Hansard

I am delighted to publish today our new action plan for health and well-being. "Better Health, Better Care" sets out a clear vision for the national health service in Scotland. It outlines the actions that we will take during this session to improve health, to tackle health inequalities and to enhance the quality of our health care services. "Better Health, Better Care" builds on the strong foundations of the NHS in Scotland. We will retain what is working well, but we are determined to add fresh impetus and new momentum to our efforts to improve health and to deliver health care that is truly patient centred.

Our action plan has at its heart a strong commitment to participation and involvement—to the participation of patients as partners in their own care and to the involvement of patients, the public and staff in the design and delivery of health care services in the future. The action plan has developed out of one of the most thorough and wide-reaching consultation processes ever seen in Scotland. More than 2,000 people took part in face-to-face discussions, and we received around 600 written responses. I am grateful that so many people and organisations took the time and trouble to give us their views, and I place on record today my thanks to all of them.

The consultation process demonstrated the passion of people in Scotland for the NHS. I brought to this job a firm belief that that passion should be viewed as a strength to be harnessed, as a powerful driver of change in the NHS, and not as an obstacle that NHS boards need to get round. My experience over the past few months has served only to reinforce that view—I have been impressed time and again by the commitment of patients, the public and staff to using their experiences to drive change and improvement in how services are delivered. I have also been left in no doubt that their voices must be heard and listened to even more.

Our action plan represents a new era for patient and public participation in our NHS, and it represents a step change in the power, influence and voice that the Scottish public will have in it. It recognises the public not just as consumers who have rights, but as owners of the NHS who have both rights and responsibilities. It represents a radical shift towards an NHS that is truly publicly owned.

The action plan sets out a clear vision of a mutual NHS, in which ownership and accountability are shared with the public and the staff who work in the NHS. That concept of mutuality does not mean a change in the financial or structural arrangements of NHS Scotland, but it does mean gathering the people of Scotland, the voluntary and community sectors, all our partner organisations and the staff of the national health service around the common purpose of building a healthier Scotland. That common purpose, which will be delivered through integrated care and co-operation, involves a genuinely collaborative approach to health care that builds on the founding values of the NHS but completely rejects the market-based model that is favoured elsewhere in the United Kingdom.

Over the next three years, we will take a number of steps towards a more mutual NHS in which patients, the public and staff are treated as partners in health and as co-owners of the national health service. We will launch a public consultation on the possible content of a patients' rights bill by May 2008. That will cover waiting time guarantees and the right of patients to be treated as partners in their own care.

We will produce proposals for independent scrutiny of major service change by April 2008, building on our experiences of the independent scrutiny panels that are already established and working well in Ayrshire and Arran NHS Board, Lanarkshire NHS Board and Greater Glasgow and Clyde NHS Board.

Following public consultation, we will by next summer introduce a local health care bill that will include proposals for direct elections to NHS boards. We will also develop a participation standard for all NHS boards to reflect the needs of our diverse population and we will by 2009 incorporate assessment against that standard into NHS Scotland's performance management system.

We will produce and distribute an annual ownership report to every household in Scotland. It will set out the rights and responsibilities of patients and their carers alongside information on how to access local services and raise issues or complaints.

The strategy is a step change. It will take time to fully embed that new mutual approach, but I believe that the steps that I am announcing today set us firmly on the right path.

I turn to the twin challenges of improving health and tackling health inequalities. Last month, the chief medical officer for Scotland published his annual report on the state of our nation's health. He accepted that our health is improving—it is—but that it is improving faster in the wealthiest sections of our society than it is in the poorest sections of our society. As a result, health inequalities are widening. This Government is clear that, in a country that is as rich as Scotland, those health inequalities are simply not acceptable, which is why we have made tackling health inequalities our top health priority.

The ministerial task force on health inequalities—led by Scotland's first-ever Minister for Public Health—will report to Cabinet by May 2008 on a range of cross-Government recommendations to tackle our most significant and widening health inequalities. The discussion around "Better Health, Better Care" has informed the work and the priorities of the task force and the action plan sets out some of the early measures that we will take to add real momentum to our shared national drive to improve the health of people who live in our most disadvantaged communities.

As I announced in Parliament last week, we will abolish prescription charges by April 2011 and, in so doing, remove a tax on ill health and a significant barrier to self-management of long-term conditions. We will develop new approaches to anticipatory care, building on the early success of the keep well programme, and we will introduce life begins health checks. We will roll out simple but effective interventions to promote good health in our acute hospitals and we will implement a systematic approach to assessing the impact of policies and strategies on health and health inequalities.

Crucially, we will ensure that the NHS uses its considerable influence as Scotland's largest employer to promote good health and to take the lead in getting people into work through innovative employment schemes that offer pre-employment training and first-destination work opportunities for people who are on benefits.

Of course, it is not the job of the NHS alone to improve health and tackle inequalities, but there is no doubt that it has a leading role to play. That is why the plan puts greater-than-ever emphasis on the unique contribution that the NHS can make, in working with its partners, to enable people to improve and sustain their health.

We recognise, of course, that health improvement requires a long-term effort. The full value of the work that we do now to support children might not become apparent until those children have become parents or grandparents. However, there is action that the NHS can take now to create the conditions in which people have the confidence, motivation and ability to make healthy choices. That is why we will invest an additional £3 million a year in new measures to prevent smoking and set a target for NHS boards to increase the number of people they support through smoking cessation services.

We will invest an additional £85 million over the next three years to tackle alcohol-related harm, with greater focus on changing behaviour through brief interventions delivered by general practitioners and other professionals in primary care. We will also invest a total of £94 million to allow NHS boards to increase drug treatment and rehabilitation services. We will invest an additional £11.5 million to tackle the rising tide of obesity in our country and set a new target for completion of programmes that support healthy weight management. In other words, we will focus the NHS on activity that has real and practical effects while leaving plenty of scope for boards and their highly professional staff to use their initiative and judgment to achieve the best outcomes.

We recognise that good health requires more than the absence of disease—it also requires good mental health. Scotland is rightly recognised internationally for some of its work around mental health legislation and services. However, we will do more to address stigma, prejudice and discrimination, particularly for people who have been diagnosed as suffering from psychosis. We will roll out the mental health first aid programme so that more key workers are mental health and well-being literate.

We will also do more to deliver better outcomes for people who suffer from depression by matching appropriate therapies to their specific needs. Although antidepressants will offer the most appropriate help for some people, for many more a range of other interventions will be more effective. That is why we will target NHS boards to reduce the annual increase in antidepressant prescribing to zero by 2009-10 and to reduce it by 10 per cent in the years thereafter.

We can make the biggest difference in the long term—and must do so—by giving our children the best possible start in life. Work that is emerging from around the world shows that the circumstances in which a child is brought into the world can have a major impact on physical and mental health. It is therefore critical that we give our children the best possible start by supporting good health choices and behaviours that will enable them to sustain good health throughout their lives. The key to that approach will be the development by autumn 2008 of a cross-Government early years strategy, which will provide the framework within which we will work with our partners to deliver effective early years support for children and young people.

The action plan also outlines a range of steps that we will take now to improve the life chances of our young people and to break the link between early-life adversity and adult disease. For example, we will focus intensive support on children who are identified as being particularly vulnerable; we will expect each NHS board to identify a lead maternity care professional to help mothers quit smoking and drinking during pregnancy; we will challenge boards to improve breastfeeding rates; we will extend entitlement to free school meals; we will increase nursing and other health care support in schools; and we will roll out a new schools-based preventive dental service and ensure that 80 per cent of all 3 to 5-year-olds are registered with a dentist by 2010-11.

We must make our health service better, more local and faster. First, let me acknowledge progress that has already been made. Waiting times are shorter and outcomes for patients are improving, so I pay tribute to the previous Administration for the part that it played in delivering that success. However, above all else, I want to pay tribute to everyone who works in our NHS because their hard work has delivered that success. We all owe them an enormous debt of gratitude.

The challenge now is to accelerate the pace of improvement on behalf of the patients and the public whom we serve. Better quality care has a number of dimensions: it must be patient centred, safe, effective, efficient, equitable, and timely. It must also be designed for the future as well as for the present. The challenges that we face—an ageing population, a rise in long-term conditions and growing inequalities—require us to further shift the balance of care towards community and anticipatory services that are effective. That means that we must develop primary care services that are more accessible and flexible.

During the consultation, we were told repeatedly by members of the public that improved access to primary care is important. The current contract for general practitioners defines their opening hours as being from 8 am to 6.30 pm, Monday to Friday. However, routine appointments are usually scheduled between 9 am and 5.30 pm, with very few GP practices offering early morning, evening or even lunch time appointments.

No-one expects GP services to be available 24 hours a day, seven days a week, but many patients—including those in some hard-to-reach groups—want to see, and would benefit from being able to see, a GP before or after work or at the weekend. That is why the Government will work with professional bodies, NHS boards and individual GP practices to provide a more accessible service that fits in with the lives of patients. That will involve more flexible access during existing contract hours as well as some extended-hours opening. We will use the framework of patient experience surveys to develop a robust evidence base that will support the drive towards improving access and patients' experience of care.

Another issue that is of concern to patients, certainly in some areas, is their inability to book appointments in advance, or with a GP or member of the primary care team of their choice. We will, therefore, work with the profession to secure guaranteed access within 48 hours to an appropriate member of the practice team, and to secure more flexible advance booking arrangements.

Of course, improving access to primary care should not be just about providing more of the same; we will develop innovative methods of accessing services, such as more effective use of telephone consultations and e-mail communication. We also intend to enhance the role of community pharmacies. Community pharmacies offer convenient access to primary care in high streets and other community settings. That is why, by March next year, we will establish pilot projects in five of our largest health board areas—Grampian, Greater Glasgow and Clyde, Lanarkshire, Lothian and Tayside—which will provide walk-in access to a range of primary care services via community pharmacies. Those pilots will be located at main commuter points, major shopping centres and inner-city areas. They will provide extended-hours walk-in access to a wide range of services, including nurse-led minor injury treatments, sexual health screening, simple diagnostic tests and some adult immunisations.

That ambitious package of improvements to our system of primary care—more flexible GP access, development of the keep well model of anticipatory care and easy walk-in access to a range of primary care services—will start to deliver the local and more preventive health service that we must develop for the future.

I now turn to the very important issue of patient safety. First, I assure the public that NHS Scotland is safe by any international standards. However, there is no room for complacency—as the report that NHS Quality Improvement Scotland published today reminds us. I want NHS Scotland to be a world leader in patient safety. The Scottish patient safety alliance has been established to achieve significant measurable improvements in patient outcomes through the implementation of specific evidence-based interventions. That work will ensure that robust quality improvement methodologies are implemented, and that we embed a culture of patient safety in all our NHS hospitals.

Of course, one of the key aspects of patient safety is our work to tackle hospital-acquired infections. The prevalence of infections in our hospitals and, indeed, in other health care settings is understandably a matter of considerable public concern and anxiety. That is why the Government will introduce a range of new measures to tackle health care associated infection and why we will invest more than £50 million to support their implementation through the HAI taskforce. Those measures will include the introduction of a national MRSA screening programme, tougher hospital cleaning standards and a more rigorous approach to hand hygiene.

I turn now to timeliness. The benefits of national waiting times for patients are very clear: earlier diagnosis leads to better outcomes, there is less unnecessary worry and upheaval and, of course, there is less postcode variation. Shorter waits benefit the NHS as well, because they reduce the need to manage complex queues and backlogs for treatment. That is why, by 2011, the Government will deliver a maximum wait of 18 weeks from GP referral to treatment. That target differs from previous waiting time targets because it does not focus on a single stage of care, but will instead apply to the whole patient journey. Achieving that ambitious target will demand new ways of working in the NHS. That is why, by spring 2008, we will publish a national framework for delivery of the 18-week target and why we will support its implementation with £270 million of new resources in the next three years. That commitment represents the biggest step change in waiting times in the history of NHS Scotland. It is no exaggeration to say that it will transform patients' experience.

I have been able to touch on just a few of the areas that are covered in "Better Health, Better Care". Its publication today will be followed by detailed guidance on implementation for the service and those who work in it.

Finally, I will touch on a central and important issue, which is how the Government will hold NHS boards to account, and how Parliament will hold me and the Government to account for delivery of our ambitious programme. "Better Health, Better Care" sets out new annual performance targets and measures for NHS boards in Scotland. It describes a framework that identifies and drives NHS Scotland's contribution to the Scottish Government's overall strategic objectives. It also links closely with the new accountability and performance arrangements that will apply to local government, and demonstrates a clear alignment between short-term operational targets and our longer-term direction of travel.

The new performance framework represents a better balance than we have had before in relation to the impact that the NHS can have on the health of the people of Scotland. It places much more emphasis on health improvement, mental health, efficiency and anticipatory care, and it reduces correspondingly the number of targets around waiting times. For the first time, it also includes targets on the unique contribution that NHS boards will make to our overall approach to health improvement; targets on our manifesto commitment to make dementia a national priority and achieve agreed improvements in early diagnosis and management of patients with dementia; targets on reduction of hospital admissions for patients with a primary diagnosis of chronic obstructive pulmonary disease, asthma, diabetes or coronary heart disease; and targets on delivery of clear milestones towards the 18-week whole journey waiting time.

In the next few months, all NHS boards will be expected to produce local delivery plans that show how they will meet, or make progress towards, those targets in the next year. Boards will track their progress against the plans and take action where necessary to bring performance back into line. The health directorates will manage boards' performance to ensure that planned levels of achievement are delivered. The performance management approach provides a sound basis for outcome agreements that are established jointly with other service delivery partners. It will also provide the basis on which I will report NHS Scotland's progress to the public and be held to account by Parliament.

The action plan is published at a significant time. As I have said before in the chamber, the NHS will celebrate its 60th birthday next year. That will be an occasion on which to reflect on what the NHS has achieved—it has achieved so much—and to ask questions about its future direction. With the action plan, we show how the NHS in Scotland will answer those questions. We have set out a plan for a national health service that is based on the values of collaboration and co-operation—not on the whims of the market. We affirm a unified structure in which decisions are made in the interests of the people whom we serve and not to meet the demands of internal competition. We describe a public service that is used by the public, paid for by the public and owned by the public.

"Better Health, Better Care" sets out a vision for a national health service that is true to its founding principles but which also has the confidence to extend those principles through a commitment to involving the public, patients and staff in shaping its future direction. It delivers a national health service for the Scottish nation—a truly Scottish health service. I hope that our action plan will have the whole-hearted support of all members.