a developing vision of future healthcare for berkshire and...
TRANSCRIPT
A developing vision of future healthcare for Berkshire and Buckinghamshire
Jeśli potrzebujecie Państwo tłumaczenia tego dokumentu, prosimy przejść na ostatnią stronę.
यदि तपाईंलाई यो कागजातको अनुवाद चाहिएमा, कृपया पछाडिको पृष्ठ हेर्नुहोला
جے تہانوں ايس دستاويزدا ترجمہ کروان دی لوڑہيگی اے تے، مہربانی کردياں ہوياں پچهلے صفحے تے جاوو۔
اگر آپ کو اس دستاويز کا ترجمہ درکار ہے تو برائے مہربانی آخری صفحہ مالحظہ کيجئےयदि आप इस दस्तावेज का अनुवाद चाहते हैं तो कृपया पीछे का पृष्ठ पलटेंإذا رغبت بترجمة هذه الوثيقة، فيرجى الذهاب إلى الصفحة األخيرة.
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Stoke Mandeville
Wycombe
HillingdonWexham Park
Heatherwood
Royal Berkshire
West Berkshire
Buckingham
Florence Nightingale House
Amersham
Chalfont and Gerrards Cross
Marlow
Townlands,Henley
St Marks, Maidenhead
Upton, Slough
Kind Edward VII, Windsor
Wokingham Hospital
Dellwood / Duchess of Kent / Prospect Park
West BerkshireCommunity Hospital
Thame
Berkshire West
Berkshire East
Buckinghamshire
Buckingham
Aylesbury
Amersham
Beaconsfield
Slough
Windsor
Maidenhead
High Wycombe
BracknellWokingham
Newbury
Reading
Acute trust
Community hospital
Primary road
PCT boundary
Motorway
Stoke Mandeville
Wycombe
HillingdonWexham Park
Heatherwood
Royal Berkshire
West Berkshire
Buckingham
Florence Nightingale House
Amersham
Chalfont and Gerrards Cross
Marlow
Townlands,Henley
St Marks, Maidenhead
Upton, Slough
Kind Edward VII, Windsor
Wokingham Hospital
Dellwood / Duchess of Kent / Prospect Park
West BerkshireCommunity Hospital
Thame
Berkshire West
Berkshire East
Buckinghamshire
Buckingham
Aylesbury
Amersham
Beaconsfield
Slough
Windsor
Maidenhead
High Wycombe
BracknellWokingham
Newbury
Reading
Acute trust
Community hospital
Primary road
PCT boundary
Motorway
Acute trusts in thAmes VAlley
Contents
Introduction 3Summary 4OurchangingNHS 6Thechallenges 8Workingtogethertoimproveservices 10
Developingavisionoffuturehealthcare 11Emergingfindings 13Whatitwillmeanforpatients 15Buildingonthebest 16Glossary 19
3
Stoke Mandeville
Wycombe
HillingdonWexham Park
Heatherwood
Royal Berkshire
West Berkshire
Buckingham
Florence Nightingale House
Amersham
Chalfont and Gerrards Cross
Marlow
Townlands,Henley
St Marks, Maidenhead
Upton, Slough
Kind Edward VII, Windsor
Wokingham Hospital
Dellwood / Duchess of Kent / Prospect Park
West BerkshireCommunity Hospital
Thame
Berkshire West
Berkshire East
Buckinghamshire
Buckingham
Aylesbury
Amersham
Beaconsfield
Slough
Windsor
Maidenhead
High Wycombe
BracknellWokingham
Newbury
Reading
Acute trust
Community hospital
Primary road
PCT boundary
Motorway
ThisdocumentsetsouthowweplantoimprovetheNHSforthe1.4millionpeoplelivinginBerkshireandBuckinghamshire.
IntroduCtIon
TheseplansarebeingdevelopedbyGPs,consultants,nurses,midwivesandotherhealthcareprofessionals,patientsandthepublicandourpartnersinlocalauthoritiesandsocialservices.
TheNHSinBerkshireandBuckinghamshireisbringingpeopletogethertoshapetheseplans,understandwhatmattersmosttopeopleandagreewhatworksbestsothat,together,wecanmakethebestdecisionsabouthowandwherecareisprovidedinthefuture.
EachNHSorganisationinBerkshireandBuckinghamshirealreadyhasitsownplansforcontinuingtoimproveservices,addressinglocalissues,andrisingtothechallengesthattheNHSfaces.Someoftheseplansareattheearlystages;othersarealreadybeingdiscussedwithlocalpeople,staffandpartners.
Forexample,inBuckinghamshire,wearealreadylookingathowbesttoprovideurgentcarethroughourImPACTprojectandthrough
thishavealreadysetupaGPleadhealthcentreinWycombeHospital,andextendedourGPoutofhoursservice.InBerkshireEast,followingonfromtheRight Care, Right Placeconsultation,thePCTsetupanurgentcarecentreinMaidenhead,awalk-incentreinSloughandisdevelopinganurgentcarecentreatWexhamParkhospital,duetoopenlaterthisyear,toimproveaccesstohealthservices.AndinBerkshireWest,projectshavebeendevelopedtoshiftcareoutoftheacutesectorandtomanageproactivelylongtermconditionstoavoidunnecessaryemergencyadmissions.
However,byworkingtogetherwithasharedvisionthroughCarefortheFuture,wewillbeabletoensurethatallourplansbringthegreatestimprovementsandbenefitsforlocalpeopleandpatients.Wewillbeabletofindsharedwaystomeetrisingdemands,reducevariationsbetweenservicesandgetthegreatestbenefitfromnewmedicaladvances.
4
LocalhealthprofessionalsandNHSorganisationshavejoinedforcestoimprovetheNHSforthe1.4millionpeoplelivinginBerkshireandBuckinghamshire.
Why chAnGe?
TheNHSisbusierthaneverbefore,treatingmorepatientsmorequicklyandtohigherstandards.Muchhasbeendonetodevelophighquality,community-basedservicessopatientsreceivecareclosertohome.
Asahealthsystemweareusedtomakingthebestuseofourresourcesbutinthefutureweneedtoensurewemakeevenbetteruseofwhatisavailabletous.
TheNHSneedstoadapttomeetthewaysocietyandtechnologyarechanging.Keepingthingsthesameastheyarenowisnotanoption:
•Advancesinmedicinemeanthatmanytests,treatmentsandprocedurescouldbedeliveredmoreconvenientlyforpatientsoutsideofhospital
suMMArY
•Peoplehavetoldustheywouldliketoreceiveevenmorecareandhaveawiderrangeofservicesavailableclosertohome
•Thepopulationisgrowingandpeoplearelivinglonger.Age-relatedlong-termillnessessuchasdiabetesandhighbloodpressureareincreasingthedemandforhealthcareservices
•Unhealthylifestyles,highlevelsofobesity,excessalcoholconsumptionandsmokingallputthehealthserviceunderevengreaterpressure
•Thedemandforservicesissteadilyincreasingatatimewhenfundingisaffectedbytheeconomicdownturn.
5
Wewanttoheartheviewsofasmanypeopleaspossibletounderstandwhatmattersmosttoyousothattogetherwecanmakethebestdecisionsabouthowandwherecareisprovidedinthefuture.
the Benefits for pAtients
Patientswillseerealbenefits.Everyonecanbeconfidentthattheyareenjoyingthebesthealthandreceivingthehigheststandardsofcare,nomatterwheretheyliveorwhichservicestheychosetouse.Carewillbeprovidedinmuchmoreconvenientwaysandtherewillbebetterco-ordinationbetweendifferentservices.
next steps
Thisreportcontainsourpreliminarythoughtsandideas.Thesehavebeendevelopedbymedicaldirectors,GPs,consultants,nursesandmidwives,patientandpublicrepresentativesandotherhealthprofessionalssuchaspharmacists,dieticiansandphysiotherapistsfromacrossoursevenorganisations.Beforewedevelopthesefurtherwewanttosharethemwithyouandinviteyourfeedback.
InthecomingmonthswewillbedevelopingourproposalsingreaterdetailandholdingpublicdiscussionsinBerkshireandBuckinghamshire.
your feedBAck
Untilthen,ifyouwishtocommentonourideasandemergingvision,wewouldverymuchliketohearfromyou.Youcancontactusat:
CarefortheFuture,57-59BathRoadReadingBerkshireRG302BA
Telephone:01189822789Email:[email protected]
WorkinG toGether to deVelop A Vision of heAlthcAre for the future
ByworkingtogetherwithasharedvisionthroughCarefortheFuture,wewillbeabletobringthegreatestimprovementsandbenefitsforlocalpeopleandpatients.Inparticular,wecanbothimproveservicesandsignificantlyreducecostsbyworkingtogethertomakesurewegettheright‘pathways’ofcareinplaceacrossandbetweenourservicesforindividualpatients.
Togetherwehavefourclearaims:
•Todevelopasharedvisionofthebestpossiblehealthcareforthelocalpopulation
•Toimprovepeople’squalityoflifeandlifeexpectancy,withintheresourcesavailabletous
•Tofocusonpreventingillhealthaswellasprovidingtreatment
•Tomanageourfinancialresourcesmoreeffectivelysothatwecanreinvestinfurtherimprovementsforpatients.
Asweworkonthisoverthecomingmonthswewantyoutohelpusshapeourideasandplans.Nodecisionshavebeenmadeyet.
6
TheNHShasmadesignificantimprovementsinrecentyears.Patientswhousedtowaitoverayearfortreatmentarenowseenwithinafewweeks.Patientsareabletohaveagreatersayoverwhenandwheretheyarecaredfor.ItiseasiertoseeaGPatmoreconvenienttimes.Andourhospitalsarecleanerandofferpatientsgreaterprivacythanbefore.
Buttheworlddoesn’tstandstill,andneithercantheNHS.Weknowweneedtodoevenbetter.Acrossourlocalareatherearesomeexcellentservices.Butwewanteveryonetoenjoytheverybesthealthandhaveaccesstothehighestqualityservicesregardlessofwheretheyliveorthecaretheyneed.
GettinG the riGht cAre
Traditionally,peopleoftenthinkofhealthcareashospitalservices.YetonlyasmallproportionofwhattheNHSdoeseverydaytakesplaceinhospitals.Thevastmajorityofpeople’scontactwiththeNHSiswiththeirGP,practicenurseorcommunityservice.
our CHAnGInG nHs
Thediagrambelowshowsthatmostpeoplecanmaintaintheirhealththroughselfcare,withoccasionaladviceandsupportfromtheirGP,nurse,pharmacist,dentistoroptician.
However,somepeoplerequiremorecontinuousmedicalhelp.Forexample,apatientwhoneedstocontroltheirdiabeteswiththesupportoftheirGPorspecialistnurse.
Andthentherearearelativelysmallerproportionofpatientswhoneedgreaterhealthandsocialcaresupport.Thismightincluderegularhospitaladmissionsorcontinuingcareservicessuchaspatientsondialysisorwithmoreseriousheartdisease.
Self care eg: healthy eating, regularexercise, breast feeding
eg: GPs, dentists, opticians, pharmacy services
COST OF HEALTH CARE & TREATMENTREDUCIN
G NUM
BER OF P
ATIENTS
eg: specialist nursing teams,disease management
eg:outpatientclinics
Specialisthospital sevices
eg: cancer treatment
Generalhospitalservices
Local healthServices
CommunityServices
GOOD HEALTH
PATI
ENT
CA
RE
PATH
WA
Y
7
more serVices in the community
Inrecentyears,thewaypeoplereceivetheirhealthcarehasincreasinglybeenthroughservicesprovidedatGPpracticesandwithinthelocalcommunity.Tests,scansandsimpleproceduresthatusedtorequireahospitalvisitorovernightstaycannowbedonemoresafely,convenientlyandcost-effectivelyatGPsurgeries,inclinicsinthecommunity,orinapatient’sownhome.
Inthefuturewewillseefurtherdevelopmentofmoreconvenientandeffectivelocalservices.Todothiswewillneedmoreclinicalstaffcaringforpeopleintheirownhomes.
more speciAlist hospitAl serVices
Asmoreofwhatusedtohappeninhospitalstakesplaceinthecommunityandinpeople’shomes,hospitalservices,andthehealthcareprofessionalsprovidingthem,arebecomingmorespecialised.Advancesinmedicineandmedicaltechnologymeanthatnewandinnovativetreatmentsareavailable.Butalltheevidenceshowsthatpatientsgetbetterresultsiftheyaretreatedbystaffwithspecialistknowledgeinspecialistfacilities.Thismeansthatinthefuturetherewillbeagreaterconcentrationofspecialistcareinfewersites.
usinG resources more Wisely
Thewayhealthserviceshavebeenorganisedanddeliveredinthepastisn’talwaysappropriatenow,andtherearewayswecanbecomemoreefficient.
Forexample,weknowpatientssometimesspendtoolonginhospitalbecausethedischargesystemisnotasefficientasitcouldbe.Wealsoknowthatpeopledonotalwaysusetherighthealthservicesintherightway–aroundathirdofpeopleusingourlocalA&Edepartmentscouldhavebeentreatedelsewhereand,nationally,afifthofpeopleseeingaGPcouldhavetreatedthemselves.Andwecouldfreeupclinicalstafftospendmoretimewithpatientsbygivingthemnewtechnologytohelpwithadministration.
8
WewanttocontinueimprovingtheNHSforpatientsacrossBerkshireandBuckinghamshire.Butwehavetodothatinthecontextofincreasingdemandforservices,thechangingneedsofourlocalpeople,andtheconstraintsontheresourcesandfinancesavailabletous.
A GroWinG And AGeinG populAtion
ThepopulationsofBerkshireandBuckinghamshirearegrowing.Peopleinourareatendtobehealthierandsolivelongerthanaveragewhencomparedwiththerestofthecountry.Thisisgoodnews,butitdoesmeanthataswegetolderwestarttosufferfrommorelong-termconditions,suchasdementiaandheartdisease.Localhealthserviceswillneedtogrowandadapttothesechangingneeds.
tHe CHAllenGes
unheAlthy lifestyles
Obesity,smokingandalcoholconsumptionaremajorpublichealthissues.Itisestimatedthat60%oftheUKpopulationcouldbeobeseby2050.Althoughourpopulationisgenerallyahealthyone,amongsomegroupsofpeople,theseissuesaremajorcausesofconcern.Unhealthlylifestylesleadtoanincreaseinlong-termillnessessuchasdiabetes,heartdiseaseandhighbloodpressure.
9
keepinG up With medicAl AdVAnces
NewdrugsandtreatmentsmeanwecanprovidebetterpatientcarebutsometimesatamuchhighercosttotheNHS.Therearefiniteresourcesavailablewithinthehealthsystemandnotallthedrugsandtreatmentsworkforeverybody,sowehavetomakecarefuldecisionsabouthowtogetthebestvalueformoneytoachievethebestpossibleoutcomesforallourpatients.
VAriAtions BetWeen serVices
TheNHSperformswelloverallinBerkshireandBuckinghamshireandtherearemanyexcellentservices.However,therearevariationsinthequality,easeandspeedofaccess,andthepatientoutcomesbetweensomeservices.Ourlocalpeopleshouldexpecttoenjoytheverybesthealthandhighestqualityservicesregardlessofwheretheyliveorthecaretheyneed.
doinG more Within fundinG constrAints
Publicservicesarereceivinglessfundingaswetrytoreducethenationaldebt.AlthoughthenationalNHSbudgetisbeing‘ring-fenced’
toprotectit,itwillnotgrowasithasinthepast.Meanwhile,thecostofhealthserviceswillcontinuetoriseandthedemandsplacedonserviceswillalsoincreaseasourpopulationgrowsandages.
Therefore,ourplanningassumptionisthatwedonotexpectanyincreasesinNHSfundinginBerkshireandBuckinghamshireinthecomingyears.We’veestimatedthat,unlesswetakeactionnow,thehealthsysteminBerkshireandBuckinghamshirecouldfaceafinancialshortfallofupto£400millionby2013/14.
Addressingthisfinancialshortfallwillbeachallenge,butwehaveidentifiedwaysinwhichwecandoit.
Reducingmanagementcosts,therenegotiationofcontacts,andchangesinthenationalNHSpaymentsystemwhichwillencourageallproviderstobemoreefficient,shouldsaveover£250mannually.
And,bycomparinghowwedeliverourservicesfordifferentconditionsandtypesofcareagainstbestpractice,webelievewecanachievefurthersavingsofover£200meveryyearbyprovidingtherightservices,intherightway,intherightplaceandattherighttime.
1.7
2.1
2013/14 2012/13
2.4
2011/12 2010/11 2009/10
Reg
ion
al N
HS
spen
d (
£bn
)
1.9
2.0
2.2
2.3
1.8
£280m £160m £400m £45m
Expected rise in NHS spend if we do not make any changes
No increase expected in real-terms NHS funding
Likely funding gap if wedo not make changes
10
EachNHSorganisationinBerkshireandBuckinghamshirealreadyhasitsownplansforcontinuingtoimproveservices,addressinglocalissues,andrisingtothechallengesthattheNHSfaces.Someoftheseplansareattheearlystages;othersarealreadybeingdiscussedwithlocalpeople,staffandstakeholders.
ButbyworkingtogetherwithasharedvisionthroughCarefortheFuture,wewillbeabletoensurethatallourplansbringthegreatestimprovementsandbenefitsforlocalpeopleandpatients.Wewillbeabletofindsharedwaystomeetrisingdemands,reducevariationsbetweenservices,andgetthegreatestbenefitfromnewmedicaladvances.
Inparticular,wecanbothimproveservicesforpatientsandsignificantlyreducecostsbyworkingtogethertomakesurewegettheright‘pathways’ofcareinplaceacrossandbetweenourservicesforindividualpatients.Thiswilldeliversomeofthemostsignificantimprovementsforpatientsandenableustoaddressthefinancialshortfallthatwewillfaceifwedon’ttakeactionnow.
Workingtogetheralsomeanswecanensurethat:
•Changesmadeinoneareadonothaveanegativeimpactonanotherarea
•Wecanshareourlearningandopportunitiestomakeimprovements
•Weshareourresources,usingthemmoreefficiently.
WorKInG toGetHer to IMProVe serVICes
Who is inVolVed?
CarefortheFutureinvolvesGPsandtheprimarycaretrusts,acutehospitalsandprovidersofcommunityhealthservicesinBerkshireandBuckinghamshire
WearebeingsupportedbyNHSSouthCentralStrategicHealthAuthorityandworkingcloselywithSouthCentralAmbulanceServiceNHSTrust.
our Aims
Togetherwehavefourclearaims:
•Todevelopasharedvisionofthebestpossiblehealthcareforthelocalpopulation
•Toimprovepeople’squalityoflifeandlifeexpectancy,withintheresourcesavailabletous
•Tofocusonpreventingillhealthaswellasprovidingtreatment
•Tomanageourfinancialresourcesmoreeffectivelysothatwecanreinvestinfurtherimprovementsforpatients.
11
WeareproudoftheimprovementstheNHShasmadeinrecentyears,butweknowthatpatientsexpectmoreandwewanttodobetter.
deVeloPInG A VIsIon of future HeAltHCAre
our principles
Ourworktodevelopourvisionisbasedonasharedsetofunderlyingprinciples.Wewill:
•Seektoreduceinequalitiesinhealthandimprovepatientoutcomes
•Promoteandsupportselfcareandgoodhealthwhereverpossible
•Activelysupportvulnerablepatientsandindividualsatriskofbecomingill
•Workwithpatients,carers,GPsandstaffintheredesignofservices
•Treatpatientsintheirlocalcommunitywherepracticalandeffective
•Recognisethatwhilesomecoreservicesshouldbeprovidedfromeveryhospital,somespecialistservicesarebestprovidedfromfewersitestoenablethebestpossiblecareandsafetreatment
•Ensurethatappropriatequalityandstandardsofcarearemaintainedandcontinuallyimproved
•Supportthepersonalisationofcareandenablepatientstoexercisegreaterchoice
•Useclinicalbestpracticeandevidenceasabenchmarkinmakingdecisionsaboutplansforfuturehealthcare.
WewanttobuildontheimprovementswehavealreadymadetocreateanNHSinBerkshireandBuckinghamshirethatprovidesallpatientswithaccesstotherightcare,intherightplaceandatthetimeitisneeded.Wewantto:
•Putpatientsattheheartofallwedo,givingthemmorechoiceandcontrol
•Ensurethatallservicesarefocusedondeliveringtheverybestoutcomesforpatients
•Continuedevelopingmoreconvenientcommunity-basedservicessothathospitalstaffcanconcentrateonprovidinghighquality,safe,expert,specialistcare
•Ensureweuseourresourcesasefficientlyaspossiblesothatwecanreinvestmoreinfurtherimprovingservices.
TodothiswearedevelopingavisionforthefutureofhealthcareinBerkshireandBuckinghamshire.Weareworkingwithdoctors,nursesandotherswhoprovidecare,patients,carers,thepublicandourpartnerstoagreehowwewantcaretobeprovidedinthefuture.
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hoW We Are deVelopinG our Vision
Anychangesneedtobedirectedbythedoctors,nursesandotherswhoprovideourhealthcareservicesandfullyinvolvepatients,carersandthepublic.
InthefirstphaseofthisworkwesetupfourCarefortheFutureworkinggroups.ThesewereledbymedicaldirectorsandincludedGPs,consultants,nursesandmidwives,socialcarestaffandmanagers,patientandpublicrepresentativesandotherhealthprofessionalssuchaspharmacists,dieticiansandphysiotherapistsfromacrossoursevenorganisations.
Eachgroupwasgiventhetaskoflookingataparticulartypeofcare:
•planned care:carethatispre-arrangedsuchasscheduledhospitaloperationsoroutpatientappointments
•urgent care:emergencyservices,includingpeoplegoingtoA&Eorbeingadmittedtohospitalinanemergency
•long-term conditions:chronicillnessessuchasdiabetes,heartdiseaseorasthma
•paediatrics:children’sservices,includingmaternityandneonatalservices.
Thisphaseofworkalsoincludedresearchandcarefulanalysisofbestpracticeinhealthcareinthiscountryandabroad.Bydoingthiswecouldidentifyareaswherewecouldmakeimprovementsandensurethatanyideascouldbetestedagainstwhathasalreadyworkedwellelsewhere.
Thesegroupswentthroughanumberofstepstohelpthemclarifyandchallengetheirthinkingabouthealthandhealthservices–fromhealthpreventiontotreatment(bothoutofandinhospital)throughtorehabilitation.Theywereaskedtofocusonopportunitiestoimprovethequalityofprimary,communityandacute(hospital)careandtotakeaccountofthefollowing:
•Currentandfuturehealthcareneedsofthelocalpopulation
•UKandinternationalhealthcarebestpractice
•Increasingfocusonpreventionaswellastreatment
•Futurerestrictionsonfunding.
Thegroupscameupwithanumberofpreliminaryfindingswhicharethefirststeptodevelopingclearerproposalsforimprovingthequalityofpatientcare,increasingtheservicesprovidedtopatientsinthecommunityandmakingthemostefficientuseofourvaluableresources.Thesefindingsareoutlinedinthenextsection.
next steps in deVelopinG our Vision
Theseworkinggroupideasareataveryearlystage.Morediscussionisneededtoassesswhethertheywillworkinpracticeand,ifso,howwewillimplementthem.Thiswillbeledbythedoctorsandnurseswhoareprovidingtheservicesnow,andwhowillbeprovidingtheminthefuture.
Inthecomingmonthswewillbediscussingthisreportindetailwithourownemployees,withdoctors,nursesandGPsandwithotherNHSorganisations.Wewillalsobeaskinglocalcouncils,patientsgroupsandthepublicfortheirearlyviewsonthesefindings.
Whenwehavedevelopedmoredetailedplans,wewillbeginconsultationswiththepublicsothateveryonehasanopportunitytoseewhatweareproposingandhavetheirsay.
Ouraimistostartimplementingagreedchangesby2011sothatthepeopleofBerkshireandBuckinghamshirewillbeabletoenjoyhigh-quality,modernandreliablehealthservicesinthefuture.
Inthemeantime,we’dliketohearyourviewsandcomments.YoucangetintouchwithusatthecontactdetailsintheSummaryofthisdocumentonpage5.
13
heAlthcAre out of hospitAl And closer to people’s homes
Inrecentyears,anumberofnewinitiativeshavebeendevelopedatGPlevelandwithinthecommunity,includingcertainservicesthatwouldhavebeenlocatedinahospital.Forexample:
•Supportingandmanagingtheconditionsofpatientswithconstantandrecurringlongtermconditionssuchasasthmaanddiabetes
•Carryingoutdiagnosticandinvestigativeproceduresandminorsurgery
•Developmentsinprovidinghealthcareforolderpeopleintheirhomesratherthaninhospital.
Despitethisprogress,tosupportanageingpopulationandmeetlongtermcareneeds,wemustdevelopconsiderablymoreservicesoutsidehospitalsettingsinlocalcommunities.
TheCarefortheFutureclinicalworkinggroupscameupwithanumberofemergingfindingsandguidingprinciplesaroundhowpatientscouldbehelpedtobetterlookafterthemselvesandhowmoreeffectiveservicescouldbeprovidedoutofhospital.
Theseincluded:
•Strengtheningprimarycareandprovidingcareclosertopatients’homes,forexamplebygivingGPsaccesstoarangeofdiagnostictestsdirectly,beforereferringpatientstohospitalspecialists
•MultidisciplinaryteamswitharangeofskillstosupportandhelpGPswhohavepatientswithlongtermconditions,soGPsaremoreabletotreatthosepatientswithmorecomplexneeds
•Encouragingpatientstotakemoreresponsibilityformanagingtheirowncare,forexamplebygivingpatientsinformationontheirconditionandaccesstosupportnetworksandmakingbetteruseoftechnologytohelppatientsmanagetheirconditionsthemselves
•Providingoutpatientappointments,diagnosticsandtreatmentlocallyandperformingminoroperationsoutsidehospitals
•Developingcommunitynursingteamswith12hoursadaysevendaysaweekaccesstosupportchildrenwithlongtermconditions
•Morelocalintermediatecareserviceswithinthecommunitytobringcareclosertothosedischargedfromhospitalbutstillneedingsupportbeforetheyareabletoliveindependentlyathome
•Healthadvice,supportandinformationeasilyavailabletoallviaasinglepointofaccesswhichcouldalsobookappointments.
eMerGInG fIndInGs
14
deVelopinG key serVices At locAl hospitAls
Ourvisionforhelpingpeoplemanagetheirconditionsmoreeffectivelyathome,supportedbyacomprehensiverangeofcommunitybasedservices,supportandhelp,meanswecanfocusonprovidinghighqualityspecialistcareatourhospitals.
Localhospitalshaveanimportantroletoplayindeliveringmodernhealthcareandwillcontinuetodoso.Giventhechallengesdescribedearlier,weneedtolookatthebestwaytodeliverhospitalservicesandhowtheycancomplementcareclosertohome.Weneedtomakesurethattherightservicesareprovidedintherighthospitalssoeveryonehasaccesstothehighestqualitycare.
TheCarefortheFutureclinicalworkinggroupscameupwithanumberofemergingfindingsandguidingprinciplesaroundhowhospitalservicescouldbeprovided.Theseincluded:
•Someconditionsrequiringhighlyspecialisedcarearebesttreatedinspecialistcentres.Thismeansthatafewpatientsinafewspecialtieswillnotbetreatedinlocalhospitalsinthefuture,andtheircarewillbeprovidedatspecialistcentres
•Wewillworkwiththeambulanceservicetoensurethatpatientsaretakendirectlytothehospitalthatcanbestdealwiththeirneeds,andtoensurethatpatientsarereturnedtotheirlocalhospitalafteracutecarejustassoonasitissafetodoso
•Separatepathwaysareneededtodealwithcomplexcasesoranemergencyandthosethatcanbetreatedasdaycaseswithoutanovernightstay
•Theincreaseinthenumberofdoctorsrequiredtoprovidespecialistcarearoundtheclock,whilstmeetingtheWorkingTimeDirective,meansthatacutehospitalservicesneedtobeprovidedonalargerscaleatfewersites
•Tomakesurespecialistcliniciansremainwellskilledandtoensurehighqualitycare,therangeofservicesofferedwillvaryacrossdifferenthospitals
•Ifservicesarecentralised,significantchangestopre-hospitalcarearerequiredsopatientsareadequatelyassessedandtransportedtoappropriatelocations
•Toenablespecialistcentrestodevelop,daysurgeryshouldbethenormformosttypesoftreatment,withadmissiontohospitalreservedforspecialistoremergencycases
•Whenpatientsareadmitted,theyshouldbegiventhedateonwhichtheyareduetobedischarged,tohelpthemandtheteamswhowillbecaringforthemtoplanahead
•Tosupportthistypeofhealthcarearrangement,networksofspecialistswillbeneededtoworkacrossdifferenthospitalsites.
15
Patientswillseerealbenefits.Everyonecanbeconfidentthattheyareenjoyingthebesthealthandreceivingthehigheststandardsofcare,nomatterwheretheyliveorwhichservicestheychosetouse.Carewillbeprovidedinmuchmoreconvenientwaysandtherewillbetterco-ordinationbetweendifferentservices.
more cAre, closer to home
Aswellasbeingabletohavemoretestsandsimpleprocedures,likemoleremoval,atyourGP’ssurgery,somehospitalconsultantswillalsobeabletoseeandtreatyouthereifyoulike,makingiteasiertoaccesshospitalservicesinyourcommunity.DistrictnursesandhospitalserviceswilllinkinbetterwithyourGP,meaningyouwon’thavetogivethesameinformationoverandoveragainorwaitsolongforreferralstobemade.Therewillalsobemorecommunitysupportavailabletoyouintheeveningsandatweekends.
hospitAl serVices tAilored Around you
Ifyoudoneedtogotohospitalforanoperation,itislikelythatanytests,scansorassessmentswillhavealreadybeencarriedoutatyourGPpracticeorcommunityclinic.Medicaladvances,suchaskeyholesurgery,aremakingoperationsquickerandsaferandmeanthatpatientsarebackontheirfeetmuchsooner.Moreoperationswillbecarriedoutasdaysurgery,wheneverdoctorsthinkitissafetodoso.Thismeansthatyouarelesslikelytoneedtostayovernightinhospital.Communitynurseswillvisityouathometoprovidefollowupcare,suchaschangingdressings.
the Very Best speciAlist cAre for those Who need it
Patientswithurgentspecialistcareneeds,forexamplepatientssufferingfromstrokeorheartattack,willbeseenbydoctorsandnurseswiththehighestlevelsofexpertise.Thesestaffwill
beconcentratedinfewer–butmorespecialist–centresofexpertise.Thesehospitalscanhavespecialistconsultantsavailablearoundtheclock.Evidenceshowsthattheseproducebetteroutcomesforpatientswithspecialistneedsthansmallerhospitals.
more inteGrAted serVices
Ifyouhaveacomplexorlongtermconditionyouwillbesupportedbya‘multidisciplinary’team.Thesearegroupsofhealthcareprofessionalswhoworktogethertoprovideallthedifferenttypesofcarethatsomeoneneedsinajoinedupway.Forexample,someonewithdiabetescouldneedthesupportofaspecialistnurse,districtnurse,dietician,podiatristandeyespecialist.Ratherthanseeingthesepeopleindividually,theywouldworktogethertosupportyou,ensuringthattheadviceandservicestheyprovidearejoinedup.Therewillalsobeabetterjoinupwithsocialservices.Ifyouareadmittedtohospital,socialserviceswillimmediatelybeinvolvedinmakingsureeverythingissetupandreadytogiveyouthesupportandanyequipmentyouneedathomewhenyouaredischarged.
more informAtion
Youwillbegivenmoreinformationaboutyourconditionandtreatment,givingyoumorecontroloveryourcareandenablingyoutobettermanageyourownhealthwhereverpossible.Peoplewillhaveaccesstomoreadviceandsupport,including24hourhelplinestohelpmanageexistingconditionsandtostayhealthy.
WHAt It WIll MeAn for PAtIents
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Therearealreadymanyexamplesofbestpracticearoundourregionthatwecanlearnfrom.Oftensimpleideasgreatlyimprovepatientcareandsavemoney.
community mAtrons keep pAtients out of hospitAl
SinceApril2009,ateamofdedicatedcommunitymatronsandcasemanagersinNHSBerkshireWesthashelpedover400peoplereceivehealthcareathomeratherthanspendtimeinhospital.Theyhelppatients,mainlyover-65s,tomanagemultiplelong-termhealthconditionssuchasrespiratoryproblems,diabetes,neurologicalandheartconditions.
Eachcommunitymatronhasacaseloadofaround50patientsatonetimewhohavebeenidentifiedasbeingatriskfromfrequentadmissiontohospital.Theyworkwiththepatients,GPs,districtnursesandotherhealthandsocialcareworkerstoidentifythepatient’sneedsandensurethattheyreceivetherighthealthcare,reducingtheneedforunplannedhospitaladmissions.Ifapatientisadmittedtohospital,theyworkwithhospitalstaffsothepatientcanreturnhomeasquicklyaspossible.
Better suBstAnce misuse serVices in the community
Anewcommunity-basedalcoholandsubstancemisuseservicehasbeenrunninginNHSBerkshireEastsinceJanuary2010,reducingthenumberofemergencyhospitaladmissions.
Patientsnowhaveachoiceofdetoxservicesinhospitalorthecommunity.Counsellinganddrop-inclinicsareavailableinthecommunityforpatientsthroughouttheirtreatmentjourney,reducingtheriskofthemcontinuingorreturningtoalcoholordrugs.KeyworkerssupportGPstobettercareforpatientswithalcoholorsubstancemisuseproblemsfromtheirownsurgeries.
promotinG heAlthy heArts
NHSBerkshireEast’sHealthyHeartsteamachievednationalrecognitionafterscreeningmorethan700peopleforheartproblems.Theiraimistoreach20%ofpeoplewhoaremostatriskofheartproblemsbutdonothaveanexistingdiagnosis.
Bycatchingproblemsearly,peoplecanbeofferedtreatmentbeforetheirconditionworsens,maintainingtheirqualityoftheirlifeandreducingthelikelihoodofanemergencyhospitaladmission.GPsandpharmacistsarenowbeingtrainedtocarryoutmoreheartchecks,sothatevenmorepeoplecanbescreenedearlier.
BuIldInG on tHe Best
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Communitymatron,ChrisFinegan,added:“TelehealthenablesustointerveneearlierwhenaCOPDpatient’ssymptomsworsen,andearliertreatmentmeansabetteroutcomeforthepatient.Itimprovestheirqualityoflife.”
mAkinG more time for pAtient cAre on WArds
TheProductiveWardprogrammehasbeenintroducedacrosscommunityhospitalsinNHSBerkshireWesttohelpstaffspendmoretimeondirectpatientcare.Staffhavebeenabletoanalysehowtimeisusedonandaroundthewards.Forexample,simplystoringitemsinthebestplacecansavehoursofnursingtimeotherwisespentonfetchingandreturningthem.Inadditiontohelpingnursesandtherapistsspendmoretimeonpatientcare,italsoimprovessafetyandefficiency,boostingtheaimsofdeliveringsafe,highqualitycaretopatients.
teleheAlth keeps people independent in BuckinGhAmshire
SixtyBuckinghamshirepatientswithconditionssuchasdiabetes,chroniclungdiseaseandcoronaryheartdiseasearebenefittingfromaTelehealthsystem.
Thesystemtakestheirpulse,oxygenlevels,bloodpressureandweightmeasurementsatregularintervalsandsendsthemtoalocalcommunitymatronorspecialistnursetomonitorremotely.Previouslytheywouldhavetomakefrequenthospitaltripstohavetheirconditionmanaged.
MargaretRobsonfromAylesbury,wholiveswithCoronaryObstructivePulmonaryDisorder(COPD),said:“ThemonitorisveryreassuringandIwouldn’tbewithoutitnow.Knowingthereissomebodyonhandallthetimehasputmecompletelyatrest.”
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sAfe, heAlthy stArts for children And younG people
TheFamilyNursePartnershipinSloughprovidesyoung,first-timemotherswithadditionalvisitsandsupportbeforeandafterthebirthoftheirchild.Studieshaveshownthatthisprojectwillimproveoverallhealthoutcomesforchildrenandreduceobesityastheygrowup.
TheLittleAcornChildren’sCentreatStMark’sHospitalwashighlightedasanexampleofgoodpracticeforsuccessfuljointworkingbetweenhealth,socialcareandeducation.Speechandlanguagetherapyandbreastfeedingsupportwereidentifiedasstrengths.
oxyGen therApy At home
PatientswithlungproblemsinNHSBuckinghamshireareincreasinglyhavingoxygentherapyathomeratherthaninhospitalwiththeaimofimprovingtheirqualityoflife,givingthemgreaterchoiceandcontroloverthemanagementoftheirconditionandreducinghospitaladmissions.
BettyWiggfromAylesburysaid:“WheneverIsufferfromshortageofbreath,Igoontotheoxygenmachinebasedinmyhome.Iprefercareathome.Icangetonwithmyday-to-daylife,andIhavethefreedomtodowhatIwant.There’snoneedtogointohospital.”
LesleyHarridge,CommunityMatron,said:“Aswellasreceivingoxygenathome,seniorclinicalstaffseepatientsasoftenasisnecessary.Thismaybeonceortwiceamonth,oreverydayiftheyareacutelyunwelltoensurethattheyaremakingagoodrecovery.”
neW WAlk-in centre reducinG A&e AttendAnce
Anewwalk-incentreatUptonHospitalinSloughisreducingthenumberofpeoplewhovisitA&Eunnecessarily.Open8am–8pmeveryday,patientscandropintoseeadoctorornurseforfast,effectiveandconvenienthelpforawiderangeofminorillnessesandinjuriesincludinginfections,cutsandburns.AboutaquarterofpeopleattendingA&Ecouldhavebeentreatedmoreappropriatelyelsewhere.Thewalk-incentreishelpingtobringthatfiguredown.
supportinG cArers to cAre
InNHSBerkshireEast,voluntaryorganisationshavebeencommissionedtoproviderespitecareforyoungcarersandpeoplewithmentalillnessordementia.Recognisingtheimportantrolethatcarersplay,theaimistosupportcarersintheircaringroleandalsotosupportthemtohavealifeoftheirown.Activitiesincludedtraining,practicalhelp,transport,shortbreaksorgroupactivitiesandthecarershavewelcomedtheinitiative.
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We have tried to make sure that we have not used any jargon in this document. however, you may come across some words that you are not familiar with, and may hear some of the following used in discussions about the vision and our plans.
Acute:Usedtodescribeadisorderorsymptomthatcomesonsuddenlyandneedsurgenttreatment.Itisnotnecessarilysevereandisoftenofshortduration.Acuteisalsousedtodescribehospitalswheretreatmentforsuchconditionsisavailable.
Benchmarking:Benchmarkingistheprocessofcomparingbusinessprocessesandperformancewiththebestintheindustryorfromotherindustriestohelpidentifywhereimprovementsinqualityandcostcanbemade.
clinical best practice:Thetechnique,methodorprocessthathealthcareexpertsbelieve,basedonevidence,isthemosteffectiveforanyparticularconditionorsituation.
clinicians:Aprofessionaldirectlyprovidinghealthcareservices.
commissioners:Ateamofpeopleresponsibleforidentifyingwhathealthcareserviceslocalpeoplewantandneedandforcommissioning(whichmeansarrangingandbuying)theseservicesontheirbehalffromproviders.Thetermiscurrentlymostoftenusedtorefertoprimarycaretrusts(PCTs).
community health services:Careprovidedoutsidehospitalbynurses,midwives,therapistsandotherprofessionals.
day surgery:Asurgicalprocedurethatdoesnotinvolveanovernightstayinhospital.
diagnostics:Testsandscans,suchasX-rays,bloodtestsandMRIscansandotherprocedurestohelpidentifythecauseorextentofaproblem.
Gps (General practitioners):Doctorswhoworkfromalocalsurgeryorhealthcentreprovidingmedicaladviceandtreatmenttopatientswhohaveregisteredontheirlist.
health inequalities:Thegapbetweenthehealthofdifferentpartsofourpopulationbecauseofwheretheyliveortheirbackground.
life expectancy:Theaveragenumberofyearsanindividualcouldbeexpectedtolive.
long-term conditions:Long-lastingillnessessuchasdiabetes,heartdiseaseandasthma.
multidisciplinary team:Agroupofhealthandcareprofessionalswhoprovidedifferentservicesbutworktogethertoprovidecomplementaryservicesforpatients.
paediatrics:Thebranchofmedicineconcernedwiththetreatmentofinfantsandchildren.
pathways:ThepatientpathwayistheroutefollowedbyapatientthroughandoutofthevariousNHSandsocialcareservicesthattheyneed.
planned care: Carethatispre-arranged,suchasscheduledhospitaloperationsoroutpatientappointments.
practice nurse:AnurseworkinginaGPsurgery.
primary care trust (pct):Responsibleforidentifyingwhathealthcareserviceslocalpeoplewantandneedandforcommissioning(whichmeansarrangingandbuying)theseservicesontheirbehalf.Oftenreferredto,forexample,asNHSBerkshireWest.
specialist nurse:Expertsinthediagnosisandtreatmentofcertaintypesofconditions.
stakeholders:People,groupsororganisationswhocanaffectorbeaffectedbyanorganisation’sactionsorhaveaninterestinitswork.IntheNHS,thetermusuallyappliestothebroadrangeoforganisationsandpartnersthatworkwiththeNHSandholdittoaccount,suchaslocalcouncils,voluntaryandcommunityorganisations,privateproviders,patientandcarerrepresentativegroups,LINks,MPs,etc.
urgent care:Careserviceswhichpeopleneedtouseunexpectedly.ItincludesA&Eand999services,butcanalsoincludeemergencyappointmentswithGPs,visitstowalk-incentresorminorinjuries’units.
Vulnerable patients:Someonewhomaynotbeabletotakecareofthemselvesbecauseofamentalhealthproblem,adisability,becausetheyareoldandfrail,orhavesomeformofillness.
Working time directive:Alawthatlimitsthenumberofhourssomeonecanwork.Ithasmeantchangestothewayhospitalsarestaffedovernight.
GlossArY
Thisdocumentisavailableinlargeprint,Brailleandonaudiotape.Ifyouwouldlikethisdocumentinanotherlanguageorformat,pleasecontactus:
By post:CarefortheFuture,57 - 59BathRoad,Reading,BerkshireRG302BABy telephone:01189822789By email:[email protected]
Thisdocumenthasbeenproducedbytheprimarycaretrusts(PCTs),acutehospitalsandprovidersofcommunityhealthservicesinBerkshireandBuckinghamshire:
• BerkshireHealthcareNHSFoundationTrust• BuckinghamshireHospitalsNHSTrust• HeatherwoodandWexhamParkHospitalsNHSFoundationTrust• NHSBerkshireEastPCT• NHSBerkshireWestPCT• NHSBuckinghamshirePCT• RoyalBerkshireNHSFoundationTrust
WearebeingsupportedbyNHSSouthCentralStrategicHealthAuthorityandworkingcloselywithSouthCentralAmbulanceServiceNHSTrust.
September2010
Ky dokument është rreth planeve tona për të përmirësuar shërbimet e kujdesit për shëndetin në gjithë Berkshire dhe Buckinghamshire. Ju kërkon mendimet dhe komentet tuaja. Nëse këtë dokument e doni të përkthyer, ju lutemi nga kontaktoni në mënyrat e dhëna më poshtë.
Este documento refere-se aos nossos planos de melhoria dos serviços de cuidados de saúde em Berkshire e Buckinghamshire. São-lhe pedidos os seus pontos de vista e comentários. Se necessitar deste documento traduzido, por favor contacte-nos (consulte os nossos dados abaixo).
本文件是关于我们改善整个伯克郡 (Berkshire) 和白金汉郡 (Buckinghamshire)之健康护理服务的计划。它征求了你的看法和建议。如果你需要本文件获得翻译,请按照下列的详细说明与我们联络
Dokumantiganu waxa uu ku saabsan yahay qorshahanaga lagu casriyaynayo adeega daryeelka caafimaadka ee deegaanada Berkshire iyo Buckinghamshire. Waxana lagaa codsanayaa aragtidaada iyo wixii faalo ah. Hadii aad rabto in laguu soo turjubaano dokumantigan, fadlan nagala soo xidhiidh xidhiidhadan hoos ku xusan
Acest document prezintă planurile noastre cu privire la îmbunătăţirea serviciilor de sănătate în Berkshire şi Buckinghamshire şi vă solicită părerile şi comentariile dumneavoastră. Dacă aveţi nevoie de traducerea acestui document, vă rugăm să ne contactaţi la datele de contact de mai jos.
دا سند په ټول برکشاير او بکينګهم شاير کې د روغتيايي خدماتو د ښه کولو په اړه زموږ د پالنونو په هکله دی. په سند کې ستاسو د نظرونو او څرګندونو غوښتنه شوې ده. که د دغه سند ژباړې ته اړتيا لرئ،
مهرباني وکړئ له موږ سره تماس ونيسئ. د تماس جزييات الندې ورکړل شوي دي.
यो कागजात बर्कशिर तथा बकिङघमशिर क्षेत्रमा स्वास्थ्य सेवालाई सुधार गर्ने हाम्रो योजनाको बारेमा हो । यसलाई तपाईंको विचार र सुझावहरुको आवश्यकता छ । यदि तपाईंलाई यो कागजातको अनुवाद चाहिएमा, कृपया हामीलाई निम्न ठेगानामा संपर्क गर्नुहोस् ।
تتناول هذه الوثيقة خططنا المتعلقة بتحسين خدمات الرعاية الصحية في بيركشاير Berkshire وباكنجهام شاير Buckinghamshire. وتطلب هذه الوثيقة الحصول على أرائك ومالحظاتك حول هذا األمر. وفي
حال رغبتك بترجمة هذه الوثيقة، فيرجى اإلتصال معنا على العنوان التالي:
यह दस्तावेज बर्कशायर तथा बकिंघमशायर में स्वास्थ्य सेवाओं को सुधारने की हमारी योजनाओं के बारे में है. इसमें आपके विचार तथा टिप्पणियाँ पूछी जाती हैं. यदि आप इस दस्तावेज का अनुवाद चाहते हैं तो कृपया हमसे निम्नांकित विवरण पर संपर्क करें
يہ دستاويز بارکشائر اور بکنگهم شائر ميں صحت کی خدمات کو بہتر بنانے کے ليئے ہمارے منصوبے کے بارے ميں ہے۔ اس ميں آپ کے نظريات اور خياالت کے بارے ميں پوچها گيا ہے۔ اگر آپ کو اس
دستاويز کا ترجمہ درکار ہو تو برائے مہربانی نيچے دی ہوئی رابطے کے تفصيالت کے ذريعے ہم سے رابطہ کيجئے۔
Dokument ten dotyczy naszych planów poprawy usług medycznych na terenie Berkshire i Buckinghamshire. Prosimy w nim o Państwa opinie i komentarze. Jeśli potrzebują Państwo tłumaczenia tego dokumentu, prosimy skontaktować się z nami – dane kontaktowe znajdują się ponieżej.
ايہ دستاويزبرکشائرتے بکنگهم شائردے لئی صحت دی ديکه پہال دياں خدمتاں نوں چنگا کرن دے لئی ساڈياں منصوبياں دے بارے وچ ہيگی اے۔ ايہ تہاڈے وچاراں تے خياالں دے بارے وچ آکهدا اے۔ جے
تہانوں ايس دستاويزدے ترجمے دی لوڑ ہيگی اے تے، مہربانی کردياں ہوياں تهلے دتی ہوئی تفصيل تے ساڈے نال رابطہ کرو۔