With NHS services under increasing pressure in the modern world, health boards are searching for ways to ease the strain.
In its annual review NHS Forth Valley has highlighted a number of priorities over the next five years which include reducing the number of delayed discharges and waiting times, tackling the challenge of GP shortages and providing alternatives to hospital submission.
Improvements are being made in key areas, but more work is needed in others to meet targets. The review shows a significant improvement in waiting times with the number of patients treated within the 18 week referral to treatment (RTT) period rising from 89.9 per cent to over 93 per cent up to June this year.
Delayed discharges – patients unable to leave hospital due to a lack of available care in their home environment – did show a sharp increase this year as the total beds lost rose to 900 in July compared to a low of 76 in April this year.
The report said: “Performance against the four week target has been variable across the year. Although performance in the last quarter showed an improving trend ... the position has not been sustained into the new financial year and performance against the new two week target is currently challenging.”
There was a reduction in staff absences which sat at 4.71 per cent when recorded in July. This figure is above the national HEAT target of four per cent, but it decreased from a winter high of 5.5 per cent and was below the national average in April.
The report states the issue “remains challenging and a high priority for managers across the organisation”.
The number of people waiting less than four hours to be seen at A&E remains lower than it should be and is also a “key priority”.
The report says: “Variability in performance persists at times with ‘wait for assessment’ and ‘wait for bed’ being the key reasons for patients breaching the four hour wait. Significant activity is underway to improve consistency in our performance.”
Action being taken includes reviewing staffing levels and skills, support for morning and weekend discharges across hospitals and ensuring escalation plans are in place during peak periods.
The health board also highlighted other areas of achievement as progress on plans to integrate local health and social care services; work on the Maggie’s Centre at Forth Valley Royal Hospital; significant investment in medical equipment; and the development of the new mental health centre at Falkirk Community Hospital.
Alex Linkston, chairman of NHS Forth Valley, said: “Our recent annual review provides an opportunity to update local people on the progress made over the last year and outline some of the key priorities for the year ahead.
“These include developing a new healthcare strategy which will set out our plans and priorities for the next five years, continuing to work with our council partners to reduce delayed discharges and delivering more care and support in the community to help provide more alternatives to hospital admission.”
Redesigning primary care
One of the major challenges facing NHS Forth Valley and the rest of Scotland is the shortage of GPs in local practices.
Part of the problem is that general practice is not viewed as an attractive career option in the medical profession and when older GPs retire the vacancies aren’t filled leaving shortages like the situation at Kersiebank Medical Practice in Grangemouth earlier this year.
The practice was at crisis point when it was reduced to just two GPs when it previously had eight to care for 10,000 patients, which had to be cut to deal with the shortage.
To tackle the issue the local health board is redesigning its primary care strategy and has introduced a new system of multi-disciplinary staff so that patients will be seen when they need to.
After taking responsibility of the practice in May, NHS Forth Valley has put in place four salaried doctors who are supported by a team of locum GPs and a number of GPs from neighbouring practices.
Patients also have access to a wider healthcare team which includes four advanced nurse practitioners, two community mental health nurses, two pharmacists and a team of paramedic practitioners.
When appropriate and with the patient’s consent, they could be seen by one of the other health professionals such as the pharmacist or the mental health nurse according to their needs.
Another project being pioneered is the Advice Line For You (ALFY) which is currently running in Bo’ness as a pilot.
It’s a partnership with Falkirk Council’s social work department that provides round-the-clock health and social care for older people.
The aim is to provide services in the community that would allow patients to stay in their homes, decrease the amount of admissions to hospitals and in turn help lower the number delayed discharges.