English doctors hail Scottish vision of NHS

NICOLA Sturgeon yesterday called on the NHS to remain true to its founding principles, as she outlined her vision for the service's future in Scotland.

The health secretary said there was a "battle of ideas" between Scotland and England, and insisted the SNP administration would not go down the route of market-led reform.

Speaking at the British Medical Association's national conference in Edinburgh, in front of an audience that included dozens of English doctors, Ms Sturgeon received two standing ovations.

By deliberately comparing and contrasting the direction of the NHS north and south of the Border, she underlined the different approaches to policy.

Doctors from England told Ms Sturgeon they were envious of the development of the NHS in Scotland, having faced years of fast-moving reform. But others questioned whether Scotland's approach would remain so popular in the long term.

Health campaigners and unions said Scotland still had serious problems to tackle, including hospital-acquired infections, health inequalities and death rates – which, in some areas, are the highest in the UK.

The Conservatives accused Ms Sturgeon of using the speech to push an independence agenda.

"This is all part of the SNP's independence creep," Mary Scanlon, the Scottish Tories' health spokeswoman, said.

"Everything they do and say is focused on wooing people to their cause in Scotland and encouraging feelings of grievance in England. But the bottom line is that, if they pursue their policy of excluding the private sector, Scotland will end up with a poorer health service than England, where ideology is not put before people's need."

Ms Sturgeon reaffirmed her commitment to keeping the NHS publicly funded, without private-sector input, and involving patients when deciding on crucial changes to services.

On Monday, Hamish Meldrum, the BMA chairman, called on England to follow Scotland and drop the internal-market approach, a system under which hospitals and the private sector compete for patients. Scotland abandoned this approach almost a decade ago.

Ms Sturgeon said last week's report on the future direction of healthcare in England, compiled by Lord Darzi, a surgeon and Labour peer, highlighted the different approaches north and south of the Border, with England moving towards increased private-sector involvement.

"I think there is a real battle of ideas going on between the different parts of the UK about the future direction of healthcare and the NHS," she said.

"It is a battle between the values of the market, of internal competition, and the values of public service, of co-operation and collaboration.

"In Scotland, we have set out our stall with absolute clarity. NHS Scotland is, and always will be, a service that is owned by the people of this country. We will continue to ensure that our policies reflect the ethos and the principles upon which the NHS was founded back in 1948."

The health secretary said that patients and the public were co-owners of the service, not consumers in a competitive market-place. "I believe very strongly that our model, the Scottish model, of delivering healthcare is the best way of meeting our healthcare needs," she said.

Ms Sturgeon received applause after repeating the Scottish Government's opposition to private funding for large hospital building projects.

She said the decision to fund the new £842 million Southern General Hospital in Glasgow entirely from public capital "illustrates our move away from the private finance initiative (PFI], which I think has been a bad deal for taxpayers and the country more generally".

There was yet more applause when she confirmed she was closing a legal loophole that would allow the private sector to move into providing primary care services, as revealed in The Scotsman yesterday.

However, David Lonsdale, CBI Scotland's assistant director, said: "Many GPs are already privately contracting to the NHS, which begs the question as to why others in the private sector are to be discriminated against simply because of their ownership model.

"A diversity of suppliers can make services more responsive, and drive innovation and value for money in the provision of public services."

Doctors at the conference did not appear to share these concerns, however. Dr Geoffrey Lewis, a consultant anaesthetist from Leicestershire, said many doctors in England had become disaffected by the "dramatic and radical changes" in the NHS.

"We look with envy at the systems present in Scotland, Wales and Northern Ireland," he said.

But opposition parties also questioned the SNP's stance against having the private sector in the Scottish NHS and cast doubt on the system proposed to replace PFI, the Scottish Futures Trust, amid concerns it is PFI under another name.

Jamie Stone, the Scottish Liberal Democrats' health spokesman, said: "The SNP's dogmatic approach is very short-sighted. The role of the private sector should be considered on a case-by-case basis. Patients are more concerned with receiving timely care than with who the provider is. We have a publicly funded health service of which we can be proud and the Scottish Government must prioritise patients over dogma."

Margaret Watt, chairwoman of the Scotland Patients Association, said: "We still have patients scared to go into hospital because of healthcare-acquired infections. We need to get matrons back on the ward to improve cleanliness. We also have to get a grip on health inequalities, which are still a major issue."

Ben Bradshaw, English Health Minister, insisted last night: "Our experience in England shows that a diversity of services improves access, quality and choice and is popular with the public."

Peter Terry, the chairman of the BMA in Scotland, said Ms Sturgeon had given an impressive performance.

"I am not saying that everything they are doing in England is wrong, but they have had all these changes thrown at them at once," he said.

"I think patients should be reassured by what she said about her commitment to health improvement and public involvement with the NHS."

She's got it wrong to insist on a state monopoly

COMMENTARY: Geoff Mawdsley

THERE is plenty of evidence that NHS patients in Scotland would benefit from a wider variety of healthcare providers.

Such diversity, whether provided by the private or voluntary sectors, can help drive innovation and so raise standards and improve value for money.

In England, outcomes for patients have improved as a direct result of this greater diversity. For example, the waiting-time target for hospitals of 18 weeks is set to be achieved this year, whereas in Scotland it is unlikely to be met until 2011.

And it's not just in England that such diversity exists, but in many other European countries that achieve high standards of care while ensuring everyone is guaranteed access to healthcare irrespective of their ability to pay.

What is the justification for preventing private companies from even bidding for GP contracts? If another provider can convince the health board that it can meet local health needs by providing high-quality care and better value for money, then why should they not be awarded the contract? After all, many GPs are themselves private contractors to the NHS and it seems unfair to exclude others simply because they are private companies.

It would be better to leave the decision to health boards as they are better placed to make such a decision.

What matters in all this is the service provided to the patient. By preventing private-sector companies from even bidding for GP contracts, Nicola Sturgeon is closing off an option that could lead to major improvements.

Surely it is worth at least seeing if such a move can improve patient care for the benefit of all.

And, as we have seen in many other countries, diversity of provision can be combined with a largely taxpayer-funded service.

There is no reason why we cannot have such a service here. One that puts the patient first and where there is a level playing field for different healthcare providers in Scotland. That is the pragmatic way of finding out what works.

Maintaining the NHS monopoly in service provision may bring applause at the BMA conference, but at what price for patients if key health indicators continue to lag behind those of other countries?

• Geoff Mawdsley is director of Reform Scotland, an independent think tank. Its aims are increased prosperity and more effective public services based on limited government, diversity and personal responsibility.

Hospitals to appoint 'nutrition champions'

Craig Brown

SCOTTISH hospitals are to appoint "nutrition champions" to help improve the quality of hospital food and boost standards.

The announcement was made by the health secretary, Nicola Sturgeon, as part of measures to address the issue.

Launching the Food, Fluid and Nutrition programme at Wishaw General Hospital in Lanarkshire, Ms Sturgeon said that £1.08 million has been made available to allow boards to appoint the new champions.

They will support the programme, which is the result of a review of the NHS Quality Improvement Scotland study on hospital nutrition that took place in 2003.

Hospitals will also receive extra information on dietary provision and guidance on how they can meet the new standards. A pilot monitoring programme of the improvements will initially be tested in NHS Forth Valley, Highland and Grampian.

Ms Sturgeon explained what the programme meant for patients. She said: "It will mean better-quality food and fluid in hospital.

"For those who are nutritionally vulnerable, it will mean their recovery will be aided as a result.

"Food in hospitals is one of these things that really matters to people. Probably, outside of clinical care, it's the single thing that affects a patient's experience.

"We've set very clear nutritional standards, the need for choice and for provision to be tailored to individual needs and preferences."

Ms Sturgeon said the focus on food quality was down to a more holistic approach to healthcare.

"I don't think it's ever been as high up the agenda as it should have been, and that's understandable to some extent as hospitals have to focus on the level of clinical care that they give to patients and that's absolutely right.

"I think now, though, there's greater emphasis on other aspects of patient care, whether they are treated with dignity and respect, and issues like food. All of that affects a patient's experience."

Maureen Lees, the chief dietitian for NHS Lanarkshire, said: "I think the way medicine has moved into the hi-tech, with advances in medical care and what we can do to cure people, the emphasis has come round to looking at basic health needs, making sure they're getting something they can eat, they like and can manage.

"Nutrition is fundamental to people getting better, we know that.

"We know that if we can feed people properly pre-op, then they will get better more quickly at the other end."

IN NUMBERS

158,000
Staff employed by the NHS in Scotland.

47,500
Nurses, midwives and health visitors

3,800
NHS consultants in Scotland

14
Scottish health boards

1.55 million
A&E visits last year

1,390
Scots who fail to turn up for hospital appointments every day

12,000
Number of hip and knee replacement operations carried out

178,929
Registered blood donors

13,000
Smoking-related deaths

15 million
Prescriptions dispensed in Scotland in first year of NHS

80 million
Prescriptions dispensed in Scotland last year

894,799
Patients discharged from Scottish hospitals last year