The vision and ambition for NHSScotland is clear. It is for safe, effective and person-centred care with a commitment to supporting everyone to live longer, healthier lives at home or in a homely setting through the provision of integrated health and social care services. As the Scottish Government's 20:20 Vision puts it:
The demands for health care and the circumstances in which it will be delivered will be radically different in future years. We must be bold enough to visualise the NHS that will best meet the needs of the future in a way that is sustainable and make the changes necessary to turn that vision into reality.
So what does this mean for the healthcare science workforce in Scotland?
Healthcare scientists are an integral part of the infrastructure essential to the delivery of high-quality, safe and modern healthcare. They provide the information that underpins sound clinical decision-making with individual patients and their families in the context of advancing technology and increasing complexity.
However challenging it may seem, healthcare scientists need to become more proactive and less reactive to better anticipate and manage the systems they deliver. There are many excellent examples of how healthcare scientists are achieving this aspiration across Scotland but significant, and unnecessary, variation remains.
Many changes to the way services are delivered in terms of practice and redesign, not least through the integration of health and social care, are required. The emergence of an ageing population with multi-morbidities also presents clear implications for the service. It is therefore essential that the potential of all staff groups within healthcare science are fully realised.
Everyone has a role to play in making the NHSScotland 2020 Vision a reality. We all need to step up to grasp the opportunities and address the challenges ahead in matching healthcare demand to the effective utilisation of resources and the service's capacity to deliver.
There are approximately 6000 healthcare science staff working across Scotland. They comprise the fourth largest clinical group and are responsible for around 80% of all diagnoses. Collectively, healthcare scientists undertake over 60 million laboratory tests per year, 730,000 physiological measurements, and manage medical equipment across NHSScotland with a replacement value in excess of £760M.
This hugely diverse and highly skilled workforce delivers across the breadth of NHSScotland, from providing leading-edge technological services such as positron emission tomography and magnetic resonance imaging, through advanced laboratory diagnostics and the genomic revolution, to more patient-facing aspects of physiological sciences, including diagnosis and treatment of hearing disorders, calibration of pacemakers, providing wheelchairs and managing medical equipment.
In a time of rapid change in the NHS, with ever-increasing demands on a finite resource, healthcare scientists are ideally placed to drive the innovation and improvement required to deliver more efficient and sustainable services for the future. NHS boards therefore need to harness this untapped resource and include healthcare scientists in their planning and improvement work whenever possible.
Healthcare scientists already make a vital contribution to core healthcare provision across all sectors of the system. But with limited resources and rising demand, healthcare scientists and team members have a duty to ensure they are working at the top of their clinical capability, doing things that should only be done by them, and achieving maximum patient benefits from their resource. This is not just an argument for more education and training; it is also essential to ensure that capability already in the system is used to best effect.
We must strive for improvements that bring common-sense principles to avoiding waste, harm and variation. We must also step up to the leadership challenges of delivering sustainable and affordable services and pathways of care that reduce demand and improve outcomes. Healthcare scientists thrive in the context of problem-solving, and never has the requirement for solutions been more pressing in shaping future health provision.
We have a job to do in organising ourselves for the work ahead; strengthening healthcare science professional leadership and building improvement expertise.
The questions healthcare scientists must ask are:
Are we doing everything necessary to release capacity by reducing unnecessary testing?
Are we bringing coherence to near-patient testing, the management and calibration of equipment and training of multi-disciplinary staff involved across the system?
Are we utilising our expertise at the top end of scientific capability to deliver sustainable, affordable clinical teams and address our skill-mix across the service, including the appropriate deployment of support staff?
The National HCS Delivery Plan calls for healthcare scientists to be more visible, accountable and outcome-orientated. It aligns healthcare science activity with the National Performance Framework, the 20:20 Route Map and Workforce Vision and the current priority of unscheduled care and seven-day services. It also continues to focus on continuous improvement to support people to live longer, healthier lives and be enabled to self-manage their long-term conditions, including multi-morbidities.
Better measurement and data collection will be required to support healthcare scientists to contribute to the delivery of national outcomes, underpin improvement and strengthen efficiency and productivity.
Modern and flexible working practices (including exploiting technology) and working across traditional professional boundaries will be key to efficient and effective service delivery, maximising capacity within existing resources and realising the potential of this highly trained and skilled workforce.
Undergraduate and postgraduate education and training needs to align with this aspiration, but the education agenda is not an end in itself: delivering high-quality scientific practice across the strands of healthcare science service provision is also vital, as is utilisation of all available resources, most critically the existing workforce.
This delivery plan speaks to healthcare science as a call to action, but also to directors, clinical leads and diagnostic managers engaged in the improvement and performance-management of these services. The prize will be delivering better care and better outcomes for the people and communities we serve through engaged and empowered healthcare science staff throughout NHSScotland.
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