We want to continue improving the services available in Darlington, Durham and Tees. Key challenges include:
Our population is changing.
As well as population growth, there is an increase in the over 65s and over 80s, with rising numbers of people with multiple long-term conditions, such as respiratory disease, cardiovascular disease and diabetes.
Nearly two thirds (65%) of people admitted to hospital are over 65 years old, and an increasing number are frail or have a diagnosis of dementia.
Amongst younger people too, there are also health problems, sometimes as a result of lifestyle choices.
Across Darlington, Durham and Tees, there are variations in health and in outcomes from treatment, linked to geography, deprivation or ethnicity.
We need to provide services which meet these needs.
We also know that not all patients receive the same quality of care all of the time.
This may be because services aren’t organised in the same way, or because services aren’t available or have reduced staffing levels at different times of the day, or at weekends.
We have identified around 700 standards for providing care which have been recommended by national bodies such as NICE (the National Institute for Health and Care Excellence, and the Medical Royal Colleges such as Royal College of Obstetricians and Gynaecologists, the Royal College of Physicians and the Royal College of Paediatrics and Child Health.
Our analysis suggests that we will NOT be able to meet about a third of these standards across all of our services in the near future without change.
For more information about clinical standards, see the next section, our progress.
High quality care depends on having staff with the right skills and qualifications.
Nationally, there are shortages of doctors in training in key specialties and areas of practice, which is particularly challenging for smaller hospitals.
Recruitment into emergency medicine, nursing, paediatrics and specialist services such as geriatric medicine is becoming increasingly difficult.
Locally, there are specialties where trusts have struggled to recruit to consultant posts, or attract a strong field of candidates.
Changes in medical training also mean that there will be fewer junior doctors available over the next few years.
In GP practice, it is becoming more difficult to recruit doctors to meet the needs of local people. Applications rates into training schemes involving general medicine are also declining.
There are also pressures in the availability of nurses nationally, and the age profile of our workforce means that many experienced staff will be retiring over the coming years.
As a result of these and other issues, nursing and medical rotas often rely on locum and agency staff, which impacts on continuity of care and consistency of quality.
Currently, national information suggests that patients are more likely to die in the days following admission if they are admitted on a Sunday compared with a Wednesday.
Seriously ill patients have a greater need for diagnostics and senior clinical decision makers, and outcomes are poorer if these are not available.
This means having enough consultants available to assess and review patients, providing access to important diagnostic tests and ensuring that consultants are there to make crucial clinical judgements. Reduced staffing and fewer senior doctors on duty, as well as poor access to diagnostic tests at weekends will affect the quality and safety of care.
Nationally the NHS is working towards ensuring that seven-day services are available in all hospitals where patients receive the same high quality, safe care on a Saturday and Sunday as they do on a weekday.
Care close to home or in the home is more convenient and less stressful for patients and their families.
We know that too many of our patients, usually frail elderly, are admitted to hospital unnecessarily because services are not organised to respond appropriately to their needs at an early stage. This puts them at risk of infection, becoming institutionalised and losing their independence.
Data collected by the Care Quality Commission shows that, each year, around 500 thousand over-65s are admitted in England as an emergency for a preventable cause – such as dehydration or infections – which could have been prevented with better care.
We need to develop services and support which will reduce the number of people who require hospital care, and help people maintain independent lives in their homes or normal places of residence.
We have to make sure the NHS is making the best use of the finance it receives from the taxpayer.
Financial pressures include the costs of new treatments, drugs and equipment, rising patient numbers and the cost of locum and agency medical and nursing staff to ensure safe staffing levels.
If we don’t change the way we provide health services, by 2021, there will be a £30 billion gap between the cost of running the NHS nationally and the funding available.
The local challenge across Durham and Tees Valley has been estimated at a £345m shortfall by the end of 2018/19 if no action is taken to address this.
In all of its discussions so far, the local NHS has agreed that we will always put clinical quality and better outcomes first.
However, financial and clinical sustainability are inter-dependent. In order to both balance the books and meet clinical standards we must address these pressures over the next five to ten years.