AS the debate continues about changes to the region’s NHS, The Northern Echo has asked both those behind the changes and those who oppose them to have their say. In the first of three articles Dr Stewart Findlay, clinical lead for the Better Health Programme, which forms part of the Sustainability and Transformation Plan (STP) for the NHS, explains why maintaining the status quo is not an option

WHAT does the NHS do well? What could we do better? Health service staff have been asking local people this question at a series of events held to seek views about services. What has been clear is how passionate you are about the NHS and how much you value the care we provide.

But many of you also expressed frustration about some of your experiences and concerns about the future.

Clinical staff in the NHS, including GPs, hospital consultants, nurses, and other health staff, share many of these frustrations and concerns. We know that over the next few years demands on our services – both NHS and social care – are set to increase and we need to take action now to address this.

Earlier this month, almost 100 frontline clinicians – doctors, nurses, midwives, therapists and paramedics – came together to discuss the issues facing local health services and develop ideas about how they could be provided in the future.

There was a broad agreement on two key points. Firstly, more care should be provided outside of hospital, in the community, or in a patient’s home, with services provided by GPs, NHS community services, local councils and the voluntary sector working together. This will help us to avoid unnecessary or prolonged hospital stays, because we know that patients recover better in their own homes.

Our health needs are changing. We are living longer and have different conditions and health needs. Dementia, obesity and cancer, as well as alcohol-related disease, have become major challenges. More of us will have one or more long-term health conditions, such as heart disease, respiratory disease and diabetes, especially as we get older.

As a result, many more of us need support, sometimes for many years and much of this is best provided at home so that people can stay independent.

In the past, much of the care offered by the NHS was in hospital. Caring for long term conditions needs a different approach, with more community based support and services. And we are already doing something about this. For example, a new digital health screening service in County Durham and Darlington is transforming the lives of patients on anticoagulant medication. More than 350 people across the area now monitor their condition from home instead of going to a clinic.

In Hartlepool and Stockton, a hospital at home team is providing care for patients with breathing problems, avoiding frequent 999 calls and avoidable hospital stays.

In the South Tees area, a new scheme means more stroke patients can have their rehabilitation from home, rather than in hospital. And in Darlington, teams of health and social care professionals are identifying patients at risk of becoming ill to make sure they have the right support to stay well in their home.

What we need to do now is to take the best of these schemes and others and make them available to patients across our area.

Second, in serious emergencies patients should be taken by ambulance to a hospital where senior consultants and experienced teams of staff are available, 24 hours per day, seven days a week, seeing high numbers of patients with similar problems.

In the past, most hospitals could provide the best care available. Advances in medicine and increasing specialisation mean that this is no longer true.

Currently our hospitals cannot deliver access to specialist emergency care for everyone seven days a week and where appropriate 24 hours a day. This means people experience variation in quality of care depending on where and when they are treated. So if we want everyone in our region to get the best care, we have to make some difficult decisions about where care for the most seriously ill or injured is provided in the future, while making sure that patients continue to receive most care in their local towns and communities.

We are currently looking at future scenarios that would see specialist emergency care provided at James Cook University Hospital in Middlesbrough and at either the University Hospital of North Tees or Darlington Memorial Hospital. A detailed assessment of these scenarios, including issues such as current and future staffing, distance and travel time by ambulance and by public and private transport is being undertaken. This will lead to a formal public consultation in the second half of 2017.

As clinicians, our commitment is to make sure that you, our patients, get the best possible services for the future.

Dr Stewart Findlay has been a GP in Bishop Auckland for 30 years and is chief officer of the Durham Dales, Easington and Sedgefield Clinical Commissioning Group.