The NHS in Scotland and Regional Public Health

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The NHS in Scotland and Regional Public Health

• Dr Lesley Wilkie
• Director of Public Health
• NHS Grampian

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What I will do

• How the National Health Service is organised and
  funded
• How Public Health fits with that
• What a Regional PH service does

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UK national level

• United Kingdom Parliament (Westminster).
• Responsible for policy on (English) Health and
  Education, (UK) Foreign Policy, Social security
  benefits, Defence, Taxation, European liaison.
• Resource Allocation to English departments of
  state (Health, Education, Defence etc) and global
  sum to devolved parliaments and assemblies in
  Scotland, Wales and Northern Ireland

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Scotland

• The Scottish Parliament (Holyrood)
• Devolved Parliament with powers conferred by
  Westminster (UK) Act of Parliament.
• Elected MSPs, First Minister and Cabinet
• Responsible for separate Health, Education,
  Environment, Social Policy
• Global sum received from Westminster to Scotland
  allocated among Scottish departments based on
  Scottish set priorities

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The National Health Service

• Funded from general taxation raised by central
  government
• Free at point of use to all citizens
• Payments (standard, centrally set level) for
  certain aspects of care e.g. prescription drugs
  (though not while in hospital), dental treatment
  (to an upper limit of charge), spectacles
• These charges waived for certain patients based
  on ability to pay or condition suffered e.g. only
  approx 20 pay anything for primary care
  prescribed drugs

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The National Health Service

• Certain things reserved to UK parliament
• Such as payment scales for clinical and other
  staff
• Regulation of the clinical professions
• Basis of funding (i.e. free at point of use)
• Benefits (social security payments)

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The NHS in Scotland

• Policy direction, resource allocation and
  performance management by Scottish Government via
  Cabinet Secretary for Health and Wellbeing (The
  Minister of Health)
• Local strategy, delivery and local resource
  allocation by 14 area based Health Boards
• Resources allocated to Health Boards from
  government by capitation and needs based formula.
  For Health Board to determine use according to
  local priorities.

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The NHS in Scotland

• Boards consist of appointed (by Minister of
  Health) non executive members and employed
  executive directors (Chief Executive, Finance,
  Public Health, Medical, Nursing)
• Responsible for the management and provision of
  hospitals, primary care, and public health
  services
• Populations of Boards vary from 20,000 to over 1M
  people

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The NHS in Scotland

• Each Health Board area has sub units of
  management
• An acute unit the acute hospitals offering
  inpatient, day case and outpatient treatment.
  Doctors are medical specialists
• Local primary care organisations delivering
  generalist family doctor service and community
  based services also responsible for certain
  secondary care specialties such as mental health.
• General medical practitioners are independent
  contractors to the NHS, not employed

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The NHS in Scotland

• Each Health Board responsible for improving
  health, reducing health inequalities and
  providing health services in their region
• Within available resources, meeting national and
  local priorities
• Regional public health specialist function
  managed within Health board led by Director of
  Public Health
• Director of PH also officer of local authorities
  in Board area

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Local Authorities

• Local government organisations
• Elected members, employed officers
• Raise funding from local taxation (the council
  tax) and from direct grants from central
  (Scottish) government
• Responsible for education, social care, housing,
  waste collection and disposal and environmental
  health
• Have been given power of wellbeing for their
  population by legislation

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The public health workforce

• Is a multidisciplinary workforce
• Has specialists, practitioners and generalists
• Covers the 3 domains of public health practice
• NHS has majority of specialists, between regional
  departments, national agencies and academic
  departments

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Director of public health

• Executive director on NHS Board
• Advocate for the public health
• Influences NHS Board and local authority
  strategies for the good of the public health
• Leads the specialist public health function
• Promotes and supports network of PH specialists
  and practitioners

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Director of public health

• Monitors health of local population, including
  extent of any inequalities in health
• Produces independent report on the health of the
  population and evidence based recommendations to
  improve health
• Has statutory role in local authority functions

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Health improvement

• Focus on local communities and local partnership
  working
• Supported by public health networks
• Health promotion and community development
• Projects
• Local priorities for health, regional and
  national context
• Specific funding, joint funding and funding
  influence

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Health protection

• Responsibility spread across agencies NHS, Local
  authority, FSA (food), SEPA (environment),
  Scottish Water
• NHS PH function coordinating role for people
  issues surveillance, outbreaks, immunisation,
  screening
• LA has legal powers e.g. exclusion (historical)

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Health Services

• Population focus on delivery of health care
• Disadvantaged groups and inequalities
• Health care as a health improvement activity
• Support and science for evidence based approach
• Health economic approach and use of scarce
  resources to improve overall population health

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Summary - NHS

• Funded from taxation, free at point of use
• Health policy a devolved function
• Priorities set nationally and locally
• Health Boards make decisions on resource
  allocation for population
• Delivery of health care managed as a single
  system
• Boards have responsibility to improve health as
  well as provide health services

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Summary Regional public health

• Maintains focus on overall population health and
  inequalities in health status within population
• Supports and delivers evidence based public
  health action
• Builds capacity of PH and general workforce
• Acts as advocate for health on behalf of whole
  population, and disadvantaged groups within
  population
• Strategically influences health service and local
  authority policy and spending decisions to
  achieve health gain

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