Following extensive engagement on the NHS England ‘call to action’ initiative during the autumn of 2013, the Future Fit Programme has been set up to develop a clear vision for excellent, safe and sustainable hospital services to serve the populations of Shropshire, Telford & Wrekin and mid Wales. Services that are fit for the future are safe, accessible, offer the best clinical outcomes and attract and develop skilled and experienced staff.
The Future Fit Programme is a partnership between hospitals, the local clinical commissioning groups who have responsibility for buying health services on behalf of local patients, public, local councils and others from the population area served.
As one of their first actions, the Programme Board tasked three groups of doctors, nurses and patient representatives to generate a vision for future health care services for, planned care, emergency needs and long term conditions. These visions are based on evidence of best practice, the safest ways of working, patient-centred care, delivering the best outcomes possible for patients and services that will attract and retain highly skilled staff. The three groups have worked hard and enthusiastically to meet the task and delivered their progress report to the Programme Board this week.
The planned care group began by considering patient feedback. They recognised that patients need to be able to understand what services they need to access for their condition. Patients also want easy to understand, trustworthy, information about self-care. If a patient is referred to a specialist they want clear information about what is going to happen next and the timescale they should expect. Patients felt that simpler procedures should be delivered as close to home as possible and, only where treatment is more complex, delivered at a specialist centre by experts in those conditions who treat them regularly and with great skill.
Based on the above, the vision for planned care so far is for four levels of care;
- self-help supported by good quality advice
- low level, centres that provide day case/minor treatments, x-rays, therapies etc
- medium level, centres that provide medium complexity day case treatments and scanning equipment etc
- high level, centres for complex and specialist treatments
The doctors, nurses and patients on the emergency care group understood that when people need these types of service it is usually a distressing experience. They recognised that when patients need urgent attention they want it to be as close to home as possible, in centres that are equipped for their needs and delivered by specialists who can offer the highest levels of care and therefore the best possible health outcomes for their patients.
Given this patient feedback, the vision for emergency care so far is;
- patient’s needs to be assessed through use of 111 to provide advice on the most appropriate care centre closest to home or their current location
- a fully equipped emergency centre with highly technical and skilled emergency care staff available 24 hours a day, 7 days a week. A centre that will focus skilled staff in one place to improve teamwork and improve the quality and safety of this type of care
- multiple urgent care centres to provide expert opinion and care 7 days per week
- integrated care so that services are provided around the needs of the patient to keep people at home in familiar surroundings rather than in hospitals
The third group of doctors, nurses and patients considered long-term conditions e.g. diabetes, heart disease, respiratory diseases etc. They also looked at patient views and identified that they said; patients should be encouraged to take responsibility for managing their condition. Care should be provided and supported in partnership by GPs, district nurses, specialist consultants and other NHS and voluntary organisations. Patients are also keen to move to greater levels of prevention of illness.
The current vision for planned care therefore includes:
- greater emphasis on staying well rather than treating illness
- partnership working across health services
- self-care and planning of care to manage conditions as effectively as possible
- if conditions worsen access to ‘hospital at home’ services where more intensive treatment can be provided in the home
- if hospital treatment is needed, services to provide support to return to home as soon as safely possible
These visions for future health care services will now be tested against the needs and wishes expressed by patients at focus group meetings in late February and early March this year. They will then be combined to create a picture of how health services could look across all these areas and how they will join together.
Further consideration will be made for the number of patients with different conditions who are likely to need to access services in the future to see if the visions are fit for purpose. The financial feasibility of any future changes to services is also yet to be considered as well as continued patient feedback as the visions develop. Patients have already been very clear that any plans for specialised emergency care services must consider carefully both the future of the counties current main hospitals and options for a new hospital between Shrewsbury and Telford.
Over the coming months there will be further testing and refinement and a considerable number of opportunities for the public, patients and carers to inform and influence the shape of healthcare provided in Shropshire, Telford and Wrekin. Details will be published on the Future Fit website shortly www.nhsfuturefit.co.uk