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Why do we need to change?
All of us need the NHS - but some need it even more than others. We now have a very sound body of medical and scientific evidence, as well as patient feedback, on how best to care for and treat people with particular conditions. We must ensure that such knowledge is applied to the way services are delivered.
The NHS has three agreed clinical priorities - coronary heart disease, cancer and mental health. These priorities have been established for good reason. They must be translated into practical effect both in national policy and investment and in local action and change. To help achieve this:
Services Frameworks in the three clinical priority areas
In addition to the three clinical priorities, there are specific conditions and groups whose needs we can and must address better. This section is not a comprehensive list, but seeks to highlight some of the main areas in which changes and improvements can be made.
Coronary heart disease
Coronary heart disease (CHD) affects 500,000 people in Scotland and is one of the main causes of death and disability. At any one time, about 180,000 people suffer symptoms.
Much has already been done to tackle the effects of the disease and reduce waiting times, but reducing the impact of heart disease on Scottish life needs greater focus on primary and secondary prevention to ensure this disease is detected early.
For example, up to a third of men have high blood pressure, but only a third of them are receiving the treatment they need. Progress is being made:
These initiatives will continue to improve access to diagnostic services and reduce waiting times for treatment. For example, the waiting time for treatment for a coronary artery bypass graft is now an average of 20 weeks.
Following the Acute Services Review, the National CHD Task force was set up to conduct a comprehensive review of services in Scotland. Key issues identified in the review are:
To tackle these issues:
IT'S HAPPENING ALREADY...
Paisley has one of the worst heart disease records in Scotland. The Have a Heart Paisley national health demonstration project will lead efforts to prevent CHD and identify lessons for the rest of Scotland. It has been awarded £6 million by the Scottish Executive. Over a three-year lifespan, Have a Heart Paisley will create opportunities within the community that will lead to a long term, sustainable reduction in the town's rate of heart disease. Community health organisations are already working locally, and by linking with these and other groups, Have a Heart Paisley can make a real impact on the causes of heart disease.
More than 26,000 people in Scotland are diagnosed with cancer every year and more than 15,000 die. But survival from cancer has improved significantly over the last 20-25 years and we want to maintain that improvement:
Continued improvements in cancer survival rates require continued effort on a number of fronts. Better awareness and prevention, earlier diagnosis and better, faster treatment all have a part to play in reducing both the incidence of cancer and the deaths it causes.
We are investing more than ever before to secure the very best care
for everyone, and we must make sure that our cancer services continue to respond to the challenges ahead.
"My daughter had cancer, the nurses and doctors in the hospital and the hospice were excellent."
We are well aware that waiting, whether to confirm a diagnosis of cancer or for subsequent treatment, adds considerably to the anxieties and worries experienced by patients, their relatives and carers. We are determined to alleviate these concerns and to improve our diagnosis and treatment services by driving down waiting times for everyone with cancer. To deliver these pledges, a significant programme of work will be undertaken by the Scottish Cancer Group:
"The worst thing is worrying and not knowing."
During 2001, our investment in new equipment and additional staff is expected to improve waiting times for diagnosis for patients with symptoms suggestive of bowel cancer and lung cancer.
"MORE THAN 26,000 PEOPLE IN SCOTLAND ARE DIAGNOSED WITH CANCER EVERY YEAR "
People can do much to prevent cancer by adopting a healthy diet, stopping smoking and exercising more.
Tobacco is responsible for around 33% of all cancer deaths. Our commitment to encourage adults to stop smoking and persuade young people not to start is confirmed elsewhere in this Plan.
We have recently invested £16 million in new equipment to fight cancer from a £30 million allocation announced in July 2000.
This is in addition to a £13 million package of investment to replace ageing linear accelerator equipment. We have also announced an extra £8.4 million to be used to recruit 320 specialist staff for the NHS, including 10 new consultant doctors, mostly for cancer services.
Between a quarter and a third of the people we asked thought improvements were needed to speed up test results.
We are committed to quicker, better diagnosis and quicker, better treatment for patients.
IT'S HAPPENING ALREADY...
One-stop breast clinics allow women in a single appointment, to see a doctor, have many of the essential screening tests and get the results the same day. This reduces waiting lists and the anxiety caused by the wait between tests and results.
Better information and better communication can significantly reduce worry and anxiety but, patients and their families are often unable either to access information or receive the support they need to gain most benefit from it. This situation must be addressed:
"What I really needed was information all through the process which I could understand and which made me less scared."
Mental health and learning disability
Poor mental health can come at any time and affect anyone. One in five adults in Scotland is affected by mental health problems in any one year, and at least 30% of GP consultations have a psychological component. A high proportion of people who sleep rough suffer from mental health problems, and these may be associated with drug or alcohol misuse.
People want modern mental health services that make a difference by improving the speed, responsiveness and the quality of care through:
We will accelerate the implementation of the Framework for Mental Health.
We will look for ways to overcome the stigma that can attach to poor mental health and will develop a national framework to address unacceptably high rates of suicide - especially among young men. We will continue to support and encourage positive initiatives already being taken forward at local level. In particular:
Anxiety and depression contribute to a much wider community health problem. We will support further development of extended mental health services in primary care settings and encouraging the development of crisis services and community mental health initiatives
"WE WILL ACCELERATE THE IMPLEMENTATION OF THE FRAMEWORK FOR MENTAL HEALTH "
One priority will be the needs of women suffering from post-natal depression, which can have profound consequences both for women themselves and their children. Another priority will be addressing the mental and other health needs that result from the experience of sexual abuse and male violence more generally.
Standards are being developed to ensure that mental health services across Scotland are consistently of the highest quality.
We will continue to monitor and apply national standards as they are developed and will expect the NHS to ensure these standards are met locally.
We are reviewing the legislation on mental health in Scotland and await the recommendations of the Millan Committee. These will inform the development of a modern legislative framework to meet the needs of people with a mental illness who need care and support both in hospital and the community.
Some people with mental health problems come into contact with police and the courts. Many of these people do not present a risk to the public or to themselves, but in every case that risk is assessed before care responses are agreed.
People with a learning disability
For too long, people with severe mental health problems and learning disability have been kept in the shadows - often in institutions. We are determined to change that.
In May this year, we launched the learning disability review report The Same as You?. The report is the first in-depth analysis of services for people with learning disabilities in Scotland for over 20 years. It offers a framework for the next 10 years.
The report puts people first. It will improve their lives by promoting social inclusion and changing public attitudes, improve the way professionals work, give services a new focus and improve how they are delivered. It recognises the important contribution of housing, employment, leisure and recreation to helping people with learning disabilities lead full lives.
"THE REPORT PUTS PEOPLE FIRST. IT WILL IMPROVE THEIR LIVES "
People with a physical disability
All care journeys should reflect individual circumstances, but this is particularly important for people with physical disabilities, their families and those who care for them.
Removing the barriers that confront people with impairments will also promote the inclusion of others. For example, installing a ramp may help people with young children, and accessible information using clear simple language will benefit most people.
Many people suffer from exclusion from society by virtue of their wider circumstances. This exclusion can extend to healthcare services. It is important that the NHS acts in partnership with other agencies to ensure that the health needs of excluded groups are met effectively.
Palliative care deals with the total care needs of people including relief from pain and other distressing symptoms, and with social and spiritual issues. Family and carers are also involved. People need this care when illness cannot be cured. Specialist palliative care is provided through voluntary hospices and through specialist units in NHS hospitals, supporting the palliative care offered by primary care teams.
Palliative care has been associated almost exclusively with cancer, and is regarded as applicable only in the terminal phases of an illness. In fact palliative care has much wider application, including heart failure and many progressive conditions, such as motor neurone disease, Parkinson's Disease, Multiple Sclerosis, HIV/AIDS and now CJD. Good palliative care must be available to all those who need it regardless of diagnosis.
Palliative care involves a wide range of professions and disciplines, especially as it is provided in a range of settings, including people's homes.
Chronic medical conditions
People with chronic conditions such as diabetes, asthma and neurological conditions may access health and social services, especially in the acute or later stages of illness. Acute hospital services provide vital diagnosis and treatment, but the management of chronic conditions is largely the responsibility of patients, their families and supporters. People need easy access to the care and treatment they require as their life changes over time. Although people may require regular hospital services, the majority of people with chronic conditions look after themselves, supported by carers, family and community based health professionals. People with chronic conditions want to be provided with the support to enable them to lead as full and active a life as possible. They want to control their conditions rather than let the conditions control them.
"THE MAJORITY OF PEOPLE WITH CHRONIC CONDITIONS LOOK AFTER THEMSELVES, SUPPORTED BY CARERS, FAMILY AND COMMUNITY"
There are well-organised, well-informed patient support groups for most chronic conditions. These groups possess a powerful and valuable insight into the spectrum of needs of people suffering from enduring health problems. We want to ensure that these support groups are closely involved in service design and delivery at both a local and national level.
People want support and recognition for the key role of those who support them, often their own family, or neighbours, helped by their GP practice. However, that vital and practical help from therapists and others is not always available. Specialists do not always adopt a 'whole person' approach when identifying problems and providing solutions.
Elsewhere in this Plan, we have made a commitment to set up 'Partners in Change' programmes in each NHS Board area. These programmes will be developed initially with chronic disease groups.
Much of this can be achieved by adopting a Managed Clinical Network approach which crosses traditional boundaries between primary, secondary and tertiary care. In addition, Managed Clinical Networks ensure a co-ordinated approach which involves patients' groups, social work, voluntary organisations and other key partners.
The value of MCNs as an innovative and appropriate contribution to managing many neurological conditions has been recognised by many groups, including the MS Society in Scotland, the Scottish Partnership Agency for Palliative and Cancer Care, the Parkinson's Disease Association and the Epilepsy Association.
Diabetes is a major underlying cause of heart disease in Scotland. It is a chronic disorder which can lead to a number of serious complications, not only affecting the heart and circulation but also the nervous system, kidneys and eyes.
Although there are SIGN guidelines already in place and much work being done in diabetes, we need to consolidate and build on this in order further to raise the standard of care.
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