Realising Realistic Medicine: Chief Medical Officer for Scotland annual report 2015-2016 appendix

Golden Jubilee Foundation

Initial thoughts

In keeping with the principles of realistic medicine, the Golden Jubilee Foundation strives to deliver a patient-centred service which is strongly focused on the experience of care as well as good clinical outcomes. Episodes of hospital care should be kept as short and efficient as possible with minimal disruption to patients' everyday life and maximal clinical benefit. Underpinning this is an explicit effort towards reducing unnecessary variation in practice and outcomes.

What have we done so far?

We have already been very successful in reducing length of stay for lower limb arthroplasty in association with low re-admission and complication rates. We have significantly reduced length of stay and critical care bed use for our lung cancer resection patients over the past two years whilst retaining excellent outcomes.

Re-design work in cataract surgery is going at a rapid pace. We already benchmark well for efficiency with good clinical outcomes by UK standards as a result of changing working practices, logistics and enhanced optometrist roles.

We have a strong eHealth department and as well as physical outreach clinics we have for some time been offering routine follow up tele-consultations to patients from Shetland and Highland following joint replacement.

We are currently well into a systematic review of our treatment consent processes. As a result of this we have refreshed much of our patient information and added new material including patient-journey videos (accessible to patients on YouTube). The drivers for this have been supporting patients' understanding of what to expect from their care, optimising their engagement and participation towards getting the best out of their treatment, and promoting understanding of risks and side effects. In the context of shared decision making within realistic medicine, it has the potential to be developed much further to provide a resource for supporting dialogue around treatment choices and meaningful treatment outcomes.

What next?

The work on re-design in cataract surgery is expected to bear further fruit in the near future. We have just started piloting pre-operative tele-consultations in orthopaedics, and a further pilot is just about to commence with NHS Fife of tele-clinic assessment for 'see and treat' patients referred for assessment of suitability for cataract surgery. This last will be hugely beneficial if successful, by obviating the need for travel for those patients not progressing to operation.

We have started work on developing a clinical outcomes framework which will allow us to understand and monitor meaningful sets of clinical outcome indicators for our main specialties that are meaningful to both patients and clinicians. This is at early stage, but we are aiming to have an initial report in place for Spring 2017. This will be useful for quality-improvement, benchmarking and re-assurance, but as it develops it will become an important resource to inform shared decision making around treatment choices.

Final thoughts

Our work focuses on different but interlinked areas of Realistic Medicine. The Golden Jubilee Foundation is improving and innovating in a variety of areas to provide an enhanced service for our patients.

Still from the Golden Jubilee social media videos - one of a number of videos addressing what to expect when attending the hospital.
Available at www.youtube.com/user/NHSGoldenJubilee