A National Clinical Strategy for Scotland

6. Conclusion

This strategy sets out the need for significant change in order to adapt to changing circumstances.

In primary care we need to build capacity and provide a more broadly based mix of professionals based around practices - which should increasingly be working collaboratively in clusters. We need to increase the shift of work from acute hospitals services to primary care, and we need to ensure that we benefit from integration of health and social care, with particular emphasis on an anticipatory approach to those at risk of avoidable hospital admission, the development of flexible alternatives to hospital admission to reduce those avoidable admissions, and the prompt discharge of patients from hospital care.

In secondary and tertiary care the case for redesign of services is clear and compelling. Clinical teams who provide complex and high-tech services more often get better outcomes for their patients. This extra benefit is not marginal, and so we must review services, specialty by specialty, considering the potential for developing fewer inpatient sites that will provide more highly specialised services, linked into local hospitals which will provide a comprehensive range of outpatients, diagnostics and day case surgery. In addition, local hospitals will need to provide suitable primary emergency treatment for all conditions, with some patients referred, as now, via clinically agreed pathways, to larger centres for specialist care.

These changes are complex, and require consideration of workforce resources, potential outcomes, inter-relationships between specialties, and finance. It will require careful yet thorough conversations with the public and their representatives. However, failure to change will limit the potential to build on world-class standards of care.

Lastly this strategy calls strongly for a new clinical paradigm. This would be one that:

• adopts least invasive or disruptive processes as a first step. This will often more appropriately include lifestyle interventions before drugs and operations. This helps patients remain in control of, and responsible for, their own illnesses
• avoids unwarranted variation in standards of care or activity
• avoids wasteful investigations and treatments that do not add value for patients
• recognises that patients can only be true partners in care if they are provided with comprehensive information about their illness, the prognosis, and possible treatment options, and
• understands patient preferences and adapts treatment to their preferences.

Adoption of a changed clinical paradigm will reduce the harm and cost that can be associated with modern medical care, and by ensuring that treatment is tailored to patient preferences, will deliver care that is of greater value to patients.