1. An Overview of Scotland’s National Health Service Aziz Sheikh Professor of Primary Care Research & Development and Co-Director, Centre for Population Health Sciences, The University of Edinburgh Harkness Fellow in Health Care Policy and Practice, Division of General Internal Medicine and Primary Care, Brigham & Women’s Hospital/Harvard Medical School PNHP Annual Meeting, November 2, 2013

2. Location and population size

4.  Health is devolved from the UK government to the Scottish government  Publicly funded healthcare system with funds raised from general taxation – overall taxation contribution is on a sliding scale ranging from 0 – 45% (was 50% until April 2013)  Annual budget of £12 billion (approx. $19 billion)/year – 9.6% of GDP  Care essentially free at the point of delivery for all, including prescriptions (co-pay for adult dentistry and optometry)  Delivered through:  14 regional health boards  And a variety of specialist health boards e.g. NHS24, NHS Health Scotland (Public health), Health Improvement Scotland, Scottish Ambulance Service, NHS Education for Scotland etc. Political, financial and structural considerations

5.  General practitioners and allied health professionals (e.g. dentists, opticians and community pharmacists) are employed as independent contractors and are responsible for primary care provision: approx 12,000)  General practitioners operate as family physicians and are the main co-ordinators or “gatekeepers” to care  90% of all health care interactions take place in primary care  Paid through a combination of:  Capitation fees  Service fees  Pay for performance (Quality Outcomes Framework)  Out-of-hours care provided through NHS24 (telephone helpline) and out-of-hours consortia Primary health care

6.  Overwhelming majority of specialist care is provided by consultants and their teams from NHS hospitals  These consultants and their supporting teams are employed directly by NHS Scotland Secondary and tertiary care provision

7. Key demographic challenge

10. Improving quality of care through a focus on: 1.Increasing the role of primary care 2.Integrating health and social care 3.Improving safety in all healthcare environments 4. Improving deliver of emergency and unscheduled care 5.People powered health and care services 6.Improving support and treatment of those with chronic disorders Route map for 2020 vision: 12 priority areas for action

11. Improving population health through a focus on: 7.Early years 8.Reducing health inequalities 9.Preventive measures on alcohol, tobacco, dental health, physical activity and early detection of cancer Route map for 2020 vision: 12 priority areas for action

12. Securing the value and financial sustainability of health and care services: 10.Establish a vision for health and social care workforce 11.Increasing investment in new innovations which improve quality, reduce costs and provide growth to the Scottish economy 12.Increase efficiency and productivity through more effective use of unified approaches coupled with local solutions and decision making Route map for 2020 vision: 12 priority areas for action

13. A&EA&E BIRTH DEATH Neonatal Record SMR11 Child health surveillance Immunisation GP consultations Dental SMR13 Outpatients SMR00 Hospital Admissions SMR01 Mental Health SMR04 Prescribing Screening Community care SMR50 Cancer registrations SMR06 Cancer Registry Scotland’s linkable databases Laboratory Maternity

14. Example: Effectiveness of H1N1 vaccine for pandemic influenza

15. Preparing for the next pandemic …  Core funding in place and release of additional funds at first signs of pandemic influenza  This has enabled:  Creation of data structures to permit real-time evaluations  Permissions and approvals for data linkage and analysis  Development of detailed analysis and reporting plans

16. Conclusions

17. Further details: aziz.sheikh@ed.ac.uk