NES NES/16/21 Item 8a (Enclosure) March 2016 NHS Education for Scotland BoardPaper Summary 1. Title of Paper Strategic Developments in NHSScotland - Consideration of recent publications of strategic importance: The National Clinical Strategy; the Chief Medical Officers Annual Report, ‘Realistic Medicine’; and the Review of Public Health in Scotland. 2. Author(s) of Paper Caroline Lamb, Chief Executive 3. Purpose of Paper To allow the Board an opportunity to consider and discuss the implications of these reports. 4. Key Issues The last 6 weeks have seen the publication of three documents which are of strategic importance for NHS Scotland. These are: The National Clinical Strategy – Launched in February 2016, this strategy highlights the significant changes in Scotland’s population and in the needs and demands placed on our health and social care services. It makes proposals for how clinical services need to change in order to provide sustainable health and social care services fit for the future. The Chief Medical Officers (CMO) Annual Report – ‘Realistic Medicine’, published in January 2016, sets out to begin a discussion on some of the fundamental principles of how medicine is practiced today and how doctors can be hugely influential in improving care. The Review of Public Health in Scotland – Also published in February 2016 this report draws attention to the complex and persistent public health challenges and makes a number of recommendations in relation to achieving a more strategic and coherent approach to public health. 5. Educational Implications All these publications have important strategic implications for the future shape and direction of NHS Scotland. The National Clinical Strategy, along with the Review of Public Health and the Health and Social Care agenda are being described as the major ‘game changers’ in relation to moving to a different vision of the delivery of health and social care. 1 6. Financial Implications None yet quantified for NES 7. Which of the 9 Strategic Outcome(s) does this align to? This paper is presented to allow the Board an opportunity to discuss important developments in the strategic context in which we work. 8. Impact on the Quality Ambitions The publications highlighted in this report are designed to deliver on all of the quality ambitions 9. Key Risks and Proposals to Mitigate the Risks It is important that the Board maintain an awareness of developments in this areas so that we can ensure an appropriate strategic response. 10. Equality and Diversity These publications have a strong focus on reducing inequalities. 11. Communications Plan These are Scottish Government publications and communications have been handled accordingly 12. Recommendation(s) for Decision The Board is recommended to consider and comment on these publications. NES March 2016 CSL 2 A NATIONAL CLINICAL STRATEGY FOR SCOTLAND The Scottish Government February 2016 A NATIONAL CLINICAL STRATEGY FOR SCOTLAND CONTENTS 02 Foreword 04 Preface 06 1. Executive Summary 14 2. Introduction: Why do we need to change? 16 a. Demographic changes in our population 19 b. The changing patterns of illness and disability 23 c. The relatively poor health of the population and persisting inequalities in health 25 d. The need to balance health and social care according to need 27 e. Workforce issues 33 f. Financial considerations 35 g. Changes in the range of possible medical treatments 36 h. Remote and rural challenges to high quality healthcare 38 i. Opportunities from increasing information technology (e-health) 41 j. A need to reduce waste, harm and variation in treatment 44 3. Primary and Community Care 61 4. Secondary and Tertiary Care 77 5. The need for “realistic” medicine 85 6. Conclusion 01 A NATIONAL CLINICAL STRATEGY FOR SCOTLAND FOREWORD Over the last ten years there have been significant changes in Scotland’s population and in the needs and demands placed on our health and social care services. In 2010, in the Quality Strategy, the Scottish Government set out its strategic vision for achieving sustainable quality in the delivery of healthcare services across Scotland, in the face of the significant challenges of Scotland’s public health record, our changing demography and the economic environment. In 2011, the Scottish Government committed to integrating health and social care, to address in particular the changing needs of our growing population of people with multiple complex needs, many of whom are older. This was followed in 2012 by publication of the 2020 Vision which provided the strategic narrative and context for taking forward integration and implementing the Quality Strategy, and the required actions to improve efficiency and achieve financial sustainability. In 2015 the Scottish Government set out • Developments should be guided by the need for transformational change in evidence where available: evaluation NHSScotland to meet people’s health and of any changes should be considered social care needs by 2020 and beyond. The before making the changes. Scottish Government’s Draft Budget for • We will continue to provide caring health 2016/17 proposes significant new investment and social care services that will recognise in health and social care services to pursue the central importance of the role of ambitious reform. This National Clinical people using services, their carers, and Strategy is an important contribution to their community in providing support. This the provision of clarity on the priorities for allows people and communities to manage that reform. The Strategy is underpinned their own health more. A system that by the following set of key principles: seeks to build on this, rather than supply alternatives, is likely to improve population • Quality must be the primary concern – health and wellbeing, as well as the all developments should seek to ensure individual experience and outcome of illness. that there is enhancement of patient safety, clinical effectiveness and a • Services will be based around supporting person-centred approach to care. people, rather than single disease pathways, with a solid foundation of integrated health and social care services based on new models of community-based provision. 02 • Where clinically appropriate we will Scotland has a long tradition of providing continue to plan and deliver services at a high quality health and social care local level. Where there is evidence that services to our population and we believe better outcomes could only be reliably that we are well placed to achieve the and sustainably produced by planning transformational change required. services on a regional or national level, we will respond to this evidence to There has been extensive engagement with secure the best possible outcomes. clinicians, professionals and stakeholders in • The impact of health inequalities will the preparation of this draft of the National be minimised by ensuring equitable Clinical Strategy. However, we recognise it’s access to health and social care not the finished article and that we need support, removing barriers that make to engage further about it. The national people less likely to access care. conversation on “Creating a Healthier Scotland” provides the ideal opportunity for The Strategy makes proposals for how that engagement. So we will, through the clinical services need to change in national conversation, engage with those order to provide sustainable health and interests but also with the public whom social care services fit for the future. It health and social care services serve. sets out a vision that is both ambitious and challenging as a basis for further engagement with clinicians and the public. Professor Jason Leitch Dr Catherine Calderwood Professor Fiona McQueen National Clinical Director Chief Medical Officer Chief Nursing Officer 03 A NATIONAL CLINICAL STRATEGY FOR SCOTLAND PREFACE At the beginning of 2015 Ministers decided The National Clinical Strategy has been built that it was appropriate to draft a National on a process of reviewing written evidence on Clinical Strategy that would develop further the organisation of healthcare, and seeking the 2020 Vision, and look towards a longer contributions and comments from a wide time scale, up to 2025-30. The National range of stakeholders, from within Government, Clinical Strategy would lay out a framework and from the wider NHS in Scotland. that would take account of several significant changes in Scotland, including the changing The National Clinical Strategy is, by necessity, demographic composition of our population, both high-level and strategic, and seeks to set the increased demand for health and social out a broad direction for change to help the care that will follow the advent of Health NHS in Scotland meet the challenges ahead, and Social Care Integration, and significant with its partners in local government and the technological changes in healthcare. third and independent sectors, who provide social care services. The development of the This Strategy has been developed by a small Strategy has taken place at a time when there team (Dr Angus Cameron, Elizabeth Porterfield are a large number of other reviews ongoing and Karen MacNee) who have been led and such as the Reviews of Public Health and of supported by an oversight group drawn GP Out of Hours Services. In addition there from across the service, and consisting of: are a number of NHS Boards reviewing their strategic plans, particularly in the context of National Clinical Director: development of Integration Joint Boards. The Professor Jason Leitch Strategy seeks to give a fresh perspective Chief Medical Officer: to these reviews and strategic plans to help Dr Catherine Calderwood a more uniform approach to future change Chief Nursing Officer: Fiona McQueen that is coherent across the whole system. Finance Director: John Matheson NHS Board Chief Executives: Robert In developing the strategy, care has been Calderwood, Cathie Cowan, John taken to engage with a wide variety of Turner (until July 2015), Jill Young staff across Scottish Government and NHS Boards, with a particular focus on clinicians NHS Board Chairpersons: Lindsay Burley, and their representatives.