Speech on health to the Scottish Labour Party conference in Dundee

3 March 2012


 The huge challenge facing the NHS in Scotland derives from three factors:

Health inequalities

An ageing population, and,

Smaller budgets 

Today, I wish to offer proposals on how to deliver better health outcomes with less. 

These proposals are:

Proactive case management

Population morbidity profiling to target resources effectively, 

Before I do I want to provide a brief summary of the constraints and costs.

In the financial year 2010/11, we consumed just over £10 billion of health care resources, here in Scotland.

This may seem a massive figure and it may be difficult to relate to but basically, this equates to about £2,000 per person living in Scotland.

£2,000 doesn’t go far when you realise the full economic costs of  Accident &Emergency attendances, outpatient appointments, and a hip replacement operation which costs over £5,000

So, facing these costs, going forward we need either a healthier population or we need to do things differently.

I suggest the latter is the only option.

For every £1 spent in primary care – by this I mean GP practices, dentists, opticians and pharmacists – we spend £3 in acute i.e. in general hospitals.

One in five admissions is unplanned. 

These emergency admissions arrive from either A&E or a GP referral.

In2010/11, 10% of the total NHS budget was spent on these emergency admissions

With that in my mind, Conference, I want to share some insights on ambulatory care sensitive conditions. 

These conditions are ones where most doctors agree that a substantial proportion of cases should not advance to the point where hospitalisation is needed if they are treated in a timely fashion with adequate primary care.

These conditions are angina, asthma, COPD, diabetes, high blood pressure, iron deficiency and malnutrition. 

So, with good self management and support, people experiencing these long term conditions should not need to be hospitalised because of these conditions.

The Audit Commission estimated these conditions account for about 15 per cent of all emergency admissions. 

So, conference, I suggest the Party should develop a clear policy on pro-active case management.

By targeting people with these conditions who have moderate health needs with appropriate care, we can try to reduce further deteriorations in their health.

If a third of these admissions were actually avoided that could release millions of pounds which could be used to provide each GP practice in Scotland with at least one pro-active case management nurse.

Thus, we stop the SNP’s actions of reducing the number of nurses. 

And by moving the nurses from hospitals to GP practices, these nurses will work closely with these people to at least maintain current health levels to ensure their conditions to not worsen.

Public health professionals are great at noting prevalence of single conditions, but,GPs recognise that many of their patients have multi-morbidities, generally about 25% of the practice list.

So, there is a need to illuminate the morbidity profile of the locality’s population, in other words show how sick or healthy a population is. 

This will help to identify the neediest, and future high need groups and target resources appropriately. 

Healthcare demand ought to be based on needs not wants.

And it is the Labour Party that champions fairness.

Thank you, Conference.

Download Lesley's speech


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