2020 vision - nhs shetland€¦ · 2020 vision is a project initiated by shetland nhs board (the...

Fitting together a

vision of future

health and care

services in Shetland

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NHS SHETLAND 2020 VISION – 33

CONTENTSIntroduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Our Vision of Shetland Health and Care in 2020 . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Summary of Key Themes of 2020 Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

INTRODUCTION

2020 Vision is a project initiated by Shetland NHS Board (the Board) in September2002, to determine the optimum shape of sustainable health and care services inShetland over the next 15 to 20 years. Divided into 2 phases, 2020 Vision Phase 1defined the principles of service planning and presented the case for a new hospitalfacility for Shetland, which the Board then decided was not an affordable option atthat time. In 2004, the Board developed 2020 Vision Phase 2 to look at the future ofhealthcare in Shetland from a service delivery perspective. The aim of this piece ofwork is to present our longer-term choices for future service requirements in Shetland,and the recommendations that will help us to achieve this.

A mix of local and national issues will bring change to Shetland healthcare services inthe years to come. National issues include policy changes aiming to better coordinatehealth and care services and to break down invisible barriers between where care isprovided and by which professionals. European legislation has brought limitation onworking hours, to both ensure high quality of service for patients and quality of life forstaff. Local issues include the consistent challenges presented by remote and ruralgeography: transport, recruitment, fragile small-scale services and balancinggeneralist and specialist skills. Additional concerns specific to Shetland include thechallenge of sustaining currently high standards of community care services that arefunded by rapidly depleting local resources, and future instability of the economy as awhole with potential decline of oil and fishing industries in particular.

NHS SHETLAND 2020 VISION – EXECUTIVE SUMMARY4

5NHS SHETLAND 2020 VISION – EXECUTIVE SUMMARY

OUR VISION OF SHETLAND HEALTH & CARE IN2020

In 2020 … Shetland continues to deliver high quality, localhealth and care services, which have developed toensure they are suited to the needs of thepopulation in 2020. We make best use of ourcommunity strength, community spirit andinvolvement, which has helped to shape our servicesas well as our way of life. People feel responsibletowards each other within their own community.Self-help includes making healthy lifestyle choices,and people using their knowledge and owncapacity to look after themselves and each other.

In 2020 … Recognition of the positive elements of Shetlandlife and determination to preserve them has beenachieved through a united approach across thelocal public sector, communities and commercialinterests. Through necessity, Shetland’s economyhas diversified to maintain high levels ofemployment. We value our local environment,which we work hard to protect and share withthose who visit to admire it. We have also foughtsuccessfully to achieve investment in remote andrural areas in Shetland, to allow us to buildsustainable, viable communities. Thesecommunities and Shetland as a whole continue tovalue diversity and promote equality; both withinour everyday lives and in the way we deliverservices.

In 2020 … We have fought hard against, and continue totackle, the major threats to our health – fewer than10% of people in Shetland smoke, we have cutobesity by 50%, the whole community has beenencouraged into more exercise and healthiereating. We teach and support children andfamilies in emotional and mental well-being froman early age, and have changed the impact ofearly death and illness from the major preventablediseases.

6 NHS SHETLAND 2020 VISION – EXECUTIVE SUMMARY

In 2020 … People are in control of not just their own health,but how they use services and make decisionsabout their own care – working in partnership withprofessionals. Development of technologies hasbrought electronic patient records that patientscan hold and carry with them. Communicationtechnologies, such as the internet andvideophones, are routine public facilities that havebeen integrated into service delivery. This hashelped to improve professional and patient accessto diagnostic tests, information and advice, andto enable remote consultations for patients,helping to counter some of the isolation of remoteisland living that can affect access to services.

In 2020 … Community and primary care services (first accessservices) are provided in localities from flexibleshared facilities for the range of services that canbe provided close to people’s homes (for instance,schools and community education sharingfacilities with leisure and social activities as wellas health and social care staff). We have closerelationships amongst teams in local areasmaintaining continuity of care and ‘family healthand care’ services. The high quality infrastructureof Shetland care services have been maintainedand are used flexibly to support people and enablethem to be cared for in their local communities,whether they live with disabilities or are frail andelderly. Integrated local community transportensures equitable access to all health and careservices, made as easy as possible for those livingmost remotely.

In 2020 … People with disabilities live their lives to their fullpotential within their local communities,supported as necessary either within their ownfamilies or living independently. In addition toemployment and/or social support as necessary,communities have taken on the skills andknowledge to include people with disabilities in allaspects of life.


In 2020 … Shetland’s population receive emergency care,assessment, diagnosis, treatment and a range ofsub-specialist care through the local Remote andRural General Hospital. Multi-disciplinary teamsproviding these services consist of consultants,nurses, allied health professionals and clinicalsupport staff who work within flexible, patient-friendly facilities to deliver care in a way that cutsacross traditional and professional boundaries toprovide a patient-centred hospital service. Ourlocal workforce delivers care in all availablefacilities across Shetland, using locality facilitieswhere possible and the hospital only wherenecessary. Staff are skilled in roles relevant to thelocal service to deliver the range of care neededlocally. For additional specialist and tertiary care,patients travel to mainland centres, but onlywhere care cannot be delivered safely andefficiently in Shetland. Transition through theseexternal services is smooth thanks to efficienttransport links, the use of a single patient recordsystem and appropriate local support.


SUMMARY OF KEY THEMES OF 2020 VISION

2020 Vision Key Theme 1 – NATIONAL DIRECTION

Content: Looks at the current national direction of the NHS in Scotland andconsiders how national NHS policies may impact on Shetland.

The Vision: As an integral part of the National Health Servicein Scotland, NHS Shetland will continue to have localgovernance and local control over decision-making. We willuse our Vision to actively raise awareness of Shetland issuesat a national level - to ensure that Government policies takeaccount of and support the unique and successful elements ofour service structures.

2020 Vision Key Theme 2 – SHETLAND PUBLIC

Content: Looks at the current and future involvement of the public in planning anddelivery of healthcare, and considers this in the context of lifestyles in Shetland.

The Vision: To encourage those living in Shetland to workclosely with service providers, to help plan and build servicesthat are suited to Shetland life, and the health and careneeds of the population. We aim for everyone in Shetland tolive within and contribute to healthy communities, and totake greater personal responsibility for their own health.

2020 Vision Key Theme 3 – SAFETY & QUALITY

Content: Looks at the structures in place within the NHS to assess and improve thestandard and quality of health and care services. We describe how NHS Shetlandworks within the National Health Services but also some unique features of localservice delivery that, although different to arrangements in larger Board areas,continue to deliver high standard of services to Shetland.

The Vision: We will work to achieve national recognition thatthe small-scale of Shetland services breeds patientsatisfaction, and a close network of communication amongststaff that provide high quality services. To enable fullrecognition of this quality, we will encourage nationalassessment and monitoring arrangements that place greaterfocus on the outcome of services, rather than the processes bywhich they are delivered, and that recognise processes thatare appropriate for the local context.

2020 Vision Key Theme 4 – WORKFORCE

Content: Reviews the current processes of national workforce planning and theneed to develop the NHS workforce. Considers specific workforce challenges forShetland and local and national solutions that could help overcome them in thefuture.

The Vision: The future health and care workforce in Shetlandwill continue to deliver services in a way that is suited toShetland life, and so must retain as many specialist skills aspossible within individuals whose expertise is based on amuch broader range of general skills. In order to maintainthese skills, all staff must have good access to local andnational CPD opportunities and training for remote andrural practice will be built into national schemes.

We will work hard to achieve excellence in partnershipworking between social, voluntary and healthcare providersthat will continue to improve the efficiency and quality ofservices.

2020 Vision Key Theme 5 – TRANSPORT

Content: Illustrates the central and influential impact of transport on life and publicservices in Shetland, and considers how improvements to infrastructure could helpimprove the delivery of healthcare services in Shetland.

The Vision: Shetland will build a public transport network thatserves all communities in Shetland, to enable good access toall public services, both to those within a local area and tocentralised services in Lerwick. Improving connectionsbetween Shetland’s islands will help to ensure that this accessis Shetland-wide, and that emergency services are as efficientas possible. We will continue to lobby for affordable andreliable external transport links out-with Shetland, with acontinuing need for some patients to be sent out-withShetland for some specialist services.


2020 Vision Key Theme 6 – FACILITIES

Content: Identifies the current high standard of healthcare facilities in Shetland, andlooks to future requirements in the context of other Key Themes.

The Vision: In the future, community-based facilities will beshared between all public service providers – helping todeliver the vision of community health partnerships. Hospitalfacilities will fit with public expectations, and can be sharedflexibly between different patient groups and healthcareprofessionals, as well as incorporating rooms for family,friends and carers. New medical and informationtechnologies will help to create more flexible use of facilitiesand supported environments, including people’s homes, toenable those with additional support needs to live asindependently as possible.

2020 Vision Key Theme 7 – MEDICAL TECHNOLOGIES

Content: Considers future developments in diagnostics and treatments, and whatthey might mean for Shetland services.

The Vision: Advances in medical technology, and improvingscientific knowledge, will bring smaller, more portable, fasterand more accurate forms of diagnosis, including geneticscreening and less invasive methods of assessing diseaseconditions. We are likely to see more preventative drugs, todeter or slow the progress of disease, and next–generationtherapies, such as new surgical techniques and stem cellregeneration therapies. These developments will bring a newera of healthcare and if more affordable, could bring morenew technologies to Shetland to help support local services.


2020 Vision Key Theme 8 – INFORMATION &COMMUNICATION TECHNOLOGIES

Content: Considers how new information and communication technologies arelikely to impact on our everyday lives in the future, and how these technologies couldbe used to improve the delivery of healthcare.

The Vision: The way in which we make contact with each otherwill continue to be influenced by developing technologiessuch as videophones, wireless internet connections, hand-heldcomputers etc. Together with improved information storagesystems, these technologies should be incorporated into servicedelivery to increase the options for how we make contact withservices; improve communication between professionals andwith patients; make most efficient use of staff time; andimprove support for those living most remotely.


RECOMMENDATIONS

From this 2020 Vision Phase 2 study, we have identified the following series ofrecommendations that will be required to enable us to achieve our future vision. Theyare categorised into the different levels to which they are directed.

NATIONAL – Scottish Executive Health Department

R1 PRINCIPLE OF SUSTAINABILITY RECOGNISED AS NATIONALPOLICYSustainability of health services in remote and rural areas is important not onlyfor the health and healthcare of people living in these areas, but also for thecontribution health services make to the sustainability of the whole community– the local economy and social infrastructure. It is essential that nationalpolicies recognise and promote the principle of sustainability of services inremote and rural areas – this must be coupled to commitment for positiveinvestment in services in these areas.

R2 RECOGNISING HIGH QUALITY OUTCOMES OF SERVICE INSHETLAND, BECAUSE OF THE LOCAL SERVICE FEATURESShetland’s geography, small-scale of service areas and small population haveinfluenced the arrangement of our health services and in some ways, has led tothe evolution of unique arrangements and working relationships. Though thesediffer from larger urban areas, (perhaps because of this) Shetland continues todeliver high quality services and good clinical outcomes, meeting nationaltargets on access (e.g. waiting times) and national standards of care, as well ashigh levels of satisfaction amongst the local population.

Management and governance arrangements need to be appropriate andsensitive to the scale and context of remote and rural services.

We need success in terms of standards of service to be measured by theiroutcomes, and by processes sensitive to local circumstances, to give credit tothe ways in which services are delivered locally (where they work for patients),and for those standards to be devised with some remote and rural input.


R3 REMOTE & RURAL GENERAL HOSPITALSThe model of ‘remote and rural general hospital’ services described in 2020,reflects a refinement of the current service in Shetland. We believe this is asustainable model for health services in remote and rural areas.

It will be helpful for national policy, through initiatives such as the currentNational Service Framework, to recognise this model within NHS Scotland, andto take the necessary measures to support its continued development.

R4 INFORMATION AND COMMUNICATION TECHNOLOGYAt present, the limitations on the use of I&CT in Shetland are largely due to thelack of facilities and use made of technology in mainland services. This limitsopportunities for distance learning for professional training and development,for management and clinical networks, and for patient services. A concertedprogramme of targeted investment and recognition of this technology as apriority would, with very little additional resource, make a significant differenceto the ways in which remote and rural services can communicate across theNHS.Every facility for meetings, all health facilities, every training and conferencevenue used by the NHS in Scotland should have video-conferencing /telemedicine facilities available as standard.

In addition we need the NHS to be working with industry, and findingopportunities for research and investment in the potential benefits technologycould bring to the health service via applications such as epharmacy andelectronic communications.

NATIONAL – NHS Education Scotland (NES), Training &Accreditation Bodies including The Medical,Nursing and Allied Health Professionals’ RoyalColleges

R5 ACCREDITATION OF ‘REMOTE AND RURAL’ AS A SPECIALISMThe increasing trend towards specialisation of medicine and other professions isdifficult for remote and rural areas like Shetland for a number of reasons. Weneed to provide a range of general services within a limited staff pool, within asmall scale service that does not have reliable and close links to more specialistcentres. To ensure that we can recruit professionals with appropriate trainingand expertise, we are recommending that ‘Remote and Rural’ be recognisedand accredited as a specialism by the Royal Colleges and Education bodies whooversee professional training.


R6 FLEXIBILITY AND ROLE DEVELOPMENT FOR REMOTE & RURALSERVICESMany of the skills that staff need in remote and rural areas to provide theservices that local people need, do not fit into the traditional patterns that aredescribed in current training and professional roles. Flexibility and thedevelopment of additional skills and expertise are often needed for jobs inremote and rural services.

We need to ensure that the current national workforce policies such as Agendafor Change and the new Medical and Dental contracts (and European WorkingTime Directive) are applied in ways that support staff and services locally, anddo not impose inflexibilities that get in the way of patient care.

LOCAL – Shetland Public Sector Bodies

R7 BE MORE CREATIVE ABOUT HOW WE RECRUIT AND RETAIN STAFFThe choice to work in an area like Shetland is not usually simply based on a jobdescription – it is a choice influenced by attraction to the local ‘quality of life’.We need to recognise locally what features people are attracted to, both interms of life in Shetland, and the rewards and satisfactions of pursuing careersin Shetland, and use them to promote life and work here.

R8 INVEST IN TRAINING & CONTINUING PROFESSIONALDEVELOPMENTWe must recognise the added costs of undertaking training and continuingprofessional development in Shetland, (costs that include travel and time awayfrom work and home), and positively invest in staff time and technology toovercome these.

R9 FIND SOLUTIONS TO THE LIMITATIONS OF CURRENT TRANSPORTON SERVICE DELIVERYTransport is a central consideration in planning and organising Shetlandservices. We need recognition at national level of the limitations that currentarrangements place on local services, (ambulance and commercial transportservices) and support to Shetland in the continued drive to improve. We shouldbe able to guarantee 24/7/365 connections with mainland services. Thisincludes development of local transport, particularly for those in remote andrural communities of Shetland, which can only be achieved by collaboration atboth national and local level.

We need a national transport strategy for the public sector in Scotland thatengages commercial interests, and does not disadvantage remote areas.

We need a local integrated community transport system that supports accessto health and other public services.


R10 JOINT WORKING ACROSS THE PUBLIC SECTORShetland is in a unique position to take advantage of its boundaries, and itsgood working relationships across the public sector, to the benefit of the peopleof Shetland. The shared use of facilities across the public sector and in localcommunities is one example. Other aspects of joint working need to be realisedthrough the introduction of the local Community Health Partnership, includingthe need for better integration with the Voluntary and Independent Sector.

We want to see the benefits of integrated working across services, working withand for local communities in Shetland, to deliver as efficient and high qualityservices as possible within available resources.

LOCAL – Shetland NHS Board

R11 ENABLE SHETLAND TO MAINTAIN ADVANTAGES OF CURRENTWORKFORCE & GOVERNANCE ARRANGEMENTSSome of the ways we do business in Shetland are unique and based around theway of life here and the small scale of the organisation. For example, in mostcases, managers are only one person away from direct patient care, GPs knowall their patients individually, and consultants have close relationships with GPs.

Governance arrangements in Shetland are strengthened by the power of localknowledge that is held in the local NHS Board and managers, which supportsgood decision-making.

There are also close relationships between service providers and users – all staffare potential patients and users of the local service, and staff know manypatients as friends, neighbours or relatives. All staff therefore have a high stakein service delivery.

Shetland NHS Board must continue to recognise the workforce as their mostvaluable asset in the delivery of high standards of patient care.

R12 THAT FUTURE PLANNING OF FACILITIES THROUGH CAPITALPROGRAMMES ARE BASED ON THE VISION FOR SERVICESPRESENTED IN THIS REPORTWhile new hospital facilities are not currently considered an affordable optionfor Shetland, current facilities will need replacement at some time. It is essentialthat future plans for facilities should be driven by the service vision developedthrough 2020. These future considerations must focus on flexibility to cater forthe multi-disciplinary approach that is considered the future of health and careservices.

Facilities must be environmentally sustainable, and planned collaboratively withour partners, the workforce and the communities they will serve.


R13 THAT CURRENT PROBLEMS AND CHALLENGES IN LOCAL SERVICESARE ADDRESSED AS WE MOVE TOWARDS THIS VISION OF THEFUTUREThe ideas compiled through this 2020 Vision must apply to short-termredesign issues, as well the long-term. A good example of this is the need forsmoother transition from children’s to adult’s services. The changes requiredmust be based on our future principles of partnership-based working and theneed to look at future service structures from a patient perspective.

LOCAL – Shetland Public

R14 THAT WE REALISE THE POTENTIAL FOR LIVING HEALTHY LIVESAND REDUCING ILL-HEALTH IN SHETLANDWe want to help people in Shetland to take responsibility for their own health,not only at an individual level, but also within their communities – helping ourchildren to grow up in healthy environments with good role models, and thebest chances afforded to them to live long and healthy lives. Shetland could bea smoke-free environment, where alcohol is used but not abused, and people’semotional well-being is nurtured along with their physical and mental health.

This vision cannot be delivered without the commitment and support of thepeople of Shetland. We already know that service planning and delivery ischanging for the better because of the involvement of local people in healthservices in Shetland. As well as having helped to shape the vision, it is essentialthat the Shetland public are an integral part of the process of delivering it.


NOTES


Designed and printed by SHETLAND LITHO, Gremista, Lerwick. Telephone 01595 742000.

To request additional copies of our 2020 Vision, or if yourequire the information in any other languages or formats,

please contact:

NHS ShetlandPublic Health Department

Shetland NHS Board HeadquartersBrevik House

LerwickShetlandZE1 0TG

Telephone – 01595 743340Email – [email protected]

2020 vision - nhs shetland€¦ · 2020 vision is a project initiated by shetland nhs board (the...

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