May 2012 Serving Swansea, Neath Port Talbot and Bridgend
Mar 28, 2016
May 2012 Serving Swansea, Neath Port Talbot and Bridgend
This booklet is produced by Abertawe Bro Morgannwg University Local Health Local Board
It can be downloaded from http://www.changingforthebetter.org.uk
It is also available in other formats on request
Braille
Talking Book
British Sign Language
Large print version
There is a short video on our website and YouTube as well
Write to: Changing for the Better Team, Room C4B, ABMUHB Headquarters, One Talbot Gateway, Baglan Energy Park, Baglan, Port Talbot, SA12 7BR
Telephone: (01792) 704019
Email: [email protected]
© ABMU Health Board 2012
1
Who runs your local NHS?
Abertawe Bro Morgannwg University Health Board (ABMU) is responsible for all local NHS
services in Swansea, Neath Port Talbot and Bridgend, and some specialist services for people
further away. We are responsible for GPs, dentists, chemists and opticians as well as
providing a wide range of community services like district nursing and health visiting. We
also have four main hospitals – Morriston, Singleton, Neath Port Talbot and the Princess of
Wales, as well as our community hospitals. We provide inpatient and community mental
health services and a full range of services for people with learning disabilities. In all of this
we work closely with patients, local authorities and the voluntary sector.
Why should you read this?
There are some major challenges ahead for the NHS right across Wales, including here in
ABMU. This booklet explains them, our ambitions for improving care in the future and
possible changes to get there. We want you to give us your thoughts, views and ideas.
Who should read this booklet?
Everyone who uses our services in Swansea, Neath Port Talbot or Bridgend or who might do
in the future and their families. Also everyone who works in the NHS in the ABMU area. We
want to plan services with you for the next five years to create an NHS which you can
depend on to give you the best possible service if you need it.
We run the local NHS for
the Swansea, Neath Port
Talbot and Bridgend
areas and for people who
live further away for
some specialised services.
That’s over 500,000
people!
It is really important that
everyone who uses the
NHS now, or may do in
the future, has a chance
to help shape the services
we provide for the next
five years.
2
In the coming months we will be asking you about some specific changes we think we should
be making. We will ask for your help in shaping the proposals then, but at this stage we just
want to explain why we think your NHS needs to change and how you can be involved. This
booklet sums up lots more detailed information. If you would like to read more, check the
list of documents at the end of this booklet or visit our website
www.changingforthebetter.org.uk
Why are we doing this now?
Last year, in Together for Health, the Welsh Government said that the NHS in Wales is facing
some tough challenges [see box] and should make sure all its services are “sustainable” and
“comparable with the very best”. We agree and are reviewing everything we do to make
sure that our NHS gives the best possible care to local people. We think we must act quickly
but carefully to change how we do things.
Changing for the Better is our programme for the future of the NHS in ABMU. However, the
Health Board is not doing this on its own. Since January nearly 300 people including GPs,
hospital specialists, nurses, therapists and managers as well as patient representatives,
service users, carers, voluntary sector organisations, the local authorities and Swansea
University have come together to start developing proposals. The Community Health Council
is supervising our work and we have invited experts from across the UK to advise us too.
Your NHS faces many big challenges over the next five years
The population is getting older and demand for care is going up
Health has not improved as much for some people as for others
There are serious difficulties in recruiting enough clinical staff for some services
The quality of NHS care has improved but there is still much more to do
Expectations of the NHS
are rising
Funding is very limited and will remain so
3
How can you help us?
Please help us by telling us what is important to you for your local NHS. We also want your views about the ideas in this
booklet. If you think they could be improved please give us your suggestions. But it doesn’t end there. As we think about
new ways of doing things we want you to tell us if we could do it better. We really do want to change for the better with
your help. You will find details of how you can help us later in this booklet.
Why do we need to change how we do things?
“The number of people we look after is going up every year
and the difference in health between our communities is getting worse”
ABMU Health Board provides services for over 500,000 people in Swansea, Neath Port Talbot, Bridgend and the
surrounding areas and also for some people who live further away. The population is growing steadily.
Where you live in ABMU makes a big difference to how healthy you are likely to be. Although people are generally living
longer, we know that those who are in well-off areas live on average eight years longer than people in the poorer areas.
We are concerned that this difference is getting wider as time goes by. When we look at how many years of healthy life –
where people don’t suffer from long-term illness - the gap is even greater, up to seventeen years, in fact.
4
One of the reasons for this is differences in lifestyle and how we all look after ourselves.
We want to reduce the health gap by supporting our citizens to improve their own health.
We will work with our partners and people in poorer communities to help them live healthily
and also to improve their access to health services when they need them.
Proportion of adults in ABMU who say they smoke (NHS Wales Informatics Service 2012)
Nearly 1 in 4 adults in
ABMU smoke and over
half are overweight or
obese – all factors for
poor health
Nearly a third of
pregnant women in
ABMU smoke before or
during their pregnancy
which means their baby
is more likely to have
health problems too
Only 1 in every 16 adults
eats healthily, takes
regular exercise, avoids
smoking and drinks
sensibly – the key for
good health
5
People living in well-off areas of ABMU have on average
seventeen more years of healthy life than those in poorer areas
We know that if we can do more to support people to lead healthy lives and not just treat their illnesses, it will reduce the
need for future NHS care. But we can’t do it without you! Wellness begins at home with a healthy lifestyle; so eating a
balanced diet, exercising regularly, not smoking, and drinking in moderation is very important. Only 1 in every 16 adults in
ABMU says they do all the things recommended by experts for a healthy lifestyle. In ABMU between 49% and 62% of all
adults are overweight or obese, and this increases the chances of heart disease, arthritis, stroke and cancer.
Making sure our children know how to keep healthy is particularly important for their future. Every year more children
are born in our area. We need to cope with this extra work and still provide choice for women on whether they have their
baby at home or in hospital and how much specialist support they may need to be available. If our children are going to
enjoy longer healthier lives, we will need to help them in making healthy choices from birth, through school, college and
beyond.
People are getting older, their health needs are rising but the number of informal carers is falling
People are living longer and we need more and better services for them in the future. Older people tell us that they would
like to be supported in their own homes rather than admitted to hospital. We know that older people can have poor
experiences in hospital, particularly if they have dementia or issues with continence. They are often kept in hospital longer
than they want to be because the help they need to go home isn’t provided quickly enough.
6
Already nearly one in every four beds in hospitals is taken up by people with dementia. Most
people admitted to our hospitals now are older people. We have to plan our services to make
sure we can look after more older people in their homes and communities with better and
more responsive services for them and their families. This means that we should move some
services out of our acute hospitals and provide them closer to people’s homes. We should
provide easier ways to get the help that is required. You can tell us about your ideas for this
and what you wish to see available nearer home.
For a long time we have depended on unpaid carers (partners, family, friends and neighbours)
to provide much of the care for people in their communities. As people live longer we will
need more carers to look after them. We will need to support more carers who themselves
will be getting older and under greater strain. We need to plan for this and support the carers
that we have more effectively too.
The number of people with the most common illnesses is increasing
Experts tell us that the number of people with the most common and serious illnesses in
ABMU will continue to increase, particularly as the number of older people rises and they
become more frail too. If we carry on providing care in the same way as now we will find our
services are over-stretched. This will not allow us to look after people as well as we want to.
Different ways of providing care can be much better and more personal as well as being more
cost effective, so that more patients can benefit from our help.
The number of older
people is rising and too
many of them end up in
hospital instead of being
looked after well at
home
We need to do things
differently so fewer of
them are admitted when
it could be avoided
By 2031, if nothing
changes, the number of
admissions for heart
disease will go up by
14%, lung disease 25%,
stroke 45% and cancer
13%
7
Money in the NHS is already tight and expected to get even tighter. We
need to spend our money wisely and make it go further
We have all felt the effects of the worldwide economic situation at home and the NHS in Wales
is no different. Just as we all have to manage our household budget, so the NHS has to get the
most out of every NHS £.
Every year there are new calls on the money that the NHS receives from Government, with
new treatments and technologies being created as well as the usual pressures that we all see
every day such as inflation and fuel price rises.
We have already done well to reduce our costs and deliver services within our means up to
now by becoming more efficient - by wasting less and making our services better. But we will
have to do much more in the next few years to make the money go even further. We can do
this by making sure we get things right for patients first time, preventing the harm that
happens accidentally to some patients and by focussing hard on reducing any waste. We will
need to use our staff more effectively and flexibly in the future too.
In the future we will spend more on community-based services, including your local GP
Practice, so more services can be provided for you closer to your home and so we will
spend less on hospital services.
We will do more on preventing illness to help you stay healthy. That will save money for
the NHS in the future
We will ensure the most effective use is made of our staff and resources, and that might
mean having some services in fewer places. The benefit of this will be creating expert teams
We need to make our
money go further by
reducing waste and by
getting things right first
time
We need to spend
more on community
services and preventing
illness so that we need
to spend less on
hospital services, which
can be very expensive
We need to plan for the
changes in our
population that can be
predicted already
8
under one roof to improve patient care, rather than spreading a service so thinly that it
becomes unsafe and unsustainable.
Importantly, experience has taught us that improving the quality of care often means it is less
expensive too. It can also mean that more people can be treated better in fewer places. We
know that we will have to make sure that better transport is available where this is necessary.
We need to employ the best staff for the future
We are very proud of our staff who are vital to the quality of care and experience for patients.
If we are to provide world class care we need the very best staff now and in the future.
However, it is already difficult to recruit high quality staff in some areas because there are
shortages and all hospitals across the UK are competing for them. This is particularly true for
some specialist doctors. At the moment, this means that:
We have to rely on temporary staff from agencies to fill gaps. This does not always give us
people with the right skills and qualities, is very expensive and sometimes gives patients a
poor experience of our services. We are spending nearly £3 million each year on
temporary medical staff when we cannot get permanent staff
We cannot always provide the number of junior or consultant doctors we need to run safe
services in all of our acute hospitals: this is already very difficult in some of our hospitals
and in some specialties such as children’s medicine, maternity services, emergency
medicine, casualty departments and psychiatry. This is not expected to get better. In fact
as the proportion of doctors wishing to work part time or have career breaks increases,
this problem may become worse.
Some groups of staff
are in short supply and
it is becoming very
difficult to recruit them
across the UK.
We have particular
problems in some
specialties: children’s
medicine, obstetrics,
A&E and psychiatry
We need to change
how we use our staff to
make our services safe
and sustainable for the
future
9
If our services are to keep going and meet increasing demands we need to have the right
number of permanent and well trained staff in each team and this may mean that we
cannot provide all services in every hospital.
Instead, we want our hospitals to work together in a complementary way, developing
specialist centres of excellence rather than having specialist staff spread too thinly, trying to
work across too many different sites. These specialist centres of excellence will have teams of
experts working together, offering you a better and safer service.
We want the quality of care to be as good as the very best every time
Change can be worrying for some people, but in reality NHS care is changing all the time.
Over the past couple of years ABMU has made many changes to the way we deliver care [see
box]. These changes have been designed to improve the outcome for patients – in many cases
giving them better access to clinicians, reducing their time in hospital, a faster recovery time
and better outcomes. Sometimes these changes are urgent. In many cases these changes cost
less than before too, because they are more effective and efficient.
However, it is not enough, and we want - and need - to do even more.
We are proud that some of our services already provide world class care. We have many
teams who are working in new and innovative ways in our communities and in our hospitals
to create an excellent experience for patients and users. We need to build on that excellence
so that it is there for everyone who needs it, when they need it and not just some of the time.
Some people with
chronic lung illnesses
now have most of their
care at home instead of
having to come into
hospital
People with severe
weight problems are
being helped to lose
weight without
expensive drug
treatments
Some patients with
kidney failure are
having dialysis
overnight at home
which helps them lead
more normal lives
10
For example, more people survive a stroke in ABMU now and lead independent lives
afterwards because we have streamlined our stroke units. Our services for patients with heart
attack are as good as the best anywhere. But we know that some of our services do not
always give the best outcomes. We want to make changes so that all of our patients get the
best possible standards of care each time.
We know that we could save more seriously ill people by having more of the care provided
directly by consultant specialists and by organising our services more effectively when it is
most busy, particularly in the winter.
We know that we can make childbirth safer for women having their first baby by having
specialist doctors on the labour ward for more hours each day.
We know that by changing the way we look after seriously injured accident victims, more of
them will get back to active lives again.
But we will need to reorganise the way we deliver care to achieve these ambitions.
Delivering the highest standards of medical care is becoming much more complicated.
Keeping up with the latest knowledge and practice is only possible if our consultants work in
specialist teams, sharing knowledge, developing new skills and working closely together to
provide the best care that is needed day in day out. This also makes working in our hospitals
more attractive to new doctors and will help us recruit the specialists of the future.
For some things it is
better to be looked
after in a specialist
centre with round the
clock consultant care
instead of in the
nearest hospital
More people now
survive a stroke in
ABMU because of our
acute stroke units
Patients from across
South West Wales
now benefit from our
state-of-the-art Heart
Attack service
11
We will have to concentrate some services in specialist centres across South Wales so that we
can improve the quality of care, the experience for patients and their families and the
outcomes for a whole range of conditions. This may mean that a small number of patients will
need to travel further to a specialist centre of excellence rather than being treated at their
nearest hospital, so that there are enough specialists to provide round the clock care. Of
course, the majority of services which need to be provided in a hospital will continue to be
provided in our local general hospitals.
We also know that our services can be complicated to use and our paperwork is not always as
good as it should be. We want to make it easier for people to use our services and to improve
our “customer care”. We also want to publish a quality report each year that tells our citizens
and staff openly how well our services compare with the best.
We need to increase the choice of where we provide care Patients tell us that they would like to be able to choose to have their care at home or in their
community if possible. To do this we need to build up the services we have outside hospitals
so that we can provide more in the home, in a community centre near home, the GP surgery,
local pharmacy, leisure centre or community hospital. General hospitals and our specialist
hospital will remain for those services that are best delivered safely in hospital. We can use
modern technology to support care outside hospital and keep people safely in their home
rather than attending hospital.
You tell us that you
would prefer to have
care nearer home if it
is safe to do so
All four of our main
hospitals will have an
important part to play
in providing care that
cannot be provided in
the community, but
what each hospital
does may differ
We need to make our
services easier to use
Transport is
something we need to
consider in any
changes we propose
12
We need to make our services easier to use
We want to make sure that everyone can get the treatment, test, or see a clinician when they need to.
You tell us that reducing the time it takes to see a GP or practice nurse, for operations, outpatient attendances, blood
tests, X-Rays and treatments is really important to you and can improve the experience and your quality of life
enormously. We know we can do better.
We know that making sure you and your carers can get to our services by car, public transport or ambulance is really
important. We will work with our partners in local authorities, transport and the voluntary sector to improve transport
links and to address the transport impact of any changes we propose.
You tell us that we need to work with you and your carers to plan your care together, explaining options clearly to you
without using jargon and giving you the information you want to help you choose
Summary
We believe that we can provide services in ABMU that are sustainable and consistently as good as the best anywhere, but
to do so we will need to change the way we do things. We will need to work with other Health Boards for some services.
Changing for the Better will describe how we will make those changes and we hope you will work with us now and over
coming months to help us shape the future of the
NHS
for us all
.
13
What happens next?
We will continue to work on Changing for the Better through the summer and autumn of 2012 and will be listening to what
you have to tell us before we produce a range of options to be considered. We will work with the ABMU Community Health
Council on how best to engage with our staff and citizens about the changes we think we need to make. We will provide
regular updates through our website.
Publish this booklet and a shorter information leaflet May 2012
Feedback received about this booklet. Proposals for new and better ways of
working developed & appraisal carried out to agree preferred options
May - Aug 2012
“Changing for the Better Strategy” completed October 2012
Health Board will submit proposals to the Health Minister by November 2012
Formal consultation, if required by Community Health Council November – January 2013
14
How you can get involved
We want to hear from as many of our staff and
citizens as possible and so we have asked Swansea University, independent of the Health
Board, to develop an online community, “You Tell Us™” to help us do so. Please register
at www.YouTellUs.org, where you can share your views about this booklet and about our
services and share your ideas in confidence. You can also keep up to date with future
plans for our NHS services and help shape your local NHS for the future.
Swansea University will analyse all the information that you provide and share this with
ABMU anonymously. They will publish a summary on “You Tell Us™” so you can see what
other people think. Please encourage your friends and family to sign up too! You will also
find links to our own website there and to the supporting documents referred to in this
paper.
We will work closely with local partners, stakeholders and the Community Health Council to
agree the final plans for our services and to consult on them with you as required.
If you would prefer to write to let us know what you think, please do so to:
Changing for the Better Team, Room C4B, ABMUHB Headquarters, One Talbot Gateway,
Baglan Energy Park, Baglan, Port Talbot SA12 7BR. Telephone: (01792) 704019
Email: [email protected]
Sign up to YouTellUs™
and you can tell us what
you think about this and
help us with the choices
we have to make in the
future.
It’s free and everything
you say is treated in
confidence by the
University.
Visit our website too for
the latest news!
15
Key background information (See our website for more) TOGETHER FOR HEALTH http://wales.gov.uk/topics/health/publications/health/reports/together/?lang=en
BEVAN COMMISSION – FINAL REPORT Forging a Better Future http://wales.gov.uk/topics/health/publications/health/reports/betterfuture/?lang=en
FAIR SOCIETY, HEALTHY LIVES: Marmot Report http://www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-marmot-review
SETTING THE DIRECTION
http://wales.gov.uk/topics/health/publications/health/strategies/settingthedirection/?lang=en
MEASURING INEQUALITIES: Trends in mortality and life expectancy in Wales
http://www.publichealthwalesobservatory.wales.nhs.uk/inequalities
RIGHT CARE RIGHT PLACE FIRST TIME
http://www.rcpch.ac.uk/news/right-care-right-place-first-time
ACUTE CARE TOOLKIT
http://www.rcplondon.ac.uk/sites/default/files/acute-care-toolkit-2-high-quality-acute-care.pdf
EMERGENCY SURGERY: Standards for unscheduled surgical care
http://www.rcseng.ac.uk/publications/docs/emergency-surgery-standards-for-unscheduled-care