Partnership for Care: Scotland's Health White Paper
CHAPTER SEVEN ORGANISING FOR REFORM
1. To support the development of integrated, decentralised healthcare services that meet the needs of individual patients and local communities, we need to remove unnecessary organisational and legal barriers. By devolving management authority to the front line, we will strengthen delivery by empowering NHS staff to plan and deliver improved healthcare services within a framework of clear strategic direction and rigorous performance management.
2. There are too many separate statutory NHSScotland organisations planning and providing health services. Often they work well together but sometimes they do not. This situation is confusing both for patients and staff and for the wider community. It reinforces institutional, professional and service delivery barriers and inhibits co-operation.
3. This needs to change. The public, patients and staff expect the NHS at local level to be a single organisation with a common set of aims and values and clear lines of accountability. We will therefore continue dissolving Trusts, as is already happening in Borders and Dumfries & Galloway, and we will legislate to remove the powers relating to NHS Trusts. We will require NHS Boards to bring forward proposals, by April 2004 at the latest, to dissolve the remaining Trusts. We will also place a duty on NHS Boards to implement decentralised approaches that devolve responsibility to frontline staff.
4. Proposals should minimise disruption for patients and staff. They should also support improved local service delivery and better performance by:
ensuring that patients' everyday experience of care drives the design and development of services;
supporting the development of Community Health Partnerships and building on the achievements of the Joint Future agenda in a way which engages with Community Planning partners;
devolving duties, responsibilities and decision-making powers to staff who are directly involved in delivering healthcare; and
supporting local leadership by delegating financial and management authority and encouraging locally responsive approaches to service provision.
5. NHS Boards must concentrate on strategic leadership and performance management across the entire local NHS system. This will require well-defined operating divisions, with specific delegated authority to act without constant reference to the Board, backed up by clear, formal schemes of accountability. The introduction of single NHS organisations in each area will strengthen corporate working and provide clear strategic direction but must not result in greater central control over operational matters.
6. We need to recognise the important role of managers in working with clinicians to enable service change and clinical reform. Managers will have a critical role to play: they need the freedom to deliver. With the disappearance of Trusts, leaders of operating divisions will develop cross-system leadership roles to integrate, redesign and improve patient-centred services. There must be devolution of real management authority to local level and, crucially, to clinical staff: decentralisation of decision-making must not stop at operating division level.
7. We will extend NHS Board membership to strengthen clinical expertise and ensure that service delivery in local communities has a strong voice at Board level. We will therefore take immediate steps to secure the appointment of a Medical Director and the Chair of the LHCC Professional Committee to each NHS Board: these new appointments will play a key role in the transition to Community Health Partnerships.
8. The new duty on NHS Boards to put in place devolved systems of decision-making carries with it a responsibility to ensure that local services are provided as efficiently and effectively as possible within the resources available. NHS Boards must put in place a framework of controls which enables risk to be assessed and managed, and swift action to be taken where services do not meet the high standards of quality set for NHSScotland. The Scottish Executive will maintain oversight of service delivery to ensure that national standards and priorities are met and will intervene if necessary in the event of failure by NHS Boards.
Shared Services
9. As well as providing integrated clinical services, we need to ensure our support services (including information management and technology, finance, procurement, estates and human resources) are aligned to clinical needs. This is currently inhibited by the legacy of the internal market, which means that there are currently around 50 semi-autonomous organisations providing a diversity of support services to NHSScotland.
10. We will consider the right size for transactional administrative processes and base our decisions on a robust business case. Our approach will be incremental, based on the Best Value principles of continuous improvement and evidence-based change. It will be focused on service benefits and the risks will be carefully managed. We want to free up the skills and experience of professionals to concentrate on activities that add real value to staff and patients. By streamlining aspects of our support services we will provide greater clarity for system users and a better focus for investment. It will also open up the possibility of much closer co-operation and links with our public sector partners in future, particularly as part of the Joint Future agenda.
11. A more corporate national approach to support services will not, however, require new central organisations. We will ensure that where we can achieve clear service benefits from a more
co-ordinated approach nationally, regionally or locally, then changes will be taken forward by joint stakeholder consortia, working in a new relationship with the Common Services Agency 26 for NHSScotland.
12. As a first step, we will:
consult with NHS Boards, trade unions and staff organisations and public sector partners, including the Convention of Scottish Local Authorities (CoSLA), on the possibility of closer co-operation in the provision of support services;
champion a new approach to strategic procurement by working with the six largest NHS Boards, which between them account for 50% of total NHSScotland procurement expenditure;
develop a national integrated human resource information system and an electronic staff record; and
work with the Property and Environment Forum 27 to co-ordinate the national estate strategy and clarify the respective roles of NHS Boards and the Forum.