Realising Realistic Medicine: Chief Medical Officer for Scotland annual report 2015-2016 appendix

NHS Orkney

Initial thoughts

Geographically isolated communities such as Orkney can risk becoming isolated and losing touch with advances in medicine. Many older patients in Orkney are reluctant to travel to other health board areas for treatment or investigation which can often restrict the options available, however NHS Orkney sees this as an opportunity to open discussions regarding patient expectations of care. We need national and local leadership and strategies must reflect and be much honest about this. Cost effective use of resources must apply to all of us no matter where we are in the organisation. Locally, we need to find ways to involve the community much better in the difficult decisions we make - both about individual care and about strategic decision making.

What have we done so far?

Realistic Medicine principles are being spread within NHS Orkney. Barriers to personalised realistic care have been identified, with time constraints and IT infrastructure identified as needing special consideration. Care is being undertaken 'Realistically' in some areas such as goal-setting being a focus in the cardiac rehabilitation clinic, where people attending think about what they personally would like to achieve rather than every attendee having the same rehab package. A team development session on Realistic Medicine was also well received.

What next?

Good communication between specialties and across professions is very important. For example, it would be useful for the dental team to be notified early of a patient planning to start anti-reasorptive or anti-angiogenic drugs. There might be some instances where a person's oral health is so poor that the risks would outweigh the health benefits. The combination of people retaining teeth for longer and people living for longer with complex medical issues is creating a considerable challenge for the dental team. The risks associated with providing dental treatment increase and often co-operation (with daily oral hygiene and with dental treatment) diminishes. Therefore, a solid preventative programme needs to be in place for these patients in addition to choosing more conservative treatments.

Primary Care currently have a regular newsletter and this is an approach that could be considered elsewhere in the organisation in order to share information and generate discussion. Managed clinical networks ( MCN) share a suitable way to come together for mutual support and to work through guidelines and action plans together.

Final thoughts

We must find a way to describe that providing treatment is not always the way to go and that patient dignity must be foremost. We must have the courage to be honest, open and balanced. Accept that we all have the right to make the decisions that are right for us. Have the courage to involve the community in difficult decisions and explain these in a manner which is open and honest.