Meeting of the Parliament 02 November 2016
I agree with John Scott that missed appointments are a challenge that we need to address. Boards are looking at ways of addressing that challenge through text messages, through follow-up and through reminders. I do not think that the answer is to charge people for missed appointments—which is what the Tories are proposing—because that would just compound health inequalities in our society.
I hope that I have managed to lay out the intense level of activity that we are undertaking to meet our aspirations on the 2020 vision. We have to move at pace, so for that reason, by the end of this year and as recommended by Audit Scotland, I will present a transformational change delivery plan to deliver that vision, which will bring the various elements together in a single framework.
The Audit Scotland report confirms that our strategy is the right one. We need to work together across Parliament and with our colleagues in health boards, local government and the workforce to progress it, to ensure public confidence in it, and to make it happen at pace on the ground. It is the right plan, and no one and no party in Parliament has come forward with a different plan. I have looked at the Tory plan—it is mainly our plan with a few small additions. I suppose that imitation is the best form of flattery, so I thank them. I hope that we will get the backing of Parliament for the plan’s implementation.
We know that simply doing more of the same things yet faster will not deliver the standards of care to which people in Scotland should have access. We also need to ensure that the mechanisms that we use to measure performance keep pace with our wider reforms and our commitment to improvement. To do that, we have put in place a review of targets and indicators for health and social care. The review will ensure that targets and performance indicators lead to the best outcomes for people who are being cared for—whether that is in hospital, primary care, community care or social care services. I am delighted that Sir Harry Burns has agreed to bring his expertise to the role of independent chair of the review. I am sure that members will offer support for Sir Harry in the review, along with support from the different sectors and professional bodies that provide care.
The Government is serious about ensuring that people are supported to maintain their independence as long as possible in their own homes and communities, and about ensuring that fewer people need to go to hospital to receive care. Where hospital care is necessary and appropriate, people should spend less time there and should return home more quickly. I am pleased that delayed discharge has reduced under this Government, and I remain committed to eradicating it by continuing to invest in preventative and rehabilitative services. We know what works. If all partnerships were delivering the reductions in delay that have been achieved by the top 25 per cent, we would immediately halve all delays. We will work with partnerships to help them to deliver change to reduce delays.
In her manifesto, the First Minister outlined the SNP’s continued commitment to the six essential actions for accident and emergency, which were launched a year and a half ago and have led to significant improvement in unscheduled care. The actions comprise a home-grown programme to improve whole-system emergency care, based on clinical feedback. The programme was produced jointly with Academy of Royal Colleges and the Royal College of Emergency Medicine. It is no coincidence that Scotland’s core A and E departments have been the best performing in the United Kingdom for the past 18 months. That is a credit to all involved. However, despite those improvements, we absolutely recognise the challenges and are facing up to them. We accept that although we have a huge amount of work still to do, there is a general consensus nationally, locally and among representative bodies about enhancing the patient experience and ensuring optimal care, and there is enthusiasm in that regard.
Audit Scotland recognises the need to make a real shift from relying on treating people in hospital to providing care in the community and in primary settings, as well as in the home. We agree, which is why we are increasing the share of the NHS budget that is dedicated to mental health and to primary, community and social care. The First Minister has announced an additional £500 million to be invested in primary care, which will help to further shift the balance of care. That means that, for the first time ever, at least half of front-line NHS spending is being invested outwith acute hospitals.