Policy Information

Extract of comments on Scottish Parliament: Health and Sport Committee Call for written evidence - Draft Budget 2012-13 and Spending Review 2011

The College welcomes the commitment of the Scottish Government to protect the core budgets of Health Boards and strongly support the investment in preventative measures. The importance of long term monitoring of preventative strategies cannot be overstated as the impact on the causes of mortality and morbidity shift, particularly the effect of delaying the onset of some diseases as the population ages – the health benefits are clear but the financial consequences for Scotland are worrying.

A selection of specific comments reflecting the health priorities identified by the College include:

Protecting timely patient access to consultants

Accurate workforce planning is essential, especially in acute medicine where unplanned admissions drive the activity throughout the hospital. If Scotland wishes to make best use of her facilities and improve quality of care, investment is required in the number of consultant staff involved with the acute medical on-call. This is the only way to extend the working day for these trained decision makers and allow time off in lieu to support safe practice.

Protecting time for training

The College notes that funds allocated to workforce and training budget lines will increase modestly and then be capped for the next 3 years. Accurate workforce planning is among the most pressing tasks facing NHS Scotland as we will live with mistakes for decades to come. Quality of care depends on retaining a full complement of skilled clinical staff and the global market for doctors threatens the sustainability of services especially in the more remote parts of Scotland.

Implementing standardised clinical documentation across Scotland including electronic access to the patient’s record

The College notes that investment in e-Health is to be capped and warns that this may not be sustainable if equality of access is to be delivered across Scotland’s more remote and rural areas. Integrated care is of particular importance to older patients and all patients with long term conditions and e-Health innovations support the development of integrated care; it is far from clear that the changes required can be delivered within existing budgets.

• The full response can be viewed here

Extracts of comments on the Royal College of General Practitioners Integration of Care Consultation

The RCPE highlighted a number of points in this consultation response, including:

The potential benefits of integrated care

• The College considers that one of the key benefits of integrated care is that the individual patient will be put at the centre of the healthcare system rather than their diagnosis or disease.  For example, a patient may present with several different health problems and integrated care should mean that they receive a much more holistic approach to their care, in theory helping to address points such as support and care required after an operation at an early point in the patient journey, therefore improving the patient experience. 
• Another benefit of integration will be faster resolution of problems, and faster diagnosis and treatment.  This should be more cost effective than the current system in the long term, as problems are identified earlier and can be managed from the outset. Patients should not be sent inappropriately to multiple secondary care clinics or accident units for "rule out" attendances as more effective triage will take place.
• Integration provides a good opportunity for effective discharge planning as, for example, there will no longer be artificial boundaries between health and social care and their relevant budgets.

The potential risks of integrated care

• The risks of integrated care include a reduced standard of care if provided by less well trained or experienced staff than currently provide the service.  There is a danger that a one size fits all approach could be adopted which does not work for individuals.
• There is some concern that integration could lead to poor clinical governance and lack of clinical responsibility.  There is not always effective communication in the NHS between departments and between primary and secondary care.  Integration means this would have to be much better - can that be delivered?
• There is a possibility of conflict of interest for GPs and other health professionals where a financial incentive exists to provide a service in the integrated system, and the necessary checks and reviews to ensure that commissioning is appropriate could be prohibitive.  The reconciliation of competition and choice with integrating services could be challenging, particularly in more remote and rural areas where little choice exists.

 

• The full response can be viewed here