She claimed it was the biggest manifesto launch ever seen in Scotland and, with some 1400 people queuing to get in to this morning’s event in Edinburgh, Nicola Sturgeon’s assessment was no doubt correct.

What the SNP manifesto signals, above all, is that the decision has been made to undertake the sort of review of Scotland’s NHS that so many of their ministers have been wanting to do since first coming to power.

The manifesto document[i] is actually two publications folded into one. The outer full colour summary magazine is awash with top-line statements and pictures of SNP people and Scottish landmarks.

The SNP’s big promises include that the NHS revenue budget will increase by £500 million more than inflation by the end of the coming parliament, which it says will mean funding increases by almost £2 billion in total.

Another big-ticket promise is to: ‘…reform the NHS to meet the challenge of an ageing population by investing an additional £1.3 billion in our health and social care partnerships, reforming primary care and increasing the numbers of GPs and nurses working in our communities.’

It is the 44-page inner ‘Next Steps to a Better Scotland’ booklet that gives the meat of the party’s policies which, given the likelihood of the SNP being the next Scottish Government, gives the detail of where Scotland’s NHS is going to be going in the coming years.

As signalled by Health Secretary Shona Robison at the ALLIANCE hustings [my commentary on 6 April[ii]], there is to be a review of the structure of the Scottish NHS. The manifesto states:

‘Thirty-one new local integration bodies have been created to deliver adult health and social care. Scotland also has 22 health boards – 14 territorial and 8 special boards. In implementing the National Clinical Strategy, we will make sure the existing boundaries between health and integration bodies do not act as barriers to planning local services effectively.

‘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.

‘We will develop how budgets are allocated, focussing on areas of clinical activity as well as geography and we will continue to shift the balance of care by increasing, in every year of the next parliament, the share of the NHS budget dedicated to mental health and to primary, community, and social care.’

The manifesto signals the creation of a Scottish major trauma network based on the four cities of Aberdeen, Dundee Edinburgh and Glasgow; the promise of new elective and diagnostic centres in Edinburgh, Livingston, Dundee, Aberdeen and Inverness; and a commitment to work more closely with the Royal College of Emergency Medicine on managing unscheduled and emergency care.

In Primary Care, the SNP is committing itself to shifting the balance of care (and its funding) to community settings, and increasing the number of GP surgeries offering a broad Community Health Service:

‘Our reforms will bring together a range of professionals in GP surgeries, including practice nurses, district nurses, mental health professionals, pharmacists, and allied health professionals. All GP practices will have access to an enhanced pharmacist, allowing GPs to focus more on the patients who require their assessment.’

Therapy area-specific promises include to implement the new Cancer Strategy and the Sexual Health and Blood Borne Virus Framework; to increase provision of insulin pumps to over 6,000, more than one in five of people with Type 1 diabetes in Scotland; and the SNP, in common with other parties, is putting added emphasis on improving services to people who are mentally unwell.

On medicines policy there is a nod to the current review of the work of the Scottish Medicines Consortium (SMC), and the announcement of a move to a single formulary for Scotland to replace the 14 local sets of guidance:

‘New medicines are now more readily available and we will continue to review the appraisal system, to ensure quick, safe and effective access to drugs. We will introduce the option of a pause in the medicines appraisal process to allow for negotiation and potentially avoid the need for reapplication.

‘A new single national formulary – guidance on drug prescribing – will also be introduced to ensure quick and equitable access to new medicines.’

One detail that is not addressed is who will be responsible for managing such a national formulary and what might be the balance of ownership, for instance, between SMC and NHS National Services Scotland’s National Procurement division.

[i] SNP Manifesto 2016 http://bit.ly/1VEgRql

[ii] Commentary Bonfire of the Boards? http://www.ettrickburn.com/default.asp?page=commentary&article=2