Director of Public Health's Annual Report Looks at the Challenges Ahead
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Team Update Issue 74 November 2010 www.nhshighland.scot.nhs.uk Director of Public Health’s Annual Report looks at the challenges ahead Alcohol misuse, smoking and obesity are major public health challenges facing NHS Highland, according to the first annual report from its Director of Public Health. Dr Margaret Somerville’s report also highlights the increasing number of older people in the local population and the corresponding increase in the number of people living with long- term conditions, such as hypertension, depression, asthma, coronary heart disease, diabetes and cancer. And it looks at lessons learned from last year’s influenza pandemic and explains that a major challenge for the future will be preparing and planning for climate change. Dr Somerville, (pictured top right) who took up the post in February of this year, points out that the health service, along with the rest of the public sector, still has to deal with these issues at a time when their budget is under increasing pressure. She said: “This report reflects my own observations about the health of people in NHS Highland in my first few months in post and the major challenges that lie ahead if we are to continue improving health and closing the gap between the best and worst off in society. “With the prospect of real cuts in spending on health over the next few years, it is more important than ever that we do not lose sight of the long-term health improvement work through which we hope to contain and reduce health service use and cost.” Dr Somerville explained that the population of NHS Highland had increased by more than 5% over the last 10 years and was predicted to increase by a further 10% over the next 20 years, with the number of people aged over 75 more than doubling in the same period. She said: “Health care over the next 20 years is likely to be dominated by the growing population of older people, particularly the rapidly increasing numbers of people aged 75 years and over. Inside… p3 Lean arrives at “While many older people remain fit, active and able to live independently, Caithness there needs to be a fresh approach to helping and supporting the minority of p7 Teleneurology on the elderly population who are frail with multiple long-term conditions.” Skye p9 Renal patients on She added that the increase in long-term conditions associated with the their bike rising proportion of older people, particularly the very elderly, also p12 Get ready for Winter challenged NHS Highland to think differently about how it approached the p14 TAG Skills Centre management of these conditions. The aim is to enable people to live as independently as possible for as long as possible by supporting them to p15 Getting Greener manage their own conditions. Page 1 Life expectancy in Highland currently averages 76 years for men and 81 years for women and is increasing in line with the rest of Scotland. However, overall, Scottish life expectancy is lower than in some parts of Europe. Dr Somerville pointed out that up to half of all circulatory diseases and cancers could be prevented by tackling the major risk factors, which include alcohol, smoking and obesity. Her report records the success so far in reducing premature deaths from circulatory disease and cancer and it gives details of the cost to NHS Highland of alcohol misuse, smoking and obesity. Work done by the public health team suggests that 90 to 100 hospital beds in NHS Highland are likely to be occupied every day by people with conditions attributable to alcohol, smoking and obesity at a cost of £15.4million per year. Dr Somerville said providing targeted individual and group support to help smokers stop smoking coupled with wider initiatives, such as banning tobacco advertising and smoking in public places and promoting smoke-free homes and cars, had led to a steady decline in the number of adults who smoke. NHS Highland’s Smoking Cessation Service has grown steadily over the last two to three years. During 2009, 3,789 people attempted to quit and 46% of them were still not smoking after one month, compared to a national average of 38%. But Dr Somerville pointed out that around a quarter of the adult population still smoke so these efforts must continue to further reduce the number of people so doing. She said: “We are now taking the same approach, of helping individuals to change their behaviour both by direct support and developing environments that encourage these changes, to reduce alcohol consumption and obesity levels. However, it is too soon to note any encouraging trends in the levels of these risk factors.” Dr Somerville explained that the current economic climate made it even more important that decisions on how to use the available resources had to be made bearing in mind that the cost of every intervention resulted in less money being available for another intervention. She said: “Health care policymakers must consider the balance between the benefits of treating ill-health and the benefits of preventing ill-health. We need to continually review which interventions work, offer good value and provide the greatest benefit to the largest number of people.” The Director said lessons had been learned from the flu pandemic in 2009 - when huge efforts from public health staff, frontline health staff and many others successfully managed the major local outbreaks. Existing plans are now being modified for future use. However, she added that, while it was important to continue to plan for new pandemics, the major public health challenge for the future would be from climate change, which would have impacts on the world’s supply of food and energy availability and security. She said mitigating and adapting to climate change would involve major changes in the way we live, work and provide health services. Dr Somerville said: “Health improvement interventions are effective and cost-effective. We have to invest in the preventative work in order to prevent ill-health in the future. “At a time of financial constraint, the easiest answer would be to cut the long-term work in favour of dealing with the here and now, but we are saying that the long-term health improvement work must continue.” Page 2 Lean arrives at Caithness General Hospital Caithness General Hospital staff “leaning” at the Value Stream Mapping Staff in Caithness are working hard on their LEAN project with the support of external management consultants GE (funded by the Scottish Government) and NHS Highland Lean Leaders. A large number of staff attended Lean Awareness Sessions and Basic Training over the last month. They then participated in a Value Stream Mapping Exercise or VSM. This was held in Wick in mid November. Key staff from across the hospital took part. This included senior nursing staff, consultants, radiographers, physiotherapists, occupational therapists, pharmacist, laboratories, porters, social work and managers. During the Value Stream Mapping they set out step-by-step how patients are admitted to hospital and discharged following treatment. This was considered in detail with any unnecessary steps identified and potential solutions explored. Improvements will be tested during a Kaizen week starting on the 6th December. The main work streams are; Developing and testing a Combined Assessment Unit, Implementing Daily Board Rounds/ Ward Rounds, reviewing Documentation, managing inappropriate attendances and admissions from A&E and testing a new appointment system and Duty Radiographer role in the Radiography department. See below and on page three for views from staff taking part. Locality General Manager Pauline Craw said: “It’s been a really good two days with improved team working across the hospital.” It’s been very interesting, it has given us a chance to talk about things that have been issues for a while. There have been some really good ideas so far. If everyone is prepared to give it a go and think “out of the box” we could make some really good changes. It’s good that all departments are represented and we can think about how the hospital might work together without staff worry- ing or feeling threatened. Tracey Macleod, staff nurse, Bignold ward. Page 3 Caithness General staff talk about lean It’s been a good couple of days. I was completely shattered by the end of day one; it was quite intense but very worth- while. It has pulled everyone and the wards together. There are a lot of positive attitudes in the room and a respect for each other. Pat Magee, Senior staff nurse, Rosebank ward It’s been very interesting. I’ve worked in the hospital for 19 years but only really see my bit of the process so it has been really good to see the bigger picture. If we could standardise things to reduce duplication of paperwork etc that would be a real benefit. Drew Macleod, Porter It’s been hard work but good work. The big benefit is that everyone is here so it’s a round view. It highlights exactly what’s going on in each area. It can be hard to listen to some of it and not take it as criticism. The impact one ward can have on another has been highlighted. Too much change all at one time could have a detrimental impact on staff morale. Nancy Mackay, Staff nurse, Queen Elizabeth ward It’s a good opportunity to voice opinions, to be heard and to feel valued. The important thing will be improved communication be- tween staff groups which will be of value to patients. Doreen Berry, Senior physiotherapist Rosebank and Bignold wards Page 4 Raigmore Hospital to test giving patients early notice of their date for surgery The possibility of giving patients early notice of their date for planned surgery is to be tested in the New Year.