Getting into Shape: an IHM Scotland policy analysis

Download Getting into Shape [.pdf]

IHM Scotland has published a key paper to inform the debate about how the NHS in Scotland should respond to the challenges presented by the UK Government’s Comprehensive Spending Review.

Getting into Shape represents the views and concerns of a number of senior IHM Scotland members and NHS leaders. The paper has been circulated to all NHS Board chairs and chief executives, industry partners and other health professional organisations. IHM Scotland chair, Malcolm Wright will be seeking a meeting with the Cabinet Secretary for Health and Wellbeing to discuss the issues it raises.

Getting into Shape has been written in the context of the real terms cut in funding that the NHS in Scotland is about to experience, following the cuts made to Scottish public spending by the Westminster government. The paper outlines the challenges posed by the new financial reality and sets out a number of ideas to help the service not just maintain, but to continue to improve quality.

The fundamental premise of Getting into Shape is that, “quality improvement is still achievable when times are hard, so long as the criteria are clear and the right choices are made.”

The paper is clear from the outset that its aim is not to question the financial realities with which the Scottish Government and, as a consequence, NHS Scotland is faced. Nor does it shirk the need to find new ways of doing things; on the contrary, as the paper says, “The senior management of the NHS in Scotland are positive about responding to the challenge [and] have already begun to refocus their efforts to reflect the scale of the tasks ahead...” What the paper seeks is support from a government that is prepared to facilitate leaner and faster change and to regard NHS management “as an asset rather than merely a soft target for efficiency savings.”

The paper proposes a new framework, setting out what the criteria should be for making choices about service change:

New Government policies, quality initiatives, new developments and efficiency measures which both improve healthcare quality for patients and reduce costs, or which are quality neutral but reduce costs must be pursued.
New policies etc which are cost neutral but improve quality should be considered.
New policies etc which are not affordable within the current and future resource assumptions should not be pursued either by central imposition or locally. Equally, efficiency savings which reduce quality to an unacceptable level and do not add value should not be pursued.

Such a framework not only sets out the common goals that should be pursued across NHS Scotland, it also makes clear that - in tough economic circumstances - choices are constrained: if something can be done to improve quality without increasing costs, or to reduce costs without affecting quality, then it cannot be optional.

The paper sets out a range of ‘propositions’ under the themes of Delivering and Sustaining High Quality Services, Government Targets, Developing a Workforce with the Right Skills in the Right Place, and Timescales. The common aim of all the proposals, both singularly and taken as a whole, is the improvement of both quality and efficiency. There is a strong emphasis on working together, with patients, within the NHS and with other public sector partners; on benchmarking and developing shared outcomes; and on creating circumstances in which service change - including large-scale change - at both national and local level can be agreed and facilitated quickly.

Greater flexibility and discretion for NHS boards to make and implement decisions at local level is another important theme of Getting into Shape. While, for example, recognising that national targets have played an important role in driving improvements, it calls on the Scottish Government to review its use of targets, particularly for waiting times, and suggests that the time may have come for a “shift away from the detailed management of Health Boards through a set of defined and relatively narrow ‘targets’ and to move towards health outcomes aimed at wider objectives of improving the population’s health.

Download Getting into Shape [.pdf]