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The Scottish, Irish and Welsh outlook

24 March 2011

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By Stuart Gidden

The commissioning and delivery of health services in Scotland is carried out by 14 Health Boards across geographical boundaries. These Health Boards operate in a similar manner to primary care trusts in England, though there is greater variation in their size and scope. NHS Ayrshire and Arran, for example, provides healthcare to a population of around 367,000 people, and its expenditure in 2008/09 was roughly £625 million. NHS Greater Glasgow and Clyde, meanwhile, is not only the largest Health Board in Scotland, but the largest such organisation in the UK, with 44,000 staff. It serves 1.2 million people in its local area, but also commissions and delivers specialist services to more than half of Scotland. NHS Greater Glasgow and Clyde has an annual budget of £2.6 billion.

Currently, NHS Scotland has no plans to reform its health structure – but a general election of the Scottish Parliament takes place in May this year, so this may change.

Launched in May 2010, NHS Scotland’s Quality Strategy set out plans to “put people at the heart of everything the health service does”. It promotes a vision for patients to be “partners in their own care” and includes initiatives such as focusing on patients’ rights (including the right to continuity of care), responsibilities and expectations.

In February, politicians in Scotland debated the Patient Rights Bill, which aims to improve patients’ experiences of using health services and to support people to become more involved in their healthcare. If passed, the Bill will give patients the right to raise concerns or complaints about the healthcare they receive. NHS Scotland providers, including GPs, must take into account a set of NHS principles (which include patient participation and communication) when providing services.
However, the British Medical Association in Scotland has called on politicians to reject the Patient Rights Bill, particularly over its right to introduce a 12-week treatment time guarantee for patients, saying the Bill “is more about political rhetoric than patient rights.”

Foreshadowing the more radical reforms in England, NHS Wales has already restructured itself since October 2009, in accordance with the One Wales strategy document that labelled the previous system of 22 Local Health Boards (LHBs) and seven NHS trusts as “complex and over-bureaucratic”. The 2009 reforms reduced the number of LHBs to seven, responsible for all healthcare services.

The changes were made in part to ensure a more integrated delivery of services by “removing artificial boundaries that existed between the commissioners (LHBs) and the providers of services (the NHS Trusts).” This is in clear contrast to England where GPs are to commission secondary care services.
A Welsh Assembly Government spokesman told MiP: “There are no plans to enable GPs in Wales to commission services. We have already reformed the NHS in Wales to simplify the structure and remove the artificial boundaries that existed between healthcare organisations, particularly primary and secondary care.

“However, under the 2009 restructuring, GPs in Wales will have a stronger role to play in the provision of health services. Health Boards are establishing Locality Networks in which GPs will have a significant leadership role in ensuring local services meet local needs,” said the spokesman.

Under the Welsh healthcare reforms, seven Community Health Councils (CHCs) – statutory lay bodies – represent the interests of patients in their local health district. According to the Welsh Assembly, the CHCs champion the rights of patients, and support patients should they feel the need to raise any concerns. In some cases, a CHC may move to reorganise services if there is sufficient patient pressure.

Northern Ireland
As in Wales, the health structure in Northern Ireland was also reformed in 2009, though several months earlier (in April that year). Unlike England, however, this was changed to a more centralised system, with the single Health and Social Care Board replacing four former area-based health and social services boards. The new Board is responsible for arranging health and social care services for the 1.7 million people who live in Northern Ireland, and has an annual budget of £4.2 bn.

Commissioning is conducted by five devolved regional arms, or Local Commissioning Groups (LCGs), overseen by the Health and Social Care Board. GPs sit on LCGs, alongside other health professionals and voluntary and elected representatives, “to ensure that the work of the Board has genuine sensitivity and influence at a local level”.

The Health and Social Care board also performance-manages five health and social care trusts, geographically aligned with the LCGs, that deliver services – so commissioning and service provision are performed by separate bodies, unlike in Wales and Scotland. Northern Ireland has no plans to reform its health service at present.

The 2009 health reforms also provided for the establishment of the Northern Ireland Patient and Client Council. According to the Northern Ireland Executive, this body acts as a ‘voice’ or ‘watchdog’ for patients, and provides people with advice on many aspects of healthcare services.

Patients with any concerns or complaints about services commissioned by LCGs can approach the Council directly. The Council replaces four health and social services council bodies that previously served people in each of the four former Health and Social Services Board areas.