NHSScotland Chief Executive's Annual Report 2011/12

CHAPTER 1 DELIVERING HIGH QUALITY HEALTHCARE FOR SCOTLAND

Significant progress has been made in recent years through impressive improvements in waiting times for access to high quality healthcare services and treatments. We have a world-leading patient safety programme which is making a real difference to standards of care and to hospital mortality. We have made substantial progress on issues as varied as access to GPs and dentistry, support for people with long term conditions, and outcomes for cancer, stroke and heart disease. We are producing improved outcomes for people in terms of reduced need for hospitalisation, shorter stays, faster recovery and longer life expectancy.

Through our Healthcare Quality Strategy for Scotland* (Quality Strategy) we have set ourselves three clearly articulated and widely accepted ambitions based on what people have told us they want from their NHS: care which is safe, effective and person-centred.

THE QUALITY AMBITIONS

Safe - There will be no avoidable injury or harm to people from healthcare they receive, and an appropriate clean and safe environment will be provided for the delivery of healthcare services at all times.

Effective - The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit and wasteful or harmful variation will be eradicated.

Person-centred - Mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making.

We are already seeing real progress in terms of positive impacts for patients, including:

• improvements in safety in our hospitals have resulted in an 11 per cent reduction in Hospital Standardised Mortality Ratios (HSMR) since 2007^[1];
• improvements in care for people aged over 65 has reduced the number of emergency bed days between 2008/09 and 2011/12 by over 170,000 bed days, based on current estimates^[2]; and
• a reduction in the rates of Clostridium difficile infections of over 78 per cent since 2007/08^[3].

LOOKING AHEAD - THE CHALLENGES

We all know that the demands for healthcare and the circumstances in which it will be delivered will be radically different in future years. Over the next few years we must ensure that - in the face of these demands and changing circumstances - we can continue to provide the high quality health service the people of Scotland expect and deserve into the future. In order to achieve this, we must collectively recognise and respond to the most immediate and significant challenges we face - which include Scotland's public health record, our changing demography and the economic environment.

Over the next 10 years the number of over 75s in Scotland's population - who tend to be the highest users of NHS services - will increase by over 25 per cent. By 2033 the number of people over 75 is likely to have increased by almost 60 per cent^[4]. There will be a continuing shift in the pattern of disease towards long term conditions, particularly with growing numbers of older people with multiple conditions and complex needs such as dementia.

Scottish public expenditure will fall in real terms in the period to 2014/15. The revenue position for the NHS has been relatively protected. However, that vital protection needs to be seen in the context of the global pressures on health spending. To meet these pressures, NHS Boards have delivered £313 million of efficient government programme savings in 2011/12 to be retained locally.

We must be bold enough to visualise the NHS that will best meet the needs of the future in a way that is sustainable, and then make the changes necessary to turn that vision into reality.

OUR VALUES

The Scottish Government has been clear that it remains committed to the values of NHSScotland: the values of collaboration, co-operation and partnership working across NHSScotland, with patients and with the voluntary sector; of continued investment in the public sector rather than the private sector; of increased flexibility, provision of local services and of openness and accountability to the public. The Scottish Government will not follow the route being considered by the NHS in England as their response to the global challenges.

OUR '2020 VISION'

Our vision is that by 2020 everyone is able to live longer healthier lives at home, or in a homely setting.

We will have a healthcare system where we have integrated health and social care, a focus on prevention, anticipation and supported self management. When hospital treatment is required, and cannot be provided in a community setting, day case treatment will be the norm. Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions. There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission.

ACTION REQUIRED

• We need a shared understanding with everyone involved in delivering healthcare services which sets out what they should expect in terms of support, involvement and reward alongside their commitment to strong visible and effective engagement and leadership which ensures a real shared ownership of the challenges and solutions.
• We need to develop a shared understanding with the people of Scotland which sets out what they should expect in terms of high quality healthcare services alongside their shared responsibility for prevention, anticipation, self-management and appropriate use of both planned and unscheduled/emergency healthcare services, ensuring that they are able to stay healthy, at home, or in a community setting as long as possible and appropriate.
• We need to secure integrated working between health and social care, and more effective working with other agencies and with the third and independent sectors.
• We need to prioritise anticipatory care and preventative spend, e.g. support for parenting and early years.
• We need to prioritise support for people to stay at home/in a homely setting as long as this is appropriate, and avoid the need for unplanned or emergency admission to hospital wherever possible.
• We need to make sure people are admitted to hospital only when it is not possible or appropriate to treat them in the community - and where someone does have to go to hospital, it should be as a day case where possible.
• Caring for more people in the community and doing more procedures as day cases where appropriate will result in a shift from acute to community-based care. This shift will be recognised as a positive improvement in the quality of our healthcare services, progress towards our vision and therefore the kind of service change we expect to see.

The pursuit of our Quality Ambitions defined by the priorities areas for improvement as set out in the six healthcare Quality Outcomes will be the way in which we take the above action and achieve our 2020 Vision.

THE HEALTHCARE QUALITY OUTCOMES

Everyone gets the best start in life, and is able to live a longer, healthier life

NHSScotland works effectively in partnership with the public and other organisations to encourage healthier lifestyles and to enable self care, therefore preventing illness and improving quality of life.

People are able to live well at home or in the community

NHSScotland plans proactively with patients and with other partners, working across primary, community and secondary care, so that the need for hospital admission is minimised.

Healthcare is safe for every person, every time

Healthcare services are safe for all users, across the whole system.

Everyone has a positive experience of healthcare

Patients and their carers have a positive experience of the health and care system every time, which leads them to have the best possible outcomes. This should be demonstrable across all equalities groups.

Staff feel supported and engaged

Staff throughout NHSScotland, and by extension, their public and third sector partners, feel supported and engaged, enabling them to provide high quality care to all patients, and to improve and innovate.

The best use is made of available resources

NHSScotland works efficiently and effectively, making the best possible use of available resources.

The approach used to deliver these outcomes continues to be grounded in the principles of mutuality and co-production, working with people to create and sustain a culture where quality thrives and where the contribution of every individual is recognised and valued. This is about making the right thing easier to do for every person and at every opportunity.

The Quality Strategy has already led to real enthusiasm and opportunities for innovation, partnership working and more effective and efficient delivery of services. It has become the backdrop and context for local and national setting of priority areas for action and improvement in the delivery of healthcare services across Scotland. This annual report shares the initiatives and achievements already underway which have made a positive difference to people, and provides an opportunity to recognise this work and to value the work of staff and colleagues.