NHS Scotland National Clinical Strategy and Realistic Medicine. Dr Mike Winter

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1 NHS Scotland National Clinical Strategy and Realistic Medicine Dr Mike Winter 1

CMO 1st Annual Report Divided into 2 sections Realistic medicine the challenges that face us Surveillance data health of the nation Planned conversation

2 CMO 1st Annual Report Divided into 2 sections Realistic medicine the challenges that face us Surveillance data health of the nation Planned conversation with clinicians Feedback to CMO welcomed to agree or disagree with the content, use the data to evidence successes or as levers to drive further improvement.

3 Realistic Medicine Added Value of the contribution of doctors and clinical professionals in a Complex System Realism in Healthcare (NHS Wales) Sharing Decision-making and Informing Consent: People and Professionals combining Expertise Clinicians and the Management of Clinical Risk Changing Practice to Support Improvement Translation of Research into routine Clinical Practice

Realism in Healthcare Doctors generally choose less treatment for themselves than for patients Striving to provide relief from disability, illness and death, modern medicine may have over-reached

4 Realism in Healthcare Doctors generally choose less treatment for themselves than for patients Striving to provide relief from disability, illness and death, modern medicine may have over-reached itself hidden harm? Focus on patient unwarranted variation in clinical practice and outcomes? Multiple conditions over-complex medical regimes? Clinicians have duty to acknowledge powerlessness at times difficulty on our part should not affect patient s experience of end of life.

5 Changing our Practice to Support Improvement From Lucas, B & Nacer, H (2015) The habits of an improver. Thinking about learning for improvement in healthcare. London: The Health Foundation page 8

6 Young Academy of Scotland: Influencing Policy Dr Catherine Calderwood Chief Medical Officer for Scotland, obstetrician and gynaecologist

7 The National Clinical Strategy sets out the case for: planning and delivering integrated primary care services, like GP practices and community services, around the needs of local communities restructuring how our hospitals can best serve the people of Scotland making sure the care provided in NHSScotland is the right care for an individual, that it works, and that it is sustainable changing the way the NHS works through use of new technology. 7

8 We re going to change the main focus of the NHS from hospitals to primary/community care Primary care teams will be strengthened and will work closer with, and often alongside, colleagues in social care services and voluntary organisations. Their main aim is to support people with health and social care problems to stay in their own communities, help them to learn to manage their conditions and, whenever possible, reduce the chances of them having to be admitted to hospital. 8

9 We re going to change the way our hospitals work We re looking at two big areas of change in hospitals the processes that we have in place to care for patients seeking to make them more efficient and of greater value to patients and in the structure of specialist services, recognising that we have to change to get the best outcomes and to make best use of our skilled staff and our financial resources. 9

10 We re going to tackle over-diagnosis, over-treatment and waste Modern medicine provides enormous benefits to individuals and communities, but on occasion, people can be treated for conditions that don t really require active medical intervention. This situation leads to waste of NHS resources by providing care that doesn t add value for the patient. 10

11 We re going to change the way the NHS works through introducing more new technology Technology has enormous potential in the NHS. It can improve treatment success and safety, support patients to selfmanage their conditions better, enable professionals to communicate with each other more effectively, and allow people (including those in rural areas) to access specialist support and advice remotely. 11

12 NHS Scotland Apr 2016 Scottish Government Health and Social Care Directorates SGHSC NHS Boards(14) & Local Authorities (31) working through Integrated Joint Boards with Locality Management groups (joint working NHS/ LA/ 3 rd sector) Regional & National Designation - Cross Border / Highly Specialist services

A reminder of the challenges 90+ 80 1981 70 60 50 40 30 20 10 60000 0 4000020000 0 200004000060000 Persons Age Shifting Population Balance 90+ 80 2011 70 60 50 40 30 20 10 0 600004000020000 0

13 A reminder of the challenges Persons Age Shifting Population Balance Increasing pressure on health services Significant and Persistent Inequalities

14 Where are we now? focus on the Triple Aim Health Care Quality Population Health Sustainability Cabinet Secretary Health and Wellbeing has set 3 big challenges Ageing population Tackling Health Inequality Affordability Health and Social Care Integration Public Bodies (Joint Working) (Scotland) Act

15 Where are we now? NHS Scotland 2020 vision Health and Social Care Integration Healthcare Quality Strategy Safe, Effective, Person Centred care Efficient, Timely, Equitable NHS National Services Scotland Supporting Scotland s Health whatever it takes; whenever it is needed; wherever we can help; whoever needs it. Once for Scotland solutions 15

A Few Facts Primary care practitioners Savings

Comms Surveyed the entire NHS Estate for 1M

17 A Few Facts Primary care practitioners Savings 2BN 45M All NHSS Purchases 1BN 1/2BN NSS 50% PECOS 1BN throughput Cost Avoidance 100M 51 project capital framework Set up & manage NHS IT Comms Surveyed the entire NHS Estate for 1M Provide free INFORMATION to All NHS/ LA services & to the public

18 Services delivered through 6 Strategic Business Units Public Health and Intelligence Information Technology Procurement, Commissioning & Facilities Blood Tissues and Cells Central Legal Office Practitioner & Counter Fraud Services

19 Social Care Acute Hospital Primary & Community Care

20 supporting patients

Transforming Scottish Primary Care: Quality after QOF. Dr Gregor Smith Deputy Chief Medical Officer for Scotland

Transforming Scottish Primary Care: Quality after QOF Dr Gregor Smith Deputy Chief Medical Officer for Scotland Ken The Surgery, Larkhall National Clinical Strategy: a business case for change the world