Scotland goes its own way on health

Scotland's new health secretary Nicola Sturgeon speaks exclusively to Neil Durham about her plans.

When Labour lost the Holyrood elections in May, the Scottish National Party (SNP) formed a government. In her first 100 days, health secretary Nicola Sturgeon delivered on a pledge to overturn decisions to close A&E departments at Monklands in Airdrie, Lanarkshire and Ayr.

During half a century of Labour dominance of Scottish politics, the SNP had been a party of opposition and never of government, leaving commentators asking whether Scotland was preparing to go its own way on health.

Speaking exclusively to GP, Ms Sturgeon embraces the question: 'It already goes its own way on health. We'll continue to do what's best for Scotland while co-operating with other parts of the UK on regulation of professionals and pay.'

Scotland's future NHS
So how does her vision for the NHS in Scotland differ from what is happening in England?

Ms Sturgeon emphasises collaboration, partnership and co-operation and adds: 'The focus on markets and competition is not an approach we've chosen to take in Scotland.'

But why do markets not work in Scotland?
'There has to be a collaborative approach with different health professionals. Different parts of the health system need to work together and we've still considerable work to do in terms of improving the quality of clinical care.'

She points out that the law enables alternative providers to hold primary care contracts in Scotland as in England, but that no successful APMS bidder has been awarded a contract.

Ms Sturgeon refuses to rule out the possibility of Scotland-only changes to the GMS contract in the future but says that, for the time being, this is not something she envisages.

'I see no need to move to that just now. But none of us know what will happen in the future. We'll always do what's best for the health service in Scotland, but I see no immediate need to change.'

She says the same applies to pay negotiations and describes as 'speculation' a question asking whether GPs in Scotland should expect a third successive pay freeze in 2008/9.

'We'll have to see what the outcome of negotiations for next year will be,' she says, adding that for the moment she is happy that those are conducted UK-wide.

Asked whether she feels that she has the backing of the medical profession, she says: 'My gut feeling would be yes. I don't think GPs in Scotland want to see a system of the private sector providing services and I don't think it is in the interests of patients.'

However, one SNP proposal, for 'life begins' health checks for all adults aged 40, has attracted medical criticism for preoccupying GPs with the well at the expense of the chronically ill.

But she counters: 'We're going to push forward with this and are already working on the detail. It's an important step forward and will put a much greater focus on anticipatory care identifying problems before they arrive.

'GPs will have a big role to play, no doubt about that.'

Another source of concern for GPs is the proposal by NHS24, Scotland's version of NHS Direct, that it be employed by primary care organisations in-hours to enable practices to close and then re-open later for extended hours.

Performance improvement
Ms Sturgeon comments: 'I've said very clearly that I want to see more flexibility in the primary care system. It's something we are in discussion with GPs about. NHS24 may have a role to play in that. At the moment and for the foreseeable future it should be about improving the service out of hours.

'It has made a lot of improvements but still has a way to go in improving its performance.' She said Scotland was already pursuing its version of the polyclinic plans proposed for London by new health minister for England and surgeon Lord Ara Darzi.

She bats away speculation that the Barnett formula, which gives Scotland an extra £1,500 per head of population each year, should be reviewed. The Scottish government would prefer to have complete financial autonomy.

So, four months and more than 100 days into power, what is her message to GPs?

'I think they do a wonderful job often in very difficult circumstances. I want to work with them to make sure we continue to provide a good service and improve the service for patients that takes account of changes in society and the different ways that people lead their lives.'

BIOGRAPHY -
NICOLA STURGEON

  • Deputy first minister of Scotland, cabinet secretary for health and well-being, deputy leader of the SNP and MSP for Glasgow Govan.
  • Born: 19 July 1970.
  • MSP since first elections to the Scottish Parliament in 1999.
  • Worked as a solicitor before political career.
  • Partner is SNP chief executive Peter Murrell.
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