Issue 12

THE FUTURE OF HEALTH IN SCOTLAND

By Theresa Fyffe, Director, Royal College of Nursing [RCN] Scotland

In 2015/16, Scotland’s total annual health budget is more than £12bn for the first time ever. Given that this represents around one-third of total spending by the Scottish Government, it will not be surprising if health spending is high on the agenda in the run-up to the elections next year.

You only have to listen to the news on the radio or TV to know that the NHS in Scotland is facing significant pressures, despite the budget breaking £12bn: demand for services is rising inexorably as a result of demographic changes, particularly the growing number of frail, older people who are living with two or more long-term conditions such as dementia, diabetes, heart and lung problems or arthritis; the costs of new drugs and new health technologies are soaring; and people’s expectations of are also rising. There were 4.6m outpatient attendances at consultant clinics in 2013/14. Last year, nearly 900,000 patients used their GP out of hours services. There are over 1.6m attendances at Scottish A&E departments each year. The number of items prescribed in the NHS has risen by 35% over 10 years, now taking up nearly £1.2bn of the £12bn health budget. The NHS is a very, very busy place.

To try to balance the books and address these issues, the Government has set out an ambitious 20:20 Vision, where health and social care services are integrated and people are enabled to live longer, healthier lives at home or in a homely setting. Yet progress has been slow, particularly in shifting resources from hospitals out to the community where they are needed, if this vision is to be realised.

The RCN Scotland been arguing for some time – given the mounting pressures facing the NHS – that we cannot continue to deliver services in the same way as we do now. At the start of the summer, we published a joint statement with the Academy of Medical Royal Colleges and Faculties in Scotland, warning that difficult decisions need to be taken, with the public, about how and where money is invested in health services, if the NHS is to be sustainable into the future. This was the first time that all the Royal Colleges in Scotland were speaking with one voice and emphasises the urgent need for action.

In our joint statement, we clearly showed that tinkering around the edges of our health service and simply putting more and more money into the current system is not the answer. In a demand-led service, we need to look at new models of care, to enable people – particularly the growing population of older people – to be supported to stay at home and self-manage their own care; we need to move away from always thinking about buildings and instead think about people and communities and how they can be helped to keep well.

To achieve this radical shift, there are a number of key areas of activity which we – along with all the other Royal Colleges in Scotland – believe will have greatest impact.

The first is a genuine public debate on change. The Government is currently undertaking what it’s calling a ‘National Conversation’ on creating a fairer Scotland. This is certainly a step in the right direction. But what we must do is ensure that all sections of society are able to have their voices heard and listened to and that the National Conversations genuinely influence the plethora of (often disjointed) review groups set up by Government, for example, on sustainability and seven-day services, primary care out-of-hours and unscheduled care.

Turning now to specific health-related activities, we believe that the current national approach to targets, while having initially delivered some real improvements, is now creating an unsustainable culture which often skews clinical priorities, wastes resources and focuses the energy of too many people in the health service on the wrong things. Surely we can do better than this? We need a new approach to targets, which is evidence-based and focuses on outcomes for patients and sustainable improvements across the health service, rather than simply measuring in- or outputs.

New ways of delivering care need to be developed which are fit for the future and will deliver the best care possible in an ever-more complex and demanding world. So, for example, we need to truly harness the benefits of technology, developing telehealth and telecare; we need more innovative ways of delivering services to the most vulnerable people in our society, ensuring that health and social care services are where and when they’re needed in our most deprived communities, rather than relying on ‘traditional’ health service delivery; and we need to make sure that all staff are enabled to work to the top of their skills and experience and are not held back by lack of training or support.

Without change now, we’re putting at risk the NHS in Scotland as we know it. It’s not just about finance – pouring more money into trying to deliver services in the same way to more and more people will not work. The NHS in Scotland employs over 160,000 staff, including 67,000 nursing and midwifery staff. That’s over 900 nurses and midwives on average in each Parliamentary constituency. In the run-up to the Scottish Parliament elections next year, we need a mature debate on the current pressures on our health services and the options available to put the NHS a more sustainable footing. This will be challenging, as the political parties seek our vote, but the time for talking and point scoring has passed – we need to act and work together, now.

Theresa Fyffe is Director of the Royal College of Nursing [RCN] Scotland

By Theresa Fyffe, Director, Royal College of Nursing [RCN] Scotland

Issue 12

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