Published: 13/05/2004, Volume II4, No. 5905 Page 12 13

The big-hitting academic heading an expert group on Scottish NHS reform expects to face some difficult decisions. Jennifer Trueland reports

Professor David Kerr might not seem the obvious choice to head a group drawing up a blueprint for NHS reform in Scotland.

Although he has lived and worked north of the border, in 1992 he headed south for Birmingham and then Oxford, where he currently holds the Rhodes chair of cancer therapeutics and clinical pharmacology.

Nevertheless, Professor Kerr was health minister Malcolm Chisholm's choice to chair the advisory group on service change in NHS Scotland.

A clinician of international renown, he has led the modernisation of cancer services in England through his role as chair of the Modernisation Agency's cancer services collaborative. His new advisory group now has a blank sheet of paper and one year to come up with a framework for how health services should be delivered in Scotland.

Nothing is ruled out and the group is expected to be specific as well as strategic. It will make recommendations on how many centres should be performing neurosurgery, for example, and where they should be located.

It will also tread on territory that has already proved contentious.

So the group will address tensions between locally provided care and safe delivery of specialist services - 'hospital closures' and 'centralisation' in campaigner-speak.

So why is an Oxford don involved? 'I am doing it because I am Scottish and I love the place, ' Professor Kerr says.

'I am a Partick Thistle supporter [Glasgow's perennially underachieving third team] so I am obviously an optimist. And I am from Maryhill [a tough part of Glasgow] so I am ready for a scrap.'

Despite It is low-key launch last month, the group has still managed to attract some attention.

Politicians on the Scottish Parliament's health and community care committee quizzed Mr Chisholm about it last week.

Scottish National Party health spokesperson Shona Robison called for all current and imminent service reconfigurations to be put on hold until the group reports. A number are currently under way, most notably in maternity services - a controversial issue in Glasgow and the north of Scotland.

Mr Chisholm has rejected any moratorium, saying it was not the intention to put a 'planning blight' on the NHS in Scotland for a year.

But the spat gives a hint of the difficulty of the task ahead. Does Professor Kerr fear criticism for providing the basis on which difficult decisions will be taken?

'Maybe I am na´ve, ' he says, 'but is not it about communication?

Which would you rather have: average healthcare on your doorstep or world-class care 50 or 100 miles away?'

As an academic and a clinician, he believes that he's less vulnerable than others. He can say uncomfortable things in ways managers and politicians could only dream.

The advisory group has representation from different health professionals, social work, unions and patient groups (see box).

There is a health board chief executive and a board chair, and many members are well known for their strong views.

The group's first meeting was positive, Professor Kerr says. 'I am excited about it. Malcolm Chisholm came along and sat back and listened. There is no heavy hand on the tiller.

'I know we'll have to navigate some stormy waters but we will not fall into them.'

Access to services is a particular challenge for Scotland because of its geography. Catering for rural areas means there are around double the number of hospital beds per head of population than in England.

This obviously presents staffing headaches when trying to fill junior doctor rotas, for example.

Professor Kerr believes ambulance services may well play a key role. 'You have to decide between the wee hospital on the doorstep and the complicated journey to a more specialist unit, ' he says. 'But we also want to look at inequity of access due to poverty.

'That involves all sorts of things, including education and encouraging citizens to take more responsibility for their health.'

The group will take note of developments elsewhere in the UK and internationally, particularly when scanning the horizon to predict how care might be delivered in future. For example, it will look at how developments in radiology might facilitate remote access to care.

The group has agreed to run 1215 separate programmes, which will be brought together into one report by April 2005. The programmes have yet to be specified, but could include a managers' toolkit for service reform, for example.

The process looks like a natural follow-up to the Acute Services Review, headed by former chief medical officer Sir David Carter and published in 1998; that review is just now being implemented. But there is a crucial difference.

'This is not just about acute services, ' says Professor Kerr. 'It is about everything.And we will make specific recommendations. is not that what being brave is all about?'

Professional opinion: advisory group on service change

Professor Graham Teasdale president, Royal College of Physicians and Surgeons of Glasgow James Kennedy chair, Scottish Partnership Forum Roger Gibbins chief executive, NHS Highland Professor Nora Kearney professor of cancer care, Stirling University Dr Lesley Holdsworth clinical co-ordinator, NHS Forth Valley Professor Jillian Morrison professor of general practice, Glasgow University Dr Charles Swainson medical director, NHS Lothian Professor Gillian Needham postgraduate medical dean, North East Scotland Irene Sweeney chair, Scottish pensioners' forum Jae Ferguson chair, Mid-Argyll maternity service users' forum Alexis Jay director of social work, West Dunbartonshire Council Lesley Summerhill director of nursing, NHS Tayside Peter Bates chair, NHS Tayside