22002200 VViissiioonn ooff SShheettllaanndd’’ss HHeeaalltthhccaarree Fitting together a vision of future health and care services in Shetland NHS Shetland 2020 Vision April 2005 ii NHS SHETLAND 2020 VISION CONTENTS List of Figures & Boxes . iii List of Appendices . iv Acknowledgements . iv Abbreviations . v Executive Summary . vi Section A Introduction & Background 1 A.1 Introduction to NHS Shetland’s 2020 Vision Project . 2 A.2 Strategic Direction for 2020 – outcomes of 2020 Vision Phase 1 . 3 A.3 Introduction to Shetland . 6 A.4 Profile of Shetland Health and Healthcare . 17 A.5 Drivers for change for future Shetland Healthcare . 23 Section B Key Themes for 2020 29 B.1 National Direction . 31 B.2 Shetland Public . 36 B.3 Safety & Quality . 41 B.4 Workforce . 48 B.5 Transport . 59 B.6 Facilities . 67 B.7 Medical Technologies . 71 B.8 Information & Communication Technologies . 75 Section C Shetland Services 2020 81 C.1 Health Improvement . 84 C.2 Disability Services . 95 C.3 Community Health Services . 99 C.4 General Practice . 104 C.5 Mental Health Services . 113 C.6 Dental Services . 117 C.7 Pharmacy Services . 121 C.8 Child Health Services . 124 C.9 Older People’s Services . 131 C.10 Alcohol & Drugs Services . 137 C.11 Clinical Support Services . 144 C.12 Maternity Services . 149 C.13 Hospital Surgical Services . 153 C.14 Hospital Medical Services . 162 C.15 Cancer Services . 170 Section D Our 2020 Vision of Shetland Healthcare 177 Section E Recommendations 185 Appendices . 191 NHS SHETLAND 2020 VISION iii LIST OF FIGURES & BOXES Section A Introduction & Background Box A1 Objectives for Future Healthcare Delivery in Shetland . 3 Box A2 Principles for Future Healthcare Delivery in Shetland . 3 Figure A1 Outline Model of Future Shetland Healthcare . 4 Figure A2 Shetland in the Context of Scotland . 6 Figure A3 Map of Shetland . 6 Figure A4 Shetland Population 1901 – 2001 . 9 Figure A5 Population Changes in Shetland’s Islands 1931 – 2004 . 10 Box A3 What Could Improve Public Service Delivery In Shetland . 22 Box A4 Drivers for Change for Shetland Healthcare . 23 Figure A6 2002-based Population Projections for Shetland . 23 Section B Key Themes for 2020 Figure B1 Concept Diagram of NHS Shetland 2020 Vision . 30 Box B1 Scotland’s Health Plan . 31 Box B2 Definition of Managed Clinical Networks . 42 Box B3 Performance Assessment Framework . 42 Box B4 Waiting Times for Shetland Patients . 43 Box B5 Performance Assessment Framework Indicators . 44 Figure B2 Scottish Air Ambulance Service Flights to Orkney & Shetland . 46 Box B6 Workforce Pay Modernisation Contracts . 49 Box B7 Local Solutions to Recruitment & Retention of Nurses . 55 Figure B3 External Transport Links from Shetland . 59 Figure B4 Average Travel Costs Between Shetland and Mainland Scotland . 61 Box B8 Examples of Shetland Patient Travels . 62-63 Figure B5 Shetland Population Travel Times to Hospital . 64 Figure B6 Air Ambulance Response Times for Shetland . 64 Box B9 SAS Air Ambulance Proposals for Shetland . 65 Box B10 Difficult Choices in Shetland Services . 74 Section C Shetland Services 2020 Box C1 Scotland’s Health vs Rest of Europe . 84 Box C2 Future Scenarios for Coronary Heart Disease . 91 Box C3 Future Scenarios for Diabetes . 92 Box C4 Diabetes Primary Care in Shetland . 106 Box C5 Specific Challenges in Providing High Quality Health Services to Children in Shetland . 126 Figure C1 Community Care Services for Older People in Island Areas of Scotland . 132 Figure C2 Comparison of alcohol consumption in Shetland with Scotland . 137 Figure C3 Drug-related deaths in Shetland and Scotland . ..