FAIR TO ALL, PERSONAL TO EACH The next steps for NHSScotland
Chapter 4: Delivering the Changes
4.1 Achieving the ambitious objectives we are setting means keeping up the momentum of progress and change across the NHS. NHS teams are already working hard to respond to the needs of patients. They demonstrate dedication, professionalism and skill. Investment and reform together will support the NHS to achieve the new targets for the benefit of all patients.
More Care and Treatment in the Community
4.2 The NHS is already making good progress in treating people at home and in the community. The Executive believes strongly that care should be delivered as close to home as possible, consistent with clinical safety and quality. People should be cared for in hospital only when absolutely necessary. Care and treatment capacity in primary and community care - already accounting for over 90% of patient contact with the NHS - needs to be taken further forward.
4.3 In future there will be better planning of unscheduled care and more people will be treated effectively in the community rather than bringing them into hospital. Resources will be targeted to help the NHS respond to the needs of patients most likely to find themselves receiving unscheduled care - the elderly, people with complex combinations of illnesses, and people who suffer from chronic conditions such as diabetes and asthma.
4.4 NHS Boards are being set a new target out of the Spending Review to give priority within primary care to identify and treat patients at heightened risk of emergency admission to hospital. Every Board must reduce the number of emergency admissions for people over 65. The target for individual Community Health Partnerships (CHPs) takes account of local circumstances and factors such as deprivation, the age of the population and the amount of chronic illness. This places responsibility squarely on CHPs to improve chronic disease management in the community through supporting particular patients. CHPs will achieve the target by targeting those most at risk in the community, particularly patients with multiple long term conditions, with monitoring, support and prevention, through approaches such as intensive case management and disease management.
4.5 Patients with diabetes are being helped to manage their condition better, by assisting GP practices to take a systematic approach to care and treatment. By sustaining the improvements already achieved through the diabetes collaborative project over the next 10 years, it is calculated that over 2,600 Scots will experience fewer complications, 1,750 fewer people will suffer stroke or heart failure and there will be 780 fewer deaths from diabetes. These improvements can be achieved as the collaborative project extends its reach.
4.6 As well as offering better care closer to home, reducing emergency admissions releases hospital resources to provide more planned treatment and therefore less waiting. It also reduces the number of patients whose discharge from hospital is delayed following an emergency admission. The experience of these patients is likely to be unsatisfactory. Delayed discharges mean less capacity to treat other patients waiting for surgery.
New Roles for Staff
4.7 The future of health services means developing clinical teams and clinical leadership from a wide range of health care professions. This approach will require a major shift from conventional service delivery to provision that is focused on the needs of patients and service users and communities. Nursing and the Allied Health Professions are at the forefront of developing role flexibility and integrated team working. We are currently consulting with the NHS on a new approach to role development that will help reduce waiting times and improve clinical outcomes in key priority areas.
Helen is a nurse in Glasgow. Previously to progress her career would have meant moving into management and away from hands-on care. But new ways of working now mean that Helen is leading a multidisciplinary team to provide better services to orthopaedic outpatients. She can now develop professionally without having to move away from improving patient care. And she is now able to make changes to services that dramatically improve the patient experience. One example of this is a new nurse-led arthroplasty (joint replacement) service. Helen is able to discharge her patients rather than wait on a doctor to do this. Patients are given contact details on discharge should any problems arise and direct access can be arranged. |
Redesigning Services Round Patients
4.8 Service redesign works and can streamline patient contact. Listening carefully to patients, using technology and information effectively, and removing duplication and unnecessary work all help to increase NHS effectiveness and thus reduce waiting and improve the patient experience. Waiting times improvements of up to 80% have been achieved through successful use of service redesign methods in NHS Boards in Scotland.
4.9 NHSScotland continues to redesign key services. Over the next 3 years, it will develop and implement more programmes focused on helping to deliver the 18 week maximum wait targets for both outpatients and inpatients, building on its existing programmes within primary care, outpatients and cancer which are already improving patient access. These programmes target all aspects of the patient experience including booking, primary care, outpatients, diagnostic services, theatres, inpatient and day case services.
4.10 For example, as a result of service redesign work, in one Scottish hospital the level of patient cancellations for new Ear, Nose and Throat consultations fell from 18% to 6% while in another, checking that the patient still needed their appointment reduced waiting times in Oral Surgery from 61 weeks to 17 weeks.
4.11 Major improvements can be made through designing processes round patients.
Conor is a patient at Yorkhill Sick Children's hospital. He has attended clinics there with his mother for some time. In the past, the hospital wrote to Conor's mother and told them when their appointment would be, whether or not it suited them. Conor's mother is a single mum and works full time. Now Yorkhill have introduced Patient Focussed Booking, Conor and his mother receive a letter 6 weeks before the likely appointment. The letter asks them to call Yorkhill and agree a day and time that suits them. This is much more convenient and can be fitted around major work or school commitments. |
More Capacity
4.12 Alongside service redesign and reform, additional capacity will be provided within the NHS and from the independent sector, targeted at reducing waiting. The Executive will increase capital investment in the Golden Jubilee National Hospital at Clydebank over the years to 2007-08 to bring all of the available floor space into intensive clinical use, and we will provide extra revenue funding to pay for the staff who will care for patients in these new wards. As a result, we expect the Golden Jubilee to be able to carry out 10,000 extra procedures annually by 2007-08 when all of the additional capacity and staff are in place - taking the total number of procedures to 28,000 each year. Further expanding capacity at the hospital is a good way of ensuring that new money goes directly into reducing waiting times.
4.13 To help the NHS meet the challenging new heart treatment guarantee, new investment of up to 12 million over 3 years will go into improving facilities and increasing capacity in treating coronary heart disease. This will enable more patients to be treated quickly. In 1999, the national maximum waiting time guarantee for adult cardiac surgery was 12 months. Currently, patients wait no more than 18 weeks for heart bypass surgery or angioplasty. The new investment will help push waiting times for all cardiac interventions down to the 16 weeks guarantee.
4.14 Tackling waiting for diagnostics is a key aim. As well as being committed to maximising utilisation of all existing diagnostic equipment, we will, as part of our capital investment plan, put an additional 125 million into new medical equipment over the next 3 years. This will include provision for both replacement and additional diagnostic equipment. We will back this up with increased revenue resources that will help to pay for training, staff and related costs, and redesign programmes to ensure that the new equipment delivers reduced waiting times. In addition we will support initiatives to build radiology capacity that explore new roles for radiography staff such as radiography consultant posts as well as specialist and assistant practitioners. We will commit this additional investment on the basis that NHS Boards accept responsibility for delivering the additional activity and shorter waits that patients expect and that the investment makes possible.
In Lanarkshire, Marie helped to start a new nurse-led biopsy service - taking tissue samples for analysis - to reduce waiting times for this important diagnostic test. This new service means that when patients see a consultant and a decision is made to take a biopsy, this can be done right away without a second wait to see a doctor. Feedback from patients shows that they are very happy with the new nurse-led service. |
4.15 Plans for increasing NHS capacity through investing in new walk-in, walk-out hospitals (also known as ambulatory care and diagnostic centres or ACADs) are well advanced in Glasgow, and treatment centres are already in operation for example at Stracathro in Angus and in Leith.
Using the Independent Sector
4.16 We will fund arrangements with the independent healthcare sector for new diagnostic and treatment facilities, catering for NHS patients and offering rapid diagnosis and care. We will require the independent sector to work to strict rules designed to avoid recruitment of NHS staff in Scotland, which would simply cause shortages in NHS hospitals.
4.17 The Executive will also work with the NHS to negotiate cost-effective contracts with independent healthcare providers to purchase additional imaging capacity. This is likely to take the form of new flexible, fully-staffed mobile scanning units to provide more and quicker diagnostic testing for NHS patients. Such units are already in use under contract to the NHS in Scotland. The NHS must be satisfied that such contracts demonstrate value for money and better services for patients. As with our plans for new diagnostic and treatment facilities, we will insist on contract terms to prevent staff being "poached" away from the NHS.
4.18 In addition, we will negotiate contracts with the independent healthcare sector worth up to 45 million over 3 years to enable NHS patients to receive their operations more quickly where clinical quality and value for money can be guaranteed. This will help the NHS secure treatment for patients currently waiting longer than 18 weeks for surgery. We will target orthopaedic surgery, where there is rising demand from the ageing population.
Better IT
4.19 Investment in modern IT will help achieve a more efficient and integrated service, cutting out wasted effort in looking for paper notes, test results and letters. The eHealth Strategy will ensure that all the necessary information is available where and when it is needed.
4.20 We will target investment in our IT systems on efficient management and monitoring of each stage of care and treatment. At the heart of this will be powerful systems to help manage waiting lists and report on performance.
4.21 The IT Strategy for NHSScotland has 2 key objectives. First, sharing of patient record information among all members of the clinical team to support better care for the patient. And second, to fill gaps where modern IT systems are still not in place. For example, a national project is providing Picture Archiving Computer Systems (PACS) to store medical images such as X-rays in digital form allowing them to be transmitted electronically to where they are needed.
4.22 The aim is a single electronic clinical record for each patient in Scotland, with strict controls over access. This will help improve care for, for example, patients who move around Scotland and for patients with chronic disease.
4.23 These developments are vital to improving the patient's experience and to increasing the efficiency and effectiveness of the NHS. They will also enable the NHS to communicate better with patients. As in other large organisations, IT lies underneath the surface but is absolutely vital to ensuring that people, information and equipment are in the right place at the right time to serve patients well. Any service that aims to be fit for the 21st century and which deals with large numbers of users, working to increasingly short timescales, must use modern, well designed IT systems if it is going to succeed.
4.24 Our ultimate goal is to make it easier for patients to become directly involved in their healthcare through electronic access. Already trials are underway. For example in Irvine, patients with the Townhead GP practice are able to securely log on to a Patient Online System to book appointments, renew prescriptions, and get test results with their GP's comments. We will learn from this and similar work to develop more large scale plans.