Health Service Forum South East

                                        A member of the Scottish Health Campaigns Network

Nicola Sturgeon MSP

Minister of Health & Wellbeing

7 November 2007

Dear Nicola,

Better Health, Better Care

We take this opportunity to congratulate the Minister on her determination to make the PFI system more open to public scrutiny and also to find a better way of financing public contracts.

Our comments on the consultation are listed below.

1. Improving Your Experience of Care:

Standards should be set by clinicians as well as bureaucrats (the present system of targets leads to panic measures and/or manipulation of figures to meet them, see also “Operational targets” under Ch. 2).

Scrutiny should involve “peer-review”, e.g. by recently-retired clinicians, linked to elected Boards, which must have a financial provision for members from the public.

Centralisation is “presumed against” but not discussed in detail: remember 70% of inpatients go into general services best provided in a DGH, and only 2-3% into trauma.  Lessons can be learned from the BECaD experience in Brent, Middlesex.

Transport has so far been overlooked, e.g. we estimate that the new hospital arrangements in South Glasgow will result in over 500,000 extra journeys of over 5 miles.  NHS should have real support from other agencies in public transport and road infrastructure.

2. Best Value

In the move from inpatient to community care, one of the key indicators should be re-admissions.  “Incentives” should be used with care if they are not to be abused.

Voluntary sector - use it, but ensure it is adequately managed and resourced (costs, training, support).

Contractual levers may be effective in optimising supplies of commercial products (drugs, equipment etc) but their use in services has a poor history:  NHS Boards no longer have the capacity to deal with highly professional private service suppliers (e.g. in contracts and compliance issues) - keep services in-house as far as possible.

“Operational targets” should be set in collaboration with staff - if they are seen to be imposed they will be fudged.

3. Taking Responsibility

Dentistry - a realistic NHS contract should be devised to retain dentists within the NHS.  They currently lose money on some treatments, and many areas are virtual dental deserts.

4. Tackling Health Inequalities

The NHS can only treat the symptoms of inequality.  The causes lie with other public services such as housing, social work, education, justice.  The “across government” approach of the task force sounds right, and should be supported/enforced at Cabinet level.

Communication campaigns are expensive and notoriously ineffective on their own (e.g. after years of costly advertising etc, smoking-related conditions only began to improve when legislation kicked in).

5. Anticipatory Care and Long Term Conditions

Voluntary sector - where it is effective, use it, but ensure it is adequately a) integrated in decision-making and b) resourced (especially in training and local management).

Community care services to the housebound are patchy and open to abuse by the system. Carers’ time management is often poorly planned or controlled.

Prescription charges inhibit good healthcare.  Most prescriptions are already exempt and charges on many of the rest deter those most in need from taking them up.

6. Best Possible Start - we support the measures.

7. Continuous Improvement in Healthcare

Waiting Time management is more effective without ASCs, but the onus should be on Board Management to meet targets by empowering clinical staff to do their job, rather than on clinicians who might be tempted to manipulate lists to look good.

Pre-screening for MRSA etc should be allied to a) isolation facilities and b) tighter cleaning and hygiene protocols.

GENERAL

New Technology - there is little mention of an effective IT system linking all levels of medical care yet protecting patient confidentiality.  This should be a priority.

Local Health Councils have gone, taking with them two important roles:

                        A) Complaints, which a patient must now progress direct with the NHS system or via the long-delayed IASS (CAB, which does not have full national coverage, and depends on volunteers - trained or not),

                        B) Nomination for recognition of NHS personnel who go ‘the extra mile’ for their patients.  This was an important morale booster.

Yours sincerely

Margaret Hinds

Chairman Margaret Hinds, 4 Meadowhill, Glasgow G77 6SX. 0141 639 4925

Vice Chairman Eric Canning, 30 Polnoon Street, Eaglesham Glasgow G76 0BG

President Dr Pat Lally, 2 Tanera Avenue, Glasgow G44 5BU. 0141 637 8586

Vice President Prof. Douglas McGregor, 33, Cartsbridge Rd, Glasgow G76 8DH

Secretary Louise Laing, 433 Kilmarnock Road, Glasgow G43 2NT. 0141 632 0172

Treasurer Dan McPhail, 1 Rockmount Av.,Thornliebank,Glasgow G46 7BU 0141 585 7879

Web site www.healthforumglasgow.org