities and buildings, more even than high professional standards.

That health service is founded on treating all those who use it and work for it as individuals and involving them in designing the service to meet their particular needs.

Yes, we need investment for to build that health service - but we also need reform.

Reform to:

• provide the right care to patients at the right time and in the right place
• increase patient choice
• break down old, traditional, professional barriers and maximise the skills of all clinical staff
• use the latest technology to increase accessibility and improve the quality of care
• and reform to put decision making in the hands of those best placed to take the decisions.

Investment and reform; both are needed. They go hand in hand because we have the potential to break new boundaries, improve and extend lives, make a real difference.

That is a very exciting challenge, and together I know we can do it.