Talking-up Scotland

A World Health Organization safety checklist to encourage teamwork and communication during operations has been associated with a 37% reduction in the death rate after operations, with a notably dramatic fall since 2007/8. Dr Atul Gawande, who introduced the checklist and co-authored the above study, published in the British Journal of Surgery, said:

‘Scotland’s health system is to be congratulated for a multi-year effort that has produced some of the largest population-wide reductions in surgical deaths ever documented.’

However, it is likely that other factors will have been influential in this achievement including new improved technologies and management of the SNHS at Scottish government level. The report’s conclusion acknowledges this:

‘The WHO Surgical Safety Checklist has been implemented widely since its launch in 2008. It was introduced in Scotland as part of the Scottish Patient Safety Programme (SPSP) between 2008 and 2010 and is now integral to surgical practice. Its influence on outcomes, when analysed at a population level, remains unclear.’

The probable role of the Scottish Government, as suggested by the Nuffield Trust, in helping to enable this achievement is discussed below the frankly amazing results:

This is an astonishing trend, unique I think, in improving health outcomes with a more than halving of the mortality rates after surgery, in the space of only 10 years, and after a period of flat or worsening results under Labour.

In some ways even more impressive, the percentage of patients having to return for further surgery has fallen to almost zero! This comes after a period, under Labour, of worsening outcomes.

https://onlinelibrary.wiley.com/doi/full/10.1002/bjs.11151

The Scottish NHS and the Scottish Government

Extracts from the Nuffield Trust in 2017:

Scotland has a unique system of improving the quality of health care. It focuses on engaging the altruistic professional motivations of frontline staff to do better and building their skills to improve. Success is defined based on specific measurements of safety and effectiveness that make sense to clinicians.

Scotland’s smaller size as a country supports a more personalised, less formal approach than in England. The Scottish NHS has also benefited from a continuous focus on quality improvement over many years. It uses a consistent, coherent method where better ways of working are tested on a small scale, quickly changed, and then rolled out. Unlike in the rest of the UK, this is overseen by a single organisation that both monitors the quality of care and also helps staff to improve it.

There is much for the other countries of the UK to learn from this. While comparing performance is very difficult, Scotland has had particular success in some priority areas like reducing the numbers of stillbirths. Scotland’s system provides possible alternatives for an English system with a tendency towards too many short-term, top-down initiatives that often fail to reach the front line. It also provides one possible model for a Northern Irish NHS yet to have a pervasive commitment to quality improvement, and a Welsh system described as needing better ways to hold health boards to account while supporting them in improving care. Scotland has a longer history of drives towards making different parts of the health and social care system work together. It has used legislation to get these efforts underway while recognising that ultimately local relationships are the deciding factor. There is much for England and Wales to learn from this.

Research Report, July 2017, Learning from Scotland’s NHS at: https://www.nuffieldtrust.org.uk/files/2017-07/learning-from-scotland-s-nhs-final.pdf