Further examples of where the future is happening
Improving health, as well as treating sickness
Exercise referral - working together to improve health
Monmouthshire Local Health Board, working with the local authority, has set up a GP exercise referral scheme. Patients with conditions such as diabetes and high blood pressure can be referred for exercise to help manage their condition.
The scheme helps improve the general fitness levels of patients and can help prevent their condition deteriorating and reduce the need for drugs. The regular exercise and the opportunity to socialise also plays an important part in improving the well-being of the patients.
Allan Coffey, Chief Executive of Monmouthshire Local Health Board, says:
This is a good example of how different professionals are working together to improve the health of patients. It encourages patients to play an active role in managing their own conditions, but with support on hand when they need it. Patients often have a lot of knowledge and expertise about their own condition, and information we gather also helps us plan our services to meet their needs.
Texting for better health
School nurses in Ceredigion have introduced an innovative way of making their service available to young people, by using text messaging.
The service – the first of its kind in Wales - was set up in Cardigan Secondary School. It provides a first contact point for young people who want to ask about emotional, mental and sexual health as well as physical health.
Huw Williams from Ceredigion NHS Trust, says:
"The schoolteachers worked in close partnership with us. They issued credit card size information cards to every pupil. We also had the support of a local paediatrician.
The pupils appreciate the anonymity of the service. It gives them a contact point with health professionals on subjects they may have found embarrassing to discuss, using technology that many teenagers use every day"
Better care for patients in their communities
Caring for diabetes patients closer to home
Diabetes is one of the most widespread chronic conditions. A new scheme in Bridgend has helped improve the service for diabetes patients, by providing much more of their care in the community rather than in hospital.
Dr Ian O' Connor, a local GP involved in diabetes services in Bridgend, explains: "Diabetes specialist nurses, supported by 2 consultants with a special interest in diabetes, are now managing the care for many patients who previously had to go to hospital".
For the patients it means more continuity in their care, and better management of their condition. This in turn means they are less likely to end up suddenly needing to be admitted to hospital.
Treating skin cancer patients closer to home
A west Wales network of general practitioners is breaking new ground by providing a service for the management of low risk skin cancers across the whole area. Nine GPs holding the Diploma in Dermatology and with previous experience as clinical assistants in dermatology have been recruited and trained to the network.
Working to protocols developed by the south west Wales lead clinician for skin cancer, the network has seen over 1800 patients, who are referred by GPs across the area. It is the UK’s largest group of GPs with a special interest working to agreed protocols within a network.
The service has meant that patients can be treated closer to home, and it has also helped to reduce the waiting lists in the local dermatology department.
Better care for patients, better use of hospitals – managing chronic conditions
The Swansea Chronic Disease Management scheme has made a huge difference to patients’ lives.
Targeting frail patients and those with multiple chronic diseases, experienced clinicians support patients in their own homes. This has reduced emergency hospital admissions by around 10%. It has also reduced readmissions to hospital by 25%.
Patients, carers and the healthcare team are very satisfied with the results. The scheme has been so successful that it is now in operation right across Swansea.
Consultant Paramedic – taking emergency services to the patient
Pembrokeshire is one of the first areas in the UK to introduce this new way of providing emergency care out of normal hours.
The practitioner responds to calls to the out-of-hours service and travels to the patient. They then provide short-term treatment or advice to the patient, and can refer them to other health professionals if needed.
It means that a patient’s needs are assessed quickly, without them needing to visit a hospital, unless required for treatment.
Blood transfusions in the local community hospital
Patients who need regular blood transfusions can now have it done close to home in their local community hospital, thanks to a new scheme up and running in Conwy
and Denbighshire.
Following a successful pilot, blood transfusions are now undertaken on a regular basis at Denbigh Infirmary and Colwyn Bay Hospital.
Haematology patients, who require regular top-ups of blood, are already benefitting from this service, as are patients undergoing chemotherapy.
Teamworking and technology
Technology brings specialist expertise to the patient
Technology is being used by GP practices in Cardiff and the Vale of Glamorgan for ‘Teledermatology’. A patient goes to their GP with a skin complaint, the GP then takes their history and takes a photo of the problem.
This is then e-mailed to specialists at University Hospital Wales. The consultants can look at the picture and can then make a diagnosis and recommend treatment.
This means that the GP can get an opinion to the patient within 48 hours of their appointment. Also, it saves patients from having to go to the hospital.
Dr Andrew Morris, dermatology consultant, says it has been a huge success, as he and his colleagues can pick up on skin melanomas much more quickly, and all because of the use of a digital camera which only costs £250.
Involving the experts - the patients
The Expert Patient Programme, run by Gwynedd Local Health Board, is a self-management course for people with chronic conditions. It helps people learn skills for managing their condition, including managing pain, developing coping skills and planning for the future.
Courses are run in community settings and are led by trained volunteers who themselves have experience of living with a chronic condition.
Chief executive Grace Lewis-Parry says:
“The outcomes of the programme have been very positive. Feedback from participants has been that they feel less isolated, more confident and proactive about their illness.
Compliance with medication has also improved, and participants have said that they’re less reliant on their GPs for minor problems as they’re managing their own conditions more effectively”.
New roles for hospitals – working differently, working together
Less time to wait, and all done in a day
Cardiff and Vale Trust now carries out cardioversion - a controlled electric shock used to treat irregular heart rhythms – as a day case.
It used to be done as an inpatient procedure, with a maximum waiting time of around 11 months. But patients can now have the treatment and be discharged the same day, and the waiting time has now fallen to around 7 days.
In for a day, not for a stay - cataract surgery closer to home
Powys LHB now provides cataract surgery in both Brecon and Llandrindod Wells – previously patients had to travel to Nevill Hall hospital or even to Hereford.
This is a two-stop service with patients being seen by the consultant ophthalmologist and having a full pre-operative assessment on the same day. They agree a date for surgery, with the follow-up work done by a local optometrist.
It means patients are in for a day, not for a stay, and can have their care much closer to home.
Taking hospitals to patients - mobile treatment centres
Ambulance services and accident and emergency departments have to cope with a big increase in demand at certain times, for example during large sporting events or in city centres over peak periods. But a new innovative approach to managing this caseload at peak times is making a big difference.
Mobile treatment centres, staffed by paramedics and experienced Accident and Emergency nurses, are set up on a temporary basis near to where the demand will come from.
Paramedic officers in rapid response vehicles deal with all emergency calls, and for non-emergency cases the St John Ambulance Brigade transported patients to the centre if necessary.
Many patients can be treated in the centre instead of being taken to A and E. Police officers were also on duty at the centre, to ensure staff and patients are safe.
It shows how increasingly we can take hospitals to the patient, rather than always having to do it the other way around.
Better care for patients
MRSA infection control makes care safer
A “search and destroy” approach in Gwent Trust has lowered the MRSA rate on an orthopaedic ward, protecting patients about to undergo joint replacement.
The infection control team, with orthopaedic surgeons and nurses, work to a strict protocol, screening patients before they admitted. Only patients who are clear of MRSA are admitted. Patients who test positive for MRSA are admitted to an alternative ward, in a single room in most cases.
If a patient already admitted is found to have MRSA, they are transferred to another ward and other high-risk patients and the staff are then screened for MRSA. High-risk surgery only resumes once all patients are confirmed MRSA-free and the ward has been thoroughly cleaned.
This rigorous approach has meant a major drop in the MRSA rate. As infections mean patients have to spend more time in hospital, lowering the rate has brought a double benefit: saving valuable resources as well as reducing the risk to orthopaedic patients.
Breast cancer rehab and preventing lymphodoema
Patients with breast cancer often suffer from lymphodoema, which is a swelling of the arm or breast that can restrict their mobility and make their arm very heavy. In Swansea, an innovative scheme, the first of its kind on the UK, has been introduced to give breast cancer patients education, exercise, support and advice.
Patients are assessed before their operations and a programme of prevention and rehabilitation is put together, tailored to their needs. This includes daily physiotherapy, regular discussion with health professionals, and a 12-week exercise and education programme. Breast cancer patient user groups were involved in setting up the scheme.
The programme involves members of the genetics, dietetics, breast care and plastic surgery teams, along with colleagues at local leisure centres. The results have been very positive. Lympphodoema occurred in 30% initially but with treatment this has reduced to around 5%, meaning that ladies can return to work and normal family life.
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