Transcript Primary Prevention of Coronary Heart Disease

Looking forward,
pulling together
and pressing on
Lewis Ritchie
SCIMP 2008 Conference Ballot
Invitation to give final talk
Please choose and tick only one of the
following options:•
•
•
I am delighted & honoured to accept

I am reluctant & have serious misgivings about
this great responsibility

You have sent this invitation to me by mistake

SCIMP 2008 Conference Ballot
Invitation to give final talk
Please choose and tick only one of the
following options:•
•
•
I am delighted & honoured to accept

I am reluctant & have serious misgivings about
this great responsibility

You have sent this invitation to me by mistake

“Small men…..
cannot handle great events”
General Charles de Gaulle
Learning from the mistakes of others…..
The task:
To summarise key principles
and take home messages
An excellent Conference - packing it all in…..
Not biting off more than we can chew
A fair sense of proportion….
(proportionality)
Looking forward….
• Values, vision and leadership
• Opportunities and obligations
• Pulling together and pressing on
What of our values….?
A rapidly changing and uncertain world..
Remembering why we are all here
The importance of the clinicianpatient relationship:
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Essential humanity
Intimacy
Safety
Truthfulness
Mutual understanding
Workable consent for information sharing
Key value:
“…Do unto others as you would
have done unto yourself…..”
A few guiding principles…..
Guiding principles
• Patient centred care = patient centred
records
• Patient and health professional needs main
drivers - not available technology
• Imperative of strong clinical leadership and
professionalism
Guiding principles
• Universal CHI - key for successful record
linkage – “journey of care”
• Cultural change and confidentiality
concerns – are the ultimate obstacles - not
technological constraints
• Incremental, measured progress v “big
bang”
“Prove all things…hold fast to
that which is good”
The imperative of evaluation –
establishing resilient models,
sharing success and the avoidance
of duplication of effort
…but beware the Dubya binocular trap!
Scotland’s Health Challenge
• Ageing population
• Increase in long term conditions
• Unhealthy lifestyles / obesity epidemic
Leading to:
• Growth in emergency hospital admissions
• Pressure on services / waiting times & lists
Compounded by:
• Remote and rural dimension
• Deprivation and inequalities
• Increasing public expectations
• Technological advances / cost pressures
Confronting the Health Care Challenge
From Cell to Community
Scottish
Care
Networks
eHealth to support
world class patient
care
Community
New Evidence &
Clinical Trials
Translating
Excellence
In Life
Sciences
Cell
Vision
• Traditional boundaries of care – demarcated
by sectors of provision - must give way to
integrated care, focused on the patient
‘journey of care’
• Primary and secondary care – the language
of the past?
A patient centred service: the journey of care
In the past organisational and perceptual barriers have separated
primary and secondary care
*CH, RGH,
Patient
Home
Available as and when required
Patient
enters
hospital*
DGH
NHS 24
Health
information
etc
Pharmacy
Dentistry
Optometry
Mental
Health
Services
Sexual
Health Diagnostics
Services
Primary
Care
Emergency
Care
Community Care
GPs GPwSI
Practice, District Nursing,
Health Visiting, AHPs
Source: Carol Black (modified), 2006
Specialists
65 Specialties
GPwSI
Our Vision for eHealth
“exploiting the power of
electronic information to help
ensure that patients get the
right care, involving the right
clinicians, at the right time, to
deliver the right outcome”
Heather Strachan
Better eHealth Better Care
NHS Scotland eHealth Strategy 2008
www.ehealth.show.scot.nhs.uk
Information Access
What it looks like:
Portal
Integration and
Interoperability
Information
Applications
Clinical
Dashboard
Single-Sign-On
Management
Dashboard
SCI Gateway
Record
Locator
Service
Integration Platform
ECS
GP
SCI Store
PMS
Labs
CHI
PACS/RIS
GCS
Other
Without vision, we perish……
without values, we decay…
without leadership, we lose our way
….and the leadership thing?
“essential…in partnership with
technical and other health
professional and administrative
support staff – the team”
A defining moment, a new morning, hope for the future
Opportunities & Obligations
AM’s four year “manifesto” –
opportunity for change
“eHealth
supporting the
best clinical care
and research
environment in
the world”
Better Health Better Care
•We are committed to the delivery of high quality palliative ca
to everyone in Scotland who needs it,
on the basis of need not diagnosis,
and according to established principles of equity and personal dig
•Extend the use of high quality
generalist palliative care standards in all care settings
Palliative Care Summary (PCS)
• Macmillan Nurses led initiative
• Palliative Care Forms
– Based on Gold Standards Framework
Scotland (GSFS)
– Paper process already in place in many
GP Practices
– IT Development to assist with key patient
group
– Underpinned by new GMS DES
Elizabeth Ireland and Libby Morris
18 Weeks Referral to Treatment Time
“ a whole journey waiting time target of 18 weeks from
general practitioner referral to treatment …. by
December 2011”
Cabinet Secretary for Health and Wellbeing, Scottish
Parliament – Official Report, 28th June 2007.
Tracey Gillies
Current view of many clinicians
Speed of access
Quality
Key Message: Both please! - Imperative of service redesign
and cultural change
INFORMATION GOVERNANCE
George Fernie
Information Governance ensures necessary safeguards for, and
appropriate use of, patient and personal information.
Key areas are information policy for health and social care, IG standards
for National Programme for IT systems and development of guidance for
NHS and partner organisations.
Key message: getting confidentiality right for both
patients and professionals
A proportionality test
• A test of proportionality is the application of
objective judgement as to whether the
benefits outweigh the risks, using what some
might call the test of reasonableness or
common sense. Proportionality involves
making a considered and high-quality
decision based on the circumstances of the
case, including the consequence of not
sharing.
HealthSpace Development
• Patient portal through which they have a
secure on line domain for their transactions
with health service
• Aligned with Choices
• Place to store records – access on line
electronic records-and also from which they
can send information to their clinician
Gillian Braunold
Key Messages - HealthSpace:
• Considerable potential for real patient engagement
and supported self care enhancement
• Enhanced consent model possibilities
• Patient audit of care and of professional access
• Universality of eHealth – need to learn from other
systems
(to avoid the ‘Scots Wha Hae’ syndrome)
Use
Adapt
Analyse need
Information
Source –
Find / Capture
Literacy Cycle
Share
Evaluate
Generate /
Synthesise
Heather Strachan
Key Message
• Shared understanding and optimal use of
health care information key for both patients
and health professionals
Data Transfer v Data Migration
• Not synonymous
• Complex and usually incomplete
• Classification of Diseases etc continues to
evolve
“Transfer of electronic patient records from
one general practice to another a key
milestone in primary care computing”
Leo Fogarty
Pulling together and pressing on
Looking forward…a word of
encouragement
Success is a journey, not a
destination!
Choosing but one – ECS a
singular success
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ECS connected to 99% of practices
Accessed by A/E, NHS24 and OOHs
Palliative Care Summary next development
Pilots in Grampian for EMIS and INPS
Next year for GPASS and ASCRIBE
ECS Accesses
ECS Accesses - Cumulative Totals
1600000
1400000
1000000
800000
Cumulative Totals
600000
400000
200000
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“Much has been achieved…
there is much still to do…”
8th Annual
Conference
“Unless we share information
reliably we can’t improve care”
“That will require high quality
leadership, professionalism and
commitment at all levels…
and we’re all in this together
Scary journey but safe outcome!
“We can achieve more provided we
are prepared to give others the
credit”
Ronald Regan
Final thoughts:
America today has a new face as President,
so farewell Dubya!
Size does matter…..
Thank you
for listening
Thank yo
for
listening
…and safe home!