Controversies will arise in NHS

Transforming Tayside agenda aims to address challenges being faced

Medical experts are planning for our future good health and there is a lot at stake.

The man leading the development of an integrated clinical strategy for NHS Tayside says it is “inevitable” there will be controversies when the proposals for changing healthcare in Tayside are shared with the public.

Professor Colin Fleming, a consultant in dermatology at Ninewells Hospital and the lead in NHS Tayside’s Clinical Alliance, said the Transforming Tayside agenda aimed to develop new service models to meet the “significant challenges” facing the NHS. These include caring for an ageing population, a growing demand for services, workforce challenges and continuing pressures on public finances.

Effective service delivery is key, and Professor Fleming said NHS Tayside is working on a plan which “starts with looking at what we really need”.

At the heart of that discussion is the way in which acute hospital services are delivered.

“We want to think of that as the starting point,” he said. “How do we best deliver those services? How do we rearrange our beds to best deliver those services? How do we maximise the way our theatres are run?

“Because if you get that bit right – that flow of emergency stuff coming through – then that lets you know what you can do in a more planned fashion.”

The public will soon join the discussion, and change to our health care service is inevitable.

In an interview with The Courier at Ninewells, Professor Fleming said: “By the middle of July we need to have set up a series of possible options for how we change healthcare in NHS Tayside.

“Those options need to be fully costed and narrowed down. There’s then a fivemonth consultation which is really about ‘what is the public view of this and what is the political acceptability of the changes we are suggesting?’”

After that, there will be a report back to the board by December. Elective care is an area coming under close scrutiny.

“One example we’ll need to consider very carefully is a new elective care centre for delivery of surgery but where we put that in NHS Tayside has yet to be determined and that has to go through a process where you carefully look at the clinical and financial considerations,” Professor Fleming said.

A further stage is to “think about how we deliver planned care in a cleverer way. For example we know with surgical techniques, modern anaesthetics, we can change many of those patients from being inpatients in hospital to being day patients spending more time at home. One of the core planks of what we would like to do is really maximise the day case patient opportunities.

“That does two things – it gives you better outcomes because patients are not hanging around in hospital beds.

“But it also reduces the cost of surgery because you are not paying for those patients to stay in a bed overnight. You don’t have the nursing staff and all the associated costs with that.

“That’s an example of how we think we can really get efficiencies in the service and actually improve the care of patients.”

Professor Fleming said there was “no single answer” to the pressures facing the NHS. Some fundamental questions had to be asked about what’s a “fair expectation” of health services.

His biggest concern was the global scale of the healthcare challenge and the need to successfully bring the public along as proposals for review emerged.

Simply “throwing money” at the system, however, was not the answer.

He added: “If you look at the USA – they spend more than twice the budget we do per person on healthcare and have the same outcomes as Costa Rica that spends one eighth of what the USA spends.”

Big picture thinking, and thinking holistically, are also key.

“Throwing money at healthcare in an un-thought of manner does not lead to good outcomes,” Professor Fleming added, “and this is something where I think we are learning, and it’s one of the reasons I think we can be optimistic about improving NHS Tayside.

“We have a lot of doctors who are beginning to learn about finance and a lot of doctor managers who are learning how to manage better. We have a lot of individuals now working in joined up ways to understand the whole system. And we haven’t had to do that, actually, until relatively recently.

“The problem with being around for 70 years is that it has aggressed 70 years of good practice and 70 years of bad practice in the culture.”