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FAIR TO ALL, PERSONAL TO EACH The next steps for NHSScotland
Chapter 2: Progress so far
Reducing Deaths from Cancer and Heart Disease
2.1 Good progress has been made in reducing premature deaths from the 3 "big killers" - cancer, heart disease, and strokes. The overall mortality rate for the under 75s dropped from 486 per 100,000 in 1997 to 432 in 2003: the main reason for this was the reduction in death rates for cancer, heart disease and stroke. The combined rate for these 3 conditions - targeted for action by the Executive because of their impact on life expectancy - fell significantly from
302 per 100,000 in 1997 to 247 in 2003.
2.2 The number of women invited for breast screening has increased from 104,000 in 1997-98 to 110,000 in 2002-03, an increase of 6%. Screening helps to spot signs of cancer early so that quick and effective treatment can start. In 2001-02, we invested 10 million to support implementation of the cancer strategy, increasing to 25 million the following year and sustained at that level thereafter. The number of procedures to help restore blood flow to the heart without open heart surgery - known as coronary angioplasty - has increased from 2,400 in 1998-99 to 4,150 in 2003-04 - up by 75%.
2.3 Patients have benefited from improved cancer, heart disease and stroke services. For example, extra clinical staff have been recruited through the cancer programme: in Highland, an additional breast surgeon has helped reduce waits for first clinic appointments to 10 days. Stroke units have been established in Raigmore Hospital at Inverness and more recently at Ninewells Hospital in Dundee and at Victoria Hospital, Kirkcaldy. Patients benefit from co-ordinated services which result in higher survival rates and more people returning home to regain independence and enjoy a better quality of life.
Shorter Waiting Times
2.4 Good progress has been made with reducing waits experienced by patients making an appointment to see a member of their primary care team. From April 2004, a target has been put in place to ensure that patients can have access to an appropriate member of the primary care team - GP, nurse or other healthcare professional - within 48 hours. NHS Boards confirm that this commitment is being met. The new GP contract gives extra money for practices that meet the target.
Mary is a patient at a GP practice in Lanarkshire. Before March 2004, when she needed to arrange an appointment, it was common to wait up to 20 days to see her GP. After the practice participated in the Scottish Primary Care Collaborative change and improvement programme, Mary is now able obtain an appointment with a member of the GP practice team the same or the next day. |
2.5 Until 2001, the NHS took regular initiatives to reduce the number of patients on the inpatient and day case waiting list. This is the list of everyone who is waiting for admission to hospital for treatment. Patients are listed for a minor procedure not requiring an overnight stay (a day case) or a bigger procedure where an overnight stay is required (an inpatient).
2.6 Long waits for routine treatment are not desirable from a clinical point of view. And what really matters to patients is how quickly they will be treated, rather than how many others are waiting with them on the list. So since 2001, the Executive has focused priority on reducing the longest waits. Good progress has been made on waiting for inpatient and day case treatment. The NHS in Scotland met its maximum wait guarantee of 9 months by the end of 2003, and is on track to deliver the guarantee of 6 months by the end of 2005.
2.7 But while progress has been made on inpatients, outpatient waiting has risen over the last 3 years. Patients who are referred urgently are of course given priority but some patients with routine referrals are having to wait too long to be seen by a specialist with a view to diagnosis and to find out whether they need further treatment. The NHS is taking action to turn this round. While progress is being made in particular specialties and in some areas, the challenge is to bring all parts of the NHS up to the level of the best.
New Ways of Delivering Services
2.8 The NHS is making progress with new ways of providing care and treatment to patients that are faster and more convenient. Rapid access clinics for patients suffering from chest pain are operating in many parts of Scotland. The clinic in Paisley is staffed by a multi-disciplinary team to ensure prompt diagnosis and treatment. Patients can choose the time of an appointment to suit them, using an on-line system in the GP surgery. The next available appointment is currently within 2 working days.
2.9 In Fife, a one stop cataract surgery service has had a dramatic impact on waiting times. By redesigning the service round a fully integrated cataract unit with its own operating theatre, the number of patients who can be seen and treated in a given time has more than doubled and the wait for routine treatment is now down from over a year to 25 weeks. And quality of treatment has improved by ensuring that the patient sees the same nurse all the way through their care and treatment.
More NHS Staff
2.10 The staff of the NHS are vital to patients' experience of high quality, rapid care and treatment. Many interactions between patients and NHS staff are one to one contacts. Patients want enough of a healthcare professional's time to enable good quality consultation, diagnosis and treatment. So more staff spending more time with patients helps improve patients' experience.
2.11 Between 1999 and 2003, an additional 11,000 NHS staff were employed in Scotland - including 1,150 more hospital doctors, 2,700 more nurses and 1,250 more allied health professionals such as physiotherapists, radiographers and speech and language therapists. The graph below shows by how much each staff grouping grew:
Increase in NHS from 1999 to 2003
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2.12 Administrative and estates staff as well as clinical and technical staff make a contribution to patient care. For example, additional secretarial support for consultants releases more of the doctors' time for seeing and treating patients. Administrative staff can help patients to have a better experience by speeding the process of making appointments.
Marilyn is a medical records manager with the NHS. Recently Marilyn has led her team to make big improvements in the way patients are booked for outpatient appointments. She has worked closely with clinicians to introduce patient focussed booking across many specialties in the hospital where she works. The team uses text message reminders among other innovative approaches to help ensure that patients are able to attend their appointments. |
New Buildings and Equipment
2.13 Since 1999 substantial progress has been made in modernising and upgrading the physical fabric of the NHS in Scotland. For example:
8 new hospitals have opened, from a community hospital in East Ayrshire through 2 new general hospitals in Lanarkshire to a major teaching hospital - the new Royal Infirmary of Edinburgh.
The Golden Jubilee National Hospital was purchased for the benefit of NHS patients in 2002. From that date, since it began working as an NHS hospital, activity has gone up from 2,500 procedures a year to over 13,000 procedures in 2003-04, with a further increase to 18,000 procedures planned for this year.
33 million has been committed to radiotherapy equipment modernisation. All 5 Scottish centres now have state of the art linear accelerators able to achieve better results for more patients. By the end of 2005-06 there will be 24 modern linear accelerators in Scotland.
Better Quality Healthcare
2.14 Consistently high quality healthcare in all parts of the NHS is what people expect. The Clinical Standards Board for Scotland was established in 1999. Its aim is to help deliver consistently high standards of quality in health care. Since a new, merged body - NHS Quality Improvement Scotland - was set up in 2003, a more focused and integrated approach is being taken to quality in the NHS in Scotland. Clinical standards have been set for breast, lung, colorectal and ovarian cancer; coronary heart disease; schizophrenia; diabetes; stroke and renal services, among others. NHS Boards' performance against these standards is reviewed regularly and full reports are published. There is evidence that clinical standards are being driven up as a result.
Better Patient Experience
2.15 People quite rightly expect their hospitals to be clean and safe, that NHS staff will treat cleanliness as a priority, and that they will receive acceptable food while in hospital. In the White Paper "Our National Health", published at the end of 2000, we set the objective of introducing standards for infection control, cleaning standards, and hospital food. All standards are now in place. Inspection reports have been produced or are in process. The Healthcare Associated Infection Task Force is leading a major effort to reduce the risk of infection in our hospitals. By publishing a comprehensive National Cleaning Services Specification, Scotland has taken a lead across the UK. The number of infection control nurses has risen by 66% between the beginning of 2003 and November 2004 and now stands at 138. And over 200 NHS staff have completed training in a new programme for cleanliness champions established in 2003.
Listening to Patients Better
2.16 In 1999 the Executive realised that more needed to be done by the NHS to inform patients and involve them in their treatment. And the public and communities had to be given a bigger say in deciding how and where healthcare services are delivered. A major programme of patient focus/public involvement activity has been underway since 2001. To help deliver our commitment to ensure that people with mental health problems, and other vulnerable people, have access to advocacy services we are supporting the Advocacy Safeguards Agency. The Executive has invited 100 members of the public to help provide an equality and diversity perspective to the NHS on access to service issues. These and other initiatives are helping to ensure that patient experience is given proper weight by Boards in developing services.
2.17 This approach is underpinned by a new statutory duty of public involvement laid on Boards in the NHS Reform (Scotland) Act 2004.
2.18 The new Scottish Health Council - which will be open for business in April 2005 - will monitor progress in improving patient focus and public involvement. The Council will work with the Service to develop and spread good practice. And we have very recently set the NHS a challenging new target: all NHS Boards will achieve year on year improvements in involving the public in planning and delivering NHS services and in involving patients in decisions about their own health care and the development of services. Progress will be assessed by the Scottish Health Council and their reports will be published.
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