Lizzy Buchan: Outpatients plan shows shift from business as usual

Hospital care often conjures up images of emergency surgery, of glamorous and gritty doctors saving lives as if beamed straight from our TV screens.

Plans to overhaul outpatient appointments are encouraging provided they do not just move pressure from one part of the NHS to another.
Plans to overhaul outpatient appointments are encouraging provided they do not just move pressure from one part of the NHS to another.

Yet a large proportion of hospital visits are for non-emergency matters, such as knee operations, diagnostic tests, cataract surgery and cancer screening.

This area – known as scheduled care – is proving to be a growing headache for the Scottish Government as the population shift towards larger numbers of elderly means greater need for hip replacements and the like.

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NHS figures published on Tuesday were stark, revealing a string of missed targets in outpatient care, inpatient care, referral times and diagnostic tests.

It is easy to bash the targets as bureaucratic and unfair, but they stand for thousands of people waiting too long for care they need. More than 6,400 people were waiting too long for diagnostic tests, which could be 6,400 people who found a lump and are desperately afraid that it might be cancer.

Health Secretary Shona Robison admitted that scheduled care was “simply short of what we expect” in Scottish hospitals as she launched an overhaul of outpatient appointments, which aims to save 400,000 hospital appointments by 2020.

Looking into the fien detail of the plans, there actually seems to be a lot of sense in there.

Patients will be offered Skype consultations with their specialist or treatment in the community, which could reduce return appointments and free up doctors to see more people more quickly.

Some patients will be able to monitor their own health digitally to save attending the doctor for routine check-ups. There is already a successful project running in Lothian where patients take their own blood pressure and text the results to the surgery.

Shona Robison will launch a video clinics pilot called Attend Anywhere today which has been shaped by a programme run by Healthdirect Australia in rural towns in New South Wales.

It is encouraging to see that these ideas are tried and tested elsewhere, although Scotland’s demographic and geography will always present its own individual challenges.

Some would argue that these ideas are not even that new, as increasing the use of technology in healthcare has long been mooted as a good idea. E-health projects are springing up all over Scotland, from telehealth to help dementia patients in Renfrewshire to a digital mental health toolkit for teenagers in Glasgow.

However, it takes time and political will to get these things off the ground, so it is welcome that the Scottish Government is making a clear move in this direction.

But questions remain over how these changes will be staffed, despite the Health Secretary’s promises that it will not heap extra work on to over-stretched GPs and community health professionals.

BMA Scotland chairman Dr Peter Bennie warned that the plans must not simply amount to moving the pressure from one part of the NHS to another.

After what feels like a long period of stagnation, it is refreshing to see new policy ideas.

The devil will be in the detail, as they say, but this announcement shows that the message about the need for major change in the NHS is finally getting through.