These commentaries by John Macgill represent his opinions only and not those of any Ettrickburn client.

Three Nations Three Practices

Community Pharmacy Eliminating Hepatitis C

Homeless People make Glasgow

Heart Failure – we can get treatment right for everyone

Bundles of Safety

Community Pharmacy’s Leader in Scotland

CPO: On the Road to Achieving Excellence

Pharmacy technicians may become prescribers

Profile: Dr Norman Lannigan OBE

Profile: Jonathan Burton MBE

Profile: Clare Morrison MBE

Deep Dive Pharmacy

Mind the Gap - Diagnostic Skills for Pharamacists

Bundles of Safety

Supporting Excellence - Alison Strath Interview

2018 Pharmacy Forum Agenda Launched

Which Referendum to Choose

Three Perspectives on Pharmacy and Mental Health

Pharmacy and the New GP Contract

Bordering on Problematic

Recognised by the Queen and her community

VACANCY Reporter/Researcher: Health and Care Policy in Scotland

Prescribing in Mental Illness – A Practice Pharmacist’s Perspective

What Matters to You? Communication in Pharmacy

Prescribing in Mental Illness – A Patient’s Perspective

Focusing the Vision: Dr Rose Marie Parr on the new strategy for Scottish pharmacy

All the things that could go wrong - looking ahead to the SNP conference

Ask Once, Get Help Fast? Pharmacy and Mental Health

Automation and Delegation in Pharmacy: Understanding the Moving Parts

Initiatives Highlight Potential of Community Pharmacy

Pharmacy First in Forth Valley One Year On

Trying to concentrate on the day job

Health and the Local Elections – a strange silence

The Pharmacist Will See You Now – The Growth of GP Pharmacy

Montgomery’s Review – Dr Brian Montgomery answers questions on access to new medicines in Scotland

An afternoon with SMC

Pharmacists at SMC

SMC – are drug firms voting with their feet?

Radical Surgery on the Horizon for Scotland’s NHS

The Future’s Bright – in General Practice

Community Pharmacy in a Changing Environment

Disclosing payments to doctors – has Sir Malcolm done the pharma industry a favour?

Health and Care in the First Minister’s Programme for Government

CMO: Scotland’s pharmacists “absolutely ideally placed” to practice Realistic Medicine

Profile: Maree Todd – MSP and Pharmacist

Scottish Parliament Health Committee Work Programme

Scotland’s new NHS – a Summer of Speculation

Scotland’s New Health Committee

Two million voices in Scotland – is integration the big opportunity to listen?

Medicines – levelling the playing field

Key appointment raises the bar for health & social care partnerships

What did our new MSPs do before?

SMC says no then NICE says yes – three times

SNP promises single formulary and a review of Scotland’s NHS

More Generous than the CDF – but less transparent

Comparison of Funds: New Medicines v Cancer Drugs

Bonfire of the Boards? SNP signals NHS Review

A tribute to five retiring MSPs

New Medicines Review - Health Committee sends findings to Government

Medicines New & Old in the Scottish Cancer Strategy

Great Ambitions, Slow Progress – New Models of Care in Scotland

Scottish Minsters Demand Up-Front Medicine Price Negotiation

Opportunity and Disappointment: MSPs Investigate New Medicines Access

Scottish NHS Strategy calls for 'Realistic Medicine'

The Scottish Model of Value for Medicines: Taking Everything into Consideration

When SMC Says No: An Access to Medicines Lottery

Reviewing the Review: Access to New Medicines in Scotland

A day of psephology and kidology

Insulting the Lifesavers

Worthy of Mention – Health and Science in the Honours List

News Silence from North of the Border

A Christmas PPRS Present from Pharma

Wednesday, July 6, 2016: Scotland’s new NHS – a Summer of Speculation

Rumours, gossip and conjecture fill the vacuum when policy facts are thin on the ground or non-existent. So it is with discussion of the future shape of Scotland’s NHS. 

The only surprise is that this week’s ‘exclusive’ report in the Courier newspaper, predicting the demise of both NHS Tayside and NHS Fife, can claim to be the first of its kind. 

It is an unavoidable result of having only a few weeks between an election and the political system going into its two-month summer hibernation, that little of what is promised by an incoming government is taken forward immediately. 

Perhaps if there had not been the seismic shock of the EU referendum result, the Scottish Government might have said something about their manifesto promise that: The number, structure and regulation of health boards – and their relationships with local councils – will be reviewed, with a view to reducing unnecessary backroom duplication and removing structural impediments to better care. 

The Courier article[i] states: 

“Tayside and Fife’s health boards could be axed under a radical NHS shake-up being considered by the Scottish Government, The Courier understands.” 

And goes on to say: 

“Such a move, according to senior sources in the health service, is likely to lead to a reduction in the number of local health boards from the current 14 to possibly three or five. That would favour mergers, with the likes of Tayside and Fife almost certain to be consumed into a larger body. This larger body could potentially lead to concerns about staff numbers and patient services.” 

The Scottish Government has given itself until the end of the current parliamentary term in 2021 to take forward the next stage of NHS reform. The process might begin with an announcement as part of the First Minister’s unveiling of the programme for government in September. Equally, it might not. 

In the meantime, NHS chief executives and managers are left trying to put a diplomatic spoke in the rumour mill, none of them equipped with any facts that might let them dampen the speculation. 

While some NHS leaders are predicting a gentle and unthreatening continuation of the administrative evolution brought about by the creation of the 31 health and social care integrated joint boards, others believe that wholesale mergers are indeed on the cards – possibly to create single national boards – with entire layers of managers finding themselves surplus to requirements. 

Although nothing has been said publicly by either board mentioned in the Courier report, part of a statement to staff by NHS Tayside was helpfully shared in the comments section below the Courier’s online posting. The NHS Tayside calls the article ‘speculative’, adding: 

“We are in close contact with the Scottish Government and its ministers and NHS Tayside, along with all other Health Boards across Scotland, has been assured that any redesign of Board structures across Scotland would be the subject of significant consultation with staff, patients, their families, carers and the public.” 

The Courier report quotes local and national politicians from all sides. Their responses suggest that opinion is somewhat mixed about the merits of a review, with some questioning the Scottish Government’s track record in merging several regional organisations into one. 

The Scottish Government is generally adept at explaining the rationale of its big proposals for change, and consultation will certainly be important if the NHS and the Scottish public are to support, or at least accept, proposals for far-reaching change. 

Ultimately, change that delivers more investment into efficient and swift patient-facing services may be hard to argue against. But does the Scottish Government have the nerve to make changes that NHS people in administrative and management roles judge to be threatening their jobs – notwithstanding a no compulsory redundancies policy? 

With a five-year term and the need to do a deal with just one party to get a majority in parliament, now would have been the time for the Scottish Government to start making big changes and still allow enough time for the changes to bed in and no longer be controversial before another election. 

The ‘Brexit’ referendum has changed all that. 

Now we have the possibility that the Scottish people may be asked to vote on Scotland becoming an independent country before the UK leaves the EU. Would an SNP government, about to go into a referendum that just might, this time, win it the prize that it longs for, risk worrying or upsetting the 165,000 people working in its biggest institution – not to mention patients, their families, carers and the public? 

The current speculation-filled vacuum (if you forgive the oxymoron) on NHS reform might last quite a while longer.

[i] Courier 5 July: