Tour de Finance by Jeff Ace

This summer, unlike the many thousands of fellow Welsh folk heading south to France for one of our regular appearances in a major football tournament, I decided to head west, then east, then sort of north east. Together with our Finance Director, Katy Lewis, I recently undertook a tour of the region to try to talk directly to as many staff as possible about the challenges we were facing and to hear first hand their experiences and ideas for improvement.

In three days we travelled over 400 miles, met over 400 staff and heard from nurses, AHPs, domestics, GPs, consultants and others on issues ranging as wide as the region itself. At a number of the meetings, it was great to see social work staff in attendance, reflecting our ever closer working relationships.

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I asked Katy to open each session with a presentation on the financial situation – my thinking being that pretty much anything I then said would come as light relief. The 2016/17 numbers are grim and substantially worse than anything we’ve faced up until now. In summary, we estimate our costs will increase by around £16.5M in the year (largely driven by drug cost increases and pay / price inflation) whilst the increase in our allocation for health services is around £3.6M. The gap between these figures of about £13M (or 5%ish of our running costs) will have to be found from efficiency savings. This would be a tough ask at the best of times but, as most of you will be well aware, it comes after four years of delivering large annual efficiency savings targets.
And of course the financial problem does not sit in isolation. In each of the discussions across the region we heard of pressures caused by difficulties in attracting staff or by increased service demand driven by an ageing population. At times it felt as though we were describing a perfect storm of crises in money, recruitment and demography that threatened to overwhelm us as surely as Storm Frank had submerged parts of Dumfries.

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But just as the pub in this picture was open for business only two days later (it felt longer), things often brightened up pretty quickly in a lot of our discussions. The staff that we met were keen to highlight potential solutions, things that could change services for the better and stand up to our triple challenge.
We’re going to write up the key points raised and create a plan for delivery but some of the common themes were;

  • The right I.T. can transform the way teams work, but we need to make it connect faster and more reliably across the region.
  • We need to get far better at sharing appropriate information between health, social work and third sector colleagues.
  • We need to be quicker at admitting that some vacancies won’t be filled and to redesign and retrain teams to provide services differently.
  • Local teams need to be empowered to make locally appropriate decisions and as much resource as possible needs to be devolved to operational levels.
  • Coordinated support to teams around improvement techniques and methodologies would be helpful.
  • We need to work more closely with carers and families.
  • We need to celebrate team successes and better spread their ideas and learning.

It’s also important to remember that we’re not on our own in trying to work our way through the financial, demographic and recruitment problems. In our meetings we highlighted some of the huge amount of work ongoing at national and regional level at the moment to try to identify high quality and more sustainable models of service delivery across Scotland. Two particular strands of work have the potential to help us transform the landscape;

  • The National Clinical Strategy (written by Angus Cameron, our Medical Director) sets out a clear direction for closer working between Health Boards aimed at improving safety and effectiveness of care within their wider region.
  • The Chief Medical Officer’s work on ‘Realistic Medicine’ points to how genuinely person centred care can lead to better patent outcomes whilst reducing waste and unnecessary expenditure.

So, both locally and nationally, there are grounds for cautious optimism that we can come through these uniquely challenging times in a way that allows our teams to continue to deliver excellent health and care services for our population. It is clear though that to succeed in this, the pace of change around redesign of service models and ways of working will have to be dramatic. Whilst there’ll be a few giant leaps (it’s just over a year until we receive the keys to our new acute hospital…) most of this change will be smaller scale and driven by the local teams that we talked with on our regional tour. Our success will depend on how well we support these teams and ensure they have the skills and confidence to adapt their services in ways that allow us to deal with the financial, demographic and recruitment complexities.
Thanks to everyone who came along to speak to us on our tour.

Jeff Ace is the Chief Executive Officer for NHS Dumfries and Galloway

A Message from the CMO @CathCalderwood1

I’m delighted to have been asked to contribute an update to the Dghealth blog.

This year has got off to a busy start for me with the launch by all of the four UK CMOs of the consultation on alcohol guidelines for lower-risk drinking, and my first annual report as Chief Medical Officer for Scotland, calling for a debate on Realistic Medicine.

The guidelines advise men and women not to regularly drink more than 14 units a week, spread drinking over three days or more if you drink as much as 14 units a week and if you want to cut down how much you’re drinking. A good way to help achieve this is to have several drink-free days each week. It can be a bit tricky to understand and remember how much alcohol is in drinks, and how this can affect our health. The low risk guidelines can help with this, if you choose to drink. No-one can say that drinking alcohol is absolutely safe, but by sticking within these guidelines, you can lower your risk of harming your health if you drink most weeks. I was pleased that the new guidance also takes account of the harmful effects of binge-drinking, and brings the rest of the UK into line with Scotland by advising women not to drink any alcohol during pregnancy.

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One of the ways I try to be accessible is via my blog and Twitter feed – it was interesting to see the comments on twitter around the alcohol guideline launch, ranging from welcoming to “killjoy”. Change is always going to cause a reaction – but since the guidelines are in response to evidence of the risk of alcohol causing cancer the UK CMOs have to get our message across, however difficult that may be, so people can them make their own informed choices.

The reaction to my annual report on Realistic Medicine has been more universally positive, in the media and through feedback on twitter and my blog. The report contains the traditional publication of “health of the nation” issues examining a range of population health surveillance data and outbreaks of disease etc but the key theme is ‘Realistic Medicine’ and what this can mean for the challenges that face doctors as a profession and in healthcare. I launched the report at the Western General Hospital in Edinburgh with Dave Caesar, Consultant in Emergency Medicine, NHS Lothian and Dr Caroline Whitworth, Renal Consultant, Royal Infirmary of Edinburgh.

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I followed this up with a discussion about the questions I raise in the report with a group of about 20 doctors from NHS Lothian. This is the beginning of engagement I want to undertake across Scotland to hear views of doctors who are well placed to come up with the answers to how we improve shared decision-making; ensure we deliver person-centred care; reduce unnecessary variation in treatment and outcomes; as well as reduce harm and waste (including over-treatment) for the people doctors treat. My team produced a very helpful infographic setting out these questions and we have a range of materials for anyone in the profession who wants to discuss this among themselves and feedback to me via the clinician survey.

I would welcome feedback from everyone on the report so l can use it to inform health policy. My role and that of my team consisting of the Deputy Chief Medical Officer, Dr Gregor Smith and senior medical officers and speciality advisers is to provide the clinical voice in decision-making. As healthcare professionals we have useful knowledge and expertise to guide policy and our input is vital. I would welcome your input to help us to carry out that role effectively. I can be reached in a number of ways: 

 

Email: cmo@gov.scot

Twitter: @CathCalderwood1 [https://twitter.com/CathCalderwood1]

Blog: http://blogs.scotland.gov.uk/cmo

CMO on LinkedIN

 

Catherine