Scotland needs to shift away from a “repair shop mentality” that has developed around health and adopt a greater focus on preventing people from becoming ill in the first place, the country’s top doctor has said.
Chief Medical Officer Professor Sir Gregor Smith was speaking as MSPs were told a shift to larger “subnational” health boards would allow for a “much more” strategic approach to the health needs of the nation.
Holyrood’s Health Committee considered the issue in the wake of First Minister John Swinney announcing sweeping reforms to NHS organisation, moving from 14 area health boards currently to just two strategic boards for the whole country.
Speaking after the change was announced in the SNP leader’s Programme for Government, Caroline Hiscox, the chairwoman of the NHS Scotland Executive Group, said: “Moving to two subnational strategic health boards will allow us to think much more strategically as a country about the population’s needs.”
Ms Hiscox, also the chief executive of NHS Lothian, said the change could “make sure we are addressing all population needs, with a big focus on prevention and addressing equality of access and outcomes”.
The move to a “subnational” set up should also bring “improved financial flows”, she said, adding: “The absolute intention would have to be invest pre-emptively in prevention in a much more intentional way than we have currently been able to do.”
Prof Smith told MSPs: “It is absolutely critical that we get out of the repair shop mentality that has developed around about the health care system and make sure it is focused on preventing ill health, maintaining good health for the future.”
Much preventative activity is really local, but I do think within the regional arrangements there are enormous opportunities to learn from other areas and to scale up good practice
Public Health Scotland chief executive Paul Johnston said introducing such “subnational arrangements might support that shift to prevention”.
Giving evidence to the committee, he said: “Much preventative activity is really local, but I do think within the regional arrangements there are enormous opportunities to learn from other areas and to scale up good practice.”
Here he noted that vaccination and screening rates “do vary from area to area”, along with how people are helped with problems such as obesity and stopping smoking.
Mr Johnston continued: “Those are areas where an enormous amount of ill health can be prevented through scaling up our interventions.”
He stressed that whatever “structural changes” are made to the NHS, it is “absolutely vital that we bake-in an enhanced focus on preventing harm”.
This should happen through “tried and tested interventions like vaccination and screening”, Mr Johnston said, but also through new services that are “still emerging, such as the weight management pathways that are available”.