Hansard

We face a number of challenges to our health and social care system including poor patterns of health, health inequalities, rapidly changing demography, high levels of preventable diseases and the tight fiscal conditions. Of course, the statement by the royal colleges clearly outlines the requirement for us to take that longer-term look and develop new models of care fit for the needs of the 21st century. That is something that I am absolutely determined to do, and the view of the royal colleges fully supports my own view that the status quo is not an option and that we need to start planning transformational change now.

That is why I have announced a national debate on how we might make greater strides to improve our health and social care by 2030. I want to give added focus to how we might tackle the country’s poor pattern of health and health inequalities and, in that respect, I was heartened by the degree of consensus in the debate on health inequalities that Duncan McNeil led on 26 March. That debate demonstrated that addressing population health and health inequalities, which is vital to our economic success, must involve a cross-sector approach; it cannot be tackled solely as a health issue or by the NHS alone.

As a result, I want the public debate to consider those wider issues. I want to explore how service users and providers can have joint responsibility for a healthier population and how healthcare services can be matched by individuals actively promoting their own health and wellbeing, and I also want the debate to consider more coherent cross-sector working on population health, with firmer links with, for example, housing, welfare and employability to support sustainable economic growth.

I want to reinforce the focus on quality in developing policy and service delivery options, but I want a genuine debate about how models of care can be tailored to individuals’ needs, with success measured by improved patient outcomes, not slavish adherence to processes.

I want to make more progress on shifting the balance from hospital care to primary care, to see more care and support provided at or near home where appropriate, and to blur the boundaries between primary and hospital care and between mental and physical healthcare.

We are already taking great strides. Our three-year general practitioner contract has provided much-needed financial stability and reduced bureaucracy. “Prescription for Excellence” charts a 10-year future for the pharmacy profession in Scotland, and the integration of health and social care has provided a rich landscape for new models of care to meet communities’ needs. More volume and more complexity are already being seen outside hospital settings, although often resources have not followed. Primary care services are therefore stretched and communities rightly have higher expectations.

I want to transform our approach to primary care to ensure that people see the right professionals more quickly. That is why we will create a new GP contract in Scotland from 2017 and why I have commissioned Sir Lewis Ritchie to review out-of-hours primary care. We need to redesign and modernise primary care in a collaborative and inclusive way, transform and invigorate the primary care workforce, create new roles, and involve communities in considering how best to ensure that the vast bulk of their healthcare continues to be delivered in the local community, but in a more effective way. I will therefore seek views from as wide a base as possible on new models of care, including those that might be delivered locally through cross-professional community hubs, with a shift to regional or national centres of expertise for some acute services that are founded on quality and focused on improved health outcomes.

I am very conscious that developing new models of care and creating new roles and opportunities will require carefully managed workforce changes and effective forward planning, not least because of the education and training pathways of the professions involved. I want to continue to enhance NHS Scotland’s reputation as an exemplar employer that is committed to supporting, developing and involving its workforce in line with the Government’s approach to fair work. Again, I pay tribute to the dedication, commitment and drive of all those who work in our health and social care systems.

The workforce must have a key input into the wider debate, and it is absolutely essential that the public also have a stronger voice in shaping the future. My officials and I have begun the process of engagement that I announced in January through regular and tailored meetings with the professional bodies. I met the BMA in February and again last week, and I have visited places across the country to seek views on the GP contract. I have had wide-ranging meetings to discuss the development of a national clinical strategy to underpin local, regional and national planning and to discuss new models of care, and I have had initial engagement through the usual partnership mechanisms with NHS staff representatives.

That has helped to shape the type of wider public debate that I will launch at the annual NHS Scotland event in Glasgow on 23 June, which will be followed on 25 June by the Health and Social Care Alliance Scotland citizens wellbeing assembly in Edinburgh. Those events will reach out to health and social care staff across Scotland, more than 500 individuals who are disabled or who live with long-term conditions, and more than 300 organisations that work with them. That will be the starting point for a wide range of national and local engagement activities.

The Government is also working with the Convention of Scottish Local Authorities, Healthcare Improvement Scotland, the Scottish health council and the Health and Social Care Alliance Scotland to develop a new framework to gather the collective knowledge, wisdom and views of people with real experience of health and social care and to ensure that their voice is heard and understood.

In addition, we will use media events, social media, digital platforms and existing stakeholder groups, networks and other mechanisms to take the conversation directly to communities and individuals. My ministerial colleagues and I will use portfolio events and travelling Cabinets to seek views and contributions to the debate. I will ask health boards to use local events to facilitate public discussion and to feed back to me, and I will, of course, liaise personally with the Health and Sport Committee and the Opposition parties. I will revert to Parliament as often as is required.