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Our National Health: A plan for action, a plan for change

• this plan marks the start of a major change process for the NHS in Scotland.

Section 9: Working together

Improving our health and ending health inequalities as part of Government action to promote social justice are among the greatest challenges and prizes for Scotland. With devolution, we can take decisions close to the people they affect. With the massive extra resources now available for the NHS, we can speed up our work. The money is there. The commitment is there: in Government, in the NHS, in Local Authorities, in communities, in voluntary and other organisations and across Scotland.

This Plan marks the start of a major change process for the NHS in Scotland. The proposals set out here have been formulated following many months of involvement and consultation with key stakeholders both within and outwith the NHS. We will build on this inclusive process to take forward the proposals set out in the Plan. Our commitment will be turned into practical action in every part of the NHS in Scotland. Over the coming months, the Executive will work with key stakeholders to agree detailed actions to ensure the effective implementation of this Plan.

Roles

Many people and organisations will be involved in the work which lies ahead. Among them are:

• individuals, whose experience as patients and whose wider health is the ultimate test of our plans
• Ministers, who lead the drive for change, ensuring a sense of common purpose and direction, creating and maintaining dialogue at all levels, listening, and accounting to Parliament
• the Health Department, which will help Ministers set national policy frameworks, allocate resources, manage the performance of NHS Boards, identify and remove barriers to more effective working and create and maintain learning and good practice networks. Within the Health Department, the barrier between the former NHS Management Executive and the former Public Health Policy Unit has been removed as part of the work leading to this Plan
• the new local NHS Boards and their NHS Trusts, which will be responsible for the day-to-day planning and running of health services in their areas. They will draw up implementation plans to deliver many of the specific actions set out in this Plan. They will work with Local Authorities, voluntary organisations, independent providers and communities to ensure that they understand and respond to the needs of patients and communities
• Local Authorities, which will co-ordinate the work of Community Planning, to which Local Health Plans, prepared by NHS Boards, will contribute. They will work with the NHS to improve the health of their communities and deliver healthcare and other related services as well as articulating the views of their communities at NHS Board level. We want Local Authorities to be public health organisations in their own right, and we will help them develop that role
• healthcare professionals at all levels, who will form the front line in delivering health care to patients and communities. They will have a vital contribution to make to improving those services. We will help them develop their skills and knowledge and give them the scope to innovate
• independent providers, which will work with the NHS and others to provide some additional services as an integrated part of the NHS
• voluntary bodies which, in addition to providing a range of important services, will have a key role to ensure the views and needs of those who use services can influence change
• carers, who are vital partners in providing care for countless people, and who need the better information and support promised in the first Carers Strategy for Scotland
• individual volunteers, who will continue to provide direct support to complement the work of trained staff

Next steps

• early in 2001, we will publish detailed change programmes taking forward the proposals in this Plan

These will cover the following areas:

'Rebuilding our National Health Service': This will be taken forward over the next 12 months with the NHS and other stakeholders, to address:

• streamlining local decision making and the composition of local NHS Boards and NHS Trusts
• integrated national, regional and local planning
• revising financial arrangements
• a new performance and accountability framework for the NHS
• the complementary roles of the Scottish Executive Health Department and local NHS Boards.

Increasing public and patient involvement in the NHS: This will be taken forward with the NHS and other stakeholders to agree a firm programme of improvement by 31 March 2002 to address:

• community and public involvement in NHS planning and service modernisation
• modern consultation procedures for major service change
• improved communication with the public and patients
• improvements in the NHS complaints procedure
• the development of Diversity Frameworks to ensure the NHS meets the distinctive needs of people from minority and ethnic communities.

Developing mechanisms with the NHS to support major service change and modernisation: We will consult widely with key groups as this detailed programme for change is developed.

"WE ARE COMMITTED TO SUSTAINED INDIVIDUAL AND ORGANISATIONAL DEVELOPMENT AND WILL SUPPORT THIS ACTIVITY THROUGH CONTINUED INVESTMENT."

Supporting strategic change: delivering the Health Plan

Our success in delivering the change described in this Plan depends on individuals, teams and organisations in the NHS and elsewhere. They must be supported through formal development activities to enable them to deliver real improvements in health and health services.

We are committed to sustained individual and organisational development and will support this activity through continued investment.

A range of development activities is currently driven by a number of departments and agencies. These include:

• leadership development
• management development
• organisation development
• service redesign
• best practice.

To accelerate the pace of individual and organisational learning:

• we will establish the NHS

Centre for Change and Innovation which will provide a framework for these development programmes

If the implementation of this Plan is to achieve a step change in the modernisation of health services, it will require effective leadership at all levels. We are committed to identifying and developing individuals who have the personal qualities required to lead, motivate and enable others to achieve.

• we will launch the National Leadership Development Programme in March 2001

The challenge is one for all of us: for Scotland as a nation. Speaking to the NHS in Scotland Annual Conference on 28 June 1999, the Minister for Health said:

"Our success as an Executive -and as a Parliament - will be judged, as never before, not just on the policies that we develop - but on the way that policy is developed, and on the way it is delivered on the ground. As politicians, and as an Executive, we can lead that process and we will. But we need you - and people like you - to really make it work.

"I want to see us exploit the opportunities afforded to us by devolution. To use the powers and the processes of our new Parliament. To develop a modern NHS fit for the 21st century; to make a real impact on the health of the people of Scotland and to develop policies and to deliver services which meet - and are seen to meet - the needs of those they serve.

"I want to see us develop an NHS that cares as well as it cures. An NHS that informs as well as it operates. And an NHS that responds as well as it reacts.

"We must ensure that we improve the way the NHS talks to people.

"Yes, we need a high-tech NHS for the next century - and we are investing in that -but we must combine that with a 'human touch.

"Our new Parliament is about bringing Government closer to the people. That means that decision making on healthcare must be brought closer to the people too.

"The Parliament is about increasing openness and accountability. That approach must permeate through to every Health Board, NHS Trust and to other public bodies also.

"The Scottish Parliament will seek to break down traditional barriers in policy making and in implementation - but that must happen at a local level as well as at the centre.

Together, we will make it happen.

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