SNP focus: Health

Between SNP conference and the Scottish parliamentary election lies the small matter of winter, a time when, traditionally, strains on the health service come to the fore.
Last year, focus increasingly shone on the waiting time target for accident and emergency, which required health boards to see 98 per cent of patients within four hours. An interim target of 95 per cent was introduced.

Under pressure from Scottish Labour ,in February the Scottish Government began to publish the data from the country’s major A&E units weekly.
Last week 95.2 per cent of A&E patients were seen within the four-hour limit, but performance across the health boards varied wildly.

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Health Secretary Shona Robison greeted last week’s figures with a warning.

“Winter will continue to bring extra pressures that affect performance, but the NHS has appropriate plans and processes in place to allow a prompt recovery.

“This year we have put in place further measures to help our NHS cope with winter. Our winter guidance for boards was issued two months earlier this year compared to previous years, and additional investment of £10.7 million will help ease pressure.”

Whatever the preparations, with such focused scrutiny on this one target, the SNP may be worried a cold winter could see a chilling of voters’ trust in their record on the health service.
And apart from A&E, the NHS in Scotland is showing other signs of strain. Over 400 operations are cancelled a month for non-clinical reasons such as capacity issues.

Dr Richard Simpson, Scottish Labour’s Public Services Spokesperson, said: “We know the winter brings added pressure to our hospitals, especially A&E wards. If our hospitals do not have the capacity to carry out every planned operation now then it will likely be worse in winter.”

Against other targets, too, the NHS is under strain. The 12-week treatment time statutory guarantee, introduced by the Patient Rights (Scotland) Act 2011, has proved self-defeating, having been broken about 5,000 times, and with no sanctions laid out in the legislation.

In the summer, Royal College of Nursing Scotland director Theresa Fyffe called for a review of NHS targets.

“Targets are all well and good and have delivered some real improvements, but many of these targets, we believe, are now creating an unsustainable culture which often skews clinical priorities, wastes resources and focuses the energy of too many people in the health service on the wrong things,” she said.

Indeed, Holyrood’s Health and Sport Committee has published a report questioning the practical effects of the annual HEAT (health improvement, efficiency and governance, access and treatment) targets which measure individual health boards’ performance in key areas. In evidence, the committee heard how health boards would focus spending on those areas where they were a few percentage points below the target.

Labour Convener Duncan McNeil MSP said the committee had been scrutinising the £9m budget given to the health boards.  

“The use of targets in the NHS has long been controversial. Whilst there clearly needs to be some measurement of output and delivery, our committee has questioned if meeting that final percentage of performance targets is really the best use of public money.

“Given there is no way to measure the amount of investment that goes into this, we are calling for the Government to consider whether there should be flexibility in the targets to ensure any investment goes towards actual improvements in the quality of care.” 

In its report, the committee agreed with NHS chief executive Paul Gray, who told them: “If the expenditure to reach the last fraction of a target is proportionately excessive and does not deliver clinical benefit, that may be something we should look at.”

The redistribution of funds to the sharp end of acute care is, of course, the opposite of what is intended for the future of the health service.

The new GP contract currently under negotiation promises “radical changes” to the way primary care is delivered, according to Health Secretary Shona Robison. Work on dismantling the overly bureaucratic Quality and Outcomes Framework system of funding general practice has already begun in consultation with the BMA, she told doctors recently.

And the integration of health and social care services has been legislated for by last year’s Public Bodies (Joint Working) Bill.

Most parts of Scotland have opted for integrated joint boards containing both council and health board representatives, as opposed to the Highland ‘lead agency’ model. The integrated bodies will manage almost £8bn of health and social care resources, including those associated with over 96 per cent of delayed discharge.

Progress towards integration appears to be inconsistent across the country, however. The Health and Sport Committee heard some boards had found the shift in investment to the community “complex” when there was increasing demand on acute services.

In Orkney and Shetland, planned resources have been split almost equally between the health board and local authority, while in all other areas, the NHS board has allocated more funds than the local authority to the integrated joint board (IJB).

Bob Doris, deputy convener of the Health and Sport Committee, said: “Clearly the integration of health and social care is a process that is only just beginning but if we get it right it will unlock huge benefits for the delivery of care.  

“This is why as part of this process we’ve asked the Scottish Government to consider if the variation between boards in the level of resource transferred to integrated joint boards is reasonable. This will be critical to the operation of these boards going forward.” 

The first full year of operation for the IJBs will be next year, and will coincide with the next parliamentary session. The benefits or repercussions from the various approaches will fall on the next Scottish government’s shoulders.

Meanwhile among those already providing care in communities are Scotland’s carers, who have big hopes for the current Carers Bill.

First Minister Nicola Sturgeon told the recent Carers’ Parliament at Murrayfield the Government is committed to prevention.

“We know that caring responsibilities can cause or exacerbate mental stress and physical illness. By enabling people to ask for a support plan as soon as they become a carer, the bill will help them to get support before that happens. We can reduce the need to deal with crisis situations such as serious illness,” she said.

Sturgeon also told the assembly the bill will be amended to enshrine emergency planning – for when carers are unexpectedly unavailable – in the care plan process. This move was welcomed by Ian Welsh, Health and Social Care Alliance chief executive, who said it would give them peace of mind.

“Effective emergency planning has the potential to provide peace of mind for the many thousands of carers across Scotland about what will happen if they are no longer able to care,” he said.
Like carers, the NHS itself could do with some of that peace of mind.