An Overview of Scotland’s National Health Service

Aziz SheikhProfessor of Primary Care Research & Development and Co-

Director, Centre for Population Health Sciences, The University of Edinburgh

Harkness Fellow in Health Care Policy and Practice, Division of General Internal Medicine and Primary Care, Brigham & Women’s

Hospital/Harvard Medical SchoolPNHP Annual Meeting, November 2, 2013

Location and population size

Health is devolved from the UK government to the Scottish government

Publicly funded healthcare system with funds raised from general taxation – overall taxation contribution is on a sliding scale ranging from 0 – 45% (was 50% until April 2013)

Annual budget of £12 billion (approx. $19 billion)/year – 9.6% of GDP

Care essentially free at the point of delivery for all, including prescriptions (co-pay for adult dentistry and optometry)

Delivered through: 14 regional health boards And a variety of specialist health boards e.g. NHS24, NHS Health

Scotland (Public health), Health Improvement Scotland, Scottish Ambulance Service, NHS Education for Scotland etc.

Political, financial and structural considerations

General practitioners and allied health professionals (e.g. dentists, opticians and community pharmacists) are employed as independent contractors and are responsible for primary care provision: approx 12,000)

General practitioners operate as family physicians and are the main co-ordinators or “gatekeepers” to care

90% of all health care interactions take place in primary care Paid through a combination of:

Capitation fees Service fees Pay for performance (Quality Outcomes Framework)

Out-of-hours care provided through NHS24 (telephone helpline) and out-of-hours consortia

Primary health care

Overwhelming majority of specialist care is provided by consultants and their teams from NHS hospitals

These consultants and their supporting teams are employed directly by NHS Scotland

Secondary and tertiary care provision

Key demographic challenge

Our ‘2020 Vision’

Our vision is that by 2020 everyone is able to live longer healthier lives at home, or in a homely setting.

We will have a healthcare system where we have integrated health and social care, a focus on prevention, anticipation and supported self management. When hospital

treatment is required, and cannot be provided in a community setting, day case treatment will be the norm. Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions. There

will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission.

Improving quality of care through a focus on:1. Increasing the role of primary care2. Integrating health and social care3. Improving safety in all healthcare

environments4. Improving deliver of emergency and

unscheduled care5. People powered health and care services6. Improving support and treatment of those

with chronic disorders

Route map for 2020 vision: 12 priority areas for action

Improving population health through a focus on:

7. Early years8. Reducing health inequalities9. Preventive measures on alcohol, tobacco,

dental health, physical activity and early detection of cancer

Route map for 2020 vision: 12 priority areas for action

Securing the value and financial sustainability of health and care services:

10.Establish a vision for health and social care workforce

11.Increasing investment in new innovations which improve quality, reduce costs and provide growth to the Scottish economy

12.Increase efficiency and productivity through more effective use of unified approaches coupled with local solutions and decision making

Route map for 2020 vision: 12 priority areas for action

A&E

BIRTH

DEATH

Neonatal Record SMR11

Child health surveillance

Immunisation

GP consultations

Dental SMR13

Outpatients SMR00 Hospital Admissions SMR01

Mental Health SMR04

Prescribing Screening

Community care SMR50

Cancer registrations SMR06

Cancer Registry

Scotland’s linkable databases

Laboratory

Maternity

Example: Effectiveness of H1N1 vaccine for pandemic influenza

Preparing for the next pandemic…

Core funding in place and release of additional funds at first signs of pandemic influenza

This has enabled:

Creation of data structures to permit real-time evaluations

Permissions and approvals for data linkage and analysis

Development of detailed analysis and reporting plans

Conclusions

Further details: aziz.sheikh@ed.ac.uk