UK health services could 'learn lessons' from Scottish NHS

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The health services of England, Wales and Northern Ireland could learn lessons from the Scottish NHS, according to a new report.

The Nuffield Trust found that Scotland had a unique system for improving the quality and safety of patient care.

It has benefited from sticking with the policy rather than "chopping and changing" every few years, it added.

But the study warned that Scotland's strengths could be undermined by a "dark cloud" of financial pressures.

Mark Dayan, the lead author of Learning from Scotland's NHS, said the report identified philosophies and approaches used in Scotland which could benefit the rest of the UK.

'Difficult decisions'

He added: "Scotland's well thought-through system of improving patient safety and quality of care works by engaging frontline staff in the process, and importantly the country has stuck with that approach rather than chopping and changing every couple of years.

"Scotland has also worked on getting its healthcare services to co-operate for longer than the other nations of the UK. So we're urging healthcare leaders from England, Wales and Northern Ireland to think about what elements they might want to import from Scotland.

"However, the dark cloud on the horizon threatening these strengths is potentially serious financial problems."

The report found that the Scottish NHS needs to make average savings this year of more than 4% - higher than those in England and Wales.

The strengths of the health service could help it save money, but there is also a risk they could be undermined by the financial squeeze, its authors warned.

And they added that the country's "polarised politics" could make it hard to make difficult decisions.

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Mr Dayan said: "Scotland's NHS has the same resource constraints as England and Wales, but doesn't yet have a medium-term plan for dealing with them - and in a harsh political environment, open debate and difficult decisions can seem impossible.

"This risk could overshadow many of the strengths that other countries can learn from".

Among a series of findings, the health charity's report praised the emphasis placed on trusting clinical staff in Scotland, where it found they were encouraged to drive improvements in care.

In contrast, it said there was a focus on targets in the health services in other parts of the UK, particularly in England, and managers were tasked with improving care quality.

South of the border, it found that the policy and institutions that govern healthcare was one of "constant change and reorientation".

But the Scottish NHS, the Scottish government department that oversees it, and Healthcare Improvement Scotland (HIS) have maintained their current approach for nearly a decade.

Pioneering initiatives

The health charity's report also noted that better ways of working are tested on a small scale in Scotland, where they can be changed quickly if necessary, before being rolled out.

Unlike the rest of the UK, the system is overseen by a single organisation, HIS, which both monitors quality of care, and helps staff to improve it.

It also highlights pioneering initiatives, like the use of video links for outpatient care in remote areas, to tackle Scotland's geographical challenges. Such systems should be considered in other parts of the UK facing similar issues, it concluded.

Shona Robison, Scotland's health secretary, said she was proud that the achievements of Scotland's NHS were being recognised in the report.

She said: "Our world-leading patient safety programme has led to 20,000 fewer than expected deaths, the lowest recorded levels of healthcare associated infections and significant improvement in sepsis and surgical mortality.

"We are also delivering the integration of health and social care, which is one of the most significant reforms since the establishment of the NHS, and which is helping improve service delivery.

"By bringing these services together we are ensuring people get the right care and support for their individual needs, and that staff across health and social care are equipped to work together to make full use of their shared skills and resources.

"Our ambitions for the NHS are founded on the twin approach of investment and reform, making the changes needed for future backed by record levels of investment and staffing."

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The Scottish Conservative health spokesman Miles Briggs said that the report's findings were a testament to the commitment of staff.

He said: "It's a credit to the hardworking staff in Scotland's NHS that these conclusions should be drawn. It goes to show that all the devolved NHS departments across the UK can learn from each other and share best practice.

"That's one of the great benefits of successful devolution."

However, Scottish Labour said the report should act as a serious "wake-up call" to the SNP.

The party's health spokesman Anas Sarwar added: "It includes suggestions that the SNP is avoiding taking the decisive action our NHS needs because of its obsession with independence - and it is not doing nearly enough to shift the balance of care from hospitals to the community.

"Given the SNP has cut £1.5bn from local budgets since 2011, that is just not going to happen.

"The last thing Scotland's NHS needs is another divisive referendum, and Nicola Sturgeon must now get back to the day job of delivering for our nurses, doctors, care staff and patients."

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