A National Clinical Strategy for Scotland

Preface

At the beginning of 2015 Ministers decided that it was appropriate to draft a National Clinical Strategy that would develop further the 2020 Vision, and look towards a longer time scale, up to 2025-30. The National Clinical Strategy would lay out a framework that would take account of several significant changes in Scotland, including the changing demographic composition of our population, the increased demand for health and social care that will follow the advent of Health and Social Care Integration, and significant technological changes in healthcare.

This Strategy has been developed by a small team (Dr Angus Cameron, Elizabeth Porterfield and Karen MacNee) who have been led and supported by an oversight group drawn from across the service, and consisting of:

National Clinical Director: Professor Jason Leitch

Chief Medical Officer: Dr Catherine Calderwood

Chief Nursing Officer: Fiona McQueen

Finance Director: John Matheson

NHS Board Chief Executives: Robert Calderwood, Cathie Cowan, John Turner (until July 2015), Jill Young

NHS Board Chairpersons: Lindsay Burley, Jeane Freeman

Senior Medical Officer: Dr Andrew Longmate

Divisional Clinical Lead: Professor Craig White

The National Clinical Strategy has been built on a process of reviewing written evidence on the organisation of healthcare, and seeking contributions and comments from a wide range of stakeholders, from within Government, and from the wider NHS in Scotland.

The National Clinical Strategy is, by necessity, both high-level and strategic, and seeks to set out a broad direction for change to help the NHS in Scotland meet the challenges ahead, with its partners in local government and the third and independent sectors, who provide social care services. The development of the Strategy has taken place at a time when there are a large number of other reviews ongoing such as the Reviews of Public Health and of GP Out of Hours Services. In addition there are a number of NHS Boards reviewing their strategic plans, particularly in the context of development of Integration Joint Boards. The Strategy seeks to give a fresh perspective to these reviews and strategic plans to help a more uniform approach to future change that is coherent across the whole system.

In developing the strategy, care has been taken to engage with a wide variety of staff across Scottish Government and NHS Boards, with a particular focus on clinicians and their representatives. The engagement process has included meetings with Chief Executives, Finance Directors, Directors of Planning, Medical Directors, Nurse Directors, Chief Pharmacists, Area Clinical Forum Leads, Directors of Public Health, Chief Operating Officers, HR Directors, the Academy of Medical Royal Colleges, the Scottish National Partnership Forum, eHealth advisors, the Royal College of Nursing, the Royal College of General Practitioners, the Royal College of Surgeons and the British Medical Association. In addition there has been significant clinician engagement with meetings open to all clinicians held in Edinburgh, Dundee, Aberdeen, Inverness, Fort William, Glasgow and Dumfries.

The overwhelming impression from repeated engagement with these groups is firstly a strong appreciation of the need for change and adaptation to improve the sustainability of the service, and to enhance the quality of care. Secondly, the engagement process has achieved a high level of support for all aspects of the strategy as it has developed, and there is particularly strong clinical support for the main messages around the development of general practice and primary care, the development of hospital networks to deliver services planned at a population level, and a need to enhance the value to patients of services by addressing over-treatment, harm, waste and variation.

This National Clinical Strategy sets out challenging but deliverable aspirations for Scotland's future health service built on the basis of collaboration rather than competition. It acknowledges the challenges facing healthcare services in Scotland - as in the rest of the developed world - in improving health and reducing health inequalities in the context of demographic change and increasing pressure on resources. It is ambitious and visionary and describes how we need to shape change, and the principles underpinning that change.

Having set out an agreed, evidence-based, clinical strategy that prepares us for the next 10-15 years, it will be important to share that direction with the public to enhance understanding of the need for adaptation and change, and to seek their support for the general direction. The current "National Conversation" provides an excellent opportunity to progress this stage.

Following this, the hard work of implementing change along the lines laid out in the Strategy must begin. This will take considerable effort, as change within very busy organisations is always difficult. However, the evidence laid out in this strategy points to the importance of changing in a changing world, and stresses the urgency with which this must be approached.

I would like to end by thanking all those who so positively gave time and effort to advising the group, particularly the team of librarians who carried out two very important and extensive literature reviews to support this work.

Dr Angus Cameron. MB ChB. MRCGP. MBA (Healthcare Management)