GOVERNMENT


The manifesto commits the new government to the creation of a ‘new single national formulary…to ensure quick and equitable access to new medicines’.


Other promises include a Scottish major trauma network; five new elective and diagnostic centres; more insulin pumps for people with diabetes; implementing the new Cancer Strategy and Sexual Health and Blood Borne Virus Framework; and improving services to people who are mentally unwell.


BONFIRE OF THE BOARDS?


Speaking in the run-up to the election during a lively election hustings event in Edinburgh organised by the Health and Social Care Alliance Scotland, the SNP’s Shona Robison made it clear that, now that the Integration Authorities (health and social care partnerships) are up and running, the time is right for a review of Scotland’s NHS bodies:


‘We are having to look at the world of governance,” she said. ‘We still have 22 boards. Within that we are looking at some of the services that will lend themselves more easily to becoming national services.’


These 223 are made up of 14 territorial boards varying in size4 from Greater Glasgow and Clyde (serving a population of 1.1 million) to Orkney (serving a population of 21,500); and seven ‘Special NHS Boards’ and one public body (Healthcare Improvement Scotland).


Rationalisation of NHSScotland is clearly the next step for a party that delivered a single police force and a single fire and rescue service. Equally, it is easy to see why the Scottish Government did not rush into redrawing the map of NHS boards until they had the Integration Authorities in place.


It is no secret that ministers have been exasperated by the way that, in their eyes, NHS boards sometimes seemed only to pay lip-service to government policy, following the letter but not the spirit of instructions from government officials and allowing local decision- making to create ‘postcode lottery’ variation.


A previous health secretary wondered out loud why Scotland needs fourteen Area Drug and Therapeutic Committees to make decisions about


18 - SCOTTISH PHARMACIST


decisions already made by the national Scottish Medicines Consortium. At the Alliance hustings, Ms Robison, meanwhile, made a veiled criticism of those NHS board chief executives who she felt had failed to sell the integration agenda to their staff.


Earlier this year another SNP MSP, Kenneth Gibson, told Holyrood magazine5 that his time as convener of the Scottish Parliament’s Finance Committee had convinced him of the case for merging health boards and local authorities to ‘create more strategic bodies’:


‘What has been repeatedly emphasised is that ‘silo’ mentalities are still prevalent in too many areas, with budget design in isolation and single outcomes approached from different directions across different performance frameworks with inconsistencies across the country.’


The central question for any review of the NHS map will be: if not 22, then how many?


In terms of primary care – encompassing community health services and General Practice – the number may well be 31. For all intents and purposes the new integrated partnerships will take over local provision from territorial boards.


For everything else done by the current boards, secondary care (hospital services) and tertiary care (specialist centres), one model that seems to have some support in high places is of single national authorities, albeit with accountability to the local integrated partnerships as well as the government and parliament.


John Macgill is Director of Ettrickburn, a communications and government relations company specialising in Scottish healthcare and lifesciences. www.ettrickburn.com


PHARMACY IN THE MANIFESTOS The impact of the engagement with the political parties by Community


Pharmacy Scotland and the Royal Pharmaceutical Society in Scotland could be seen in the statements about pharmacy in each of the main election manifestos.


Indeed, Scottish Labour acknowledged the input they had had from the two organisations when it promised to draw on the expertise and training of the profession to make immediate local advice more available through the extension of the minor ailment service in community pharmacies.


Labour added: ‘Under our plans people will be able to see the local pharmacist for low-level prescribing, making your life easier and relieving some of the pressure on GPs. Opening this service to everyone and expanding the conditions it covers will cut the pressures on our local doctors.’


The Liberal Democrats promised more investment and said:


‘We’ll also give doctors, nurses, other health professionals and pharmacists greater freedom to help patients and improve services. We’ll reduce the burden of detailed targets that get in the way of effective clinical treatment.’


The Scottish Conservative manifesto was more specific:


‘We believe pharmacies should be put at the heart of primary care. Researchers have estimated that over 1 in 10 GP consultations and 1 in 20 A&E attendances could have been managed by community pharmacists utilising the Minor Ailment Service. We will therefore support an expansion of the MAS by an additional £10m every year, with broader eligibility criteria, and aim to considerably raise public awareness of the scheme.’


The Scottish Greens’ manifesto pointed to uneven access to primary care professionals in communities:


‘Primary services are vital to preventing the need for more acute services. Scottish Greens will seek to ensure that all primary care services – GPs, community and practice nurses, pharmacists and others – have the resources to reduce waiting times and improve shared working, and we will fight to ensure that primary care provision is equitable.’


The Greens campaigned for more investment in drug and alcohol treatment programmes as well as the decriminalisation of the cultivation and possession of cannabis for personal use. The party sought ‘licensing for the supply of cannabis and propose that other currently illicit drugs required as part of a programme of treatment for addiction are supplied through pharmacist-run treatment centres’.


The SNP’s manifesto is heavily influenced by its commitment to delivering Prescription for Excellence with its vision of a growing role for pharmacists in community health services:


‘Our reforms will bring together a range of professionals in GP surgeries, including practice nurses, district nurses, mental health professionals, pharmacists, and allied health professionals. All GP practices will have access to an enhanced pharmacist, allowing GPs to focus more on the patients who require their assessment.’


BIBLIOGRAPHY


1 Our NHS Timeline http://www.ournhsscotland.com/history/timeline 2 SNP Manifesto 2016 http://bit.ly/1VEgRql 3 NHS Bodies http://www.gov.scot/Topics/Health/NHS-Workforce/NHS-Boards 4 Scottish Public Health Observatory http://www.scotpho.org.uk/population-dynamics/population-estimates-and-projections/ data/nhs-board-population-projections 5 Holyrood Magazine article March 2016 https://www.holyrood.com/articles/news/structure-local-government-and- health-boards-neither-sustainable-nor-desirable-claims


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