Hansard

This statement marks the publication of "Our National Health: A plan for action, a plan for change". It sets out a radical plan to improve the health of the people of Scotland and to rebuild and renew our national health service. It is not just another Government policy document: it represents a continuum of policy, but a step change in delivery. Its focus is on the practical, and our aim is to ensure that record investment delivers record results for the people of Scotland.

This Parliament was created not just to talk about problems, but to deliver solutions. Devolution was never intended as an end in itself, but as a means to deliver improvements in people's lives. That is what the health plan is about. "Our National Health" is the culmination of almost a year's work: a year of dialogue, discussions and debate; a year of listening and learning; a year of capturing strengths and identifying weaknesses.

We did not simply sit behind closed doors in St Andrew's House when developing this plan. We reached out; we consulted the public—patients, individuals and communities; we spoke to health care providers, including NHS staff, their representatives, voluntary organisations, local authorities and many others; and we listened to the views of members of this Parliament and of its Health and Community Care Committee. The actions and priorities that are set out in "Our National Health" reflect those views.

"Our National Health" seeks to provide a platform on which we can build a national effort to improve health and health care. Improving health comes first, and rightly so. It is time for Scotland to cease being a case study in ill health, and to become a showcase of good health. Tackling the root causes of ill health is at the heart of this Executive's agenda—not just in health itself but across all our work to achieve social justice in Scotland.

We will work together to close the health gap between rich and poor. Over this and the next three years, more than £100 million will be spent through our new national health improvement fund. Health boards and local authorities will work together to route that money to local communities, especially the poorest ones. There will be a major expansion of breakfast clubs, fruit in nursery schools, free toothpaste and toothbrushes to 100,000 Scottish children and better screening and immunisation. Those are just some of the ways in which that money is being put to work.

The Public Health Institute for Scotland has recently been established, and will start work in earnest early next year. Four major health demonstration projects, backed by £15 million, have been launched in the fields of children's health, sexual health and the prevention of cancer and of coronary heart disease.

Prevention is as important as cure. We want the NHS to be a truly national health service—not simply a national illness service—working together with local authorities, the voluntary sector, the public and private sectors and, crucially, individuals and communities to improve health.

Alongside our plans for improving health are those to improve the health service. The NHS is our nation's biggest and most important public service, and its creation in 1948 was a defining moment in our nation's history. Its architects—William Beveridge, a Liberal, and Nye Bevan, a Labour minister—left us a legacy of which we can be proud. It is a legacy upon which this Labour-Liberal Democrat coalition is determined to build. The founding principle of the NHS, that care be provided according to need, not ability to pay, holds good today, as it did more than 50 years ago.

There is much to be proud of in our NHS. Too often we forget that in the cut and thrust of political debate. It has skilled and committed staff, and offers leading-edge clinical practice and life-saving treatment and care, delivered every day throughout Scotland. In just one day in the NHS in Scotland more than 60,000 people will visit their general practitioner; community nurses will make more than 12,000 visits; 2,500 operations will be performed; and more than 24,000 out-patients will be seen. It is a formidable operation, one that we should be proud of.

In our research with patients across Scotland, time and again people told us how much they value the NHS. They do not see it just as a service, but as part of the fabric of our society. They told us that, in general, they were satisfied with the care and treatment that they received and they described many examples of good practice and high-quality care.

There were also concerns. People said that there were too many delays, too much fragmentation and too much waiting. Concerns that there was too little information and poor communication came up time and again. People felt that too often the NHS did things to them rather than with them. They wanted to be cared for as well as cured. They wanted to be rushed less and listened to more. They wanted more flexible access to services and to be able to make informed choices.

It was striking that our discussions with staff echoed many of those themes. They, too, wanted to put care back at the heart of the NHS, to be able to respond more effectively to the needs of their patients, and to be valued and listened to more. They, too, complained of fragmentation and the loss of identity of the service that they joined.

This plan acts on those concerns. Our aim is to champion what works, as well as to deal with what could work better. Investment is the key to delivering improvement. The NHS has suffered from decades of underfunding and short-termism. By any measure we have made a major start to turning that situation around.

We have committed record levels of spending for this year and each of the next three years. The health budget will rise from £4.9 billion in 1999-2000 to £6.7 billion in 2003-04. Next year, every health board will receive an increase of at least 5.5 per cent. Under the new fairer funding formula, which recognises the needs of deprived and rural areas, many parts of the country will receive much more. New hospitals and health centres are coming on stream. We are investing in technology and vital equipment. We are recruiting and training more staff.

However, more spending is only half the picture; we must spend better. Our aim is to ensure that resources reach front-line patient care, and that investment is matched by reform. Reducing bureaucracy and rooting out outmoded ways of working are equally important if our people are to get the treatment they need and deserve.

Reducing waiting is a priority. We will work to ensure that the patient's journey, from GP practice to out-patient clinic, and from hospital to home, is better, faster and more responsive. Our aim is for people to get the right care in the right place at the right time. Progress has already been made. In the past year, the number of one-stop clinics has doubled, giving patients better, faster diagnosis and treatment. More people are being treated—50,000 more operations were performed this year than last.

Much more still needs to be done. "Our National Health" sets out a radical programme to transform fundamentally the experience of patients. We will provide better, more comprehensive access to services through the introduction of round-the-clock telephone advice via the new NHS 24 helpline. We will accelerate the development of telemedicine and improve communications to speed up appointments, prescriptions and test results.

We want to work with staff to make the best use of the skills of all members of the health care team. We will roll out existing pilot schemes to develop new roles for our 1,100 community pharmacists, thereby improving access to advice and medication in our communities. We will extend the role of nurses in prescribing and will publish major new proposals on public health nursing, including the school nursing service. We will develop alternative contractual options to ensure that GP services are provided where they are needed, particularly in our poorer and more remote communities.

We will work to reduce the time that patients have to wait. Our target is to ensure that appointments are available within 48 hours with an appropriate member of the primary health care team. We will reduce waiting times for non-urgent in-patient care, and will ensure that, by 2003, no one will have to wait more than nine months, instead of the current maximum of 12 months.

The patients' voice must be strengthened, and £14 million will be made available over three years to improve communication, patient information and partnership working with individuals and communities. All clinical guidelines will be made available in a patient-friendly format, and the NHS complaints system will be reviewed and improved. Advocacy services will be expanded. Training for managers and staff to involve patients and communities more effectively will be introduced.

For most of us, most of the time, the NHS is simply a reassuring presence—it is there if we need it. However, we all need it most at the beginning of life and when we grow older. We will make children and older people a priority for the NHS in Scotland.

We will provide better support for parents—along with child health promotion initiatives and better health services for the very young—to give all our children a better start in life. Better and more joined-up community services for older people will be backed by increased investment. Those services will make a real difference, as they will help older people to stay at home longer and to get home from hospital more quickly and safely.

Coronary heart disease, cancer and mental health are the three agreed clinical priorities that have been identified for special action. There is sound knowledge of what needs to be done, in relation to both prevention and treatment and support for those already affected. The challenge is to ensure that such knowledge is applied systematically to reduce illness and improve patient care.

In 2001, we will publish a national strategy for reducing heart disease and, by 2002, access to diagnosis and treatment will meet strict new targets. Managed clinical networks will link local, regional and national services for heart disease. In 2001, a comprehensive Scottish cancer plan will be published and new investment will provide equipment for the diagnosis and treatment of cancer. To improve care in mental health, we will speed up the implementation of the framework for mental health and new investment will support the delivery of national standards of care across Scotland.

Key to our approach is the development of national standards that will be delivered locally. We will work to end the postcode lottery of care that grew up under the internal market. The market fragmented the system and demoralised staff. It has been abolished, but too many of its systems and practices remain. Patients and staff need stability and now is not the time to embark on more wholesale structural reform; however, it is the time to rewire the system to make the NHS work more effectively for patients and staff.

There is a range of views on the optimum number and configuration of NHS bodies in Scotland. However, any major structural change must be the product of full and considered discussion and debate. That will take years, not months, and will almost certainly require further statutory change. We will initiate a review next year to consider those matters and to allow people to participate fully in that debate. In the meantime, we will take immediate steps to streamline the bureaucracy of decision-making structures and to improve accountability. We have made changes already in the health department to achieve greater integration and improve performance. We will do the same locally.

In each health board area the separate board structure of NHS trusts and health boards will be replaced by a single unified NHS board that will be held to account for the performance of the whole local health system. The plethora of health improvement programmes and trust implementation plans will be replaced by a single local health plan. Stronger links will be forged with local authorities and the voice of staff and patients will be enhanced.

NHS trusts will remain and will retain their operational responsibility for the delivery of services, but they will do so with streamlined management arrangements and with a greatly reduced number of non-executive trustees.

A new performance management framework will be introduced, so that each unified NHS board is held to account for its actions against agreed national and local priorities. We will work to re-establish the identity of our national health service, rather than retain the proliferation of signs and logos that confuse patients and alienate staff.

This is not about centralisation; it is about rationalisation, integration and improvement. We want front-line staff to be empowered. We want decision making to be pushed to the local level as far as possible, while remaining within a framework of strong national clinical and service standards. It is unacceptable that good policies—the result of hard work and wide consultation, approved and supported at the national level—should fall down at the crucial stage of implementation in local communities.

We believe that we can and must rebuild the NHS as a truly national health service, delivering national policy to the same standards of excellence across the whole of Scotland, from our cities to our islands. NHS staff will be at the heart of our work. The public value NHS staff, and the NHS must do the same. Staff must be involved in decision making within the NHS, in accordance with the principles of partnership working that we have pioneered and driven forward in Scotland. In future, NHS boards will be assessed on their record as employers, and staff will be involved in that through their local partnership forums. We will continue to work with the other UK health departments to develop NHS pay modernisation, and we will continue to recruit and train more NHS staff and to plan effectively for the future.

Today I have set out the main themes in "Our National Health". In the time available, I could only touch on those themes. The plan does not seek to identify every issue and every action that is important, but it sets out a clear and unequivocal direction of travel: to build a national effort to improve health; to rebuild our national health service; and to put patients and staff at the heart of that effort. The publication of this document is a beginning, not an end. Over the months ahead, a programme of measures will drive forward its implementation. We will work to change culture and practice.

"Our National Health" is a plan for action. It is a people's plan. It is a Scottish plan. It is the right thing to do. Now we need to work together to make it happen.