NHS Borders Chief Executive describes the need for change in our Health and Care System

As the provider of our local health services, NHS Borders is rooted in our local community.

We strive to provide safe patient care, and we are proud of our reputation and the commitment of our dedicated and hardworking staff.

As a society we expect a lot from healthcare services, and as we move into 2020 we want the public to be involved and engaged in the care that they receive, and for them to help us shape the way in which we provide and plan services.

Part of that involvement is making sure the public are involved in discussions about the future of local health services.

However, to do this effectively, we need to share the pressures we are facing and describe what is driving our need to adapt and change.

Firstly, the NHS is now over 70 years old and the services we provide today are very different to those provided when the NHS was created in the 1940s. We have been constantly changing over the years, as we have worked to provide the highest possible standards and most up to date care.

Secondly, we all understand that the number of older people in the Borders is increasing, even faster than it is elsewhere in the country. While this is a measure of the success of the NHS and the overall improvement in the general health and wellbeing of our population, obviously as people live longer they do end up needing more support from our health and care services.

Partly as a result of our growing elderly population we are also seeing a reduction in the number of people of working age and this is having an impact on our workforce and our ability to recruit and retain staff.

Finally, the availability of new drugs and technologies provides us with great opportunities to deliver health care differently. As a result we can do much more to improve health and provide treatments that we were simply unable to provide in the past; for example transplants and new cancer treatments.

However these developments also create pressure on the service both in terms of cost and, even more importantly, the skills and type of staff that we need.

Thinking about how services have changed, many of us will remember the time when there were large hospitals such as Dingleton Hospital in Melrose for people living with mental health conditions, where patients stayed for months, sometimes years.

Nowadays we are able to care for the majority of patients with mental health illnesses in the community, helping them to have many more opportunities and a much better quality of life.

Similar changes have taken place for physical health issues, helped by advances in technology, clinical practice and the understanding that being in hospital for longer than needed is not the best thing for patients.

For example, if you go back 30 years to when the BGH opened, we had an inpatient ward where patients who were coming in to have operations on their eyes were cared for. Now nearly all these procedures are carried out with patients going home on the same day as their operation, and we therefore no longer need to have designated beds for our eye patients.

In the past if you came in for a hip operation you would have been in hospital for weeks. Now you may well have your hip operation in the morning, be up and moving around in the afternoon and with good rehabilitation in the community be discharged within a few days. As a result your recovery is much quicker, you need much less rehabilitation and this will, ultimately, have a much better long term impact on your health.

We also often think of the health service as just being there to look after people when they are ill. However we must also remember the really important work we do to improve people's health and keep them healthy for longer.

This recognises that the most significant changes to life expectancy and health has actually been driven by improvements made to our health and lifestyle rather than new health treatments. For example better diets, improved housing over the last 100 years, better safety at work and most recently, smoking legislation and minimum alcohol pricing.

It is therefore essential that we think carefully about how we increase our focus on preventing ill health, reducing health inequalities and supporting our local Borders population to enjoy living with good health for as long as possible.

So what should this mean for the long term future of health services in the Borders?

Firstly, we need to make sure that we provide healthcare for patients in the right place, at the right time, and by the right person. This will mean increasing the proportion of our resources that are spent outside hospital settings so that we can care for people at home or in their community whenever this is possible.

To do this we will need to work ever more closely with Social Care services and the Council, creating a single team that will support all your health and care needs, based in your community. This will help ensure that people only get admitted to hospital when they really need to be, and if a hospital admission is required this should be as safe and as brief as possible.

Obviously some people will need hospital care and we intend to continue to provide local acute hospital services on the BGH site except for when the service would be more safely and sustainably provided in a specialist hospital; for example when people need to travel to Edinburgh for complex heart or cancer treatments.

There will also be opportunities to change our support services to make sure they are as efficient and effective as possible. This will help ensure that as much of our resource as possible is spent on preventing ill health and providing healthcare when required.

Information and digital technology has changed out of all recognition in the last 20 years. We should therefore use this and new and evolving digital technology differently to benefit patients by supporting you at home, and providing new ways for you to access services such as virtual or remote clinic appointments so that you do not need to actually travel to hospital to speak to a doctor or nurse or to receive information on your condition.

There are also opportunities for our employees to work differently. Many of the tasks that would normally have been done by one group of staff are now being done by another. For example, Advanced Practice Nurses now have the skills to do much of what in the past GPs or hospital doctors will have done. This allows our doctors to focus on doing those things that only they have the training and experience to do.

This is a good use of our resources, helps us deal with shortages of staff in particular areas and also gives great opportunities to make the roles that our staff have much more interesting and challenging which, in turn is good for recruiting and retaining staff in the Borders.

We also have to recognise that we can only deliver care with the staff we have or the staff we are able to develop for the future. We understand that the impact of population changes on our workforce will present challenges to how we deliver healthcare. We must therefore think carefully about how we create services that are sustainable with the workforce we are likely to have.

So, in conclusion, the underlying message is that we must embrace change. Healthcare services change and evolve over time, and if we do not change we will not be doing the best for the Borders.

Embracing the opportunities we have will allow us to deliver the best healthcare possible in the future for our Borders population.

We have approximately £250 million to spend on healthcare services each year. While we could always spend more our budget will always be limited and it is our responsibility to provide you with the best possible value from these resources. So wherever we can become more efficient we should.

Our Clinical Strategy and recently published 'Statements of Intent' set out some of our ideas about what we want to achieve, and what this might mean in practice.

As we move into 2020 and the new decade there are a number of areas where we are considering changes to ensure that the services we provide are as safe, effective, high quality and person centred as they can be, as well as sustainable and affordable.

However it is really important we get your views and thoughts on the future. We are therefore seeking your input and would like to involve you in the design and delivery of services.

If you are interested in being involved in the future planning of services please contact public.involvement@borders.scot.nhs.uk or phone 01896 825545.