If you would like: more information on issues and plans in this booklet someone to come and talk to your group about the Grampian Health Plan and how you can get involved information about health issues which are not mentioned in this booklet to give us comments or suggestions on any part of the work of NHS Grampian to find out how to get involved. Please contact: Corporate Communications Team NHS Grampian Ashgrove House Foresterhill Aberdeen AB25 2ZA Tel: 01224 554400 Fax: 01224 550655 Email: grampian@nhs.net 2
WHY health services in Grampian need to change HOW we want to involve you in this If you live in Grampian, use services in Grampian and care about health and healthcare, both now and in the future, this booklet is for you. NHS Grampian is responsible for leading efforts to improve the health of people in Grampian and for providing NHS services. We have much to be proud of. NHS Grampian has an excellent track record in: high quality health services provided for everyone in Grampian, whether you live in a city, town or a rural area the dedication, skills and teamwork of our staff the way that the NHS works with other local organisations to plan together for the future, and to help everyone in the Northeast become healthier. We need to keep looking ahead. We want to work more closely with the half-a-million people who live in Grampian and to encourage you to work with us to plan for the future. >>> 3
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What s this booklet about? We are keen to improve the way that we communicate with you, listen to you and involve you. This booklet is part of that. It aims to: explain changes taking place in our society which affect our health and the demand for health services explain how the NHS is changing make clear the things that we cannot change - and those we can explain the reasons behind the projects and developments you will hear about over the coming months explain what Healthfit is all about introduce Tomorrow s Health Today (the Grampian Health Plan for 2005/6), which has more detail about the work which we introduce here. You can also find more information on the NHS Grampian website at www.nhsgrampian.org/ healthfit. We hope that what you read here stimulates your interest and encourages you to find out more. We would like you to give us your views and, if you can, get involved in helping us to get it right, both for us all today and for future generations. 5
How has health care changed over the years? One hundred years ago in Grampian infectious diseases such as diphtheria, scarlet fever, whooping cough and measles were common. There were fifteen hospitals in Grampian just for the treatment of these diseases. One in ten babies died before their first birthday. In Aberdeen itself the figure was as high as one in seven. The only vaccinations available were for smallpox and there were no baby clinics or health visitors. In Aberdeen, two female sanitary inspectors did this type of work on a part-time basis, but outside Aberdeen there was nothing - nor was there a school health service. Fifty years later, in 1955, with better living conditions and healthcare, people were living longer than ever before. Half of the population reached their 75th birthday. This brought different problems for the health service. Hospitals saw an increase in older patients, and some of the hospitals mentioned above were converted to care for elderly patients. A growing part of the district nurses work was also taken up with visits to older people. There were still only a few residential homes for older people, many of which had previously been poorhouses and were therefore regarded with some 6
suspicion or dislike. The only free chiropody services, for treatment of your feet, were those run by the British Red Cross Society. Today, fifty years further on, we have technology, vaccines, drugs and treatments that could only have been dreamed of back in 1905. And the changes continue. There are changes in society, in the way the NHS works, in medical sciences and in how we care for people. These are happening everywhere. We can t change them here in Grampian but we can view them as challenges and opportunities. We can use them to improve our local health service so that it is right for the future. For this we need your help. 7
What changes have taken place...in our society? People are living longer. In general, the older a person is, the more ill-health they suffer, and the greater their need for health and social services. Long-term chronic illnesses, such as diabetes and asthma, have replaced infectious diseases as the main work of the health service. The way we live is changing, as are our values. More people are living alone and in single-adult households. More women go out to work. This means that there are fewer family carers to look after the increasing number of older people. We expect more than ever before from our health service as we do from every other aspect of our life. We know much more about our health, health scares, scientific breakthroughs and miracle cures. Health stories are regularly the first item on the news. TV hospital dramas are watched by millions of viewers every week. Health and the NHS are of huge political interest. Scottish politicians take a very close interest in how the NHS is run, nationally and locally. 8
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...in how the NHS works? Sixty years is a long time in medicine. The treatment and care that you will receive today (should you need it) is very different from what you could expect in the 1940s when the National Health Service was introduced. How the NHS is organised and managed is also very different. Here are just a few examples: Medicine has moved on rapidly. We can do more for people, and treat people we previously could not. Cancer treatments and care have totally changed. Quicker treatment with new drugs means that people who might previously have died from a heart attack may well survive today. This is all good news but it means that people can live for many years with a long-term health condition and we have to plan services for this. As technology moves on, equipment is also becoming smaller and more portable. New equipment, though sometimes costly, can also help diagnose problems and illnesses much closer to where people live, for example, by using portable electrocardiograph (ECG) machines, which record information about your heart. This means people may not have to make long and sometimes difficult journeys for tests or treatment. In recent years, changes have been made throughout the country to try and make sure that people receive the same standard of care wherever they live. These include: - guidelines for doctors and other staff - measuring and monitoring the quality of our services 10
- targets for the maximum length of time that people should wait before having their appointment or operation. Doctors, nurses and other staff have to do certain tasks regularly to keep their skills up to date. This can affect specialist staff who work in rural areas and who do not get the chance to use that skill very often. For example, midwives and doctors who work in small rural maternity units who may not deliver enough babies every year to maintain their skills. The NHS workforce is shrinking. As our population gets older, there are fewer young people available to replace the large number of staff who will retire. There is a national shortage of people for some types of work, such as dentists, clinical psychologists and speech and language therapists. Here in the North-east we have the added challenge of attracting staff to stay and work in the area, because of factors such as the cost of living and the rural nature of parts of Grampian. 11
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So, what can we influence? Whoever we are and whatever our background, we can all influence how NHS Grampian changes to meet these challenges. We can all think about and suggest what a modern health service should provide and how this should be provided. Over the coming months we will be asking you for your views and ideas, by telephone, letter, email and at meetings and public events. But firstly, here is some general information that may be helpful to you: >>> 13
How does NHS Grampian currently spend it s money? For the year April 2005 to March 2006, NHS Grampian will receive around 760 million from the Scottish Executive to spend on health in Grampian. We plan to invest in the following key areas: Buildings and services to support patient care Wages for our 16,000 staff 50 million 380 million Drugs, medical supplies and equipment 210 million Projects to improve health in Grampian Providing General Practice (GP) services Care in the Community with local authority partners 4 million 80 million 40 million 14
The 760 million is 40 million more than we had last year. This is certainly good news. However we know that we will need all of this extra money to pay for: improved heart and kidney services, to bring us in line with other areas of Scotland the cost of a national pay award for all 16,000 staff increases in the cost of drugs prescribed by GPs and hospital doctors the cost of new out-of-hours services to provide medical cover when GP surgeries are closed. 15
Why have we got financial pressures? You may have seen stories in the local press and on the television about the financial pressures facing NHS Grampian. What is the true position? Firstly, it is important to remember that we have an excellent record of providing high-quality services. A recent report produced by independent auditors showed that we have a good record for making best use of our money. However, we receive the smallest amount of funding per person of all the Scottish NHS Boards. This is because a lot of people in Grampian have good health compared to other areas. Areas of Scotland with a higher level of illness and higher rates of people dying earlier receive relatively more money to spend per person on health services. Also, in Grampian we have experienced many pressures on health services over recent years. We have funded these extra demands to make sure we continue to provide high quality care for patients. For example, minimising the risk of hospital infections, investing in services for people with hearing problems and spending extra money on new drug therapies have all been important to us in the last year. This has caused us to build up a debt of around 10 million by the end of March 2005. We know we cannot continue to spend money that we don t have. We must come out of the red, and over the next two years, pay back the debt we owe to the Scottish Executive. 16
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What could happen if we don t change? If we just carry on as we are, this is what could happen: Waiting times for hospital clinics, treatments and operations could get longer. GPs would have to continue to refer patients to hospitals for tests, investigations and treatments, as there would be no options for doing this closer to where people live. We could need to treat a huge number of people for health problems, which could have been prevented. These include obesity, some forms of diabetes, sexually transmitted infections and the problems caused by binge drinking. We could continue to have to spend a lot of money trying to look after old buildings. This is money that we could spend instead on more staff, new equipment and new drugs. 18
So, how can NHS Grampian balance the books and respond to these changes? We believe that we can do both, if we: look at what we already have, in terms of staff, buildings and facilities and see if we can make even better use of them sell old buildings and land that are no longer suitable for the services we need to provide change our services, so that they meet the needs of people today and tomorrow and not those of the past make sure that the people who use our services have information about those services and are involved in discussing and debating with us what changes they think need to be made look at how our services can be better used, which may also help to save money. 19
What do we need to do better? Here are some of the issues that we need to work on: Listening to you better, avoiding jargon and NHSspeak, and involving you whether as a patient, relative or carer, member of the public or as part of a community. Working with you and your community to prevent diseases such as those caused by obesity, smoking or the misuse of drugs or alcohol. Helping people to manage their own health conditions, such as heart disease, diabetes or asthma. Closing the health gap between people who are better off and those who are not. Supporting people who are caring for relatives, friends and neighbours, and giving them better information. Making better use of technology so all of our staff have the information they need about a patient s care. Making it easier for the people of Grampian to use our health services, whatever their needs. Helping people get appointments and treatment more quickly and closer to where they live, wherever possible. 20
Continuing the fight against healthcare-associated infections such as MRSA and encouraging staff, patients, visitors and the general public to work together to prevent infections. Tackling the problems of the reducing number of available staff, including making full use of the skills of all the members of the healthcare team. 21
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What is Healthfit? In 2002 we began a new approach to developing a way forward for the health service in Grampian, and how we might achieve it. Members of the public were involved with doctors, nurses and managers in thinking about how health services should be improved and developed across Grampian. We have used this method since then and we call this process Healthfit. It involves us working with you and has helped us agree what we want to achieve for the future and how we can make this happen. We won t achieve this overnight. Healthfit is a long-term process. But we believe it will help us work towards the changes listed above AND be within our budget. It is also encouraging to see that the messages in Healthfit are the same as those in the recent Scottish report, Building a Health Service Fit for the Future, so the way forward nationally is consistent with our local thinking. 23
Healthfit means: The people of Grampian having a say about their local health service. Clear patient pathways, which combine the strengths of primary and community care with the specialist services provided by our acute hospitals. Health professionals working together as networks, which will in time grow beyond Grampian to cover the north of Scotland, to share skills, experience, services and education. Acute hospitals (such as those at Foresterhill) focusing on providing specialist skills and services that can only be provided in central locations. New services, where community and hospital staff work together to provide care for patients who need more than is normally provided at their GP practice but who don t need the specialist services of the acute hospitals. Patients conditions being investigated and treated more quickly and closer to home. We would use mobile services and telemedicine which uses the latest technology to make it possible for a patient at a local centre to be seen by a hospital specialist many miles away. Closer teamwork between NHS and local authority social work staff, voluntary organisations and private care homes to provide a system that links health and social care together. 24
New roles for Grampian s community hospitals, as local health and social care services work more closely together. People playing a greater part in looking after themselves and being supported to do so. 25
So, how could it look by 2015? Just imagine all the following.. We are able to care for older people in their own homes for longer than was ever previously possible. We have tackled the shortage of GPs and dentists by developing the skills of all professionals in the healthcare team, such as specialist nurses, pharmacists and others. GPs have taken the opportunity to further develop their skills and they now deal with almost half of all patients who previously would have had to wait to see hospital consultants. To do this, they have the best equipment in their practices and local centres have been developed for tests and treatment. Because more is being done at GP practices and centres in the community, our acute hospitals are able to concentrate on more complex specialist care. Ten years of investment in building work and new technology has made Aberdeen Royal Infirmary one of the top specialist hospitals in Europe. If you have to go into hospital you will probably be treated as a day patient rather than staying in overnight. You could have your operation at a weekend. We could go on dreaming But first we have to make it happen and this is where we need your help. If you ve been interested by what you ve read here, you may want to read the Grampian Health Plan. 26
What is the Grampian Health Plan? The Grampian Health Plan is updated every year, but is really changing and improving all the time. It shows where we currently are and what we need to do to move further on. It details the programmes and projects which are happening now - and which you have the chance to contribute to and influence. You can read this year s Grampian Health Plan, which is called Tomorrow s Health Today, on the NHS Grampian website www.nhsgrampian.org/healthfit or you can get a copy from the contact details at the end of this booklet. 27
How can you find out more and get involved? You can find more about NHS Grampian on our website www.nhsgrampian.org. It is currently being developed and will soon include updated information on: what the Grampian NHS Board does and who is on it more about our hospitals, GP surgeries and other local services other information which will be useful to you - whether you are a patient, visitor, student, or as any member of the public. If you would like: more information on issues and plans in this booklet someone to come and talk to your group about the Grampian Health Plan and how you can get involved information about health issues which are not mentioned in this booklet to give us comments or suggestions on any part of the work of NHS Grampian to find out how to get involved. 28
Please contact: Corporate Communications Team NHS Grampian Ashgrove House Foresterhill Aberdeen AB25 2ZA Tel: 01224 554400 Fax: 01224 550655 Email: grampian@nhs.net If you would like any of this information in a different format (such as large print or audiotape) or a language other than English please get in touch using the contact details above. DESIGN Corporate Graphic Design, NHS Grampian PHOTOGRAPHY Medical Illustration, NHS Grampian Aberdeenshire Council 29
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Designed and produced by Corporate Graphic Design NHS Grampian 2005.