More details of the Scottish government’s plans for NHS reform have been unveiled in a letter sent by the NHS Scotland Chief Executive to local health board leaders.

Clinicians will no longer be restricted to the NHS board area in which they are based, with acute care to be increasingly delivered within the community or remotely, according to the letter.

Instead, acute care in Scotland will be operated at a service level and delivered by a nationwide network of clinicians.

Specialist Centres of Excellence will also be set up in order to ‘attract and retain the best talent’ while encouraging more services to be delivered across traditional geographical boundaries.

‘Fragile’ services that are imminent risk of collapse because of an unsustainable workforce or service model, including vascular, oncology and diagnostics, will be the first focus.

Cancer leaders warned earlier this year that the oncology workforce is not moving in the right trajectory, with consultant vacancies in the north of Scotland providing especially difficult to fill.

The letter says a national Remote, Rural and Islands Group has been established to consider how struggling services in these areas can be made sustainable for the future.

In her letter, NHS Scotland Chief Executive and Director-General of Health and Social Care Caroline Lamb says the government will oversee a ‘step change’ in innovation and the use of digital technologies to drive through reform:

‘In delivering on the reform, we will drive new models of care, and improve productivity through innovation, technological advancements, and workforce models that directly respond to the challenges in our system.

‘In the future this may require structural changes, but the immediate focus must be transformation of services within the existing structure and maximising current assets; delivering a population-based approach to healthcare that crosses traditional boundaries and parameters.’

It comes as NHS boards across Scotland consider how best to cut services to deliver hundreds of millions in savings this financial year.

NHS Tayside has published draft ‘extreme’ scenarios that, if agreed, will see the end of local breast cancer screening, while almost 900 patients will go without their planned operation, as theatre capacity is realigned to neighbour board NHS Grampian.

The recent letter from the NHS Scotland chief executive says the government will encourage more collaboration between local boards, to support new models of care and commissioning of services that allow people to be treated closer to home.

In the longer term, the government says it is looking to ‘fundamentally change how the acute system is structured’, while driving down demand with more investment in prevention and early intervention.

This will include a reset of the relationship between Scots and their country’s health, through the development of a 10-year population plan.

Scotland’s Health and Social Care Secretary Neil Gray launched a programme of national engagement on his plans for NHS reform in June just before the parliament wound down for summer.

He told MSPs that input from the workforce, service leaders, royal colleges, the third sector and the public will all inform the changes.

The recent letter from Ms Lamb has also committed the government to use social media to build understanding and confidence among staff and the public as services undergo transformation.

More information on how NHS reform will be progressed is expected to be unveiled in a National Clinical Framework, which is thought to still be in development by the Scottish government.

Read more: Plain speaking and the NHS conversation; Workforce and public to inform NHS reform

 

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