In times of difficulty for our national health services, it is encouraging to see a positive approach being recognised, by a solution focused investigation. The Nuffield Trust is a health charity, and it is carrying out a survey of the NHS in all four of the devolved areas of the UK, Scotland, Northern Ireland, Wales and England. It is looking to find aspects of good practice and effective working in each of the areas which can be shared by the others. The eventual outcome should be that each area has learned from all of the others and improvements are enabled across the UK.
Scotland has been the first region to be looked at. While each region will have its individual strengths, it is encouraging, and refreshing, to see these strengths recognised, and how these might be shared with other areas.
Key Points of the report are:
- Scotland has a characteristic approach of building quality through the altruistic, professional motivation of frontline staff to improve quality in an ongoing way. Success is measured in clinically relevant achievements in safety and in effective treatment.
- A quality improvement focus has been central to the agenda of the service over many years. Because Scotland is a small country, a more personalised approach allows local initiatives to be tested, then rapidly rolled out where they are successful. A consistent national scrutiny by Heath Improvement Scotland has assisted in driving improvement and innovation forward.
- Particular achievements in this approach have been in reducing still birth frequency and delivering services in remote areas. Other regions of the uk could learn from this, where top-down initiatives in larger systems can often mean that they do not reach front line services. There is benefit in having one overall monitoring body to ensure that improvements in quality are promulgated and delivered consistently across the region.
- While Scotland faces unique problems of inequality in health outcomes and providing service in remote areas, innovative schemes have been introduced to overcome the problems. For example, they found schemes to specially support individual children in areas of deprivation, and a Link service to provide personalised support where needed.
- Scotland has used legislation to drive through organisational change, to ensure that health and social care integration becomes a reality. This is in its early years, but some progress has been made already, in setting up and running local partnerships and management boards.
- Scotland faces problems which the rest of the UK is struggling with. The demand for acute services, such as A&E, has posed challenges to shift care from a hospital basis to the community. Like other regions, Scotland is struggling with this in some areas.
- Another UK wide problem faced also in Scotland is the apparently relentless reduction in funding year on year. This affects and threatens many of the quality achievements made in Scotland since its devolution.
Overall the report makes rewarding reading in its details, and holds promise of the Nuffield Trust promoting quality across all four areas of the UK in promoting our national health.