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The Kerr Report Briefing

June 2005


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.

Key Proposals

  • NHS Boards to put into place systems to care for the most vulnerable people with long term conditions at home or in their communities
  • 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 of NHS
  • 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 units
  • 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 for patients.
  • Specialist and complex care to be concentrated in fewer sites.
  • Rural areas need a different type of service. Rural hospital networks to be developed and a School of Rural Health care established
  • Health Boards to make regionally based decisions about hospital based services
  • 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.

Specialist treatments

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.

Waiting times

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.

Maternity services

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.

Rural provision

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.

Public consultations

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.

Ageing population

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.


Current view

Evolving model

Geared towards acute conditions

Geared towards long term conditions

Hospital centred

Embedded in communities

Doctor dependant

Team based

Episodic care

Continuous care

Disjointed care

Integrated care

Reactive care

Preventative care

Patient as passive recipient

Patient as partner

Self care infrequent

Self care encouraged and facilitated

Carers undervalued

Carers supported as partners

Low tech

High tech

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

Further Information

Contacts list:

Dave Watson

Aileen Ward

@ P&I Team 14 West Campbell Street GLASGOW G2 6RX Tel: 0845 355 0845 Fax: 0141 307 2572