Dorset Clinical Commissioning Group today publishes a case for change, setting out why the NHS in the county needs to change if it is to deliver effectively for local people into the future. The CCG, the organisation responsible for planning and commissioning most NHS healthcare in Dorset, is carrying out an extensive review of how healthcare is delivered in Dorset with the aim of ensuring that everybody has access to care, which is both high quality and affordable for the future. The CCG has been talking to doctors, nurses, other clinicians and health leaders and looking with them at the evidence on how services are currently performing.
This evidence, brought together in Dorset’s Health Services – The Need to Change presents a compelling case for why services need to adapt to changing needs and cannot continue to be delivered in the same way.
The Case for Change shows that, just like elsewhere across England, there are a number of challenges facing healthcare in Dorset. The needs of patients in Dorset today are very different from when the NHS was set up. Then average life expectancy was lower, and the biggest threats to people were injuries, heart attacks and strokes. Now people live longer, often into their 90s and it is estimated that the number of pensioners in Dorset will rise by 30% over the next decade. With this comes an increase in the kinds of chronic illnesses that come with longevity, like diabetes and dementia.
At the same time, as with the rest of the public sector, the NHS in Dorset faces a growing financial challenge. If nothing changes in the way services are provided, Dorset will face a predicted shortfall between the income it gets and rising costs of between £167-200 million in five years.
The Case for Change shows:
· By 2023 the population of Dorset is expected to grow by 6% from 754,000 to over 800,000. However, the number of people aged 70 or over is expected to rise by almost a third (30%) in the same period.
· In Weymouth and Portland, life expectancy varies by over 11 years between men living in the most deprived and more prosperous areas.
· By 2020 around one in ten people in Dorset is expected to have diabetes, and one in eight will have heart disease.
· The quality of general practice care in Dorset is high, but there is significant variation – for example, with regards to the amount of evening and weekend appointments – which needs to be addressed.
· More than half the patients currently admitted to community hospitals could instead be treated, cared for and supported at home and a further third nursed in their own home, helping to maintain their independence.
· Access to mental health services is generally good, but in some areas there is not enough support provided to patients outside working hours and in other places there are not enough services for children with mental health conditions.
· A&E attendances have increased significantly over the past few years but over half of these patients have minor conditions that do not require hospital treatment.
· Emergency surgery in the three Dorset acute hospitals doesn’t always meet national quality standards, partly because in smaller units surgeons are not always treating enough patients to maintain a specialist skill.
· The number of stroke patients receiving a potentially life-saving diagnostic brain scan within an hour is 10 per cent lower than the national average.
· Emergencies can happen at any time of the day or night, but there is not currently 7-day consultant cover on site in all three hospitals.
· Access to planned care is good across Dorset, with most patients treated from GP referrals within the national target of 18 weeks. But there is variation in the quality of this care depending on the health condition, particularly in some cancer treatment.
· There could be more consultant cover in obstetric maternity units.
· The rural nature of Dorset creates access problems, with 10% of the population having no easy public transport link to an acute hospital. For West Dorset this rises to 25%.
Chair of Dorset CCG and local GP, Dr Forbes Watson, said: “The evidence we have gathered on the current picture of healthcare shows that most patients currently receive good care in Dorset, but there is too much variation, both against national standards and within Dorset itself. In addition we know our population is changing and getting older, and that brings new health demands we need to meet. And the money we have to secure healthcare for local people isn’t increasing at the same rate as rising costs and demand. We want to make sure we are putting resources where they will give the best return and the maximum health gain for Dorset’s population.
“We need to ensure that everybody has access to the best standards of care, in the most affordable way. That is why we have launched a review of health care across the whole system – to ensure that everybody does have access to high quality care which is affordable now and in the future. This gathering of the evidence in a case for change is the first step on our journey to design a sustainable health system for Dorset for the long-term.”
