An injection of modern planning for our NHS
PROVIDING the best possible care within the resources available is the laudable ambition of potentially the biggest change to NHS services in South Wales for decades.
Health chiefs admit there are challenges preventing that from happening. But they say they are confident they can overcome them.
Those challenges are set out in Abertawe Bro Morgannwg University Health Board's Changing For The Better (C4B) programme, which describes its vision of the future of health care in Swansea, Neath Port Talbot and Bridgend.
One of the biggest challenges is the fact many services are still based on a healthcare system designed in 1962.
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This, C4B points out, was in an era when people still watched black and white TV. There were 240 pennies to the pound and man had yet to walk on the moon.
"It was also a time when life expectancy was shorter — it was unusual to live past your 70s — and there were fewer tests and treatments for illnesses like cancer or health conditions so people were less likely to survive them.
"Now medical and social care has improved and people live longer. This brings its own challenges, however, as patients are likely to need more care as they grow older and in many cases become frailer."
The NHS's average spend per year per patient for different age groups varies enormously. For those aged one to nine, for example, it's just £285 but for those aged 80 and upwards it's £3,358.
Chronic conditions like diabetes and obesity are also on the increase.
"So while NHS care is constantly evolving, the system it works within just isn't keeping up with changing and increasing demands," C4B says.
"We can't just tinker at the edges. We need to make substantial changes if we are to meet these healthcare challenges."
Another major issue is doctor shortages, particularly in paediatrics, emergency medicine (A&E) anaesthetics, general medicine and psychiatry. This, says ABMU, is making it very difficult to maintain safe medical teams.
"The doctor shortage has started to reach a crisis point and has forced some urgent changes," C4B states.
Neath Port Talbot Hospital has lost its acute medical services for that reason. It also led to the children's ward at Singleton merging with the one in Morriston in 2009 and caused disruption at Singleton's minor injury unit in 2008.
C4B also examines quality of care, pointing out that patients and families rightly expect the NHS to meet increasingly higher clinical and quality standards.
"We know that we do not always have the best outcomes every time at the moment. Creating expert teams who work effectively together is key to delivering better outcomes."
An example is the care of people suspected of having strokes. They are now assessed on two sites instead of four where specialist wards and treatments are available, leading to fewer deaths and long-term complications.
The last, but by no means the least, of the challenges facing ABMU and the NHS generally is money. C4B acknowledges that the NHS is not immune to the effects of the worldwide financial crisis.
According to the Wales Audit Office, there will be a funding gap of between £250 million and £445 million in Wales, just to allow health services to stand still.
"We can't afford to keep going as we are," is C4B's stark warning. "We will run out of money and some services will collapse.
"However experience has taught us that if we have services which are effective (they help people get better faster) and efficient (they don't waste money, staff or supplies) then they will also generally save money.
"A change in the way a service is run may not cost less up front. In some cases it may even mean additional investment."