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By Jennifer Trueland ...
By Jennifer Trueland

An ambitious 20-year blueprint for the NHS in Scotland will require strong leadership to turn the vision into a reality, ministers have been warned.

The 'bold and confident' plan from the group chaired by David Kerr involves a radical shift of emphasis from acute to community-based care - particularly for long-term conditions - and tackles the issues of Scotland's rural areas.

It also calls for separation of planned and urgent care, says specialist services should be concentrated on fewer sites, insists that the NHS will have to plan better at a national and regional as well as a local level, and proposes a leadership programme with service improvement at its core.

The report, A National Framework for Service Change in the NHS in Scotland: building a health service fit for the future, was commissioned last year by then health minister Malcolm Chisholm against a background of public disquiet.

Campaign groups, most backed by local MSPs, had set up across the country to protest at service reorganisation, which was inevitably leading to hospitals facing closure or a change of function.

In particular, rural areas feared they were losing services to increasing centralisation. The report did not make recommendations on specific local plans but set out a framework for safe, sustainable services to meet today's challenges.

Managers largely welcomed the report when it was published last Wednesday. In particular there was relief that it did not signal a major change of direction, endorsing the way in which many NHS boards were already travelling.

But they acknowledged that turning it into a reality would not be easy. NHS Lothian chair James Barbour said: 'The challenge is translating the Kerr report into delivery. Leadership across the NHS will have to step up to meet the Kerr challenge.'

He identified difficult issues, including developing new staff roles and encouraging more cross-border working, as well as getting the public on board with changes. 'The Kerr report contains some quite sophisticated trade-offs - we need to look at how we communicate these.'

Scottish NHS Confederation director Hilary Robertson called the report a 'compelling narrative for why health services in Scotland need to change' as well as proposals for making it happen. But she added: 'It is only a framework, and NHS boards will have to make some tough decisions in order to deliver it with the resources available.'

Those who had feared the report would recommend a wholesale adoption of English health reforms - particularly around privatisation - were relieved. Scottish ministers had been criticised in the run-up to last month's general election because the health service north of the border did not seem to be improving at the rate of England.

But the report scarcely mentions private healthcare, although it acknowledges that the private sector could be used for specific short-term surgical contracts to reduce back-logs, for example.

British MedicalAssociation Scotland chair Peter Terry was pleased that the report appeared to identify 'Scottish solutions to Scottish problems,' adding: 'Simply adopting strategies from elsewhere in the UK will not necessarily address the failings of our health service.'

Unison Scotland organiser on Health Jim Devine was more explicit: 'As Professor Kerr's report highlights, the Scottish healthcare system is very different from England.

This is quite right, devolution is about innovation, not imitation. We are also pleased that Professor Kerr has ignored the lobbying for increased private sector involvement in our NHS.'

He did, however, sound a cautionary note, asking the Scottish parliament to be 'mature' enough to look at healthcare on a Scotland-wide basis. He also called for no restructuring of the NHS for 'at least five years' to allow stability.

The 68-page report was accompanied by a much longer 'manual' for the NHS.

The blueprint's key tenets

* Concentrate specialised or complex care on fewer sites

* Separate planned and urgent care, make day-case surgery the norm and have better access to community-based diagnostics

* Accelerate development of regional planning for hospitals

* Set clear agenda for cross-discipline community health partnerships

* All NHS boards to have a systematic approach to caring for people with long-term conditions in the community and avoid hospital admissions

* Develop 'anticipatory care', particularly in deprived areas, to prevent illness and reduce inequalities

* Urgently implement a national single information and communications technology system, including an electronic patient record

* Multi-disciplinary teams in local casualty departments to provide vast majority of unscheduled, hospital-based care

* Develop networks of rural hospitals

* All change - new bodies and service reform

New bodies:

* A tele-health technology resource centre in Aberdeen to develop national approaches to tele-health

* A clinical school for rural healthcare to ensure workforce development

* A Scottish long-term conditions alliance to articulate patients' views

* A leadership programme with service improvement at its core

* An international action plan to develop partnerships with African care institutions

Service changes

* Neurosurgery to move from a single hub to a national network

* Children's tertiary services to become a single national service with intensive care operating from two sites

* Task force to be formed to gather evidence on the benefits and risks of concentrating services on fewer sites

* Establish referral management centres to cut inappropriate referrals - already piloted in Lothian and Glasgow

* Enhanced regional planning groups

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