December saw publication of the Scottish government's health strategy and action plan, Better health, better care. There were no real surprises — much, including the phasing out of prescription charges had already been trailed. There was also an explicit rejection of England's more market-led NHS reforms although, as an aside, it's still not clear what the Scottish National Party will do about private finance initiatives (the finance committee of the Scottish Parliament is looking at it). There was also some good news from Audit Scotland — the NHS kept within its budget last year, although there were the usual warnings about financial pressures, including rising drug costs.

The Scottish government has put patients and the public at the heart of health services in its first health strategy and action plan.

Better health, better care also promises more emphasis on health improvement and public health in a bid to reduce health inequalities.

It is also promising extended GP practice opening hours as part of a package to improve access to primary care — a move which has been criticised by doctors' leaders.

Nicola Sturgeon, the Cabinet Secretary for Health and Wellbeing, said that nobody expected GP services to be available 24 hours a day, seven days a week. But she added:

'Many patients, including those in some hard to reach groups, both want and would benefit from being able to see a GP before or after work or at the weekend.'

But Dean Marshall, chairman of the British Medical Association's Scottish GP committee, said he had yet to see the evidence. 'We are keen to ensure that any changes to the existing hours represent the best use of scarce resources and do not detract from our ability to deliver services to those with the greatest need.'

The Scottish National Party's action plan includes walk-in clinics at commuter points, which will be piloted in five pharmacies in 2008.

It maintains the fundamental direction of travel of the Scottish NHS, set out in the Kerr report (published under the former Labour-led administration), which aims to move to a more community-based health service.

Other commitments in the plan include a consultation on a new patients' rights bill, which will cover waiting time guarantees, and  production of an 'ownership report' which will be sent annually to all households, providing information and setting out patient and carer rights and responsibilities.

The plan also promises a local healthcare bill, due to be published next summer, which will include proposals for direct elections to NHS boards.

Ms Sturgeon said the plan put patients, the public and staff at the heart of planning for health. 'We've set out a clear vision of a mutual NHS where ownership and accountability is shared with the public and with NHS staff.'

She made it clear, however, that Scotland would not be following England to a more market-driven NHS. 'We have set out a plan for a National Health Service based on the values of co-operation, not the whims of the market. We affirm a unified structure in which decisions are made in the interests of the people we serve and not by the demands of internal competition.'

Further information

Scottish government document: Better health, better care

The NHS in Scotland underspent its £9.4bn budget by £98m in 2006-07, according to Audit Scotland.

Only one board — NHS Western Isles — failed to meet its financial targets.

The Overview of Scotland's health and NHS performance in 2006/07 also showed the NHS was making good progress against performance targets.

But it said better reporting on performance was needed to ensure information was robust. The report said that while spending on the NHS in Scotland had increased to £9.4bn, the service faces continuing cost pressures, including service redesign, pay modernisation and rising drug costs, reinforcing the need for strong financial management.

Robert Black, the auditor general, said: 'Financial management has shown clear improvements over previous years with all boards but one managing to stay within their budget. We would like to see this continue so that boards can adequately deal with the cost pressures they face in the future.'

Further information

Audit Scotland document: Overview of Scotland's health and NHS performance in 2006/07

Scotland will see a phased abolition of prescription charges, starting with cost reductions from next year, the Scottish National Party (SNP) government has announced.

From April 2008 the cost of a prescription will be cut to £5, reducing to zero in 2011. The cost of a pre-payment certificate (PPC) will be more than halved from £98.70 to £48 in 2008 and will see further phased reductions until abolition in 2011.

Nicola Sturgeon, the Cabinet Secretary for Health and Wellbeing, said prescription charges were a tax on ill health and a barrier to good health for too many people. She added that cutting the cost of pre-payment certificates was aimed at helping people with long-term conditions. 'While PPCs will be redundant from April 2011, I want to take this opportunity to encourage all people who have chronic conditions and need to use regular medication to use PPCs until then,' she said.

Dr Richard Simpson, Labour's spokesman on public health, called it a 'risky strategy which could put other health priorities at risk by costing more than the government have allowed for'.

The minor ailments service, operated by community pharmacists, which allows those currently receiving free prescriptions to be prescribed over the counter remedies by pharmacists, will continue for those who are on low incomes or benefits.

Originally the SNP had promised to remove charges for patients with long-term conditions within a year, but, on reflection, decided this would be too complex.

The Scottish Medicines Consortium (SMC) has issued advice on the following treatments.

Accepted for use in NHS Scotland: Arixtra (Fondaparinux) for treatment of unstable angina or non-ST segment elevation myocardial infarction Hycamtin (Topotecan) in combination with cisplatin for carcinoma of the cervix (restricted) Nexium (Esomeprazole) for treatment of Zollinger-Ellison syndrome Accepted following an abbreviated submission: Spiriva respimat (Tiotropium respimat inhaler) as a maintenance bronchodilator to relieve symptoms of patients with chronic obstructive pulmonary disease (restricted)

Not recommended for its specific use: Renagel (Sevelamer) for control of hyperphosphataemia in adults receiving peritoneal dialysis

Further information

Website:  Scottish Medicines Consortium

Staff in the NHS in Scotland are still wary about reporting safety incidents and 'near misses' for fear of being blamed, a survey has found.

NHS Quality Improvement Scotland (QIS) said the NHS compared well to many other organisations, but made recommendations for improvement.

QIS surveyed more than 13,000 members of NHS staff and received almost 4,000 responses. Every NHS board scored at least the mid-point of the scale used to describe reporting incident culture, but no board has achieved the desirable/optimal level which indicates all the essential cultural and practical foundations are in place to promote incident and near-miss reporting and to learn from experience.

Further information

QIS website: NHS Scotland incident reporting culture study

Funding of more than £10m is to be allocated to improving eye care in Scotland following a national review.

Most of the money — £8m in capital funding — will go to optical practices providing NHS eye examinations to allow them to buy digital cameras, which will improve free eye examinations.

A further £2.6m will be split between NHS boards to help with service improvements identified in the review, including the development of integrated eye care services and cutting waiting times.

Public health minister Shona Robison said: 'I recognise that the findings of the eye care review pose some challenges to optometrists and I am confident that the capital funding I have announced today will go a long way towards meeting those challenges.'

Free eye tests for all were introduced in Scotland under the previous Labour-Liberal Democrat coalition.

Parking in NHS hospital car parks is to be capped at £3 per day, the Health Secretary Nicola Sturgeon has announced.

The move followed a review of car parking charges, which also said charging should only be introduced when other methods of managing parking pressures were unsuccessful.

Ms Sturgeon said: 'The review group has found that the cost of car parking can be too high for staff on lower wages, for patients and for visitors and that a maximum charge should be set — but that further work is needed on what that maximum charge should be.

'That work will be done but in order to provide protection against unnecessary or excessive charges in the meantime I have decided to act now to introduce a cap of £3 per day.
'I believe that a £3 a day cap strikes the right balance between the pressures faced by boards and the interests of patients and staff.'

Scotland has moved a step closer to extending legal protection currently given to workers, including doctors, who are responding to an emergency.

Regulations were laid before the Scottish Parliament which would extend the Emergency Workers Act to cover all doctors, nurses or midwives working in the community.