Published: 03/11/2005 Volume 115 No. 5980 Page 9

Ministers in Scotland have announced what they say is a radical shift in healthcare services which will involve separating some emergency and unplanned care and a greater focus on care close to home.

The Scottish Executive also wants more emphasis on preventing illhealth - including sending enhanced primary care teams into communities most at risk - and clearer ways of ensuring accountability at all levels.

The measures were outlined last week in Delivering for Health, a blueprint for health services in the next decade.

The report largely accepts recommendations made by the advisory group led by Oxford cancer specialist Professor David Kerr earlier this year.

Other plans include introducing a national electronic patient record, centralising some specialist services, including neurosurgery and some children's services, on fewer sites, and better support for people with long-term conditions to be treated in the community.

Health minister Andy Kerr has made it clear he expects a 'radical, transformational' change in the health service as a result of the report. But although there is a complex and apparently detailed timetable attached, it is still not clear when the main provisions of the report will be implemented.

For example, while the report recommends concentrating neurosurgery on one site, no consultation on the specifics will be done until 2008.

The report has been largely welcomed by unions, although both the Royal College of Nursing and British Medical Association warned that capacity and workforce issues would have to be addressed. The BMA and Unison were also relieved that the blueprint did not place much emphasis on the private sector, although it does pursue the present policy of making some use of independent providers to add to capacity.

Andy Kerr said: 'We have a clear understanding of the changing demands on the health service and a clear vision of what type of NHS Scotland we need.

'With Delivering for Health we have a clear programme that will, step by step, turn that vision into reality and provide the means to hold the service to account.'