Scottish Government

The Challenge for Health and Wellbeing

Introduction

We want to help people to sustain and improve their health, especially in disadvantaged communities, ensuring better, local and faster access to health care. We therefore need to work in a coordinated way across Government to adapt and reinforce our traditional values of care, community and public service to meet the challenges facing our country. This requires a health service that works together with its partners, places the patient at the heart of everything it does, integrates care, realises efficiencies and ensures the highest standards of quality and safety.

Building a Health Service Fit for the Future

In 2005 , Building a Health Service: Fit for the Future identified the challenges to health and wellbeing from an ageing population, persistent health inequalities and a growth in long term conditions. These factors are increasing demand for health and care services and changing the pattern of that demand, with a rise in emergency admissions and an increase in age related conditions such as dementia.

The report argued that the current model of healthcare, developed at a time when the main challenge had been to provide hospital based care for acute conditions, was not sustainable in the longer term. We needed a new and different response, formed against a background of rising public expectations, the potential of new technology to transform the quality and accessibility of services and pressures on our workforce as we compete to attract the best talent in a shrinking labour market.

The challenges described in the report continue to face us and many of the required responses remain the same. We must maintain the momentum envisaged in the report and shift the balance of care through the model described below:

New Challenges and Opportunities

Over the past few years new insights, evidence and experiences have emerged which also need to be considered as we discuss our action plan for the years ahead. In particular, we are now in a position to reflect:

• New insights into the contribution of drug misuse, chronic liver disease, suicide and violence to premature deaths amongst young men
• Emerging work from the Glasgow Centre for Population Health about the links between the social, psychological and biological causes of inequalities and the links between risks in early childhood and chronic disease in later life
• Public concern about the over centralisation of services, particularly in the provision of emergency care
• Learning from actions we have taken already to implement the new model of healthcare
• Rich information from patients and their carers about the way in which they would like services for people with long term conditions to be designed and delivered in future
• A mature focus on the need to prioritise patient safety across our service

Our Approach

By streamlining the Cabinet and focussing the Scottish Government on a small number of strategic objectives, we have created new opportunities for cross-cutting working, in which every portfolio is challenged to contribute to health and wellbeing wherever, whenever and however they can. By creating the first ever Minister for Public Health and expanding the health and wellbeing portfolio to include key determinants of health - such as sport, housing, regeneration, social and financial inclusion, homelessness, and poverty - we have laid the groundwork for a more radical and inclusive approach to achieving shared objectives.

In order to deliver our strategic vision we need to:

1. Improve our patients' experience ofcare, delivering care as locally as possible and ensuring that both they and their carers are involved in the design and delivery of the care they receive

2. Secure best value from our investment by maximising efficiency and productivity to ensure that our services are sustainable over the longer term

3. Encourage everyone to take responsibility for their own health and wellbeing and prevent health problems arising wherever possible

4. Focus on tackling health inequalities in everything we do

5. Work in partnership to provide anticipatory care and improve services for long term conditions

6. Invest in early intervention and prevention to give children the best possible start in life

7. Ensure continuous improvement in services, with a determined focus on patient safety

As well as building on past success, the new Government will introduce new policies to help meet the challenges we face, these include:

• Abolish prescription charges
• Introduce direct elections to NHS Boards
• Protect local access to healthcare through a presumption against the centralisation of hospital services
• Extend entitlement to free school meals
• Introduce waiting time guarantees appropriate to needs
• Improve access to dentistry

This document seeks to open discussion about our objectives and the best means to achieve them. It describes the building blocks of our approach and demonstrates our commitment to engagement and involvement in everything we do. It poses a series of questions to give you the chance to shape the action plan we will publish in December 2007. This will be a detailed plan, with a timetable for action for NHSScotland at national, regional and local level, as well as a series of commitments from our key delivery partners.