PERIOPERATIVE PRACTICE
‘People in the lower socio-economic groups are having longer periods of ill health – while those in most need have the least access to care... This is a real problem in our society that must be addressed.’
Professor Jean White.
is going to be a ‘background’ factor that we will have to deal with – along with the consequences, such as falling, or patients not caring for themselves. The burden on carers is going to be very substantial,” said Prof. White. This trend is emerging at a time of
changes to the benefits system and coincides with an economic crisis, she pointed out, adding: “How we deal with these challenges is very important. There is a great danger that money will become the only issue that we worry about.We have seen far too many instances in which organisations, health boards and Trusts have focussed on money at the exclusion of other things. Of course we have to ensure that every penny counts, but we must ensure that we do not lose sight of why we are here – we are here for patients.”
Prevention A key focus area must be spending on prevention, if the health service is to reduce the burden of lifestyle related diseases, Prof. White asserted. Across Europe, just 4% of healthcare spending is on prevention. “More resources will need to be
allocated to this area…We must keep people healthier for longer,” she commented. “The current model of throwing more and more resources at healthcare, or trying to squeeze more and more out of current resources, will not be the answer.We need to start thinking differently.” She added that this should be treated
as an opportunity: “We are going to see changes in the way people work and the way services are delivered. This could provide the catalyst for innovation to drive up quality. In the past, we may have taken the attitude ‘if it works, why bother fiddling with it?’ “However, we must ensure we
continue to focus on patients.We know from Mid Staffs what happens when an organisation takes its eye off the ball, when it comes to patient safety, and becomes too focussed on the money. We all need to learn lessons from this,” she warned.
NOVEMBER 2012
Workforce issues She went on to examine other challenges facing the health service including work force issues. InWales, there is a shortage of medical staff – reasons for this, she suggested, include: the European Working Time Directive, difficulties in recruiting for specialties and the feminisation of the workforce, which has resulted in changing working patterns. Some specialities are unattractive to female doctors with families, for example. “This is having profound effects on
other professions such as nursing, ODP and other groups. Again, I see this as an opportunity,” said Prof. White.” She explained that there is an increasing emergence of roles, with advanced practice roles and surgical care practitioners coming to the fore. “I am not precious about what people
can and cannot do, as long as they are properly trained, fully supported and have the skills and confidence to deliver that care safely and effectively,” she commented, while adding a note of caution: “There is a risk when organisations encounter staff shortages that they will attempt to provide a quick fix, which could be dangerous.” There are also changes in retirement
and pension arrangements for healthcare workers. “There will be pressure on individuals to work longer,” she commented. “But at 67, can we do the same physically demanding tasks we did at 27? This is a challenge that has not yet been addressed,” she pointed out. Other changes to the healthcare
environment relate to the time that patients spend in hospital. Today, patients are discharged much more quickly after surgery – driven by advances such as ‘enhanced recovery’, along with increasing use of day surgery and minimally invasive techniques. Prof. White went on to point out that
healthcare-associated infection (HCAI) remains a significant challenge. Although significant inroads have been achieved in tackling infections, such as MRSA and C. difficile, there is still much work to be done. Surgical site infection (SSI), for
example, still accounts for the largest proportion of HCAIs. In 2006, SSIs accounted for 18% of HCAIs inWales. However, these figures have not shown an improvement – in 2011, SSIs accounted for 24.3% of HCAIs. Controlling antibiotic use will become
increasingly important, as Prof. White pointed out. If this issue is not addressed now, she warned, there may be a risk that an effective drug to tackle infection will not be available for some patients, in the future.
Devolution Prof. White went on to discuss devolution and health policy – providing an insight into some of the improvement initiatives that are underway inWales. “Because the politics is quite different
in each of the countries in the UK, we are going to see greater divergence of practice over time. When publications are released, people assume they apply everywhere. However, this is not the case,” she commented. InWales, a key publication is Together
for Health, which outlines a five year vision for the NHS, specific to the country. Action areas in the document include: service modernisation, health inequalities, better IT systems, improvements to the quality of care, workforce developments and a changing financial regime. It outlines the following key improvement goals to be achieved.
Health will be better for everyone • More children will have a good start in life.
• The health of the most and least deprived will be more similar.
• Obesity, smoking, drug and alcohol abuse will level off or fall.
• People will be enjoying more years of high quality life.
Access and patient experience will be better • Access to primary care services will be easier.
• More services will be provided through local pharmacies.
• More services will be available 24 hours a day, 365 days a year.
• A greater range of local services will mean less need to travel.
• More information on services and on health issues will be available by telephone and on-line.
Better service safety and quality will improve health outcomes • Dignity and respect will be guaranteed for patients.
• Systems for assuring high quality care will match the best in the world. • People will benefit more from
THE CLINICAL SERVICES JOURNAL 51
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