Ministers in Scotland have promised to remobilise Scotland’s NHS to deliver 110 per cent of pre-pandemic levels of activity. But how to do this when recruitment and training is slow and the magic money tree’s branches are a wee bit bare?

Their answer appears to be to do what the NHS does, but better.

The vehicle for this is the new national Centre for Sustainable Delivery, described by Nicola Sturgeon as ‘crucial’ in the health service’s recovery from the pandemic.

Put simply, it will make sure that each of the country’s 14 regional health boards – with populations ranging from 22,000 (Orkney) to 1.1 million (Greater Glasgow and Clyde) – are singing off the same hymn sheet when it comes to the ‘3 Rs’ – ‘remobilise, recover and redesign’.

This is what government likes to call a ‘Once for Scotland’ approach – civil service speak for doing the same thing across the health service.

This would seem logical in a country of 5.4 million – around the size of Yorkshire, or twice that of Greater Manchester – but health boards continue to follow their own approaches in everything from hospital electronic prescribing systems to the reporting of Significant Adverse Event reviews.

The Centre will bring together national programmes for scheduled and unscheduled care, waiting times and best practice – and ensure health boards are implementing them. Existing work to modernise patient pathways has now been added to the Centre’s remit.

At least one face at the new CfSD will be familiar: Catherine Calderwood, the former chief medical officer for Scotland who stood down after The Sun revealed she had been visiting her second home during lockdown.

Over the summer, the Scottish government is to publish a recovery plan setting out how it will achieve that 10 per cent increase in overall NHS activity.

Unsurprisingly, achieving this had been questioned by some. Lewis Morrison of BMA Scotland told The Times: “…when I saw that announcement I think my reaction — and the reaction of most doctors — [was] ‘how can that be a serious proposal to be delivered within 12 months?’”

Already we are seeing the first of a new system of cancer diagnosis ‘one-stop shops’ and elective care centres.

Put simply, it will make sure that each of the country’s 14 regional health boards – with populations ranging from 22,000 (Orkney) to 1.1 million (Greater Glasgow and Clyde) – are singing off the same hymn sheet when it comes to the ‘3 Rs’ – ‘remobilise, recover and redesign’

It has been pointed out that new elective care ‘centres’ are really shorthand for concentrating care in bigger specialised units, while the fast-track diagnosis centres will be actually delivering from existing NHS services.

As Dr Morrison pointed out, finding the staff could easily end up in a scenario of “robbing Peter to pay Paul” by diverting specialists from one area to another.

Given the lack of a quick fix for staffing, the Scottish government sees innovation and service redesign as the answer. And there is no lack of expectation being borne on the shoulders of the CfSD. 

Ahead of the recent Scottish election, First Minister Nicola Sturgeon referred to the Centre as being “crucial to our efforts” to remobilise the NHS for the future, saying:

“… we know we cannot simply return to the way things worked before covid.

“We must reform and adapt how the NHS provides care – principally for the benefit of patients, but also to better reflect and take advantage of new technology and modern ways of working.”

‘Once for Scotland’ it seems is also ministerial shorthand for ‘do what we tell you to do’

Jann Gardner, chief executive of the NHS Golden Jubilee hospital complex, who heads up the CfSD, told healthandcare.scot in an interview that the Centre would ensure the whole population could access services “regardless of demographic or location”.

Ms Gardner avoided the question of whether boards that did not introduce changes would be penalised, stating “…recommendations will be provided on how to fully embed it into practice, with improvement expertise provided to health boards if required” - so it could be inferred that changes will simply be imposed.

“Boards will be supported to embed new pathways in a variety of ways depending on local need – this could be providing improvement expertise at a local level or funding clinical or administrative support to manage the transition.”

She added: “…CfSD aims to implement best practice through a ‘Once for Scotland’ approach to support the rapid rollout of new techniques, innovation, and safe, fast and efficient care pathways for Scotland’s patients.”

With NHS board chief executives expected to report back on progress in delivering all the national programmes and pathways developed by the CfSD, ultimately, this will be an organisation to deliver the policy ambitions of St Andrews House – reflecting the political importance the Scottish government places on NHS recovery.

‘Once for Scotland’ it seems is also ministerial shorthand for ‘do what we tell you to do’.

 

This article was originally published in the Health Service Journal.

Read more: New NHS infection-fighting body launches; Prosecutors probe hundreds of covid hospital deaths;  New safe care hub for Scotland’s health and care staff

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