SHA Scotland

Briefing: NHS Reform (Scotland) Bill 

The NHS Reform (Scotland) Bill is the major piece of health legislation to be considered by the Scottish Parliament in the autumn 2003 session. 

The main provisions are to abolish NHS Trusts, establish community health partnerships, ensure co-operation in delivering regional services, increase public involvement and promote health improvement. All of these policy objectives will be underpinned by new powers for the Scottish Ministers to intervene in the case of service failure, as a last resort, to ensure that health care is delivered to acceptable standards.

Dissolution of NHS Trusts 

Although the Scottish Executive expects that the remaining NHS Trusts will be dissolved voluntarily using existing powers; the Bill will remove all references to NHS Trusts from the Statute Book.  

Community Health Partnerships (CHP’s)

The Bill makes provision requiring Health Boards to submit for approval by the Scottish Ministers schemes for the establishment of one or more CHP’s, which would cover the whole Health Board area. 

The development of community health partnerships (CHPs) are seen by the Scottish Executive as a key building block in the modernisation of services, with a vital role in partnership, service integration and redesign. They are seen as successors to Local Health Care Co-operatives (LHCCs), having a more consistent and strengthened role in service planning and delivery, with better accountability to local communities. This will also include the development of a local public partnership forum (PPF) for each CHP to support effective dialogue with local communities.

It is not intended that CHPs should become independent bodies separate from Health Boards, but that they should have a statutory function within Boards, thereby providing those involved in the provision of community based care a greater say in the design and delivery of services. 

Regional Planning

The Scottish Executive believes that there are some services that may be better carried out at a national or regional level.  One example is the Managed Clinical Networks (MCN’s) for cancer services which are organised on a regional basis. This requires closer co-operation between Health Boards and other agencies (such as the Scottish Ambulance Service, NHS24 etc).    The Bill provides Health Boards with a statutory duty to co-operate with each other with a view to securing and advancing the health of the people of Scotland. 

Ministerial Intervention

The Scottish Executive believes that their current powers to intervene in any part of the NHS that is failing to meet key standards are too slow and cumbersome.  The Bill therefore allows Ministers to transfer responsibility for failing services or those likely to fail, to another Health Board or expert team.  Before invoking these powers the Executive should have explored other means for restoring the service, or quality of service. 

Public Involvement

The Bill will impose a duty to secure public involvement on Health Boards and Special Health Boards while abolishing local health councils and replacing them with a new public involvement structure. This new body, the Scottish Health Council, will monitor the performance and effectiveness of Health Boards in relation to public involvement, and will report regularly on the results. 

To aid the Scottish Health Council there will be Local Advisory Councils in each Health Board area, providing information on local views relating to the involvement activities of their local health services.  The Local Advisory Councils are also expected to develop good links with local voluntary organisations and patient groups to promote good communication and partnership between all those with an interest in public involvement. 

Health Promotion

The Bill provides Ministers with a specific duty to promote health improvement.  It enhances both Ministers and Health Boards capacity to act, other than through the NHS and voluntary organisations as at present, and to provide a link to the community planning agenda. This gives Ministers the powers to allocate funding directly in support of health improvement as well as allowing greater opportunities to direct how such monies are spent by local authorities and other bodies. 

SHA Scotland Views 

Many of the Bill’s provisions are welcomed by SHA Scotland. In particular, the abolition of NHS Trusts as the last vestiges of the failed internal market. We have reservations relating to public involvement with some concern that the new Scottish Health Council will be too centralised, losing the local voice of Local Health Councils. The role and function of Community Health Partnerships are unclear and the subject of a separate consultation.

2003