The Kerr Report Briefing
UNISON has broadly welcomed the National Framework
for Service Change in the NHS drawn up by Professor David Kerr.
The Kerr Report, published in May 2005, sets out a Scottish framework
to allow the NHS is Scotland to deal with current and future challenges
such as Scotland's overall poor health, health inequalities and
the ageing poulation. Professor Kerr is an international cancer
specialist based in Oxford and was born in Glasgow.
The report aims to bring together the voices of
the public and health professionals in Scotland and to provide
a framework for the future development of health services in Scotland.
Professor Kerr found that " the basic ethos
of the NHS in Scotland- free comprehensive care to all- still
commands universal public support. The future of our health service
needs to be built from that base." It needs to be
" Fair to all "and "personal
to each of us"
Key Policy Themes of Report
- Ensure sustainable and safe local services
- View the NHS as a service delivered predominantly in local
communities not in hospitals
- Preventative, anticipatory care rather than reactive management
via the separation of planned and unplanned care
- Galvanise the whole system
- Become a modern NHS
- Develop new skills to support local services
- Develop options for change with people not for them
UNISON is encouraged that the report does not recommend
further incursion of the market into Scottish healthcare.
- NHS Boards to put into place systems to care for the most
vulnerable people with long term conditions at home or in
- Target anticipatory care in deprived areas to reduce future
ill-health and reduce health inequalities
- Encourage and support patients and their carers in managing
their health care needs
- Urgently introduce new technology like electronic patient
records and tele-medicine to improve access, quality and integration
- Use community casualty departments with multidisciplinary
teams for the majority of hospital based unscheduled care.
Use tele-medicine to link these units to consultant led emergency
- Move to day surgery as the norm. It is proposed that the
separation of planned and unplanned care will reduce waiting
times. The report emphasises that this needs to be linked
to improved community access to diagnostics and information
- Specialist and complex care to be concentrated in fewer
- Rural areas need a different type of service. Rural hospital
networks to be developed and a School of Rural Health care
- Health Boards to make regionally based decisions about hospital
- Community Health Partnerships to have a clear agenda to
work across barriers between primary and secondary care and
engage with social care partners to shift the balance of care.
Kerr states that the workforce is increasing but
there are recruitment and retention challenges. The workforce
requires re-profiling and investment in training and education
across clinical professions. This appears to indicate a need to
take a new approach to staffing hospitals at night.
Accident and emergency services
Professor Kerr estimates that 70% of current A&E
cases can be handled at Community Casualty Units staffed by paramedics
and nurse practitioners and tele-linked to consultants. There
will be fewer level three casualty units where those likely to
require surgery or treatment will be directed. There will also
be a few specialised centres (level 4) providing heart chest and
brain surgery and specialised critical care.
The report finds that some treatments such as heart
by-passes should be undertaken in specialised centres where teams
of consultants see high numbers of similar cases while others
such as removal of tonsils are safe for smaller hospital delivery.
He has asked for more research to be done into some disorders
where currently there is no clear picture. The Minister has agreed
to the research.
As stated above separating planned and emergency
care is seen as a key strategy to cut waiting list by preventing
emergency cases suddenly taking up beds. The proposal for more
day surgery should also cut waiting lists. It also notes that
partnership with the private sector in Scotland and abroad could
be explored to clear backlogs.
The report says little about the current controversy
round the provision of maternity services. Further research mentioned
above should provide answers. It is likely that the current trend
towards midwife led units will continue in the mean time.
The report finds that there is a need to develop
an understanding of rural health needs and to develop this as
a speciality. Further and ongoing staff training will be necessary.
Health Boards should involve the communities they
serve in developing proposals rather than making plans and then
presenting them for comment. Professor Kerr is particularly keen
to see boards develop integrated regional plans.
Scotland's ageing population is key to the need
for a change in the way health is managed. 1% of patients take
up ward beds for 16% of the time. The NHS of the future must focus
on managing the care of the vulnerable in the community to prevent
their condition deteriorating leading to patients requiring hospital
care. The NHS should also focus on preventative health to ensure
that there is less demand for acute services as the current working
population moves into old age.
Geared towards acute conditions
Geared towards long term conditions
Embedded in communities
Patient as passive recipient
Patient as partner
Self care infrequent
Self care encouraged and facilitated
Carers supported as partners
UNISON's initial response called for the Executive
and Health Boards to endorse the Kerr Report recognising that
implementation will be challenging for the service