Health in Your Hands – What matters to you?

Communities across the Scottish Borders can expect to be fully engaged in discussions as a review of services by NHS Borders is conducted over the next 18 months.

That was the pledge given on behalf of the Board by its chairman, John Raine, when the proposed review was approved by the Board yesterday (19^th February).

The purpose of the review, starting with inpatient services, is to consider what needs to change to achieve the vision of everyone being able to live longer healthier lives at home, or in a homely setting, and with seamless provision of service across health and social care.

Looking at different models of care and service delivery across Scotland and internationally to identify examples of good practice will be part of the scope of the review.

Last year, the Board developed a clinical strategy in consultation with the public and the staff. This established agreed criteria for any service changes including the need for services to be safe and effective and delivered as close to home as possible.

Factors driving the need for change, identified in the Board report, include the increasing elderly population – life expectancy in the Borders being the highest in Scotland – coupled with the availability of new technologies, better treatments and medicines. These challenges have to be met in cost effective ways that demonstrate value for public money.

“An extensive public engagement plan will be quickly developed” said John Raine. “We want to share information about our services with our communities and start a dialogue so that we hear what people want from their NHS.

“What the Board has agreed to embark upon is a rational and sensible look at how services might be better organised within tightening budgets. Unfortunately the debate so far has been hijacked by controversy about hospital closures.

“There is no plan to close community hospitals and no hidden agenda. Any changes to health services will take full account of what people have to say to us about what they consider is important to them.”

The executive directors` report to the Board states that ‘the Borders General and our Community Hospitals are integral and important to the way in which we deliver the best care to our patients and will continue to be so as we move forward’. This point is echoed by Associate Medical Director for Primary and Community Services, Dr Jonathan Kirk; “our hospitals play a vital role within our communities and this will evolve. Currently, of course, hospitals are places we go when we get sick. We associate them with illness more than wellness. As we explore new models across primary care, acute care and mental health there will be a valuable opportunity to consider how best to deliver services to patients closer to homes, making the very best use of all of the assets at our disposal.”

Commenting on the review, NHS Borders Medical Director, Dr Sheena MacDonald said: “As we move towards 2020 there will be a requirement to deliver care in very different ways, maximising self care and community support and avoiding hospital admissions wherever possible.

A rise in elderly people with multiple and complex long term health conditions will increase the demand on health services.  From time to time people will experience episodes of ill health and we need to ensure that we are in a position to look after acutely ill people in hospital when that type of care is needed. A lack of planning could mean that care is delivered in a reactive way and our acute services are likely to become stretched beyond their limits.”

Highlighting the importance of public engagement in the process, Interim Chief Executive, Jane Davidson added: “throughout this review we will be making considerable efforts to engage patients and the public, and our expectation is that the outcomes of service reviews will emphasise the need for new models of care that reflect a more active role for patients as partners in their treatment and care.

“We look forward to progressing this work hand in hand with the public as co-owners of our services, as we move into an exciting and innovative phase of person-centred healthcare.”

The review will work to the following timescale: 

Activity	Description	Timescale
Launch of a full review of all NHS Borders Inpatient Services	Review group established with full role, remit and scope agreed.  Robust project plan and outputs approved. This will include a full stakeholder analysis and Communications & Engagement plan developed. Project Workstreams identified.	April 2015
Collection of key data and examples of modern or innovative approaches to care	A full analysis of our patients currently in our inpatient services including bed modelling.  Reviewing all information received from engagement exercise	May/June 2015
Dialogue with our communities, understanding what matters to our population	Conversations and listening points with all key stakeholders and the communities of the Borders	June/July 2015
Project workstreams identified in line with agreed scope and from dialogue with our population	Review all areas within scope including looking at other models of care and service delivery, regionally, nationally and internationally. This may identify examples of good practice that may have the potential to be implemented or tested at this stage of the review	July/August 2015
Dialogue with our communities – what we heard, what we have done, what the possibilities might be	Conversations with all key stakeholders to inform, engage and consult on initial findings from above work	August/September 2015
Identification of ideas	All potential ideas identified and considered and subjected to robust appraisal. This may identify examples of good practice that may have the potential to be implemented or tested at this stage of the review	October/November 2015
Shortlist of options agreed and prioritised	A shortlist of options agreed and worked up proposals to outline how services could be redesigned to deliver future needs and recommendations.  These will be prioritised in the form of short, medium and longer term options	November/December/January 2015-16
Engagement with key stakeholders	Conversations with all key stakeholders to inform, engage and consult on preferred options	February – March 2016
Recommendations to Board	A report back to the Board to outline preferred options taking into account information received from above consultation	June 2016
Implementation	Full implementation of agreed options.	July 2016 onwards

NHS Borders Clinical Strategy Key principles:

• Services will be Safe, Effective and High Quality.
• Services will be Person-Centred and Seamless.
• Health Improvement and Prevention will be as important as treatment of illness.
• Services will be delivered as close to home as possible.
• As a consequence of the above principle, admission to hospital will only happen when necessary, and will be brief and smooth.
• We are committed to working in Partnership with staff, communities and other organisations to deliver the best outcomes for the people we serve.
• Services will be delivered efficiently, within available means.

These principles are in line and fully support the 2020 vision for Healthcare in Scotland. The vision is that by 2020 everyone is able to live longer healthier lives at home, or in a homely setting. We will have a healthcare system where we have integrated health and social care, a focus on early intervention and prevention and supported self management. When hospital treatment is required, and cannot be provided in a community setting, day case treatment will be the norm. Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions. There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with no risk of re-admission.