Report calls for more community based health care in Scotland
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《英国医生杂志》
A radical shift away from hospital based care is proposed in a framework document for the future development of the Scottish health service that acknowledges that the status quo cannot be maintained.
It also proposes that Scotland should embrace "preventive, anticipatory care" by targeting packages of support at the most frail and vulnerable people to prevent future ill health and reduce health inequality.
The report has been produced by an advisory group led by David Kerr, professor of cancer therapeutics and clinical pharmacology at Radcliffe Infirmary, Oxford.
It comes after protests across Scotland at the planned closure of many local maternity and emergency units and the downgrading of other services.
Professor Kerr said: "We need to shift the balance of care and to think of hospital admission as a failure of the collective health system." He described the extent of the proposed shift and the proposals on anticipatory care as unprecedented in any European health system.
The report proposes a tiered approach to service provision, with most needs being met by community based services. Further care for those who need it would be provided by community hospitals and specialist, city based hospitals for more complex treatments. Elective surgery should be separated from emergency work to reduce the risk of operations being cancelled.
It emphasises the importance of improving the care of patients with chronic conditions and calls on all Scotland抯 NHS boards to draw up plans to manage these conditions at home or in the community to reduce the chance of hospital admission. It also recommends a more systematic approach of self care to support people in managing their illness.
The report says it is impossible to have enough staff in every hospital to do everything and that change is needed now if the Scottish NHS is to cope with rising demand from a growing elderly population, an increase in chronic illness, and ever increasing numbers of emergency admissions.
It proposes revitalising rural health care by establishing a network of rural general hospitals, developing training for rural practice, and extending the role of GPs. Evidence is also to be gathered on which services can be offered safely in local hospitals and which will need to be centralised in specialist hospitals. Professor Kerr said that, through this work, Scotland can lead the world in producing answers to difficult questions facing health services everywhere.
The report has been welcomed by the Scottish Executive, which supports many of the recommendations but is studying its detail before making a full response.
It was also welcomed by Dr Peter Terry, chairman of the BMA in Scotland. He said: "It is important that we find Scottish solutions to the unique problems we face in delivering high quality, safe health services to all the communities of Scotland. Simply adopting strategies from elsewhere in the UK will not necessarily address the failings of our health service."(Edinburgh Bryan Christie)
It also proposes that Scotland should embrace "preventive, anticipatory care" by targeting packages of support at the most frail and vulnerable people to prevent future ill health and reduce health inequality.
The report has been produced by an advisory group led by David Kerr, professor of cancer therapeutics and clinical pharmacology at Radcliffe Infirmary, Oxford.
It comes after protests across Scotland at the planned closure of many local maternity and emergency units and the downgrading of other services.
Professor Kerr said: "We need to shift the balance of care and to think of hospital admission as a failure of the collective health system." He described the extent of the proposed shift and the proposals on anticipatory care as unprecedented in any European health system.
The report proposes a tiered approach to service provision, with most needs being met by community based services. Further care for those who need it would be provided by community hospitals and specialist, city based hospitals for more complex treatments. Elective surgery should be separated from emergency work to reduce the risk of operations being cancelled.
It emphasises the importance of improving the care of patients with chronic conditions and calls on all Scotland抯 NHS boards to draw up plans to manage these conditions at home or in the community to reduce the chance of hospital admission. It also recommends a more systematic approach of self care to support people in managing their illness.
The report says it is impossible to have enough staff in every hospital to do everything and that change is needed now if the Scottish NHS is to cope with rising demand from a growing elderly population, an increase in chronic illness, and ever increasing numbers of emergency admissions.
It proposes revitalising rural health care by establishing a network of rural general hospitals, developing training for rural practice, and extending the role of GPs. Evidence is also to be gathered on which services can be offered safely in local hospitals and which will need to be centralised in specialist hospitals. Professor Kerr said that, through this work, Scotland can lead the world in producing answers to difficult questions facing health services everywhere.
The report has been welcomed by the Scottish Executive, which supports many of the recommendations but is studying its detail before making a full response.
It was also welcomed by Dr Peter Terry, chairman of the BMA in Scotland. He said: "It is important that we find Scottish solutions to the unique problems we face in delivering high quality, safe health services to all the communities of Scotland. Simply adopting strategies from elsewhere in the UK will not necessarily address the failings of our health service."(Edinburgh Bryan Christie)