Professionalism and Excellence in Scottish Medicine - A Progress Report

Chapter 1

Introduction

In 2008, the 60^th anniversary year of the NHS, SMASAC produced a paper 'Promoting Professionalism and Excellence in Scottish Medicine' which was subsequently published as a supplement to the Scottish Medical Journal in February 2009 and separately by the Scottish Government in June 2009 www.scotland.gov.uk/Publications/2009/06/12150150/0. In this the 65^th anniversary year of the NHS, SMASAC felt that a progress report in this area would be timely, given the significant changes to the policy context in which NHSScotland is operating since the original publication.

The Quality Strategy www.scotland.gov.uk/Resource/Doc/311667/0098354.pdf published in 2010 sets out the 3 Quality Ambitions of safe, effective and person centred care which have been pursued since then. Allied to these aims has been the 20:20 Vision for Health and Care in Scotland which states that:

'Our vision is that by 2020 everyone is able to live longer healthier lives at home, or in a homely setting. We will have a healthcare system where we have integrated health and social care, a focus on prevention, anticipation and supported self-management. When hospital treatment is required, and cannot be provided in a community setting, day case treatment will be the norm. Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions. There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of readmission.'

In recognition that over the next few years demands for health and social care, and the circumstances in which they will be delivered, will be radically different, a Route Map to the 20:20 Vision www.scotland.gov.uk/Topics/Health/Policy/Quality-Strategy/routemap2020vision has recently be published to retain focus on improving quality, with specific deliverables in 2013/14.

The Route Map includes a number of key features, the first of which is that it:

'Develops our strategy for engaging and empowering our workforce, providing our response in Scotland to addressing many of the issues raised by the Mid-Staffordshire/Frances Inquiry, and equipping them to work in an integrated way which reflects the different needs of different people and different cases across Scotland'.

This is clearly directly relevant to this Progress Report and will be pursued, in particular, through the implementation of the 20:20 Workforce Vision which was launched at the NHSScotland annual event in June 2013 www.scotland.gov.uk/Topics/Health/NHS-Workforce/Policy/2020-Vision. This sets out a commitment to the delivery of high quality healthcare that the people of Scotland expect and deserve, and to valuing the workforce and treating people well. During the consultation period 10,000 people, including many NHS staff and professional organisations, contributed to developing the values that are shared across Scotland's Health Service. These are defined as:

• Care and Compassion
• Dignity and Respect
• Openness, Honesty and Responsibility
• Quality and Teamwork.

Work is now underway to ensure that the 20:20 Workforce Vision becomes a reality, and this offers a very clear opportunity to put medical professionalism and excellence at the heart of the NHSScotland workforce strategy. Increasing sub specialisation and the adverse impact of modernising medical careers (MMC), the New Deal and the European Working Time Directive (EWTR), on how the medical workforce now has to be structured and organised to deliver the service, was acknowledged in Promoting Professionalism and Excellence in Scottish Medicine. All of these factors have also been under consideration in the UK Review of the Shape of Training, led by Professor David Greenaway, which was published as: Securing the Future of Excellent Patient Care,* just as this present progress report was being finalised.

http://www.shapeoftraining.co.uk/static/documents/content/Shape_of_training_FINAL_Report.pdf_53977887.pdf *

NHSScotland (in the widest sense) has participated fully in that review, and presented a cogent set of arguments around the need for change in current systems of medical training. The Greenaway Review makes a number of recommendations to underpin a safe, effective, flexible and sustainable workforce of the future, driven by a growing number of people with multiple co-morbidities, an ageing population, health inequalities and increasing patient needs and expectations. The Greenaway Review is predicated on patient needs driving how doctors must be trained in the future and cites the original SMASAC Report, which recognises the paramount importance of professionalism as a key driver in defining new ways of working.