Brian Donnelly, The Herald, 10 April 2009
A legally binding patients\’ charter should be introduced in the NHS, a think-tank said yesterday.
The report by Reform Scotland also said the NHS should become more like "insurance-based" health systems in other north European countries.
Scotland still lags behind other comparable European countries despite a 55% rise in health spending over the past 10 years, the report entitled Patient Power claims.
A new NHS constitution would set out the relationship between the health service and patients and clarify the role of the Scottish Government.
"By giving patients legal entitlements, it ensures the system is accountable to them, not government," the report says.
Report author Geoff Mawdsley said the proposed charter goes further than provisions in the SNP Government\’s Patients Rights Bill because it defines entitlement to care, in the same way as happens in the Netherlands.
But measures in the forthcoming legislation could be adopted to minimise court action from disgruntled patients, Mr Mawdsley said, adding that he did not want to "feather the nest" of lawyers.
The "public sector monopoly" enjoyed by the NHS has not provided value for money, according to the report.
"Insurance-based systems provide clear accountability to patients, while other countries routinely offer patients a greater choice of GP or where they are treated," it says.
Health services in other comparable European countries, such as Sweden and the Netherlands, whether taxpayer-funded or insurance-based, are designed with incentives to meet the needs of the patient.
Mr Mawdsley said: "Other countries have enshrined this vital principle without the need for a public sector monopoly over healthcare."
The reforms would mean having greater choice over where patients could be treated and it is claimed this would end the postcode lottery attached with healthcare in Scotland.
Mr Mawdsley said he believed there is a wider range of choice of treatment south of the border, which puts England ahead of Scotland in healthcare.
It also calls for health boards to be scrapped and replaced with new bodies solely responsible for commissioning treatment from separate providers.
Hospitals themselves would be run by independent non-profit making trusts under the new set-up.
The overall budget for the NHS would come out of general taxation and be distributed to the new health commissioning co-operatives.
"That should give patients a much wider range of choice and should mean we can get rid of performance management through targets and central control," Mr Mawdsley said.
Centrally imposed performance targets for waiting lists and times would also be scrapped, with local NHS managers and clinicians given greater freedom to improve patient services.
While these have seen patients treated quicker in recent years, this system will ultimately "hit the buffers" and a new approach is needed, Mr Mawdsley said.