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Future Fit.

A contribution to the debate by

David Sandbach.

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We should not tolerate this data, we should use NHS funds more effectively to reduce premature death among our fellow citizens in Harlscott and Malinslee and else where in Shropshire.

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In Shropshire we need to do the following:

• Increase health literacy and self-care capacity in the healthy population. • Increase health literacy and self-care capacity in the population who are heading

towards an acquired long term condition. • Increase health literacy and self-care capacity in the population who have long

term conditions. • Increase health literacy and self-care capacity in people who are born with or

have acquired disabilities by accident or as a result of the ageing process and frailty.

• Increase health literacy and self-care capacity in people who are hard to reach

e.g. homeless people, travellers, addicts, prisoners, immigrants etc.

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Principle policy objective:Move money from Acute to Primary care services.

Reorganise Acute services and reinvest around £ 70 million into reorganised

primary care services.

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Re-invent Primary care services. The four components of a 21st Century Family Doctor Service.

Diagnostic and treatment and referral service as now plus Urgent care capacity and point of care diagnostics.

Health promoting and LTC / independent living support e.g. annual health plan / med recs access / at home assessment.

Civic health issues service and interaction with local community.

Market intelligence (PH) and evidence based change service.

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I want:• NHS funded access to Genomic testing routines.

• NHS funded medical al la BUPA “Essential Health” type testing annually.

• Access to my GP and hospital records.

• An annual written health plan worked up with my family doctor or practice nurse.

• A practice with enough labour and equipment to do point of care diagnostics.

• A practice which is video conference enabled P2home, P2P and P2Hospital.

• A practice with enough labour to support integrated care delivery preferably in home.

• A practice with enough labour to support health and self-management routines.

• A practice with enough labour to support me when I acquire a LTC.

• A practice with enough labour to engage in local civic development programs.

• A practice with enough labour to engage in PH intelligence gathering which can be converted to evidence based change at practice level.

• A practice with enough labour to help me die a good death.

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I want:

Urgent Care services delivered in my home by well trained and well equipped Paramedics.

Admission to a virtual Urgent Care bed and to receive my care from A&E or MAU using a virtual ward system.

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I want:

The CCGs to contract for 300+ digitally enabled virtual beds.

Serving people who can be cared for at home using a combination of digital health delivery techniques plus professional out reach staff and their own in home resources.

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I want this kind of service:

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I also want access to body worn in home sensors as part of an integrated hospital and virtual ward service.

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And this

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I want to get from here

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I want two A&E departments.

????? TBD

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I want:

My RSH or PRH out patient appointment to be held in the town centre i.e. Shrewsbury or Telford.

Ditto my planned diagnostic appointments e.g. MRI, CT, Ultrasound, Plain film.

Ditto my Phlebotomy, Cardio test, Physiotherapy appointments.

Why? My time is very valuable and I like to use it efficiently i.e. health appointment then onto my club or into M&S to buy my supper.

Also access, equity, pollution and commercial stimulation considerations.

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I want a health hub with the following:

• Children and family support centre.• Local access point for social care, social benefits, housing issues,

legal aid, police / crime stoppers.• Library area.• Annual Health screening centre.• Longevity support centre, self- care and wellbeing learning centre,

Assisted Living Technology and eHealth demonstration area.• Voluntary sector offices and facilities e.g. stores.• Base for out-reach personnel – social workers, Nursing and AHPs.• e-Health e.g. Virtual Ward support centre and integrated Video

Conferencing centre.• Digital health kiosk

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I want:• RSH to do all the

Emergency in-patient work load for the county.

• RSH to house A&E department A.

• RSH to have an ITU facility.

• PRH to do ALL the planned in-patient work load for the county on a 7 day a week basis.

• PRH to be the location for all in patient work currently done at RJ&AH.

• PRH to house A&E department B.

• PRH to have an ITU facility.

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Speed and value for money.

• The capital cost of a twin track hospital service would be circa £ 10 million*

• This is because most of the capital build required is already in situ.

• The time frame for implementation would be 6 – 12 months.

• The capital cost of relocating OPD to new locations is zero – leased property policy.

* Excluding the RJ&AH component.

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I want:

• People to realise that we spend too much money on hospital buildings.

• People to realise that we should reduce the number of main NHS sites in Shropshire from 3 to 2.

• People to realise that a separate planned and emergency hospital combination is super efficient and very productive.

• People to realise that paying more attention to demand side issues (keeping people healthy) is just as important as improving supply side techniques.

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I think:• The hospital models on offer A) Centralised one hospital or B) a hot

and heavy model have been around since early in the 1990s.

• Neither stack up for socio-political reasons.

• The public need a better offer with more and easy access to GP facilities which they can trust to keep them healthy and independent as well as diagnose and treat them when they are sick.

• The public would trade off distance to planned or emergency hospital services for ease of access to locally delivered healthy living support, health care and in home care during periods of sickness.

• The public need to be able to think about change in terms of gain not loss. The positive balance of benefits equation.

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Why I feel the need to dissent.• FF PEP is flawed because it excludes consideration of too many aspects

of HEALTH and health service design.

• FF is too focused on redesigning supply side mechanisms at the expense of demand reduction and health literacy.

• FF fails to fully grasp impact of digital technology on how things will be done in the future.

• FF fails to apply fully the doctrine of production line separation.

• FF in many ways thinks that the time belonging to citizens is a free resource which does not have to be taken into account when planning out-patients and ambulatory services.