All four UK National Health Services face the same challenges of increasing demand, workforce shortages and tight finances. However, last year's Nuffield Trust report, 'Learning from Scotland's NHS', highlighted how health services north and south of the border have diverged significantly since devolution - in structure, financing and quality improvement.
The most fundamental difference is that Scotland has an integrated NHS, with hospital and community services run by area Health Boards which are working with local authorities to integrate health and social care.
In contrast, the 'healthcare market' approach in NHS England has fragmented the system, making it difficult for GP's, let alone patient, to navigate services.
While it was Labour who introduced private healthcare companies into the NHS, and saddled all UK Health Services with financially crippling Private Finance Initiatives (PFI), it was the Conservative-Liberal Democrat Coalition Government's Health and Social Care Act that forced healthcare contracts in England to be put out to tender between NHS and private providers.
The contracting and transitional costs of that market are estimated to waste £5-10 billion each year in administration, whilst the cherry-picking of straightforward cases, by some private providers, leaves the more difficult and expensive patients to the NHS. Trusts accrued debts of almost £2.5 billion by 2015/16 which has led to the closure of beds, A+E departments and even hospitals. That has caused a marked decline in Emergency Care - consistently lagging behind NHS Scotland's A+E performance. It has also lead to the rationing of common treatments, such as joint replacements and cataract surgery, but this response is shortsighted as it just makes elderly patients more dependent and in need of social care.
The SNP Scottish Government chooses to invest significantly more per head on health and social care because, in a comprehensive system, a pre-emptive approach is more cost effective. Free prescriptions ensure people take their medications and keep chronic conditions under control, while joint replacements and cataract surgery help older people to remain active. Free Personal Care allow the elderly to stay in their own homes, rather than end up in care homes or hospital.
The integrated nature of NHS Scotland has enabled a Scotland-wide approach to Quality Improvement and Patient Safety. The involvement of frontline staff in their design is the most distinctive aspect of Scottish healthcare improvement projects and has created a sense of buy-in among those delivering patient care, rather than being just a tick-box exercise.
Comprehensive guidelines were developed for common conditions, followed later by clinical performance targets for the most important treatment recommendations.
Extensive audit data has been collected and, in my own specialty of breast cancer, audit reports have been published since 2002. Sadly, clinical audit in England was cut back and a recent report from 'Breast Cancer Now' was unable to provide much detail on treatment. It is hoped the ned 'Getting it Right First Time' project will audit, then reduce, treatment variations across NHS England.
The internationally recognised Scottish Patient Safety Programme (SPSP) was established in 2008, making patient safety the core philosophy of NHS Scotland. In contrast, the 'market' approach in England has created an overwhelming financial imperative, which can overshadow clinical priorities as NHS Trusts compete for crucial contracts to survive. That was found to be at the heart of the Mid-Staffordshire Hospital disaster as staff concerns were ignored by managers focussed on achieving Foundation Trust status, rather than patient care.
The SPSP took many lessons from the airline industry, and I experienced this when a team approach to 'pre-flight checks' was introduced in operating theatres to reduce surgical errors. Despite dealing with older and more complex patients, Scottish Hospital Standardised Mortality has been reduced by approximately 25 per cent. The SPSP also seeks to reduce harm from complications which, as well as being better for patients, can reduce costs. One example is a 31 per cent drop in bed-sores since 2012 which could potentially save £2million - £5 million each year.
NHS England is currently undergoing yet another extensive reorganisation. That is an opportunity to abandon the costly healthcare market and develop an integrated public NHS, providing patient-centred care and focusing on quality and safety. As NHS England turns 70, the opportunity must not be missed!
Published in Politics First Magazine (September/October 2018 edition)
Transcribed with permission of the author.
Dr Philippa Whitford is the MP for Central Ayrshire and the SNP Spokesperson for Health.