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improving hospital servicesAcute and
Community Trusts throughout Scotland are |
The reduction in the number of NHS Trusts in Scotland providing acute hospital care, shows that the NHS in Scotland is committed to a more collaborative approach to health care services. This ensures that acute services in an area will be planned more coherently with patients interests foremost.
But improving health care in hospitals is not just about acute services. Community hospitals are important in providing wider access to services, especially in the remoter parts of Scotland, and the NHS continues to be responsible for the care of people with long term needs, some of whom will be looked after in hospital settings. The NHS in Scotland has continued to improve the environment in which such care can be delivered.
Hospital Activity
The NHS is committed to improving the quality of care provided to patients. The NHS in Scotland continues to treat more patients, with a significant number of patients waiting a relatively short time for treatment. It is also important to ensure that patients have easy access to treatment and hospitals need to balance these needs carefully.
Last year the NHS in Scotland provided treatment for more people than ever, with the number of patients being treated as day cases continuing to increase. Over half of all patients with planned admissions in acute specialties are now treated as day cases. table 8 (page 56) shows the proportion of elective admissions treated as day cases, for five procedures. The NHS in Scotland is committed to increasing further the number of patients treated as day cases.
The NHS is trying to cut the number of occasions when patients have their admission to hospital cancelled. Overall, almost 98% of hospital admissions in the 7 key specialties went ahead as planned in 1998/99, table 9, (page 57).
In 1998/99, from a total of over 1.3 million new out-patient referrals, almost 148,000 patients did not attend their appointment, table 7 (page 54). This is a small decrease on the figures for 1997/98. Nevertheless, the number of patients who do not attend for their outpatient appointment is significant, and this clearly does not make the best use of doctors' time and leads to longer waiting times for all patients. There are of course many reasons why patients do not attend for their appointments. Hospitals need to continue to investigate this issue and ascertain whether there are actions or initiatives which they can implement which will maximise attendance at out-patient clinics, and enable all patients to be treated more quickly.
Waiting Lists And Waiting Times
Most people do not wait long for treatment in hospital. More than half of those who require to come into hospital are admitted immediately, and 4 out of 5 patients are treated within three months of being placed on the waiting list. For the few who do have to wait longer, this can be a time of anxiety and discomfort. They will be given either a specific guarantee that they will be admitted within a certain time or covered by the overall guarantee that no-one should wait longer than 12 months except for certain conditions of low clinical priority.
Specific local inpatient waiting time guarantees are offered for hip, knee, cataract and cardiac surgery. These guarantees were largely met in 1998/99, table 5, (page 52).
In 1992, targets were set for the maximum time that patients should wait for their first outpatient appointment, and the following year these targets were made into guarantees for the 6 main specialties. In 1998/99, almost 66% of outpatients in Scotland were given a first appointment within 9 weeks of referral.
The inpatient/day case waiting list rose sharply in 1997/98 - by almost 5,000 from April 1997 to March 1998. In 1998/99, an additional £44.5 million was made available to the NHS in Scotland specifically to tackle waiting lists. A high level Support Force was appointed to drive forward work in this area and to provide assistance to Health Boards and NHS Trusts to ensure that sustained reductions in waiting lists and waiting times were secured for the benefit of patients throughout Scotland.
The waiting list for inpatient and day case treatment fell dramatically from 89,525 on 31 March 1998 to 70,227 on 31 March 1999, a reduction of 21.5% . The NHS in Scotland is currently working to sustain these waiting list reductions and to reduce waiting times. In addition it is implementing over 190 individual projects designed to achieve long-term, sustained reductions, including proposals to improve the interface between the primary care and secondary care sectors, the establishment of one-stop, fast-track and nurse-led clinics and the re-design of specific services. Many projects will introduce changes in current practices and procedures and improve the quality and delivery of services through shorter waiting times _ both for inpatients and outpatients _ and more streamlined procedures, thus improving the patient's experience from GP consultation to hospital discharge.
The Scottish Executive is committed to set targets to speed treatment and shorten waiting times for outpatients as well as for inpatient and day case treatment and work on taking forward this commitment is currently underway.
Acute Services Review
A considerable amount of work was put in train during the year to take forward the thinking set out in the report on the Acute Services Review, which was published in June 1998.
A multi-professional Acute Services Group was set up under the chairmanship of the Chief Medical Officer. Apart from monitoring implementation of the proposals set out in the Report of the Review, the Group's remit is to serve as a resource to the Management Executive in taking forward specific tasks arising from the Report and to Health Boards, Trusts and professional groupings in implementing relevant proposals.
Managed Clinical Networks (MCNs) are widely accepted as the most significant idea to emerge from the Review, and the development of the concept was the Acute Service Group's top priority during the year. The Group felt that the introduction of Networks must be properly managed, not only to avoid disruption of services but to enable thorough evaluation of the concept. To those ends, guidance setting out the core principles underlying MCNs was issued to the Service on 9 February. Encouragement was given during the year to plans for the development of a number of different types of MCNs.
A meeting was held in Inverness in October 1998 with a wide range of interested parties to discuss the setting up of a Remote and Rural Areas Resource Centre. Although the report of the Review advocated such a centre for the Highlands and Islands, it subsequently became clear that the Centre would have benefits for all remote and rural parts of Scotland, and its remit was extended accordingly. An announcement was made in November 1998 that the Centre would be based at Raigmore Hospital, with funding of £2 million a year. Particular issues which the Centre will consider include: improving recruitment and retention of key health professional staff: training and development of skills: transport and travelling times; sponsoring Managed Clinical Networks; communications, telemedicine and information technology; research and development; and designing new-style jobs to meet rural community healthcare needs.
As a result of the Report's recommendations that the role, remit and composition of the National Medical Advisory Committee (NMAC) should be reviewed, the Scottish Medical and Scientific Advisory Committee was created by merging the NMAC with the National Advisory Committee of Scientific Services. The new Committee offers a suitable mechanism for taking forward work on diagnostic and support services. In particular, it has created 3 Sub-Groups to look at: the development of a national framework for the Management Executive to use in capital funding, using the purchase of radiological equipment for cancer services as a model; the development of Managed Clinical Networks on a regional basis for diagnostic and support services, using breast cancer services as a model; and the recruitment, retention and training of Medical Laboratory Scientific Officers.
Work has also been in progress during the year on the development of the Ambulatory Care Centre concept, which was one of the 4 priorities for action identified by the then Scottish Office Minister for Health in the Review. The report recommended the establishment of a least one major pilot centre in Scotland so that the effect on patients and the clinical and resource implications could be evaluated. The location of that pilot is under consideration.
Named Nurse
All patients and their relatives are now given the name of the nurse, health visitor or midwife who is responsible for all aspects of their care. Revised guidelines on the implementation of the Named Nurse were issued in summer 1998 in response to the results of a country-wide audit. This audit indicated that although widely implemented, the value of the concept in practice was not clear. The new guidelines simplify and clarify use of Named Nurse, while making its impact easier to evaluate.
Mixed Sex Accommodation
While every effort is made by staff to preserve the dignity and privacy of patients, the public has expressed concern about mixed wards. Following a review of present practice, hospitals were asked from September 1996 to inform patients before they are admitted if they were going to be cared for in a mixed sex ward. Where possible the patient's preference will be met and patients can choose to defer admission until suitable accommodation is available. Hospitals are working to eliminate mixed sex accommodation as quickly as possible, but the best way to achieve this is through local solutions. This was adopted as one of the 3 priorities for quality improvements in the NHS in Scotland Priorities and Planning Guidance for 1998/99. In August 1998, the NHS Management Executive set up a Working Group to audit the position on mixed sex accommodation in hospitals throughout Scotland. The Working Group's Report was published in March 1999. All new hospital developments or refurbishment programmes will incorporate single sex accommodation.
The Patient's Charter
Following the publication of the Patient's Charter in 1991, development of the Charter has continued at local level with Health Boards and NHS Trusts preparing their own Charters. A recent review of this approach has concluded that it has achieved its aims.
The White Paper"Designed to Care" commits the NHS Management Executive to reviewing and re-launching the Patient's Charter. An Advisory Group made up of representatives of the public, patients and NHS staff was established in December 1998 to oversee the review. A wide-ranging consultation exercise on the new Charter will be carried out in 1999, leading to the launch of a new Charter in 2000.
Patient Involvement
"Designed to Care" aims to encourage new means of ensuring more public involvement in the NHS. Plans include discussing with the NHS in Scotland the scope for the use of focus groups, citizen's juries etc as methods of achieving this.
In addition, the NHS Management Executive has been developing guidance with the Scottish Consumer Council (SCC) and the Scottish Association of Health Councils (SAHC), aimed at encouraging patient/public involvement in primary care settings. An initial report "Putting Partnership into Practice: Involving The Public In Primary Care" was published in January 1999. The final report "Designed to Involve: Public Involvement In The New Primary Care Structures" will be published during 1999. The third phase of the project will involve an SAHC/SCC Development Officer supporting Primary Care Trusts to develop and implement local policies and strategies.
Volunteering in the NHS
As part of a three year project, Volunteer Development Scotland (VDS) is working with Health Boards, NHS Trusts and the primary care sector to develop and enhance the role of volunteers in all parts of the NHS in Scotland. Guidance was issued in June 1998 to Health Boards and NHS Trusts asking them to examine their current practices to ensure that they co-ordinate, monitor and support the development of volunteer services. Health Boards were specifically asked to develop a volunteering policy for their respective areas and to submit it to the Department by December 1998. Trusts will shortly be asked to develop and implement policies complementary to their Health Board's policy for volunteering in hospital settings, by the end of 1999. VDS have also established 2 action research projects in Culloden and Dundee to encourage and increase the contributions of volunteers in primary care settings.
Patient Information
In early 1998, the Scottish Association of Health Councils and Scottish Health Feedback published the findings of a review of health information literature entitled "Putting Patients in the Picture". Also, the Health Service Research Unit of the University of Aberdeen has been funded to develop a guide to providing health information materials. In addition, the White Paper has committed the NHS Management Executive to extending the existing NHS Helpline so that the public will be able to ring the Helpline and receive local information on health and social care. Work is ongoing to achieve this aim, together with the Ministerial announcement to pilot NHS Direct in Scotland, which will provide the public with 24-hour access to health advice.
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