When society changes, so must the NHS.
The Scottish population is much older and frailer than it was, which means increasing pressure on hospitals. The question is: how should our health service respond? We could build more and more hospitals and employ more and more staff to cope with the demand, but as part of our NHS: Time for Action campaign, The Herald has called for a public debate about what the priorities and structures of the NHS should be. Finally, that debate is now gathering pace.
In one of her first decisions as Scotland's new chief medical officer, Dr Catherine Calderwood is now taking the debate out into the country. Dr Calderwood has revealed that NHS managers will be travelling around Scotland this summer to discuss, via community centres, Twitter, newspapers and other forums, the future of the health service prior to a new clinical strategy being drawn up. She has also revealed that one of the proposals that will be under discussion during the consultation is the idea of treating more patients in their own homes.
In principle, the idea is attractive. First, it has the potential to ease the pressure on hospitals. Second, it could lead to better outcomes for patients in some cases. As discussed in a report by Healthcare Improvement Scotland published today, frail and elderly patients can sometimes mentally deteriorate in hospital due to the busy unfamiliar environment and disrupted sleep patterns. Treatment at home in a more familiar environment could help avoid the problem. It could also help people stay safe and well at home for longer.
However, there could be downsides to more treatment at home - the time it takes for staff to visit patients for instance, or the cost of having staff out and about and travelling. The point is that we do not know the full effects and potential benefits of moving to more treatment at home, and no serious and broad analysis has been done to find out. The consultation announced today will help in establishing whether there is a consensus for change, but what the NHS really requires is a serious study that could answer some fundamental questions. Is treatment at home better for patients? Can it reduce hospital admissions? Could it reduce costs? And so on.
As far as Dr Calderwood is concerned, the ideas up for discussion include giving patients treatment they would normally receive in hospital - such as blood tests, transfusions and intravenous antibiotics - but a public consultation and debate, healthy though it is, cannot compete with a thorough study into the potential benefits of less care in hospital and more at home. As Dr Calderwood says, what people want from the health service is changing. It is now time to find in what ways the NHS must change too.
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