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Priorities for health - An update for the newly elected Scottish Parliament

May 2007

I am pleased to highlight the BMA’s key priorities for health in Scotland. By identifying what the BMA and doctors believe are priorities, we can help political parties and MSPs deliver what is best for the nation’s health. This is an important year for the NHS in Scotland. The 10 year strategy outlined in Delivering for Health will be in its second year. Last year was spent laying the groundwork and the focus for 2007 and beyond must be to implement many of its proposals. We ask MSPs to reaffirm their commitment to the strategy. It is a package and to break it apart would be to return to the old problems that have dogged the NHS for too long.

Much debate in the past year has centred on hospital or service closures. NHS boards must improve their consultation processes and find new ways to involve the public and the profession in service change. NHS boards must find better ways to communicate change to local communities. However, the BMA is not convinced that elected health boards are the answer. NHS boards must find ways to demonstrate that patients will not lose out because of changes to the way services are delivered.

The health agenda for our politicians has never been so important. There are many priorities for health in Scotland and I hope that as our new MSPs, you will continue to keep health high on the agenda and at the heart of decision-making. On behalf of the BMA in Scotland, I hope to work with you all to try to improve the NHS and the health of our people.
Dr Peter Terry
Chairman of BMA Scotland

• NHS Reform
• Public Health and health improvement
• Workforce

NHS Reform
Following years of upheaval in the NHS, doctors in Scotland believe that further significant structural reform now would be detrimental. Developing policies for the long term will allow services to evolve. Control should be given back to those who deliver and use services and reform should only go ahead when there is demonstrable evidence that changes will improve patient care.

Clinical priority not political targets
Doctors believe that clinical need must dictate priority for treatments. However, politically driven waiting list initiatives can distort such clinical priorities. 98% of doctors surveyed stated that establishing waiting times based on the individual patient’s clinical needs was more important than focusing on political targets. The BMA would welcome the opportunity to discuss with MSPs how clinical priorities could and should be determined in Scotland.

Local health service changes
Local health service configuration has generated much media coverage and public controversy over the last few years in Scotland. Doctors strongly believe that decisions on changes to local health services should be based on clinical need and patient safety. Boards have a duty to undertake public consultation where major service redesign is considered. BMA Scotland believes all stakeholders should be involved at an early stage, including those who work in the NHS and those who use the NHS. The BMA would like to work with MSPs to identify opportunities for better public and professional engagement.

PFI
The BMA would like to see much greater consideration of the effects that private finance initiatives have on the long-term health of the NHS in Scotland and less focus on short-term funding issues. The BMA is keen to discuss measures to replace PFI in Scotland that could be more cost effective and beneficial for patients in the long term.

Public health and health improvement
Encouraging people to adopt healthier lifestyles is an approach the BMA would welcome from this Scottish Parliament. Equipping the public with the information and power to make decisions about their lifestyles and, where appropriate, legislating to protect the public health, can all have a positive impact.

Raising the purchase age of cigarettes to 18
Research shows that most smokers begin in adolescence and that the younger someone starts smoking, the less likely they are to give up. Doctors agree that raising the minimum purchase age of tobacco from 16 to 18 would decrease the number of young people smoking in Scotland by reducing the availability of and access to cigarettes. When coupled with improved enforcement of the higher age limit, young teenagers would find it more difficult to purchase tobacco from shops.

England and Wales are introducing this policy in October 2007. The BMA is delighted with the recent announcement to raise the age to 18 in Scotland at the same time. Campaigns to raise awareness could run in tandem and complement each other. Any further delay to implementation leaves more time for underage children to purchase cigarettes, causing significant damage to their health in the short and longer term. The BMA therefore welcomes the short timescale as it gives a strong message that tobacco use among the young is dangerous and it will save lives.

Alcohol misuse
Scotland is renowned for its problems with binge drinking and alcohol misuse. One in 30 of all deaths in Scotland is related to alcohol and alcohol costs the NHS in Scotland an estimated £110 million each year. Doctors are calling for a law to be introduced, rather than voluntary measures, requiring alcohol products to carry a label listing alcohol content, recommended daily units and warnings of excessive drinking. Linked with increased powers to prevent deep discounting and introducing education programmes beginning in primary schools, this would help Scots make informed decisions about the amount of alcohol they consume and highlight the dangers associated with excessive drinking.

Workforce
A full complement of a well-trained and well-regulated workforce is essential for high quality patient care in Scotland. At present however, junior doctors are facing major changes to their training programme and attempts to increase the number of consultants were abandoned by the Scottish Executive last year. Medical student numbers are rising while numbers of medical academics to teach them are falling and vacancies in all branches of medicine are high, with many posts remaining vacant for six months or longer. By involving clinicians and adopting a long term approach to workforce planning, we believe that we can help the Government ensure that Scotland has the future medical workforce required to provide high quality patient care.

Expand GP trainee places
GP practices should be at the centre of developments in community based health service delivery. However, training places are capped and a record number of GPs are expected to retire shortly. This problem is easily solved. By increasing funding for more GP places in Scotland, implementing measures to encourage GPs nearing retirement to remain in practice, and undertaking detailed workforce planning, Scotland will have the GPs required to continue to provide high quality good value care to patients in their communities especially as we shift care out of hospital and closer to patients’ homes.

SAS contract
More than 1500 Staff and Associate Specialist doctors working in Scotland’s NHS are being over-looked and disadvantaged because of unacceptable delays with their new contract. UK-wide negotiations on the contract began in 2005 between the BMA and NHS Employers and agreement was reached in November 2006. However, delays in the approval process by the Secretary of State for Health and Public Sector Pay Committee in England has meant the contract has not yet gone out to ballot in any part of the UK. The BMA is therefore calling for support from the new Scottish Parliament for this group of hard working senior career grade level doctors who provide direct patient care in hospitals. The contract was approved by the last Scottish Executive. Doctors in Scotland should therefore have the opportunity to vote on whether it should be implemented in Scotland.

Receive the BMA Scotland newsletter
BMA Scotland produces a bi-monthly electronic newsletter that is sent to BMA Scotland members. If you would like to receive a copy to keep you up to date with key health issues in Scotland email ggrant@bma.org.uk now.

Meet the BMA
The BMA represents doctors across the whole of Scotland in all branches of medicine. For further information on health policies, detailed background briefings or to arrange a meeting with local doctors from your area or a BMA committee chairman email Gail Grant at the BMA Scotland Public Affairs Office at ggrant@bma.org.uk or call 0131 247 3050.

Read detailed background briefing papers providing information on key health areas.