Hansard

It is precisely because I am determined that the NHS should give the best possible service to elderly people—and all the people of Scotland—that I want us to make progress in developing in our hospitals and in our communities the patient-centred health service that the people of Scotland need.

The Executive is determined to do that. We want to build on the foundation that we inherited from the previous Labour Administration, which drew a line under the madness of the internal market, ended the inequity of GP fundholding and so began the process of healing the health service. No one should underestimate the damage that was done by the divisiveness of the internal market and by policies that put political ideology before the needs of patients.

We have begun the process of renewal, but I am determined that we will see it through to fruition. First, we must ensure that the NHS of the future is based truly on collaboration, not on competition. I want us to increase the pace of collaboration and partnership in the NHS in Scotland, not just between trust and health board or trust and trust, but between manager and clinician, doctor and nurse and carer and cleaner. There must be a new mobilisation of all the staff who deliver our NHS services.

Through the Scottish partnership forum, we have put that philosophy into practice. We have brought together NHS staff, trade unions, management and Government, not across the table, but around it. We have worked together to deliver real improvements: the first ever education, training and lifelong learning strategy for the NHS in Scotland, the soon-to-be-launched occupational health and safety strategy for NHS staff and other products of partnership working, such as the millennium pay deal and action to reduce junior doctors' working hours. Those are real improvements for NHS employees, which in turn deliver real improvements to NHS patients.

The partnership approach is now being developed at local level and, over the months ahead, I want to ensure that partnership working becomes a reality across the NHS in Scotland. There is no one better placed to help shape the future of the NHS than the people who work in it. I want them to be at the heart of the decision- making process.

Alongside that, I will be working to bring about a step change in the way in which the NHS—locally and nationally—communicates and engages with the wider public. The NHS belongs to the people of Scotland. They must feel that it does.

It will not be easy to achieve that change in culture. It will take years, not months, to make it happen, but happen it must. Local communities and local elected representatives have a right to know who takes decisions and why they are taken and must have the opportunity to contribute to the decision-making process.

The remote and faceless NHS boardroom of the internal market must become a thing of the past. Next month, I plan to meet all NHS board and trust chairmen to discuss with them how that change can be achieved. Over the coming months, I will be taking steps to attract a far wider pool of people into NHS boardrooms.

As a first step, I am writing to every MSP of every political hue to ask them to identify people in their local communities who could make a contribution in NHS boardrooms. That new sprit of openness, accountability and inclusion must extend to patients. A patient-centred NHS must be more than just a slogan—it must become a way of life.

That is why, in our programme for government, we committed ourselves to developing the patients project, which will aim fundamentally to change and improve the way in which the NHS communicates with patients through every stage in their journey: from GP surgery to out-patient clinic, from hospital to home. That work, which will draw widely on the views and experiences of patients themselves, will start in earnest early in the new year.

As well as keeping patients informed, we must work to reduce delays throughout the system. No single issue dominates my mailbag more than that. Such delays provoke a fear of the unknown: patients and their relatives wait and worry, not knowing what will happen next or when or where it will happen.

Our investment in a modern telecommunications system, linking up all GPs and hospitals in Scotland, will mean that, by 2002, patients will be able to leave their GP practice knowing when and where their out-patient appointment will be. Early next year, we will launch the first pilots of Scottish

NHS Direct, designed here in Scotland with the active participation of GPs and nurses. It will provide high-quality expert nursing advice via the telephone, 24 hours a day.

Our work does not end there. In our programme for government, we committed ourselves to set targets for speeding up treatment and shortening waiting times. Over the past few months, an expert support force has been working with the NHS across Scotland to explore how best we can do that.

Doctors, nurses and patients' representatives have told us that we have to tackle the inequalities in waiting times across Scotland, and that we have to address all the stages of a patient's journey through the NHS, not just one part of it. They have told us to redesign that journey so that it is not only faster but better planned, with realistic timetables that are met day in, day out, so that patients can have confidence that promises will be kept. I intend to heed their advice.

That is why I can announce today that, over the coming months, we will be working with the NHS to establish national maximum waiting times to be met by March 2001 in the key clinical priorities of heart disease, cancer and, for the first time, mental illness.

Much of that work will be achieved through the redesign of existing services. It can be done. We know that because, in many cases, it has been done. For example, the cataract redesign project in Ayrshire has resulted in the waiting time being reduced from 12 months to six weeks. Think of the difference that that makes for an elderly person waiting for a cataract operation. I want that approach to be rolled out across the country. That is why we will double the number of one-stop clinics and why we will work with NHS staff to support staff in the modernisation and redesign of services.

There will be a new alliance for patients, in which the Executive will work together with staff to deliver a new type of patient-centred care where services are made to fit people, not the other way about.

To achieve such changes and to deliver services in Scotland that can be the envy of the world, we must change the way in which the NHS delivers care. We must build on success, using innovative service design, our leading-edge work in clinical standards and our new approaches to multidisciplinary working. However, that process of modernisation and improvement also requires us to tear down some of the relics of the NHS of the past, including the outdated ways of working and, sometimes, the outdated buildings and shells that house them.

That will require hard decisions: a new way of

doing things; a new alliance of interests—an alliance for patients; a modernisation of people and priorities rather than just of technology and terrain. The NHS is not just about bricks and mortar—it is about the people who provide care and the quality of care that people receive, in hospital or increasingly in their community or home.

Fifty years ago, when most of our hospitals were built, they were the home of services because there was no other way of delivering them. Today, they are a hub for many services because so much more can now be delivered away from a hospital setting—in GP surgeries, community health centres and at home, with the support of health visitors and other community-based health care professionals.

Of course, we need new facilities. That is why there will be nearly £500 million of new hospital developments between now and 2002. That is why we are developing a new generation of walk-inwalk- out hospitals that harness new technologies and the benefits of day surgery.

Throughout Scotland, a process of reviewing local facilities is now taking place, to give people the best possible quality of care. That process will draw the blueprint of a new NHS. Our aim is to deliver local, convenient services wherever possible. It will be an NHS that will not shirk from the need to provide first-class treatment of the highest quality, because quality matters.

The reviews will propose changes to services. They will be changes for the better. Let me set another challenge to members.