NHS across UK has ‘much to learn’ from Scotland

Written by Tom Freeman on 5 July 2017 in News

NHS Scotland’s strengths undermined by ‘serious financial predicament’ amid a ‘polarised, hostile political context’ finds Nuffield Trust

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NHS systems in the other UK nations have “much to learn” from the NHS in Scotland, according to an independent report by health charity the Nuffield Trust.

In the first of four reports into the different health systems across the UK, ‘Learning from Scotland’s NHS’, the Nuffield Trust said there was an “important lesson” for England and Wales from Scotland.

Scotland’s “more cooperative culture and legal framework” avoided the complexity of England’s internal market and top-down initiatives, it said.

However, “a polarised, hostile political context” is holding back progress, it warned.


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While the progress of the integration of health and social care is “very uneven” in Scotland, the report said, it has a “firmer legal standing and a clearer role for local government” than the equivalent systems elsewhere.

There has also been some evidence the reform has provided a catalyst for a change in practice on the front line, it added.

The Scottish Patient Safety Programme, set up to make clinical practice safer, is described as “a watershed”.

“Scotland has a unique system of improving the quality of health care. It focuses on engaging the altruistic professional motivations of frontline staff to do better, and building their skills to improve,” the report said.

“Success is defined based on specific measurements of safety and effectiveness that make sense to clinicians.”

However, the report also warns NHS Scotland faces “a serious financial predicament” as health boards are forced to make ‘efficiency’ savings.

“There is a risk that the financial situation will undermine the best aspects of the Scottish NHS before they can be brought to bear in addressing it,” it concluded.

Other UK health systems use multi-year strategic funding planning, while Scotland’s is more short-term.

Also, “difficult and unpopular decisions” needed to address pressures and move people out of hospital are hampered by “a polarised, hostile political context”, it added, “with the SNP Government seeking majority support for independence and a largely hostile press looking to attack their record on the NHS”.

Lead author Mark Dayan said: “Scotland’s NHS has the same resource constraints as England and Wales, but doesn’t yet have a medium-term plan for dealing with them – and in a harsh political environment, open debate and difficult decisions can seem impossible.”

The Scottish Government’s National Clinical Director, Professor Jason Leitch said: “This report highlights the efforts of many thousands of dedicated staff who over a number of years have ensured that the healthcare system in Scotland is one of the best in the world.

“It is very encouraging to see the NHS in Scotland commended for the ‘continuity and consistency’ of the leadership and Scotland’s ‘emphasis on building up a cohort of staff equipped with skills for change’.

“The Health Secretary has been clear that there is no room for complacency and we are working to build on these successes and continue to improve the quality and safety of care provided to the people of Scotland, ensuring that wherever improvements are needed they are introduced and maintained.”

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