NHS Grampian aims to be the best performing provider of health care services in Scotland. Dr Roelf Dijkhuizen,
Medical Director, explains.
The NHS is renowned all over the world because it delivers a wide range of services to patients, free of charge at the point of delivery. In modern times, with improved communication and technology, it is possible for us to provide services close to people's homes, where in the past they would have had to travel to larger centres. In 2002, NHS Grampian developed the 'Healthfit' approach, which aims to provide services locally as much as possible and reserve acute hospitals for complex interventions that need specialist care in a hospital setting.
Since 2002, local clinics in cardiology, orthopaedics and dermatology have been established across Grampian. Telemedicine has allowed emergency cases to be seen without travelling to Aberdeen. Diagnostic tests such as ultrasound are carried out in the community, and community hospitals are acting as focal points for services provided by GPs and other health professionals. Partnerships with local authorities and voluntary organisations have been formed to support rehabilitation and respite close to home. In Aberdeen, Woodend Hospital is run by the City Community Health Partnership to provide rehabilitation and intermediate care, allowing Aberdeen Royal Infirmary (ARI), to focus on complex, specialist hospital care.
Shifting the balance of care
Shifting the balance of care is what Healthfit is all about:
- Shift from big expensive hospitals to community based services.
- Shift from doctor-dependent care to involve other healthcare workers and self-care.
- Shift from emergency admissions to prevention of ill-health, with patient-centred support of long term conditions such as diabetes, heart disease and lung disease.
Adapting to survive
In times of economic pressures and an ageing population, shifting the balance of care becomes even more important. If we did not shift the balance, we would have to build an extra hospital with 600 beds every three years in Scotland.
Rather than building more of the same, we aim to improve the facilities already available to our patients. The first stage of a comprehensive site development programme at Foresterhill in Aberdeen will be completed in 2012, this will make inpatient facilities fit for 21st century care. Facilities in Dr Gray's Hospital in Elgin, as well as community facilities for general and dental practice, are also being developed and modernised.
Much has been achieved but much more needs to be done to become the best provider of healthcare in Scotland. Difficult choices will need to be made. For example, the development of local community based care in North Aberdeenshire involved the upgrade of facilities at community hospitals in Banff and Fraserburgh, but the closure of Portsoy and Maud hospitals.
A safe service
Patient safety has to be at the core of everything we do. Healthcare associated infections have been a particular problem across the NHS in Scotland. After a poor year in 2009, NHS Grampian has seen a large improvement with levels of infections such as Clostridium difficile and MRSA coming down. This has been achieved by changes in antibiotic prescribing and upgrade of facilities available to patients, combined with strict infection control measures by staff and visitors to our premises. Staff in NHS Grampian are determined to provide services with the lowest infection rates in Scotland, nothing less will be good enough.
Access to services
Clinicians from primary and secondary care are working together to design the most effective and efficient patient pathways as part of our 'Better Care Without Delay' Programme. By March 2010, no patients available for treatment waited longer than 12 weeks for an outpatient appointment and nine weeks for an inpatient appointment. We achieved this with greatly reduced reliance on one-off waiting list initiatives and the private sector.
A number of our specialities are already achieving the 18 week referral to treatment standard and we are well placed to meet this target across the board during 2011.
The development of patient pathways will enable us to identify those elements of the pathway that can be delivered in primary and intermediate care settings, shifting the balance of care towards locally accessible services, wherever appropriate.
During the consultation on our priorities, some people told us of continuing problems in getting GP appointments within 48 hours. In Moray and Aberdeenshire, GP practices are working together to ensure consistent standards and to influence the pattern of care, both in the community and in hospitals. In Aberdeen, a major project to revolutionise the way in which primary care services are provided in the City will be taken forward during the three year life of this Health Plan. The Aberdeen Health Village, planned to be developed in the centre of the city, plays an important role in this changed way of working, by providing diagnostic and treatment services for patients
We will ensure that these and other initiatives result in patient-centred, consistent and easy access to GP services and also to services in the community provided by pharmacists, optometrists and other health professionals. This will also mean improved access for those people with mobility, language and communication difficulties.
Facilities fit for 21st century care
Timely access to diagnostic services is essential to quicker treatment. We will pay particular attention to radiology, endoscopy and laboratory services over the life of this plan. We are already in the process of providing two new MRI scanners and one new CT scanner at ARI during 2010. Our strategy for the future development of these diagnostic scanners will be completed by April 2010. During 2009/10 we upgraded our endoscopy facilities in the Department of Gastro-Intestinal Medicine at ARI and our plans for endoscopy services in both hospital and community settings have been developed with support from Aberdeen University and informed by patients' views.
Fast access to diagnosis and treatment is vital for patients with suspected cancer. Nurse-led colorectal and prostate cancer models of care are working well, and this innovative work will continue to develop. Delivering these kind of services close to home is a first in Scotland. Upgrading of cancer inpatient and outpatient services in Aberdeen and Dr Gray's is well under way and new inpatient facilities will be completed in 2012. Two new linear accelerators for the treatment of cancer will be completed at Foresterhill by 2013.
Many of the major projects to improve facilities are being taken forward by the Health Campus Programme. Shifting the balance of care, supported by the development of community services and modernisation of hospital services, will continue to reduce reliance on high cost hospital services and make our service sustainable and fit for the future.