Integrated Care at Home
Our vision is for a Scotland where people live longer healthier lives at home or in a homely setting, underpinned by our ambitions for care that is person-centred, safe and effective. That will mean more care being provided locally to avoid the need to go into hospital where a better alternative can be provided in the community.
To achieve this, we need integration across health and social care services, forging partnerships between patients, their families and service providers.
James in our film lives with Chronic Obstructive Pulmonary Disease (COPD). Following multiple admissions to Ninewells Hospital in Dundee he was referred to the COPD specialist nursing team, who were able to organise a home nebuliser, a pulmonary rehabilitation programme, and daycare at Roxburghe House. A self-management structure, including a plan for rescue medication, has been developed.
Before James’ current care plan, he was in hospital around once a month. Since the COPD specialist team’s first visit in December 2016, he’s been admitted just once. Quality of life for him, and for his wife, has improved considerably.
Supporting People to have Greater Choice and Control in Social Care
The Social Care Act of 2013 gives people in Scotland a choice about how their social care is organised and delivered. This approach - called Self-directed support (SDS) - is based on the understanding that greater control leads to improved health and wellbeing, and means that clients and families can have significant influence on how the budget for their care is spent.
Between 2011 and 2017, the Scottish Government invested £60.4 million to help transition to new SDS structures. More than 53,000 people a year - almost half of all social care clients - are now receiving SDS.
Self-directed support can bring particularly dramatic benefits for families facing complex challenges. In our film we meet twelve-year-old Grant and his mum Elaine, along with Grant’s carer Aidan.
Grant has a number of conditions which together make managing his health and comfort difficult - so much so that conventional practice would mean him living in residential care. Self-directed care has enabled his parents to keep their son within the family home. A team of carers, managed largely by Elaine, supports Grant at home, at school and on visits to his favourite places.
Providing Specialist Nursing and Care
Motor Neurone Disease
In 2015 the First Minister announced an additional £2.5 million per year to provide more and better specialist nursing. Since then NHS Boards have created more than thirty additional roles for specialist nurses, who are now supporting patients and families across hospital and community settings throughout Scotland.
Motor Neurone Disease (MND) is a terminal illness that can cause sufferers to lose the ability to walk, talk and even breathe unaided - although not all patients experience all symptoms to the same degree. Specialist MND nursing can allow people with the condition to continue living comfortably at home, accessing support and services when they need them and planning for the future when their condition may deteriorate. Since 2015 the number of MND specialist nurses has more than doubled, and a National Co-ordinator has been appointed by the Government to develop a national strategy in collaboration with MND Scotland and the University of Edinburgh.
Susan Stewart is an MND specialist nurse based at Aberdeen Royal Infirmary. In our video she speaks about her role in co-ordinating care and support for Philip, who also appears in the film along with his wife Diane. She has developed links with Robert Gordon University, as well as third-sector organisations including MND Scotland, Sue Ryder, and local carers’ groups. In helping to look after Philip, Susan has also become a family friend.
Improving Cancer Outcomes
When Fred met Liz
For most common forms of cancer, early detection can dramatically improve the chances of effective treatment. But as Liz says in our film, the first symptoms can be hard to spot, and many people won’t think of seeing the doctor until the disease is more advanced. That’s why screening for early signs is a major life-saver.
The Detect Cancer Early Programme combines marketing, digital engagement and work with primary care, NHS Boards and the third sector to promote screening and early presentation. In the last year alone, the Programme has run campaigns on screening for bowel, lung and breast cancer, resulting in a significant increase in early-stage diagnosis and treatment. Overall cancer death rates in Scotland have dropped by over ten per cent in the last ten years, and work to detect cancer early will help that trend continue.
In this film, comedian and broadcaster, Fred MacAulay - who featured in the campaign to promote screening - meets Liz, who saved her own life by doing a simple bowel cancer test.
Promoting Physical Activity
Football Fans in Training
Football Fans in Training - or FITT - is an initiative run by the SPFL Trust, with funding from the Scottish Government. Thirty-two football clubs across the country now provide structured fitness and weight loss programmes to fans, and around 3,000 men have taken part so far. Now the scheme is being extended to women, and rolled out in the English leagues and the German Bundesliga.
A randomised trial found FFIT participants lost an average of over five kilos in the first year, and a research team is now following up to see if they managed to keep the weight off in the longer term. The cost-effective scheme has attracted men who might not otherwise do much physical activity, and as well as diet and exercise, the scheme addresses issues around alcohol, mental health and social isolation.
This video features fans and organisers from the Cowdenbeath FC FFIT programme. As director Tom Ewing says in his interview, the club benefits from a strengthened relationship with the local community, making FFIT a win-win game for everyone involved.
Making Change Happen
NHSScotland is its people. Our talented, hard-working staff deserve to be valued and supported - and we know that when they’re treated well, the end result is better care and improved patient outcomes. This commitment is reflected in our 2020 Workforce Vision, which states that we ‘will create a great place to work, and deliver a high-quality healthcare service that is among the best in the world.’
Supporting our staff begins with recruitment and training, and continues through the day-to-day working experience. It’s also vital that our culture allows and rewards engagement, feedback and teamwork, from the sharing of constructive ideas to a robust and supportive response to whistleblowing.
This video touches on several aspects of staff policy including: iMatter, a continuous improvement model that involves staff in making the decisions that affect them and their clients; integrated assessment working; and the bursary and free tuition for student nurses.
Achievements in Numbers
Satisfaction with NHSScotland
Satisfaction with NHSScotland remains high, with 90 per cent of hospital inpatients who participated in the Scottish Inpatient Patient Experience Survey 2016 reporting overall care and treatment to be good or excellent, and 87 per cent who responded to the Health and Care Experience Survey 2015/16 rating the overall care provided by their GP Practice as good or excellent.
The Cancer Patient Experience Survey provides high-quality national and local data on patients’ experiences of cancer care. The results found that 94 per cent of patients rated their care positively (giving an overall rating of seven out of 10 or above).
The Maternity Care Experience Survey presented a very positive picture of women’s experiences of maternity care overall. In most instances women said that they received excellent care from staff, with 92 per cent of women rating their care during labour and birth as either excellent or good.
Making Healthcare Safer
The Scottish Patient Safety Programme (SPSP) is a unique national initiative that aims to improve the safety and reliability of healthcare and reduce harm whenever care is delivered.
Within acute care there has been an overall reduction in Hospital Standardised Mortality Ratios (HSMR) of 8.4 per cent, between January and March 2014 (first quarter after new baseline) and January and March 2017 (most recent quarter), with 11 out of the 29 hospitals having a greater than 10 per cent reduction. We have also seen a 21 per cent reduction in mortality from sepsis.
There have been substantial reductions in HAI. Figures published in July 2017 show that cases of Methicillin-resistant Staphylococcus aureus (MRSA) have reduced by 90 per cent and cases of Clostridium difficile in patients aged 65 and over have reduced by 87 per cent since 2007.
Improving Unscheduled Care
In 2016/17, 94.1 per cent of patients were seen, treated and discharged or admitted within four hours in Scotland’s A&Es. This is the best performance since 2011/12. Scotland continues to see the best A&E performance across the UK administrations – and has done for over two years.
The Scottish suicide rate reduced by 18 per cent between the periods 2001-2005 and 2011- 2015, using five-year rolling averages (European Age Standard Rates) – from 16.7 per 100,000 population to 13.7 per 100,000 population. Suicide is extremely complex so it is impossible to ascribe any single reason for the long-term downward trend in the suicide rate. However, over the past several years a range of Scottish Government-funded actions have been underway to help improve mental health and wellbeing.
Detecting Cancer Early
Overall cancer death rates have dropped by 10.6 per cent over the past ten years and early detection is vitally important to continuing this trend. In the combined calendar years of 2015 and 2016, 25.5 per cent of lung, breast and colorectal cancers were diagnosed at the earliest stage, an increase of 9.2 per cent on the baseline combined calendar years of 2010 and 2011.
As a result of improved treatments and a greater focus on prevention, premature mortality (deaths among those aged under 75 years) has reduced substantially, down 16 per cent since 2006 to a death rate of 439.7 deaths per 100,000 population in 2016.
Improving the Health of the Population
The latest Scottish Health Survey reveals encouraging progress in reducing smoking rates. It shows that 21 per cent of adults now smoke – one in five adults in Scotland. There was also a decrease in the percentage of children who were exposed to second-hand smoke in the home (11 per cent to 7 per cent).
Scotland continues to be seen as a world-leader in addressing alcohol-related harm. It was recognised several years ago that Scotland’s relationship with alcohol had become unbalanced, and bold action has been taken to tackle alcohol misuse. Alcohol Brief Interventions (ABIs) play an important preventative role in tackling this as part of a wider strategic approach to addressing problem alcohol use. In 2016/17, 86,560 ABIs were carried out, exceeding the target of 61,081 by 42 per cent.
Our workforce is our greatest asset and is key to delivering modern, sustainable health services. NHSScotland needs to have a committed, supported workforce that has the right skills, flexibility and support. Our 2020 Workforce Vision is that we will respond to the needs of the people we care for, adapt to new, improved ways of working, and work seamlessly with colleagues and partner organisations.
In 2016/17, spending on health received an above inflation increase and rose to almost £13 billion. NHS Territorial Boards received a 5.5 per cent increase compared to 2015/16 budget levels. This included an additional £250 million which the new Health and Social Care Partnerships invested in social care under arrangements for the integration of health and social care.
Over the course of this Parliament, the NHSScotland revenue budget will increase by £2 billion, which will enable shifting the balance of care to mental health and to primary, community and social care, and will include additional investment of £500 million in primary care.
This means that, for the first time ever, more than half of frontline spending will be on community health services, delivering primary, community and social care. In 2017/18, funding on health has exceeded £13 billion.
Despite the increased level of resources, it is clear that more needs to be done than simply giving the NHS extra money – which is why our plans for change and approach to investment and reform are so important.
NHSScotland is committed to supporting a culture of openness that welcomes feedback, comments, concerns and complaints, and uses them all as a source of intelligence to drive continuous improvement.
There were 23,507 complaints made about NHS services in Scotland in 2016/17. This was a 10 per cent increase compared to the previous year, reflecting a better awareness of how people can make a complaint and increased confidence that their complaint will be listened to and acted on.
NHS Boards must listen to all complaints received, learn from them and take action where necessary in order to continuously improve services.
NHSScotland continued to engage with the independent website Care Opinion, which provides an online route for people to share their experiences of care – whether good or bad – and to use this to improve care.
There were 2,637 stories shared on Care Opinion about NHSScotland in 2016/17, of which 62 per cent were positive, and these stories were viewed over 880,000 times. The increasing number of experiences shared has been mirrored by the numbers of NHS staff accessing the site, with over 780 staff now reading stories, a 48 per cent increase on the previous year. Sixty-eight changes and improvements to services were made or planned as a direct result of stories shared in this way.
Here are just some of the stories posted and some of the resulting actions taken*.
My mother was admitted with stage 4 lung cancer and pneumonia. The care our mother received was fantastic and due to this ward being very busy nothing was an issue to any of the staff…. Your staff have been exceptional. I have nothing but praise on the staff and service we received.
Relative of patient, Ayr Hospital, NHS Ayrshire and Arran
[My husband] was placed in a seat by one of the staff and told to wait there until his name was called. He did wait, for 2½ hours, by which time he was shivering with cold as his seat was opposite a door. My husband is almost 91 years old and suffers from loss of memory so you will understand I was very concerned. I sincerely hope this is a very unusual occurrence.
Relative of patient, Crosshouse Hospital, NHS Ayrshire and Arran
I was distressed to hear your post. We have let you down in the most fundamental aspect of a clinic visit and I am truly sorry for this. Thank you so much for giving us the opportunity to address this issue to prevent anyone else experiencing it and once again apologise for the distress both of you experienced.
I have recently gone through a course of radiotherapy for prostate cancer at the Beatson. …The receptionist escorted me to the waiting area on the first day and every visit after greeted me each time I arrived… For someone who has in their life had very little to do with hospitals I found the experience very re-assuring that we have such professionals working in our Scottish NHS service.
Patient, Beatson West of Scotland Cancer Centre, NHS Greater Glasgow and Clyde
I have been attending the Breast Clinic annually for many years. I was to undress for my routine examination. No privacy and no gown offered... I believe that no one should have to undress in front of a health care professional unless they require and ask for assistance, and that all patients should be provided with the means of maintaining dignity and therefore they are only exposed for a minimal period of time.
Patient, Gartnavel General Hospital, NHS Greater Glasgow and Clyde
Breast examination is a very vulnerable and distressing time for patients and we always ensure that the curtains are closed round prior to undressing and we ensure that gowns are provided if the patient wishes to use them. I would like to apologise that this was not offered to you on this occasion.
My daughter had a small procedure done at Larbert hospital on the ambulatory ward. From start to finish we looked after really well, the receptionist was polite and helpful, the nurse was friendly and kind and the doctor did a great job of putting myself and daughter at ease. They explained the procedure, what the strategy was going to be and throughout were thoroughly caring, thoughtful and professional in every way.
Relative of patient, Forth Valley Royal Hospital, NHS Forth Valley
My daughter has a five and a half week old baby who attended x-ray department to have an ultrasound scan carried out..... during the procedure baby started crying. My daughter was upset as her baby still didn’t settle and she was told she should have fed her baby before appointment which she had done. ….No empathy was shown at any time towards her or her baby, she felt totally unsupported and she left the x-ray department in tears.
Relative of patient, Forth Valley Royal Hospital, NHS Forth Valley
Since receiving your posting, as a department we have discussed what facilities we can provide within the x-ray department for parents who wish to feed their baby, to ensure parents are given dignity, privacy and time. We now have in place a number of options available to parents when they need to feed their baby.
What I found exceptional was the standard of care by all the Doctors and nursing staff who adopt a very professional attitude in all aspects of the treatment……It's difficult to single one out and perhaps not fair as they were all good …Many thanks to all, you have much to be proud of and for me the NHS is brilliant.
Patient, Wishaw General Hospital, NHS Lanarkshire
The ward is piloting a new 24hr visiting initiative where relatives can visit their loved ones around the clock. My one negative about this initiative is that it is not conducive to patient convalescence, some patients may need their rest to gather their strength,... I witnessed several visitors not leaving the room when patients were being consulted by their ward doctors.
Patient, Wishaw General Hospital, NHS Lanarkshire
We are currently testing “open visiting” across the hospital following on from our successful implementation of John’s Campaign which demonstrated benefits for our patients and their families. During our test we will be speaking to patients, visitors and staff, to consider the benefits and any associated challenges with unrestricted visiting times, I will ensure your points are included in our evaluation.
My Grandmother was recently taken into Raigmore having taken very unwell. ..At each step along the way, the healthcare professionals were brilliant. .. …. my Grandmother eventually received palliative care and sadly passed away, the nurses brought us blankets and pillows so we could sit with her through the night. They made us endless amounts of tea and offered each of us a shoulder to cry on. In her last days my Grandmother was afforded dignity and treated with the utmost respect, for this my family are very grateful to the brilliant nursing teams in Raigmore Hospital.
Relative of Patient, Raigmore Hospital, NHS Highland
I recently attended the early pregnancy clinic at Raigmore Hospital. As is unfortunately so often the case I received some distressing news….I had to immediately leave the room and exit into the area where happily pregnant ladies were passing through. I find it shocking in this modern age that there is no designated room close to the consulting room for ladies to sit after they have received such news in order to compose themselves.
Patient, Raigmore Hospital, NHS Highland
I have now had a chance to discuss your feedback with the divisional midwifery manager for the area. .. She has assured me that steps are being taken to resolve your situation happening again by two developments. While they are restricted for space they have now identified an area that with some small changes, can be used to separate early pregnancy women from those in at a more advance stage of pregnancy. The second thing they are doing is reviewing how clinics are run and are looking at scheduling, appointment setting and overall environment.
I was treated for a broken ankle after a fall on holiday in the Hebrides and had to have an operation in the hospital. The treatment I received from all the staff was fantastic. … Their professionalism too was amazing….The after-op treatment was first class too. All the staff are a credit to the NHS and I will remember their kindness for a long time as will my wife who was as impressed as myself at the treatment received.
Patient, Western Isles Hospital, NHS Western Isles
I had an appointment at the Stornoway Hospital for a hearing test, an appointment I had waited three months for. Having had a lengthy trip to the hospital I arrived to find the audiologist was off sick and the appointment had been cancelled. ….. I’m not sure when I’ll get another appointment and whether I’ll have another wasted round trip to Stornoway. Not easy when you’re getting on a bit.
Patient, Western Isles Hospital, NHS Western Isles
The issue you raise is one that the hospital management and outpatients team was already aware of and had been discussing recently. I can advise that all patients from that clinic have been reappointed and should receive letters of appointment within the next couple of days…We try hard to improve our services based on the comments we receive from our patients, and your feedback helps us to do this.
* These stories are abridged versions of the stories and responses posted. For more Care Opinion stories visit: www.careopinion.org.uk