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Theresa Fyffe of RCN Scotland

Theresa Fyffe of RCN Scotland

Nursing leaders have warned that further changes to NHS pensions, on top of a proposed pay freeze and job losses would be “a step too far”.

Speaking as an Audit Scotland report revealed that public sector pensions cost £3 billion per year, RCN Scotland director Theresa Fyffe said that the impact of changes already agreed should be monitored first.

In its report on the cost of public sector pensions in Scotland, published today, Audit Scotland says that the Scottish Government and councils will need to implement changes in Scotland to ensure that pensions are fair and affordable in the future.

Currently, public bodies – or the tax-payer – pay £2.2 billion per year, while employees pay around £810 million towards the cost of providing pensions.
The report looks at Scotland’s six main public pension schemes, which cover around a million people (including those already receiving pensions and those who have yet to retire.

It comes ahead of the report next month of the independent review of public pensions across the UK. Chaired by former Labour minister Lord Hutton, this is expected to suggest options which would lead to employees having to bear more of the brunt of the cost.

On average, employees’ contributions cover around a quarter of total pension costs and vary between 1.5 per cent and 11 per cent of pay. Public sector employers pay the largest share with contribution rates ranging from 11.5 per cent to almost 25 per cent of pay. Although higher contributions tend to reflect higher benefits in some schemes, the Audit Scotland report says there appears to be no clear reason for these variations.

Pensions are earned according to pay and length of service. The average annual pensions (excluding lump sums) range from £4,222 in the civil service scheme to £15,674 in the police scheme.

Ms Fyffe said that the report “explodes the myth about gold-plated public sector pensions” because the average annual pension for people who worked in the NHS in Scotland is £7,057.

“Indeed, most retired nurses receive even less because women who worked in the NHS receive an average of only £5,098. 90% of nurses in NHS Scotland are women,” she added.

“Our members understand the pressures on public sector pensions resulting from our ageing population and we have previously supported changes to the NHS pension. This included an increase in contributions to the scheme, progressive increases for higher earners, an increase in pensionable age for new entrants and protection for the tax-payer against increased liabilities.

“There is no need to make any further changes to the NHS pension at this stage: the impact of the changes already agreed should be monitored instead.

“Pensions reform has featured heavily in UK public debate in recent months, but any further changes to pensions, on top of the proposed pay freeze and increased workloads as staff numbers are cut, would be a step too far.”

But watchdogs suggested action was needed. Robert Black, Scotland’s Auditor General,said: “Pensions are a large and important part of public sector pay – one in five Scottish people have or will get a public sector pension and it costs the Scottish public sector £2.2 billion a year to support the six major public schemes. With major UK-wide pension reforms imminent, the Scottish Government should look at the differences between the country’s schemes, and consider how to implement changes that will be both fair and affordable in the long term.”

John Baillie, the chairman of the Accounts Commission for Scotland, pointed out that councils were facing escalating pension costs.

“Over the past five years employers’ contributions to the scheme have increased by 25 per cent in real terms to £836 million a year. Scotland’s councils should now decide on the extent and pace of further reform to ensure the scheme stays sustainable. This includes considering how to share the increasing costs of pensions most fairly with employees.”

NHS Scotland logoScotland’s NHS is facing the worst financial pressure since devolution, according to watchdogs.

In a report published today, Audit Scotland forecasts trouble ahead, with NHS bodies forced to find significantly more financial savings to deliver the same level of quality provided in previous years.

In its overview of NHS Scotland’s finances for 2009/10, the organisation congratulates health boards for a good financial performance, with all ending the year within budget.

But the Auditor General, Robert Black, added: “They have had to find significant savings to balance their budgets and will need to find even more to continue to do so.

“While the NHS budget will rise in 2011/12, this will be a far smaller increase than in previous years and is likely to be outstripped by rises in demand and cost pressures.”

He said the NHS was taking action to meet the longer term financial challenges, which include increased demand from patients, and rising costs of fuel, drugs and staff pay.

“For [the action] to be successful, it needs good workforce planning, better information on costs, quality and activity, close partnership working and sound leadership.”

Nicola Sturgeon, the health secretary, said the report “recognises the excellent financial performance on the NHS” and pointed out that the health service had exceeded the government’s two per cent efficiency target.

“It is clear the pressure on NHS finances will continue to increase but I am confident that the health service is prepared for the challenges ahead. We will work with health boards to eliminate waste and encourage modernisation programmes to increase productivity and efficiency gains, while enhancing the quality of care.”

Unions and opposition politicians were less impressed, however. Labour, the Lib Dems and Tories all called for savings realised through efficiencies to be directed at frontline services. And Theresa Fyffe, director of RCN Scotland, said the report backed up the union’s own findings on the financial pressures facing boards.

“With demand for health services growing and healthcare costs increasing, the NHS is far from protected from the cuts that the wider public sector is now grappling with,” she said. “This is particularly so as the NHS may end up providing healthcare for the people who need more support as a result of cuts by local authorities. However, if health boards keep cutting away at staff numbers to deal with these pressures, there could be serious and costly repercussions for patient care in the future.”

Brian Keighley, chairman of the BMA in Scotland, said that making indiscriminate cuts was short-sighted and that the government should plan to make savings. “Plans so far have included cutting nursing staff numbers, imposing a recruitment freeze and attempts to undermine the terms and conditions of NHS doctors,” he said. “These may deliver a quick reduction in financial spending but they are not the long term solution. There are areas where there is a genuine need to examine ways of working and service delivery to ensure that they are delivered in the most cost effective manner – without affecting the quality of patient care. Government can only do this if they work in partnership with the profession.”

Audit Scotland points out that funding increases for the NHS in Scotland are slowing compared with recent years. Between 2001/02 and 2009/10 NHS spending rose by 38 per cent in real terms. The increase between 2009/10 and 2010/11 was 2.6 per cent and the proposed 2011/12 budget of £11.4 billion will be up just 1.7 per cent on the current financial year.

NHS Scotland logoNursing leaders have accused Scotland’s health boards of providing reports which are inconsistent, generally inaccessible and which “obscure what’s really happening on the ground”.

This makes it difficult for the public and for campaigners to scrutinise what health boards are doing and whether their decisions take into account patient care and safety, the Royal College of Nursing Scotland says.

In a report published today, the RCN says that there is not nearly enough information publicly available to judge whether health boards are acting in the best interests of patients.

And it calls on health boards to make their financial plans and reports public “in a transparent and timely manner” so that difficult funding choices can be fully understood and debated.

The report, Taking the Pulse of NHS Scotland, tries to build up a picture of NHS boards’ financial and workforce issues. The union concedes that the document has some limitations – partly because of a deficit of available information.

Nevertheless, it reveals some interesting snippets. For example, although official figures show that all NHS boards broke even (financially) in the year 2009/10, 10 of the 14 built up a recurring deficit over the year, which they had to offset with underspends in their non-recurring budgets.

The report also says that boards’ own local delivery plans raise clear warnings about financial challenges, particularly in how they will achieve the required efficiency savings at a time when public sector finances are being squeezed.

The report also queries the apparent inconsistencies in approach taken by different boards. For example, the planned pay bill for NHS board employees ranged from 39 per cent to 61 per cent of expenditure at March 2010.

Theresa Fyffe, the RCN Scotland director, said: “Despite claims that the NHS is protected from the budget cuts now facing the wider public sector, what we were able to find out shows that many health boards are already facing real financial difficulties. Demand for health services is rising, key healthcare costs are running ahead of general inflation and GP prescribing budgets, for example, were overspent last year by over £20m.

“With NHS funding under a great deal of pressure, we’re already seeing health boards cutting their staff, particularly nursing and midwifery staff, as they are the largest staff group at just under half of the NHS Scotland workforce. What is not clear is whether the consequences of such headline cuts to staff have been properly assessed – or whether they are simply short term solutions to financial pressures.”

Ms Fyffe rejected any suggestion that the RCN might be motivated to challenge what’s happening because it is its members which are affected. “We do not believe you can keep cutting staff in this way, without affecting patient care. It’s not protectionism that’s driving us to challenge what’s happening; it’s for the protection of the public. Rather than short-term, financially-driven responses – which focus on reducing the workforce – we need to find longer term, sustainable solutions. This means we have to have enough clear and consistent information so that a proper debate can take place about what kind of future we want for our NHS.”

RCN logoThe Royal College of Nursing is urging Scotland’s largest health board not to bring in external consultants to review district nursing services at a time when it is planning to cut 553 nurse jobs.

The organisation says that NHS Greater Glasgow and Clyde is pressing ahead with plans to employ consultants while disregarding trade union involvement or agreement.

The board says, however, that no decision has been made and no consultants have been appointed.

Norman Provan, RCN Scotland associate director for employment relations, said that the health board was in discussion with an external consultancy firm which had suggested that £2.8 million could be saved. “These discussions have taken place without any trade union involvement or agreement. We are deeply suspicious that, once again, Greater Glasgow and Clyde is disregarding partnership working and has no intention of using free NHS resources and tools to conduct this review.

“The health board must now get back around the table with the trade unions, make public what its plans are and how much the external consultancy firm is costing. It must also explore options to use internal resources – available locally and nationally – to undertake this review.”

This role of community nursing in Glasgow has been fraught with controversy since 2008, when the health board announced plans to remove health visitors from GP practices and align them with social workers.

These plans were put on hold after an outcry from patients and GPs, which reached the Public Petitions Committee of the Scottish Parliament.

But health boards across Scotland have been trying to find better ways of managing nursing in the community – which includes district nursing, health visitors and school nurses – amid fears that demand for services is rising beyond existing capacity.

NHS Greater Glasgow and Clyde, however, has provoked particular ire among trade unions for allegedly failing to involve employee representatives in its planning.

Ellen Hudson, RCN Scotland associate director, said that planning to use external consultants was a “desperate move” which made no sense whatsoever.

“We know that all health boards are having to make savings, but this is not the way to go about it. For the largest health board in the country to claim, as NHS GG&C has done, that it does not have the capacity to undertake this review, while at the same time cutting back on the number of nurses it employs, is deeply flawed.

“The health board may believe that it will save money in the short term, but all it is doing is storing up huge problems for communities in Glasgow, who rely on district nursing services, and which will be extremely costly to rectify in the future.”

A spokesperson for NHS Greater Glasgow and Clyde stressed that no decision had been taken. “We are planning to review the district nursing service in Glasgow working in partnership with trade union and professional organisations, however a decision on what form this approach will take remains to be agreed.”

<em>Picture: comedy_nose</em>

Picture: comedy_nose

Nursing leaders have compiled a guide – open to the public – which shows how much money each health board needs to save to break even in the current financial year. The RCN Scotland’s Frontline First website, due to go live today, also shows how many posts are set to be lost in NHS boards, with a particular focus on nursing jobs.

Although the information isn’t new – it’s actually based on the Scottish Government’s own information on health board budget allocations, and on boards’ workforce predictions – it’s the first time it has been brought together in this way.

Overall, the figures suggest that NHS boards will have to save around £250 million in 2010-11, although the RCN says that this could well be an underestimate, as some boards have said they will need to make additional savings.

Among the hardest hit, according to the website, will be NHS Forth Valley, which will have to save £26.5 million or 6.6 per cent of its basic allocation to break even in 2010-11. The board is projecting a reduction of 96 whole time equivalent nursing and midwifery posts over the year, a decrease in 3.5 per cent, and an overall reduction of 154 posts across all staff groups.

Two of the smallest boards, NHS Orkney and NHS Western Isles, face the biggest challenge in percentage terms. They face making cost savings of eight percent and 7.6% respectively.

In financial terms, NHS Greater Glasgow and Clyde (as the biggest board) has to find the most savings at £54 million, although this equates to just 2.9 per cent of its budget allocation. It plans a 3.6% decrease in nursing and midwifery posts (553 whole time equivalent) this year, 44% of reductions across all staff groups.

Norman Provan, associate director of RCN Scotland, said the union was in no doubt that politicians genuinely want to protect frontline services, but that there seemed to be a gulf between rhetoric and reality. “That is why we have used information from a range of publicly available sources to establish just how severe the problem is that health boards across Scotland are facing,” he said. “This reveals that health boards need to save a total of at least £250m this financial year, in addition to two percent efficiency savings, just to break even.”

He said RCN members would be encouraged to come forward with examples of where cuts are being made and asked for ideas on how money could be saved.

“Nurses are realistic about the need to tackle the severe financial challenges facing the NHS, and they know how to do it. By sharing innovative care and helping to reduce waste we can help meet these challenges.”

Nicola Sturgeon, the health secretary, said that the Scottish Government had increased NHS funding in real terms, despite a £500 million cut in the Scottish budget.

“As part of their workforce planning processes, boards have considered their future service delivery and workforce needs,” she said. “However, I have made clear that ensuring a quality service for patients must be at the centre of these plans and I have also given a guarantee that there will be no compulsory redundancies. I’m also confident that by the end of this parliamentary session there will be more staff in the NHS than there were at the start of it.

“In these challenging financial times, with the toughest settlement since devolution, we have protected health in the budget. NHS boards must ensure they use all their resources efficiently to secure best value for money.”

Theresa Fyffe

Theresa Fyffe

Theresa Fyffe, director of RCN Scotland, sets out what she wants from the new “scrutiny group” which will review proposed job cuts in the NHS – and says the government must act on any problems it identifies.

After weeks of speculation and leaks we finally have the workforce projections for every health board in Scotland. And in response to the frenzy that has built up, and to the concerns that we have consistently raised with health boards, MSPs and the Scottish Government for some time, Nicola Sturgeon is now to lead a “national scrutiny group” to review the workforce plans for all of the health boards. However, there is a fine but important distinction here: the information provided on Thursday are workforce projections which contain no explanation of how cuts in numbers of nurses and other staff groups are to be made and whether these reflect redesign of services. We need this information – which is contained in the full workforce plans – in order to engage in this new group.

As the director of the largest nursing trade union, I am quite clear that we must work with the Scottish Government and health boards to ensure that their workforce plans do indeed reflect new approaches to the provision of services and that the safety of patients will be paramount. We will also do everything possible to save jobs, but recognise that there will be some changes and reductions in the workforce if services are properly redesigned. However, we will do everything we can to stop the current unsustainable cost-cutting measures that are being used by health boards in an incoherent manner. Tactics being employed include not recruiting new staff when people leave or retire, reducing hours and redeploying much-needed specialist nurses to hospital wards.

We have agreed to take part in the scrutiny group in principle, but only if the health secretary demonstrates that she is prepared to intervene and stop health boards implementing their workforce plans if they do not reflect service redesign. There is no point in scrutiny if problems are identified but not acted upon.

All health boards must demonstrate explicitly that they have identified and mitigated any risks to patient care as a result of changes to their workforces. If the scrutiny group finds this information to be lacking the workforce plans must be sent back to health boards to be reworked through the “partnership” process with trade unions, in order to ensure patient safety.

I am particularly concerned that health boards such as NHS Greater Glasgow and Clyde are already beginning to replace registered nurses, ie those on “Agenda for Change” bands 5 and above, with nursing and healthcare assistants, ie bands 3 and 4, without giving due consideration to the implications for patient care. Nursing assistants have a valuable role as part of healthcare teams, however, a simple downgrade of registered nursing posts to nursing assistant posts is not a solution. Nursing assistants must have appropriate training in order to ensure registered nurses can delegate care duties without compromising quality and safety of care. Any such changes to the “skill mix” as it is known, must be supported by the national workforce tools.

The nursing workforce is an easy target because of the relative size of this staff group, but all groups of staff should be considered when making changes to the workforce. Otherwise the skills and expertise of the workforce are not considered holistically and gaps will appear.

While these are some of our “lines in the sand” which will form the basis of our participation in the scrutiny group, I am sure that there will be a number of other questions to consider over the next few weeks. For instance, do the figures in the workforce projections, which are for the entire nursing and midwifery staff group, mask a greater cut in registered nurses, partly compensated for by an increase in nursing assistants?

There is no doubt that this crunch time for Scotland’s health boards, but this should not mean it is crunch time for Scotland’s patients. Continuing to squeeze the wage bill using the short-term measures outlined above can only lead to an overstretched and demoralised workforce. This could potentially be extremely bad news for standards in patient care. We will use our position on the new scrutiny group to press home our concerns on behalf of our members and on behalf of patients. It will then be up to Nicola Sturgeon to take action and ensure that health boards make any necessary changes to their workforce plans in the interests of good quality and safe patient care.

NHS Scotland logoThe Scottish Government has bowed to opposition pressure to publish workforce projections for the NHS in Scotland.

Publication is surrounded by huge caveats – the introduction explicitly says it has been done “in response to the Opposition Parliamentary Motion on the NHS” and warns that the information is not “quality assured”.

The main findings are an estimated reduction in whole time equivalent (WTE) staff members of 3,790 (2.8 per cent) by the end of the financial year 2010/11. Nursing and midwifery takes the biggest hit – 1,523 WTE, followed by administration services (1,053 WTE).

In an accompanying press release, health secretary Nicola Sturgeon repeats her guarantee that there will be no compulsory redundancies, and says that there will be more staff in the NHS at the end of this parliamentary term than at the start. She also says the quality of patient care is paramount.

She has also announced that a national scrutiny group will be formed, made up of the main health trade unions, NHS employers and the government, to scrutinise plans and “ensure they do not compromise the quality of care”.

“NHS boards are committed this year to securing more than £100 million in non-workforce related efficiency savings which will all be reinvested in frontline care. But the drive to deliver services more efficiently also involves looking at staffing requirements and these projections are part of that process.

“These figures are not set in stone. I expect boards to continue to try to minimise the reductions by working hard to maximise non-workforce related efficiencies.”

Unison expressed concern. Tam Waterson, Chair of UNISON Scotland’s Health Committee said: “We are concerned at the scale of these planned job cuts. The Scottish government’s commitment to ensure no compulsory redundancies is welcome, as is the involvement of unions in scrutiny of the health board plans. But it is clear that we face deep cuts which will impact on our vital health services.”

The union says that 1250 job cuts are planned for Greater Glasgow and Clyde this year, 700 in Lothian – with another 1,300 in the pipeline for next year. Tayside plans to 500 full time equivalent jobs. Grampian has announced 600 job cuts, and Highland plans to cut 100.

Unison adds that NHS Scotland requires to save £270 million in the current financial year to balance the books following a tight Scottish budget settlement in February – and warns that further pressure on funding is likely after the Westminster government implements its emergency budget in June.

RCN Scotland director Theresa Fyffe accused health boards of short-termism, saying that as the wage bill makes up 70 per cent of health board budgets, it had become the primary target for cuts.

“RCN Scotland fully recognises that health boards need to find ways to save money. However, in the interests of protecting standards in patient care, health boards must focus on the long-term needs of patients, rather than on short-term cuts to the workforce this year, which may cause costly problems in the future.”

Speaking ahead of today’s parliamentary debate on the cuts, she added: “Health boards are using a number of short-term measures to cut wage bills, ie not replacing someone if they leave, replacing registered nurses with unregistered nursing assistants or redeploying highly skilled and higher-paid specialist nurses to carry out regular ward shifts to cover staff shortages.

“If health boards across Scotland continue to pursue such cost cutting measures on the wage bill without properly carrying out service redesign and looking at other areas of cost pressures, they will be left with a demoralised and overstretched workforce and may risk standards in patient care. It would also make it difficult and more costly to redesign services to meet patient needs in the future as appropriately skilled nurses and other healthcare professionals may no longer be in the workforce, due to today’s short term cost-cutting measures.”

She said the RCN had agreed in principle to be part of the scrutiny group, but warned: “We will also be seeking assurances that health boards will only implement their workforce plans if they have first considered all the options available to them, not just short-term cuts to the workforce.”

The BMA has also confirmed it will be part of the scrutiny group. Scottish chairman Dr Brian Keighley said: “The NHS is currently running at full capacity where even small cuts to frontline services will have a direct impact on patient care. It is therefore essential that in reaching these decisions, NHS managers consult with healthcare professionals locally and value the medical leadership offered by doctors to reshape and develop services to make them more efficient without affecting the quality of patient care.

“As part of this national scrutiny group, the BMA will seek to ensure that decisions made by local NHS boards to make cuts will have a minimal impact on patient care and will maintain the high quality care services that our patients expect.”

The tables can be found on the Scottish Government website.

RCN logoHealth boards in Scotland are already cutting the number of nurses to save money, the RCN warned today.

On the final day of the union’s annual congress in Bournemouth, nurses voted to call on all health organisations and governments to ensure nursing expertise is not sacrificed in attempts to make ends meet.

The union warned that cuts are already taking place in Scotland – despite the government’s pledge to protect frontline service. It said that NHS Greater Glasgow and Clyde was planning to replace 386 registered nurses with 229 nursing assistants by 2013, while NHS Grampian was freezing nurse vacancies to help save an estimated £34 million in the current financial year.

Geoff Earl, an RNC Scotland board member, questioned the Scottish Government’s pledge to protect frontline services. “It is health boards that make decisions about staffing levels and they are already beginning to make cuts. Patients value the expertise of registered nurses, but with staffing costs being the largest part of NHS budgets, replacing registered nurses with unregistered support staff is often seen as an easy fix. Such short-term savings on the wage bill will only result in costly mistakes in the future. The Scottish Government needs to ensure that health boards deliver on its own commitment not to cut frontline services, otherwise its promise is meaningless and patient care will suffer.”

He said nurses were already overstretched, with 44 per cent of RCN members saying in a recent employment survey that understaffing meant patient care was compromised at least once or twice a week. “Cutting registered nurses will simply make this worse,” he added.

“RCN Congress today has called for the political rhetoric to protect frontline services to be matched by actions on the ground.”

<em>Picture: Howard Lake</em>

Picture: Howard Lake

Most people in Scotland are unaware of the scale of public sector cuts facing the country in the next three years, according to a poll published today.

Almost two thirds (63 per cent) do not realise that public spending in Scotland is expected to fall by £1 billion (figures from the Independent Budget Review Panel). While 40 per cent underestimate the level of cuts, 23 per cent could not say how swingeing they are likely to be.

The poll – carried out by YouGov for the Royal College of Nursing – shows high awareness of the fact that the NHS needs to make savings over the next three years. But although seven out of 10 of those questioned knew this, most (51 per cent) thought spending on the NHS should go up, while 41 per cent thought it should stay the same.

It also shows that health is the Scottish public’s second biggest spending priority for the next government (after the economy).

The RCN published the poll – which questioned 4,486 adults, 529 of whom were in Scotland – as nurses gathered in Bournemouth for the union’s annual congress.

RCN Scotland director Theresa Fyffe said that new ways of delivering services would be needed. “We know that public sector spending in Scotland is going to be under immense pressure for a number of years to come and that this is happening at a time when the demand for some services is rising.

“The Scottish Government and health boards must look closely at how they deliver services and work together with staff and unions to find effective solutions.

“Health boards must not think – as some are already doing – that they can simply cut costs by cutting registered nursing staff or replacing registered nurses with healthcare and nursing assistants.”

RCN Scotland board chair Eileen Frame welcomed the vote of confidence from those who took part in the survey. “As out poll shows, the public really values the NHS in Scotland and believes that we should continue to invest in it over the difficult times ahead.”

Last week, the Scottish government launched a Patient Rights Bill, which would introduce legally binding waiting times and give patients a legal right to complain. RCN Scotland director Theresa Fyffe – who visited Norway to see such a system firsthand – is not convinced.

Theresa Fyffe

Theresa Fyffe

As with so many of the Scottish Government’s policies, Scandinavian approaches to patients’ rights seem to have influenced the government’s take on its own Patient Rights Bill. This led me to go on a fact-finding trip to Norway – where a similar system is in operation – to discover what such a concept means in reality. What I found there convinced me that this is not a route we should be going down in Scotland.

Nursing staff deliver the vast majority of direct patient care, so it’s clear that a Patient Rights Bill has the potential to make a big difference not only to patients but also to nurses, many of whom are members of the Royal College of Nursing. This bill has the potential to affect us all, as nurses, as patients and as members of the public.

After meeting with the Norwegian Nurses Organisation, members of the Norwegian Board of Health Supervision and the Norwegian Patients’ Association, it became clear to me that there are major differences between the principles that underpin both the health and legal systems of Norway and those of Scotland. This in turn means that the Norwegian approach to patients’ rights would simply not be effective in Scotland.

For instance, the Norwegian Patients’ Rights Act provides patients with a basic foundation of procedural rights, many of which we already take for granted, such as informed consent and access to medical records. More substantial rights that we might expect in Scotland, ie rights that are above and beyond those that are already in place, are not part of the Norwegian act. This stems from the fact that the motivation behind the Norwegian act was to clarify judicial positions rather than to improve patient advocacy.

Fundamentally, the act in Norway aims to establish equality, but this does not necessarily correspond with delivering equity. This means that the act provides everyone with the same rights, but does not provide additional support for those individuals who need assistance to be able to benefit from those rights. This attempt to improve equality then has the potentially converse effect of increasing inequalities.

From the organisations and individuals I met, it emerged that two of the more significant and costly rights that have been achieved by the act in Norway are the right to transportation to hospitals and health centres to ensure access to healthcare and the right to expect the purchase of health interventions from outside the country. Both of these areas would be affected by the part of the Scottish Patient Rights Bill which sets out healthcare principles, but it is not yet clear how they would be implemented. If the Norwegian approach is taken, the costs could potentially be phenomenally high for Scotland’s health boards.

Finally, as is now the case with the Scottish bill, the Act in Norway concentrates largely on hospital care at the expense of primary and community care. As the long-standing ambition of the Scottish Government is to “shift the balance of care” from hospitals to the community, I wonder if this is going to result in a policy mismatch?

As soon as the surface of the patient rights system in Norway is scratched, it is apparent that there are some fundamental differences between us and Norway, with Norway starting from a significantly lower base in terms of the principles which underpin its healthcare system. Then there is the unintended consequence that “rights” sometimes make inequalities worse, and the almost inevitable rise in costs of delivering some rights. Add to this the fact that the Scottish Government’s long-running plans for the bill have been overtaken by developments such as its own Quality Strategy for the NHS – which aims to drive up standards of patient care – and we now take the view that the Patient Rights Bill will not improve patient care in any meaningful way. Indeed, it has the potential to increase inequalities and skew resources towards delivering rights at the expense of other areas of patient care.

I firmly believe that instead of spending money on ineffective pieces of legislation that could prove extremely costly in the future, the Scottish Government should target its resources at frontline care, where it will make a real difference to the treatment that patients receive.