Sustainable Seven Day Services

Access to services was a common theme raised throughout the Conversation.  You told us that you’d like services to be more accessible and available where and when you need them. You also expressed a need for more flexibility and ease when making appointments and discussed the option of out-of-hours services and community hubs.  Some of these issues were explored in our last blog on Primary Care (insert link).  This blog will focus more on your comments around seven day services and better access to care in the community.

To do so, Mark Lawson from the Scottish Government’s Sustainability & Seven Day Services Programme tells us more:

Q. Mark, throughout the Conversation there were many comments about seven day services.  Can you tell us more about the role of the Sustainability & Seven Day Services Taskforce, and its current work to address some of these issues?

A. The Scottish Government established a ‘Sustainability & Seven Day Services’ Task Force in late 2014. The Task Force, supported by a small Programme Team, is responsible for taking forward work to ensure that Scotland can provide sustainable services for the future across 7 days.  By undertaking this work, we are aiming to ensure a consistent level of high quality care across the whole week for those people who require urgent or emergency care.  This essentially means that we want to make sure that patients who are already in hospitals have access to the tests and services they need irrespective of the day of the week, and can be discharged across seven days. We also want to ensure that people are only admitted to hospitals when they really need to be there. To achieve this, part of our work is considering how new models of care can deliver a better experience for patients, whilst treating them in a place that is best suited to their needs.

It is important, however, that people are aware that our work is not about providing all services on a 24/7 basis. A good example of this is that we are not looking at being able to provide a routine eye operation at 3am on a Sunday morning. For a start this is not what the majority of patients would want, and it would not be sustainable for NHS Scotland either.

Progressing this area of work is a huge task; so it is being taken forward in a number of stages. The Task Force has already overseen a lot of work to understand what services are already available across Scotland, and further work is now being taken forward which, amongst other things, includes initiatives to support the medical services offered by Scotland’s Rural General Hospitals, reviewing the services provided by the 29 sites in Scotland that undertake acute surgery; and considering new models for reviewing and reporting diagnostic imaging.

Q. People also told us that hospitals are not the best place for people to be treated unless they really require it, and that they would like to have easier access to services in their community.  Is this something that the Taskforce is exploring?

A. Yes.  One of the key aims of the Government is to make sure that people have better and easier access to health services at home and in their local community.  Too many people currently end up in acute hospitals, for both short and long stays, when this treatment could be provided closer to their homes. To achieve this, part of our work is considering how new models of care can deliver a better experience for patients, whilst treating them in a place that is best suited to their needs.  This includes testing of innovative ‘Community Health Hubs’ in both Fife and Forth Valley, starting in early 2017.

In the long term we anticipate that through these Hubs the local population will be able to access a range of services in a community setting which they would normally have to travel to an acute hospital for. A unique feature of the Hubs is that part of the healthcare team will be a new type of doctor – qualified GPs who will receive an additional year of training to give them the skills to work across community and hospital settings. We anticipate that a variety of other health workers such as advanced nurse practitioners, allied health professionals and prescribing pharmacists will also be based in the Hubs to ensure that patients will have access to an appropriate member of the health workforce for their needs.

Q. Can you tell us a bit more about each of the test sites?

A. The exact details of how each test site will be set up and function are currently being developed by the Health Boards. We recognise the importance of ensuring that the Hubs are responsive to the needs of their local communities, and as such each will be tailored to local requirements. There will, however, be a number of similarities between the Fife and Forth Valley test sites, as both will have a minor injuries unit, a number of short stay beds and will provide some out of hours service.

In terms of what local people can expect, the Hub GPs will serve to strengthen local services already provided in the community – for example ‘Hospital@Home’ in Fife. Over time we hope that this will result in fewer people being admitted to acute hospital where it’s not absolutely necessary.

In cases where someone is not well enough to be at home, but does not require a specific intervention or treatment that can only be provided in an acute hospital, admitting them to beds in the Hub will offer a short-stay alternative that does not currently exist.

The Hubs will, therefore, allow a patient to be treated in their local community – closer to their home, friends and family and in a more homely setting, without the disruption to their lives that is caused by a prolonged stay in an acute hospital.

Q. Are there any plans to extend the pilots further?

A. There are no immediate plans for more test sites at this stage. We will, however, be monitoring how successful the two test sites are.  An evaluation of the Hubs will be undertaken over two years to enable us to see what aspects have been successful and what could be done better. We also want to understand if this can improve patient experience and help keep people out of hospital who don’t need to be there.

Q. How can members of the public get more involved or find out more?

A. If you would like any further information on Community Health Hubs you can contact the Sustainability & Seven Day Services Programme Team on 0131 244 5994 or by e-mailing Luke.McPherson@gov.scot.

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