A developing vision of future healthcare for Berkshire and Buckinghamshire

Jeśli potrzebujecie Państwo tłumaczenia tego dokumentu, prosimy przejść na ostatnią stronę.

यदि तपाईंलाई यो कागजातको अनुवाद चाहिएमा, कृपया पछाडिको पृष्ठ हेर्नुहोला

جے تہانوں ايس دستاويزدا ترجمہ کروان دی لوڑہيگی اے تے، مہربانی کردياں ہوياں پچهلے صفحے تے جاوو۔

اگر آپ کو اس دستاويز کا ترجمہ درکار ہے تو برائے مہربانی آخری صفحہ مالحظہ کيجئےयदि आप इस दस्तावेज का अनुवाद चाहते हैं तो कृपया पीछे का पृष्ठ पलटेंإذا رغبت بترجمة هذه الوثيقة، فيرجى الذهاب إلى الصفحة األخيرة.

如果你需要本文件获得翻译，请转看背页

که تاسو د دغه سند ژباړې ته اړتيا لرئ، مهرباني وکړئ وروستۍ پاڼې ته والړ شئ

Se necessitar deste documento traduzido, por favor consulte a última página.

Hadii aad rabto in laguu soo turjubaano dokumantigan, fadlan fiiri bogga xaga dambeDacă aveţi nevoie de o traducere a acestui document, vă rugăm citiţi ultima pagină

Nëse ky dokument ju duhet i përkthyer, ju lutemi shkoni tek faqja e mbrapa

Stoke Mandeville

Wycombe

HillingdonWexham Park

Heatherwood

Royal Berkshire

West Berkshire

Buckingham

Florence Nightingale House

Amersham

Chalfont and Gerrards Cross

Marlow

Townlands,Henley

St Marks, Maidenhead

Upton, Slough

Kind Edward VII, Windsor

Wokingham Hospital

Dellwood / Duchess of Kent / Prospect Park

West BerkshireCommunity Hospital

Thame

Berkshire West

Berkshire East

Buckinghamshire

Buckingham

Aylesbury

Amersham

Beaconsfield

Slough

Windsor

Maidenhead

High Wycombe

BracknellWokingham

Newbury

Reading

Acute trust

Community hospital

Primary road

PCT boundary

Motorway

Stoke Mandeville

Wycombe

HillingdonWexham Park

Heatherwood

Royal Berkshire

West Berkshire

Buckingham

Florence Nightingale House

Amersham

Chalfont and Gerrards Cross

Marlow

Townlands,Henley

St Marks, Maidenhead

Upton, Slough

Kind Edward VII, Windsor

Wokingham Hospital

Dellwood / Duchess of Kent / Prospect Park

West BerkshireCommunity Hospital

Thame

Berkshire West

Berkshire East

Buckinghamshire

Buckingham

Aylesbury

Amersham

Beaconsfield

Slough

Windsor

Maidenhead

High Wycombe

BracknellWokingham

Newbury

Reading

Acute trust

Community hospital

Primary road

PCT boundary

Motorway

Acute trusts in thAmes VAlley

Contents

Introduction 3Summary 4OurchangingNHS 6Thechallenges 8Workingtogethertoimproveservices 10

Developingavisionoffuturehealthcare 11Emergingfindings 13Whatitwillmeanforpatients 15Buildingonthebest 16Glossary 19

3

Stoke Mandeville

Wycombe

HillingdonWexham Park

Heatherwood

Royal Berkshire

West Berkshire

Buckingham

Florence Nightingale House

Amersham

Chalfont and Gerrards Cross

Marlow

Townlands,Henley

St Marks, Maidenhead

Upton, Slough

Kind Edward VII, Windsor

Wokingham Hospital

Dellwood / Duchess of Kent / Prospect Park

West BerkshireCommunity Hospital

Thame

Berkshire West

Berkshire East

Buckinghamshire

Buckingham

Aylesbury

Amersham

Beaconsfield

Slough

Windsor

Maidenhead

High Wycombe

BracknellWokingham

Newbury

Reading

Acute trust

Community hospital

Primary road

PCT boundary

Motorway

ThisdocumentsetsouthowweplantoimprovetheNHSforthe1.4millionpeoplelivinginBerkshireandBuckinghamshire.

IntroduCtIon

TheseplansarebeingdevelopedbyGPs,consultants,nurses,midwivesandotherhealthcareprofessionals,patientsandthepublicandourpartnersinlocalauthoritiesandsocialservices.

TheNHSinBerkshireandBuckinghamshireisbringingpeopletogethertoshapetheseplans,understandwhatmattersmosttopeopleandagreewhatworksbestsothat,together,wecanmakethebestdecisionsabouthowandwherecareisprovidedinthefuture.

EachNHSorganisationinBerkshireandBuckinghamshirealreadyhasitsownplansforcontinuingtoimproveservices,addressinglocalissues,andrisingtothechallengesthattheNHSfaces.Someoftheseplansareattheearlystages;othersarealreadybeingdiscussedwithlocalpeople,staffandpartners.

Forexample,inBuckinghamshire,wearealreadylookingathowbesttoprovideurgentcarethroughourImPACTprojectandthrough

thishavealreadysetupaGPleadhealthcentreinWycombeHospital,andextendedourGPoutofhoursservice.InBerkshireEast,followingonfromtheRight Care, Right Placeconsultation,thePCTsetupanurgentcarecentreinMaidenhead,awalk-incentreinSloughandisdevelopinganurgentcarecentreatWexhamParkhospital,duetoopenlaterthisyear,toimproveaccesstohealthservices.AndinBerkshireWest,projectshavebeendevelopedtoshiftcareoutoftheacutesectorandtomanageproactivelylongtermconditionstoavoidunnecessaryemergencyadmissions.

However,byworkingtogetherwithasharedvisionthroughCarefortheFuture,wewillbeabletoensurethatallourplansbringthegreatestimprovementsandbenefitsforlocalpeopleandpatients.Wewillbeabletofindsharedwaystomeetrisingdemands,reducevariationsbetweenservicesandgetthegreatestbenefitfromnewmedicaladvances.

4

LocalhealthprofessionalsandNHSorganisationshavejoinedforcestoimprovetheNHSforthe1.4millionpeoplelivinginBerkshireandBuckinghamshire.

Why chAnGe?

TheNHSisbusierthaneverbefore,treatingmorepatientsmorequicklyandtohigherstandards.Muchhasbeendonetodevelophighquality,community-basedservicessopatientsreceivecareclosertohome.

Asahealthsystemweareusedtomakingthebestuseofourresourcesbutinthefutureweneedtoensurewemakeevenbetteruseofwhatisavailabletous.

TheNHSneedstoadapttomeetthewaysocietyandtechnologyarechanging.Keepingthingsthesameastheyarenowisnotanoption:

•Advancesinmedicinemeanthatmanytests,treatmentsandprocedurescouldbedeliveredmoreconvenientlyforpatientsoutsideofhospital

suMMArY

•Peoplehavetoldustheywouldliketoreceiveevenmorecareandhaveawiderrangeofservicesavailableclosertohome

•Thepopulationisgrowingandpeoplearelivinglonger.Age-relatedlong-termillnessessuchasdiabetesandhighbloodpressureareincreasingthedemandforhealthcareservices

•Unhealthylifestyles,highlevelsofobesity,excessalcoholconsumptionandsmokingallputthehealthserviceunderevengreaterpressure

•Thedemandforservicesissteadilyincreasingatatimewhenfundingisaffectedbytheeconomicdownturn.

5

Wewanttoheartheviewsofasmanypeopleaspossibletounderstandwhatmattersmosttoyousothattogetherwecanmakethebestdecisionsabouthowandwherecareisprovidedinthefuture.

the Benefits for pAtients

Patientswillseerealbenefits.Everyonecanbeconfidentthattheyareenjoyingthebesthealthandreceivingthehigheststandardsofcare,nomatterwheretheyliveorwhichservicestheychosetouse.Carewillbeprovidedinmuchmoreconvenientwaysandtherewillbebetterco-ordinationbetweendifferentservices.

next steps

Thisreportcontainsourpreliminarythoughtsandideas.Thesehavebeendevelopedbymedicaldirectors,GPs,consultants,nursesandmidwives,patientandpublicrepresentativesandotherhealthprofessionalssuchaspharmacists,dieticiansandphysiotherapistsfromacrossoursevenorganisations.Beforewedevelopthesefurtherwewanttosharethemwithyouandinviteyourfeedback.

InthecomingmonthswewillbedevelopingourproposalsingreaterdetailandholdingpublicdiscussionsinBerkshireandBuckinghamshire.

your feedBAck

Untilthen,ifyouwishtocommentonourideasandemergingvision,wewouldverymuchliketohearfromyou.Youcancontactusat:

CarefortheFuture,57-59BathRoadReadingBerkshireRG302BA

Telephone:01189822789Email:careforthefuture@nhs.net

WorkinG toGether to deVelop A Vision of heAlthcAre for the future

ByworkingtogetherwithasharedvisionthroughCarefortheFuture,wewillbeabletobringthegreatestimprovementsandbenefitsforlocalpeopleandpatients.Inparticular,wecanbothimproveservicesandsignificantlyreducecostsbyworkingtogethertomakesurewegettheright‘pathways’ofcareinplaceacrossandbetweenourservicesforindividualpatients.

Togetherwehavefourclearaims:

•Todevelopasharedvisionofthebestpossiblehealthcareforthelocalpopulation

•Toimprovepeople’squalityoflifeandlifeexpectancy,withintheresourcesavailabletous

•Tofocusonpreventingillhealthaswellasprovidingtreatment

•Tomanageourfinancialresourcesmoreeffectivelysothatwecanreinvestinfurtherimprovementsforpatients.

Asweworkonthisoverthecomingmonthswewantyoutohelpusshapeourideasandplans.Nodecisionshavebeenmadeyet.

6

TheNHShasmadesignificantimprovementsinrecentyears.Patientswhousedtowaitoverayearfortreatmentarenowseenwithinafewweeks.Patientsareabletohaveagreatersayoverwhenandwheretheyarecaredfor.ItiseasiertoseeaGPatmoreconvenienttimes.Andourhospitalsarecleanerandofferpatientsgreaterprivacythanbefore.

Buttheworlddoesn’tstandstill,andneithercantheNHS.Weknowweneedtodoevenbetter.Acrossourlocalareatherearesomeexcellentservices.Butwewanteveryonetoenjoytheverybesthealthandhaveaccesstothehighestqualityservicesregardlessofwheretheyliveorthecaretheyneed.

GettinG the riGht cAre

Traditionally,peopleoftenthinkofhealthcareashospitalservices.YetonlyasmallproportionofwhattheNHSdoeseverydaytakesplaceinhospitals.Thevastmajorityofpeople’scontactwiththeNHSiswiththeirGP,practicenurseorcommunityservice.

our CHAnGInG nHs

Thediagrambelowshowsthatmostpeoplecanmaintaintheirhealththroughselfcare,withoccasionaladviceandsupportfromtheirGP,nurse,pharmacist,dentistoroptician.

However,somepeoplerequiremorecontinuousmedicalhelp.Forexample,apatientwhoneedstocontroltheirdiabeteswiththesupportoftheirGPorspecialistnurse.

Andthentherearearelativelysmallerproportionofpatientswhoneedgreaterhealthandsocialcaresupport.Thismightincluderegularhospitaladmissionsorcontinuingcareservicessuchaspatientsondialysisorwithmoreseriousheartdisease.

Self care eg: healthy eating, regularexercise, breast feeding

eg: GPs, dentists, opticians, pharmacy services

COST OF HEALTH CARE & TREATMENTREDUCIN

G NUM

BER OF P

ATIENTS

eg: specialist nursing teams,disease management

eg:outpatientclinics

Specialisthospital sevices

eg: cancer treatment

Generalhospitalservices

Local healthServices

CommunityServices

GOOD HEALTH

PATI

ENT

CA

RE

PATH

WA

Y

7

more serVices in the community

Inrecentyears,thewaypeoplereceivetheirhealthcarehasincreasinglybeenthroughservicesprovidedatGPpracticesandwithinthelocalcommunity.Tests,scansandsimpleproceduresthatusedtorequireahospitalvisitorovernightstaycannowbedonemoresafely,convenientlyandcost-effectivelyatGPsurgeries,inclinicsinthecommunity,orinapatient’sownhome.

Inthefuturewewillseefurtherdevelopmentofmoreconvenientandeffectivelocalservices.Todothiswewillneedmoreclinicalstaffcaringforpeopleintheirownhomes.

more speciAlist hospitAl serVices

Asmoreofwhatusedtohappeninhospitalstakesplaceinthecommunityandinpeople’shomes,hospitalservices,andthehealthcareprofessionalsprovidingthem,arebecomingmorespecialised.Advancesinmedicineandmedicaltechnologymeanthatnewandinnovativetreatmentsareavailable.Butalltheevidenceshowsthatpatientsgetbetterresultsiftheyaretreatedbystaffwithspecialistknowledgeinspecialistfacilities.Thismeansthatinthefuturetherewillbeagreaterconcentrationofspecialistcareinfewersites.

usinG resources more Wisely

Thewayhealthserviceshavebeenorganisedanddeliveredinthepastisn’talwaysappropriatenow,andtherearewayswecanbecomemoreefficient.

Forexample,weknowpatientssometimesspendtoolonginhospitalbecausethedischargesystemisnotasefficientasitcouldbe.Wealsoknowthatpeopledonotalwaysusetherighthealthservicesintherightway–aroundathirdofpeopleusingourlocalA&Edepartmentscouldhavebeentreatedelsewhereand,nationally,afifthofpeopleseeingaGPcouldhavetreatedthemselves.Andwecouldfreeupclinicalstafftospendmoretimewithpatientsbygivingthemnewtechnologytohelpwithadministration.

8

WewanttocontinueimprovingtheNHSforpatientsacrossBerkshireandBuckinghamshire.Butwehavetodothatinthecontextofincreasingdemandforservices,thechangingneedsofourlocalpeople,andtheconstraintsontheresourcesandfinancesavailabletous.

A GroWinG And AGeinG populAtion

ThepopulationsofBerkshireandBuckinghamshirearegrowing.Peopleinourareatendtobehealthierandsolivelongerthanaveragewhencomparedwiththerestofthecountry.Thisisgoodnews,butitdoesmeanthataswegetolderwestarttosufferfrommorelong-termconditions,suchasdementiaandheartdisease.Localhealthserviceswillneedtogrowandadapttothesechangingneeds.

tHe CHAllenGes

unheAlthy lifestyles

Obesity,smokingandalcoholconsumptionaremajorpublichealthissues.Itisestimatedthat60%oftheUKpopulationcouldbeobeseby2050.Althoughourpopulationisgenerallyahealthyone,amongsomegroupsofpeople,theseissuesaremajorcausesofconcern.Unhealthlylifestylesleadtoanincreaseinlong-termillnessessuchasdiabetes,heartdiseaseandhighbloodpressure.

9

keepinG up With medicAl AdVAnces

NewdrugsandtreatmentsmeanwecanprovidebetterpatientcarebutsometimesatamuchhighercosttotheNHS.Therearefiniteresourcesavailablewithinthehealthsystemandnotallthedrugsandtreatmentsworkforeverybody,sowehavetomakecarefuldecisionsabouthowtogetthebestvalueformoneytoachievethebestpossibleoutcomesforallourpatients.

VAriAtions BetWeen serVices

TheNHSperformswelloverallinBerkshireandBuckinghamshireandtherearemanyexcellentservices.However,therearevariationsinthequality,easeandspeedofaccess,andthepatientoutcomesbetweensomeservices.Ourlocalpeopleshouldexpecttoenjoytheverybesthealthandhighestqualityservicesregardlessofwheretheyliveorthecaretheyneed.

doinG more Within fundinG constrAints

Publicservicesarereceivinglessfundingaswetrytoreducethenationaldebt.AlthoughthenationalNHSbudgetisbeing‘ring-fenced’

toprotectit,itwillnotgrowasithasinthepast.Meanwhile,thecostofhealthserviceswillcontinuetoriseandthedemandsplacedonserviceswillalsoincreaseasourpopulationgrowsandages.

Therefore,ourplanningassumptionisthatwedonotexpectanyincreasesinNHSfundinginBerkshireandBuckinghamshireinthecomingyears.We’veestimatedthat,unlesswetakeactionnow,thehealthsysteminBerkshireandBuckinghamshirecouldfaceafinancialshortfallofupto£400millionby2013/14.

Addressingthisfinancialshortfallwillbeachallenge,butwehaveidentifiedwaysinwhichwecandoit.

Reducingmanagementcosts,therenegotiationofcontacts,andchangesinthenationalNHSpaymentsystemwhichwillencourageallproviderstobemoreefficient,shouldsaveover£250mannually.

And,bycomparinghowwedeliverourservicesfordifferentconditionsandtypesofcareagainstbestpractice,webelievewecanachievefurthersavingsofover£200meveryyearbyprovidingtherightservices,intherightway,intherightplaceandattherighttime.

1.7

2.1

2013/14 2012/13

2.4

2011/12 2010/11 2009/10

Reg

ion

al N

HS

spen

d (

£bn

)

1.9

2.0

2.2

2.3

1.8

£280m £160m £400m £45m

Expected rise in NHS spend if we do not make any changes

No increase expected in real-terms NHS funding

Likely funding gap if wedo not make changes

10

EachNHSorganisationinBerkshireandBuckinghamshirealreadyhasitsownplansforcontinuingtoimproveservices,addressinglocalissues,andrisingtothechallengesthattheNHSfaces.Someoftheseplansareattheearlystages;othersarealreadybeingdiscussedwithlocalpeople,staffandstakeholders.

ButbyworkingtogetherwithasharedvisionthroughCarefortheFuture,wewillbeabletoensurethatallourplansbringthegreatestimprovementsandbenefitsforlocalpeopleandpatients.Wewillbeabletofindsharedwaystomeetrisingdemands,reducevariationsbetweenservices,andgetthegreatestbenefitfromnewmedicaladvances.

Inparticular,wecanbothimproveservicesforpatientsandsignificantlyreducecostsbyworkingtogethertomakesurewegettheright‘pathways’ofcareinplaceacrossandbetweenourservicesforindividualpatients.Thiswilldeliversomeofthemostsignificantimprovementsforpatientsandenableustoaddressthefinancialshortfallthatwewillfaceifwedon’ttakeactionnow.

Workingtogetheralsomeanswecanensurethat:

•Changesmadeinoneareadonothaveanegativeimpactonanotherarea

•Wecanshareourlearningandopportunitiestomakeimprovements

•Weshareourresources,usingthemmoreefficiently.

WorKInG toGetHer to IMProVe serVICes

Who is inVolVed?

CarefortheFutureinvolvesGPsandtheprimarycaretrusts,acutehospitalsandprovidersofcommunityhealthservicesinBerkshireandBuckinghamshire

WearebeingsupportedbyNHSSouthCentralStrategicHealthAuthorityandworkingcloselywithSouthCentralAmbulanceServiceNHSTrust.

our Aims

Togetherwehavefourclearaims:

•Todevelopasharedvisionofthebestpossiblehealthcareforthelocalpopulation

•Toimprovepeople’squalityoflifeandlifeexpectancy,withintheresourcesavailabletous

•Tofocusonpreventingillhealthaswellasprovidingtreatment

•Tomanageourfinancialresourcesmoreeffectivelysothatwecanreinvestinfurtherimprovementsforpatients.

11

WeareproudoftheimprovementstheNHShasmadeinrecentyears,butweknowthatpatientsexpectmoreandwewanttodobetter.

deVeloPInG A VIsIon of future HeAltHCAre

our principles

Ourworktodevelopourvisionisbasedonasharedsetofunderlyingprinciples.Wewill:

•Seektoreduceinequalitiesinhealthandimprovepatientoutcomes

•Promoteandsupportselfcareandgoodhealthwhereverpossible

•Activelysupportvulnerablepatientsandindividualsatriskofbecomingill

•Workwithpatients,carers,GPsandstaffintheredesignofservices

•Treatpatientsintheirlocalcommunitywherepracticalandeffective

•Recognisethatwhilesomecoreservicesshouldbeprovidedfromeveryhospital,somespecialistservicesarebestprovidedfromfewersitestoenablethebestpossiblecareandsafetreatment

•Ensurethatappropriatequalityandstandardsofcarearemaintainedandcontinuallyimproved

•Supportthepersonalisationofcareandenablepatientstoexercisegreaterchoice

•Useclinicalbestpracticeandevidenceasabenchmarkinmakingdecisionsaboutplansforfuturehealthcare.

WewanttobuildontheimprovementswehavealreadymadetocreateanNHSinBerkshireandBuckinghamshirethatprovidesallpatientswithaccesstotherightcare,intherightplaceandatthetimeitisneeded.Wewantto:

•Putpatientsattheheartofallwedo,givingthemmorechoiceandcontrol

•Ensurethatallservicesarefocusedondeliveringtheverybestoutcomesforpatients

•Continuedevelopingmoreconvenientcommunity-basedservicessothathospitalstaffcanconcentrateonprovidinghighquality,safe,expert,specialistcare

•Ensureweuseourresourcesasefficientlyaspossiblesothatwecanreinvestmoreinfurtherimprovingservices.

TodothiswearedevelopingavisionforthefutureofhealthcareinBerkshireandBuckinghamshire.Weareworkingwithdoctors,nursesandotherswhoprovidecare,patients,carers,thepublicandourpartnerstoagreehowwewantcaretobeprovidedinthefuture.

12

hoW We Are deVelopinG our Vision

Anychangesneedtobedirectedbythedoctors,nursesandotherswhoprovideourhealthcareservicesandfullyinvolvepatients,carersandthepublic.

InthefirstphaseofthisworkwesetupfourCarefortheFutureworkinggroups.ThesewereledbymedicaldirectorsandincludedGPs,consultants,nursesandmidwives,socialcarestaffandmanagers,patientandpublicrepresentativesandotherhealthprofessionalssuchaspharmacists,dieticiansandphysiotherapistsfromacrossoursevenorganisations.

Eachgroupwasgiventhetaskoflookingataparticulartypeofcare:

•planned care:carethatispre-arrangedsuchasscheduledhospitaloperationsoroutpatientappointments

•urgent care:emergencyservices,includingpeoplegoingtoA&Eorbeingadmittedtohospitalinanemergency

•long-term conditions:chronicillnessessuchasdiabetes,heartdiseaseorasthma

•paediatrics:children’sservices,includingmaternityandneonatalservices.

Thisphaseofworkalsoincludedresearchandcarefulanalysisofbestpracticeinhealthcareinthiscountryandabroad.Bydoingthiswecouldidentifyareaswherewecouldmakeimprovementsandensurethatanyideascouldbetestedagainstwhathasalreadyworkedwellelsewhere.

Thesegroupswentthroughanumberofstepstohelpthemclarifyandchallengetheirthinkingabouthealthandhealthservices–fromhealthpreventiontotreatment(bothoutofandinhospital)throughtorehabilitation.Theywereaskedtofocusonopportunitiestoimprovethequalityofprimary,communityandacute(hospital)careandtotakeaccountofthefollowing:

•Currentandfuturehealthcareneedsofthelocalpopulation

•UKandinternationalhealthcarebestpractice

•Increasingfocusonpreventionaswellastreatment

•Futurerestrictionsonfunding.

Thegroupscameupwithanumberofpreliminaryfindingswhicharethefirststeptodevelopingclearerproposalsforimprovingthequalityofpatientcare,increasingtheservicesprovidedtopatientsinthecommunityandmakingthemostefficientuseofourvaluableresources.Thesefindingsareoutlinedinthenextsection.

next steps in deVelopinG our Vision

Theseworkinggroupideasareataveryearlystage.Morediscussionisneededtoassesswhethertheywillworkinpracticeand,ifso,howwewillimplementthem.Thiswillbeledbythedoctorsandnurseswhoareprovidingtheservicesnow,andwhowillbeprovidingtheminthefuture.

Inthecomingmonthswewillbediscussingthisreportindetailwithourownemployees,withdoctors,nursesandGPsandwithotherNHSorganisations.Wewillalsobeaskinglocalcouncils,patientsgroupsandthepublicfortheirearlyviewsonthesefindings.

Whenwehavedevelopedmoredetailedplans,wewillbeginconsultationswiththepublicsothateveryonehasanopportunitytoseewhatweareproposingandhavetheirsay.

Ouraimistostartimplementingagreedchangesby2011sothatthepeopleofBerkshireandBuckinghamshirewillbeabletoenjoyhigh-quality,modernandreliablehealthservicesinthefuture.

Inthemeantime,we’dliketohearyourviewsandcomments.YoucangetintouchwithusatthecontactdetailsintheSummaryofthisdocumentonpage5.

13

heAlthcAre out of hospitAl And closer to people’s homes

Inrecentyears,anumberofnewinitiativeshavebeendevelopedatGPlevelandwithinthecommunity,includingcertainservicesthatwouldhavebeenlocatedinahospital.Forexample:

•Supportingandmanagingtheconditionsofpatientswithconstantandrecurringlongtermconditionssuchasasthmaanddiabetes

•Carryingoutdiagnosticandinvestigativeproceduresandminorsurgery

•Developmentsinprovidinghealthcareforolderpeopleintheirhomesratherthaninhospital.

Despitethisprogress,tosupportanageingpopulationandmeetlongtermcareneeds,wemustdevelopconsiderablymoreservicesoutsidehospitalsettingsinlocalcommunities.

TheCarefortheFutureclinicalworkinggroupscameupwithanumberofemergingfindingsandguidingprinciplesaroundhowpatientscouldbehelpedtobetterlookafterthemselvesandhowmoreeffectiveservicescouldbeprovidedoutofhospital.

Theseincluded:

•Strengtheningprimarycareandprovidingcareclosertopatients’homes,forexamplebygivingGPsaccesstoarangeofdiagnostictestsdirectly,beforereferringpatientstohospitalspecialists

•MultidisciplinaryteamswitharangeofskillstosupportandhelpGPswhohavepatientswithlongtermconditions,soGPsaremoreabletotreatthosepatientswithmorecomplexneeds

•Encouragingpatientstotakemoreresponsibilityformanagingtheirowncare,forexamplebygivingpatientsinformationontheirconditionandaccesstosupportnetworksandmakingbetteruseoftechnologytohelppatientsmanagetheirconditionsthemselves

•Providingoutpatientappointments,diagnosticsandtreatmentlocallyandperformingminoroperationsoutsidehospitals

•Developingcommunitynursingteamswith12hoursadaysevendaysaweekaccesstosupportchildrenwithlongtermconditions

•Morelocalintermediatecareserviceswithinthecommunitytobringcareclosertothosedischargedfromhospitalbutstillneedingsupportbeforetheyareabletoliveindependentlyathome

•Healthadvice,supportandinformationeasilyavailabletoallviaasinglepointofaccesswhichcouldalsobookappointments.

eMerGInG fIndInGs

14

deVelopinG key serVices At locAl hospitAls

Ourvisionforhelpingpeoplemanagetheirconditionsmoreeffectivelyathome,supportedbyacomprehensiverangeofcommunitybasedservices,supportandhelp,meanswecanfocusonprovidinghighqualityspecialistcareatourhospitals.

Localhospitalshaveanimportantroletoplayindeliveringmodernhealthcareandwillcontinuetodoso.Giventhechallengesdescribedearlier,weneedtolookatthebestwaytodeliverhospitalservicesandhowtheycancomplementcareclosertohome.Weneedtomakesurethattherightservicesareprovidedintherighthospitalssoeveryonehasaccesstothehighestqualitycare.

TheCarefortheFutureclinicalworkinggroupscameupwithanumberofemergingfindingsandguidingprinciplesaroundhowhospitalservicescouldbeprovided.Theseincluded:

•Someconditionsrequiringhighlyspecialisedcarearebesttreatedinspecialistcentres.Thismeansthatafewpatientsinafewspecialtieswillnotbetreatedinlocalhospitalsinthefuture,andtheircarewillbeprovidedatspecialistcentres

•Wewillworkwiththeambulanceservicetoensurethatpatientsaretakendirectlytothehospitalthatcanbestdealwiththeirneeds,andtoensurethatpatientsarereturnedtotheirlocalhospitalafteracutecarejustassoonasitissafetodoso

•Separatepathwaysareneededtodealwithcomplexcasesoranemergencyandthosethatcanbetreatedasdaycaseswithoutanovernightstay

•Theincreaseinthenumberofdoctorsrequiredtoprovidespecialistcarearoundtheclock,whilstmeetingtheWorkingTimeDirective,meansthatacutehospitalservicesneedtobeprovidedonalargerscaleatfewersites

•Tomakesurespecialistcliniciansremainwellskilledandtoensurehighqualitycare,therangeofservicesofferedwillvaryacrossdifferenthospitals

•Ifservicesarecentralised,significantchangestopre-hospitalcarearerequiredsopatientsareadequatelyassessedandtransportedtoappropriatelocations

•Toenablespecialistcentrestodevelop,daysurgeryshouldbethenormformosttypesoftreatment,withadmissiontohospitalreservedforspecialistoremergencycases

•Whenpatientsareadmitted,theyshouldbegiventhedateonwhichtheyareduetobedischarged,tohelpthemandtheteamswhowillbecaringforthemtoplanahead

•Tosupportthistypeofhealthcarearrangement,networksofspecialistswillbeneededtoworkacrossdifferenthospitalsites.

15

Patientswillseerealbenefits.Everyonecanbeconfidentthattheyareenjoyingthebesthealthandreceivingthehigheststandardsofcare,nomatterwheretheyliveorwhichservicestheychosetouse.Carewillbeprovidedinmuchmoreconvenientwaysandtherewillbetterco-ordinationbetweendifferentservices.

more cAre, closer to home

Aswellasbeingabletohavemoretestsandsimpleprocedures,likemoleremoval,atyourGP’ssurgery,somehospitalconsultantswillalsobeabletoseeandtreatyouthereifyoulike,makingiteasiertoaccesshospitalservicesinyourcommunity.DistrictnursesandhospitalserviceswilllinkinbetterwithyourGP,meaningyouwon’thavetogivethesameinformationoverandoveragainorwaitsolongforreferralstobemade.Therewillalsobemorecommunitysupportavailabletoyouintheeveningsandatweekends.

hospitAl serVices tAilored Around you

Ifyoudoneedtogotohospitalforanoperation,itislikelythatanytests,scansorassessmentswillhavealreadybeencarriedoutatyourGPpracticeorcommunityclinic.Medicaladvances,suchaskeyholesurgery,aremakingoperationsquickerandsaferandmeanthatpatientsarebackontheirfeetmuchsooner.Moreoperationswillbecarriedoutasdaysurgery,wheneverdoctorsthinkitissafetodoso.Thismeansthatyouarelesslikelytoneedtostayovernightinhospital.Communitynurseswillvisityouathometoprovidefollowupcare,suchaschangingdressings.

the Very Best speciAlist cAre for those Who need it

Patientswithurgentspecialistcareneeds,forexamplepatientssufferingfromstrokeorheartattack,willbeseenbydoctorsandnurseswiththehighestlevelsofexpertise.Thesestaffwill

beconcentratedinfewer–butmorespecialist–centresofexpertise.Thesehospitalscanhavespecialistconsultantsavailablearoundtheclock.Evidenceshowsthattheseproducebetteroutcomesforpatientswithspecialistneedsthansmallerhospitals.

more inteGrAted serVices

Ifyouhaveacomplexorlongtermconditionyouwillbesupportedbya‘multidisciplinary’team.Thesearegroupsofhealthcareprofessionalswhoworktogethertoprovideallthedifferenttypesofcarethatsomeoneneedsinajoinedupway.Forexample,someonewithdiabetescouldneedthesupportofaspecialistnurse,districtnurse,dietician,podiatristandeyespecialist.Ratherthanseeingthesepeopleindividually,theywouldworktogethertosupportyou,ensuringthattheadviceandservicestheyprovidearejoinedup.Therewillalsobeabetterjoinupwithsocialservices.Ifyouareadmittedtohospital,socialserviceswillimmediatelybeinvolvedinmakingsureeverythingissetupandreadytogiveyouthesupportandanyequipmentyouneedathomewhenyouaredischarged.

more informAtion

Youwillbegivenmoreinformationaboutyourconditionandtreatment,givingyoumorecontroloveryourcareandenablingyoutobettermanageyourownhealthwhereverpossible.Peoplewillhaveaccesstomoreadviceandsupport,including24hourhelplinestohelpmanageexistingconditionsandtostayhealthy.

WHAt It WIll MeAn for PAtIents

16

Therearealreadymanyexamplesofbestpracticearoundourregionthatwecanlearnfrom.Oftensimpleideasgreatlyimprovepatientcareandsavemoney.

community mAtrons keep pAtients out of hospitAl

SinceApril2009,ateamofdedicatedcommunitymatronsandcasemanagersinNHSBerkshireWesthashelpedover400peoplereceivehealthcareathomeratherthanspendtimeinhospital.Theyhelppatients,mainlyover-65s,tomanagemultiplelong-termhealthconditionssuchasrespiratoryproblems,diabetes,neurologicalandheartconditions.

Eachcommunitymatronhasacaseloadofaround50patientsatonetimewhohavebeenidentifiedasbeingatriskfromfrequentadmissiontohospital.Theyworkwiththepatients,GPs,districtnursesandotherhealthandsocialcareworkerstoidentifythepatient’sneedsandensurethattheyreceivetherighthealthcare,reducingtheneedforunplannedhospitaladmissions.Ifapatientisadmittedtohospital,theyworkwithhospitalstaffsothepatientcanreturnhomeasquicklyaspossible.

Better suBstAnce misuse serVices in the community

Anewcommunity-basedalcoholandsubstancemisuseservicehasbeenrunninginNHSBerkshireEastsinceJanuary2010,reducingthenumberofemergencyhospitaladmissions.

Patientsnowhaveachoiceofdetoxservicesinhospitalorthecommunity.Counsellinganddrop-inclinicsareavailableinthecommunityforpatientsthroughouttheirtreatmentjourney,reducingtheriskofthemcontinuingorreturningtoalcoholordrugs.KeyworkerssupportGPstobettercareforpatientswithalcoholorsubstancemisuseproblemsfromtheirownsurgeries.

promotinG heAlthy heArts

NHSBerkshireEast’sHealthyHeartsteamachievednationalrecognitionafterscreeningmorethan700peopleforheartproblems.Theiraimistoreach20%ofpeoplewhoaremostatriskofheartproblemsbutdonothaveanexistingdiagnosis.

Bycatchingproblemsearly,peoplecanbeofferedtreatmentbeforetheirconditionworsens,maintainingtheirqualityoftheirlifeandreducingthelikelihoodofanemergencyhospitaladmission.GPsandpharmacistsarenowbeingtrainedtocarryoutmoreheartchecks,sothatevenmorepeoplecanbescreenedearlier.

BuIldInG on tHe Best

17

Communitymatron,ChrisFinegan,added:“TelehealthenablesustointerveneearlierwhenaCOPDpatient’ssymptomsworsen,andearliertreatmentmeansabetteroutcomeforthepatient.Itimprovestheirqualityoflife.”

mAkinG more time for pAtient cAre on WArds

TheProductiveWardprogrammehasbeenintroducedacrosscommunityhospitalsinNHSBerkshireWesttohelpstaffspendmoretimeondirectpatientcare.Staffhavebeenabletoanalysehowtimeisusedonandaroundthewards.Forexample,simplystoringitemsinthebestplacecansavehoursofnursingtimeotherwisespentonfetchingandreturningthem.Inadditiontohelpingnursesandtherapistsspendmoretimeonpatientcare,italsoimprovessafetyandefficiency,boostingtheaimsofdeliveringsafe,highqualitycaretopatients.

teleheAlth keeps people independent in BuckinGhAmshire

SixtyBuckinghamshirepatientswithconditionssuchasdiabetes,chroniclungdiseaseandcoronaryheartdiseasearebenefittingfromaTelehealthsystem.

Thesystemtakestheirpulse,oxygenlevels,bloodpressureandweightmeasurementsatregularintervalsandsendsthemtoalocalcommunitymatronorspecialistnursetomonitorremotely.Previouslytheywouldhavetomakefrequenthospitaltripstohavetheirconditionmanaged.

MargaretRobsonfromAylesbury,wholiveswithCoronaryObstructivePulmonaryDisorder(COPD),said:“ThemonitorisveryreassuringandIwouldn’tbewithoutitnow.Knowingthereissomebodyonhandallthetimehasputmecompletelyatrest.”

18

sAfe, heAlthy stArts for children And younG people

TheFamilyNursePartnershipinSloughprovidesyoung,first-timemotherswithadditionalvisitsandsupportbeforeandafterthebirthoftheirchild.Studieshaveshownthatthisprojectwillimproveoverallhealthoutcomesforchildrenandreduceobesityastheygrowup.

TheLittleAcornChildren’sCentreatStMark’sHospitalwashighlightedasanexampleofgoodpracticeforsuccessfuljointworkingbetweenhealth,socialcareandeducation.Speechandlanguagetherapyandbreastfeedingsupportwereidentifiedasstrengths.

oxyGen therApy At home

PatientswithlungproblemsinNHSBuckinghamshireareincreasinglyhavingoxygentherapyathomeratherthaninhospitalwiththeaimofimprovingtheirqualityoflife,givingthemgreaterchoiceandcontroloverthemanagementoftheirconditionandreducinghospitaladmissions.

BettyWiggfromAylesburysaid:“WheneverIsufferfromshortageofbreath,Igoontotheoxygenmachinebasedinmyhome.Iprefercareathome.Icangetonwithmyday-to-daylife,andIhavethefreedomtodowhatIwant.There’snoneedtogointohospital.”

LesleyHarridge,CommunityMatron,said:“Aswellasreceivingoxygenathome,seniorclinicalstaffseepatientsasoftenasisnecessary.Thismaybeonceortwiceamonth,oreverydayiftheyareacutelyunwelltoensurethattheyaremakingagoodrecovery.”

neW WAlk-in centre reducinG A&e AttendAnce

Anewwalk-incentreatUptonHospitalinSloughisreducingthenumberofpeoplewhovisitA&Eunnecessarily.Open8am–8pmeveryday,patientscandropintoseeadoctorornurseforfast,effectiveandconvenienthelpforawiderangeofminorillnessesandinjuriesincludinginfections,cutsandburns.AboutaquarterofpeopleattendingA&Ecouldhavebeentreatedmoreappropriatelyelsewhere.Thewalk-incentreishelpingtobringthatfiguredown.

supportinG cArers to cAre

InNHSBerkshireEast,voluntaryorganisationshavebeencommissionedtoproviderespitecareforyoungcarersandpeoplewithmentalillnessordementia.Recognisingtheimportantrolethatcarersplay,theaimistosupportcarersintheircaringroleandalsotosupportthemtohavealifeoftheirown.Activitiesincludedtraining,practicalhelp,transport,shortbreaksorgroupactivitiesandthecarershavewelcomedtheinitiative.

19

We have tried to make sure that we have not used any jargon in this document. however, you may come across some words that you are not familiar with, and may hear some of the following used in discussions about the vision and our plans.

Acute:Usedtodescribeadisorderorsymptomthatcomesonsuddenlyandneedsurgenttreatment.Itisnotnecessarilysevereandisoftenofshortduration.Acuteisalsousedtodescribehospitalswheretreatmentforsuchconditionsisavailable.

Benchmarking:Benchmarkingistheprocessofcomparingbusinessprocessesandperformancewiththebestintheindustryorfromotherindustriestohelpidentifywhereimprovementsinqualityandcostcanbemade.

clinical best practice:Thetechnique,methodorprocessthathealthcareexpertsbelieve,basedonevidence,isthemosteffectiveforanyparticularconditionorsituation.

clinicians:Aprofessionaldirectlyprovidinghealthcareservices.

commissioners:Ateamofpeopleresponsibleforidentifyingwhathealthcareserviceslocalpeoplewantandneedandforcommissioning(whichmeansarrangingandbuying)theseservicesontheirbehalffromproviders.Thetermiscurrentlymostoftenusedtorefertoprimarycaretrusts(PCTs).

community health services:Careprovidedoutsidehospitalbynurses,midwives,therapistsandotherprofessionals.

day surgery:Asurgicalprocedurethatdoesnotinvolveanovernightstayinhospital.

diagnostics:Testsandscans,suchasX-rays,bloodtestsandMRIscansandotherprocedurestohelpidentifythecauseorextentofaproblem.

Gps (General practitioners):Doctorswhoworkfromalocalsurgeryorhealthcentreprovidingmedicaladviceandtreatmenttopatientswhohaveregisteredontheirlist.

health inequalities:Thegapbetweenthehealthofdifferentpartsofourpopulationbecauseofwheretheyliveortheirbackground.

life expectancy:Theaveragenumberofyearsanindividualcouldbeexpectedtolive.

long-term conditions:Long-lastingillnessessuchasdiabetes,heartdiseaseandasthma.

multidisciplinary team:Agroupofhealthandcareprofessionalswhoprovidedifferentservicesbutworktogethertoprovidecomplementaryservicesforpatients.

paediatrics:Thebranchofmedicineconcernedwiththetreatmentofinfantsandchildren.

pathways:ThepatientpathwayistheroutefollowedbyapatientthroughandoutofthevariousNHSandsocialcareservicesthattheyneed.

planned care: Carethatispre-arranged,suchasscheduledhospitaloperationsoroutpatientappointments.

practice nurse:AnurseworkinginaGPsurgery.

primary care trust (pct):Responsibleforidentifyingwhathealthcareserviceslocalpeoplewantandneedandforcommissioning(whichmeansarrangingandbuying)theseservicesontheirbehalf.Oftenreferredto,forexample,asNHSBerkshireWest.

specialist nurse:Expertsinthediagnosisandtreatmentofcertaintypesofconditions.

stakeholders:People,groupsororganisationswhocanaffectorbeaffectedbyanorganisation’sactionsorhaveaninterestinitswork.IntheNHS,thetermusuallyappliestothebroadrangeoforganisationsandpartnersthatworkwiththeNHSandholdittoaccount,suchaslocalcouncils,voluntaryandcommunityorganisations,privateproviders,patientandcarerrepresentativegroups,LINks,MPs,etc.

urgent care:Careserviceswhichpeopleneedtouseunexpectedly.ItincludesA&Eand999services,butcanalsoincludeemergencyappointmentswithGPs,visitstowalk-incentresorminorinjuries’units.

Vulnerable patients:Someonewhomaynotbeabletotakecareofthemselvesbecauseofamentalhealthproblem,adisability,becausetheyareoldandfrail,orhavesomeformofillness.

Working time directive:Alawthatlimitsthenumberofhourssomeonecanwork.Ithasmeantchangestothewayhospitalsarestaffedovernight.

GlossArY

Thisdocumentisavailableinlargeprint,Brailleandonaudiotape.Ifyouwouldlikethisdocumentinanotherlanguageorformat,pleasecontactus:

By post:CarefortheFuture,57 - 59BathRoad,Reading,BerkshireRG302BABy telephone:01189822789By email:careforthefuture@nhs.net

Thisdocumenthasbeenproducedbytheprimarycaretrusts(PCTs),acutehospitalsandprovidersofcommunityhealthservicesinBerkshireandBuckinghamshire:

• BerkshireHealthcareNHSFoundationTrust• BuckinghamshireHospitalsNHSTrust• HeatherwoodandWexhamParkHospitalsNHSFoundationTrust• NHSBerkshireEastPCT• NHSBerkshireWestPCT• NHSBuckinghamshirePCT• RoyalBerkshireNHSFoundationTrust

WearebeingsupportedbyNHSSouthCentralStrategicHealthAuthorityandworkingcloselywithSouthCentralAmbulanceServiceNHSTrust.

September2010

Ky dokument është rreth planeve tona për të përmirësuar shërbimet e kujdesit për shëndetin në gjithë Berkshire dhe Buckinghamshire. Ju kërkon mendimet dhe komentet tuaja. Nëse këtë dokument e doni të përkthyer, ju lutemi nga kontaktoni në mënyrat e dhëna më poshtë.

Este documento refere-se aos nossos planos de melhoria dos serviços de cuidados de saúde em Berkshire e Buckinghamshire. São-lhe pedidos os seus pontos de vista e comentários. Se necessitar deste documento traduzido, por favor contacte-nos (consulte os nossos dados abaixo).

本文件是关于我们改善整个伯克郡 (Berkshire) 和白金汉郡 (Buckinghamshire)之健康护理服务的计划。它征求了你的看法和建议。如果你需要本文件获得翻译，请按照下列的详细说明与我们联络

Dokumantiganu waxa uu ku saabsan yahay qorshahanaga lagu casriyaynayo adeega daryeelka caafimaadka ee deegaanada Berkshire iyo Buckinghamshire. Waxana lagaa codsanayaa aragtidaada iyo wixii faalo ah. Hadii aad rabto in laguu soo turjubaano dokumantigan, fadlan nagala soo xidhiidh xidhiidhadan hoos ku xusan

Acest document prezintă planurile noastre cu privire la îmbunătăţirea serviciilor de sănătate în Berkshire şi Buckinghamshire şi vă solicită părerile şi comentariile dumneavoastră. Dacă aveţi nevoie de traducerea acestui document, vă rugăm să ne contactaţi la datele de contact de mai jos.

دا سند په ټول برکشاير او بکينګهم شاير کې د روغتيايي خدماتو د ښه کولو په اړه زموږ د پالنونو په هکله دی. په سند کې ستاسو د نظرونو او څرګندونو غوښتنه شوې ده. که د دغه سند ژباړې ته اړتيا لرئ،

مهرباني وکړئ له موږ سره تماس ونيسئ. د تماس جزييات الندې ورکړل شوي دي.

यो कागजात बर्कशिर तथा बकिङघमशिर क्षेत्रमा स्वास्थ्य सेवालाई सुधार गर्ने हाम्रो योजनाको बारेमा हो । यसलाई तपाईंको विचार र सुझावहरुको आवश्यकता छ । यदि तपाईंलाई यो कागजातको अनुवाद चाहिएमा, कृपया हामीलाई निम्न ठेगानामा संपर्क गर्नुहोस् ।

تتناول هذه الوثيقة خططنا المتعلقة بتحسين خدمات الرعاية الصحية في بيركشاير Berkshire وباكنجهام شاير Buckinghamshire. وتطلب هذه الوثيقة الحصول على أرائك ومالحظاتك حول هذا األمر. وفي

حال رغبتك بترجمة هذه الوثيقة، فيرجى اإلتصال معنا على العنوان التالي:

यह दस्तावेज बर्कशायर तथा बकिंघमशायर में स्वास्थ्य सेवाओं को सुधारने की हमारी योजनाओं के बारे में है. इसमें आपके विचार तथा टिप्पणियाँ पूछी जाती हैं. यदि आप इस दस्तावेज का अनुवाद चाहते हैं तो कृपया हमसे निम्नांकित विवरण पर संपर्क करें

يہ دستاويز بارکشائر اور بکنگهم شائر ميں صحت کی خدمات کو بہتر بنانے کے ليئے ہمارے منصوبے کے بارے ميں ہے۔ اس ميں آپ کے نظريات اور خياالت کے بارے ميں پوچها گيا ہے۔ اگر آپ کو اس

دستاويز کا ترجمہ درکار ہو تو برائے مہربانی نيچے دی ہوئی رابطے کے تفصيالت کے ذريعے ہم سے رابطہ کيجئے۔

Dokument ten dotyczy naszych planów poprawy usług medycznych na terenie Berkshire i Buckinghamshire. Prosimy w nim o Państwa opinie i komentarze. Jeśli potrzebują Państwo tłumaczenia tego dokumentu, prosimy skontaktować się z nami – dane kontaktowe znajdują się ponieżej.

ايہ دستاويزبرکشائرتے بکنگهم شائردے لئی صحت دی ديکه پہال دياں خدمتاں نوں چنگا کرن دے لئی ساڈياں منصوبياں دے بارے وچ ہيگی اے۔ ايہ تہاڈے وچاراں تے خياالں دے بارے وچ آکهدا اے۔ جے

تہانوں ايس دستاويزدے ترجمے دی لوڑ ہيگی اے تے، مہربانی کردياں ہوياں تهلے دتی ہوئی تفصيل تے ساڈے نال رابطہ کرو۔