Shaping the Future The Clinical Strategy for NHS Argyll & Clyde Paper for Public Consultation 14 June – 17 September 2004 NHS Argyll & Clyde Consultation paper 2 NHS Argyll & Clyde Consultation document Executive Summary 1. This document contains proposals for the future provision of health services for the people of Argyll and Clyde. It is based on a set of seven key principles – safety, sustainability, quality, affordability, integration, access and timeliness. 2. A clear plan for health services in NHS Argyll & Clyde is necessary to help tackle both the pressures that health services across Scotland and the UK are experiencing generally and those that apply to the particular circumstances of Argyll and Clyde. These pressures mean that we are unable to sustain the current way in which we provide health services in Argyll and Clyde. If we do not address these pressures effectively, there is a real danger that services will fail and that a poorer quality of service with much diminished access will result. 3. As part of this process of developing a clear plan for the future, we have talked with, and listened to, a great many people from across Argyll and Clyde. These have included patients, carers, people in local communities, our partners and our staff. The proposals contained in this consultation paper are based on these discussions and on the work that took place in the many workshops and meetings across Argyll and Clyde over a period of eight months. We have also looked carefully at professional standards and advice and taken these into account in our proposals. 4. Five overall themes emerged in our discussions, reflecting the views of public, patients and staff about the health services we should provide. These included the wish of patients and carers to be treated as equal partners in the healthcare process, the importance of better access to care and how these, and other improvements, could be achieved through building on the patient pathway approach. Maximising care in local communities and making sure of continued access to high quality acute services were also highlighted. This paper contains proposals for service redesign to deliver the improved services that people told us they wanted to see. 5. We need to change the way in which our health services are provided to meet the aspirations of patients and public. We believe we can do this through developing primary care, introducing intermediate care models more widely and building a healthcare network across Argyll and Clyde. But before we can do this, we must make sure our services are stable. 6. This paper contains our proposals to provide services that are safe, sustainable and of high quality. In some cases this means significant change to the current pattern of services. We propose to maintain our main acute hospital sites although we will have to change some services to do this. We intend to provide additional services as we shift the emphasis of care from institutional to community-based care for older people, people with a mental health problem or with a learning disability. 7. We propose to develop services at the Royal Alexandra Hospital as the major acute hospital for Argyll and Clyde. This will include the major accident and emergency department networked to other emergency services across the area. We have outlined the options for the provision of services in the Inverclyde and Lomond areas to provide as many services as possible locally. We will work with NHS Argyll & Clyde Consultation paper local communities in Argyll and Bute to develop health services for remote and rural services. 1 NHS Argyll & Clyde Consultation document Contents 1. Introduction 2. The need for change 3. Redesign of services and working practice 4. Modernisation and reform of services and infrastructure 5. How to give us your views Glossary References NHS Argyll & Clyde Consultation paper 2 NHS Argyll & Clyde Consultation paper 1. Introduction This paper describes NHS Argyll & Clyde’s plans for future health services in our area. When making these plans we need to consider the geography of Argyll and Clyde, the kind of communities we live in, and projected changes to the population of Argyll and Clyde. We also need to take into account the views of the 418,000 people in Argyll and Clyde whom we serve, and the staff who provide the services. In doing this, we must have a view to the future and our responsibilities to the next generation of service users, to local communities and to our staff. Since October 2003 we have been talking with people across Argyll and Clyde to hear their views about the development of our NHS. These discussions have been with members of the public, politicians (MSPs and MPs) and local councillors, as well as many of our staff, patients, carers, advocacy groups and other organisations, both statutory and independent. More than 4000 people have been directly involved so far in these discussions. We have listened carefully to what we have been told over the last eight months by patients, the public, staff and partners. People want healthcare services that work better together to meet their needs as fully as possible. They want assurance that the healthcare services they use are consistently of high quality. They want to be able to rely on their services, and be reassured that the services they require will be available to them when they need them. This paper describes, therefore, not simply an acute services strategy but covers all healthcare services for the people of Argyll and Clyde. Neither does it suggest short term or quick “fixes” that would only mask underlying challenges and problems. Instead, we have outlined the tough decisions that need to be made both now and into the future. 1.1 Key principles It was also clear from the discussions we have had over the past eight months that some principles must shape the future design of services. Taken together, these principles provide us with a robust framework within which to develop the Clinical Strategy. They are: Safe services A service is safe when we can be confident that the care provided by our staff compares well against national standards and that, for most people, the expected health outcomes will be achieved. We are confident that all the proposals in this plan are consistent with this view on safety. Sustainable services We have a duty to ensure that our plans serve communities in Argyll and Clyde well into the future. We believe this is a duty shared equally by the community at large. This means we will only invest in services that are sustainable. This strategy describes developments that are realistic and robust enough to be enduring, but also flexible enough to adapt to changing needs and new opportunities. 1 NHS Argyll & Clyde Consultation paper Quality services The services that we provide must be fit for the purpose intended. Each service in itself must demonstrate a commitment to continuously improving the quality and standards of care. This view of quality accepts that we will provide services in a variety of ways to meet local needs but each service must be able to demonstrate that it is fit for purpose. Affordable services On behalf of the 418,000 people living in our area, we have a duty to live within the budget given to us by the Scottish Executive. We cannot spend money we do not have. This means only spending the money on our strategy for health services that has been allocated as our fair share of the Scottish health budget. Integrated services We must make sure that our services are designed and delivered with the individual needs of patients as the focus. This means that service providers work together, involving patients and carers, to break down any artificial boundaries and deliver seamless care to patients and carers. One of our key aims in this strategy will be integrating primary, secondary and social care pathways and, in this way, creating new opportunities to redesign local services. Access to services We must make sure people have good access to the services they need. This is not just access on a geographical basis, in other words, how far and with what difficulty patients must travel. Improving access means we must play our role, along with our partners, in dealing with transport issues. But access is also about how easy it is to take up services, including waiting times, bureaucracy, staff attitudes, deprivation and disability. It is only by providing services in new ways, by re-defining the nature of services and recognising new types of healthcare practitioners that we will be able to develop and support sustainable access to services. Achieving change over time This strategy proposes change over a time period from two to fifteen years. Stability for acute services will mean that changes to acute hospital services must be completed within two years. Developments in primary care, which are significant and transformational, will be put in place over the whole period of this strategy, from two to fifteen years and beyond. 1.2 Choice Whatever the final decisions following the conclusion to this consultation, NHS Argyll & Clyde fully recognise the right of individual patients to exercise choice when referred from their GP or other healthcare practitioner to hospital services for planned care. This means that, in discussion with their GP or healthcare practitioner, all patients will have the right to be treated in any appropriate NHS hospital which can meet their care needs. This includes hospitals outside NHS Argyll & Clyde. 2 NHS Argyll & Clyde Consultation paper 1.3 What is this public consultation about? We are proposing radical change to many services across Argyll and Clyde, and we would like you to comment on our proposals.