W2D-003 Health care-0.txt
better service better care

What the changes in health and social services mean for you

About this booklet

Every person in Northern Ireland comes into contact with the Health and Personal Social Services at some time, be it simply a visit to their GP or dentist, or perhaps a spell in hospital for something more serious. For those who, for whatever reason are unable to live independently Ð for example disabled or elderly people Ð contact with the caring services will be much more frequent, perhaps with visits at home by social work or community nursing staff.

So the changes taking place in the Health and Personal Social Services are of interest to everyone. Some people however are worried about what services will be available in the future. Some of the questions being asked are: - will I still be able to get my prescription, even if the medicines are expensive? - if my family doctor has a practice fund, will I still get the treatment I need? - can I still have a choice of hospital if I need treatment? - will I still have a choice about where I have my baby? - will hospitals which become self-governing Trusts stay completely within the health service? - will health services still be free?

The answer to all these questions is "Yes"."

This booklet has been designed to provide answers to questions like these and to give other information as well. However, it does not list all the services that are available. Information about services that are not covered here can be obtained from the bodies listed at the end of the booklet.

The Government's proposals

The reforms described in subsequent pages result mainly from the Government's White Papers "Promoting Better Health", which was published in 1987, and "Working for Patients", published in 1989. These proposals were aimed at making the Health Service more responsive to the needs of people and more concerned about improving their health, rather than just treating their illnesses.

Community care services

Since the publication of these White Papers the Department of Health and Social Services has issued "People First", in March 1990, which contained proposals for the future development of community care. These are in line with the Government's approach to community care services, which is that they should be flexible and sensitive to individual need, that they should offer choice, intervene no more than necessary and should concentrate on those with the greatest needs.

This booklet does not over the changes in community care Ð many of which will not be in place before 1993. However further information will be made available in the future.

The welfare of children

An important part of the community care reforms will be new laws dealing with the welfare of children, which will be published for consultation later this year. The new legislation will reform the present law dealing with the care, protection and upbringing of children and the provision of services for them and their families and draw them together into single and more accessible code.

Your family doctor

Your family doctor Ð or GP Ð will be able to offer you and your family a wider range of services in future. There will be more emphasis on promoting good health and preventing disease.

SERVICES FOR THE FAMILY

Good health care is not just about treating you when you are ill, but also about giving help and advice so that you stay fit and well.

The Department's Chief Medical Officer says: "More and more nowadays, people are realising the benefits of a healthy lifestyle. There are no spin-offs: healthy people make fewer calls on the resources that we put into treating the sick and injured; and they enjoy life more. So the emphasis in the future must be more on prevention, less on cure."

What services should you now look out for?

For all adults

You will be able to get regular "life-style" check-ups. These will be offered to you when you first register with a doctor, or if you have not seen your doctor for some time. The purpose of these check-ups is to: - give you the chance to discuss anything worrying you; - provide an opportunity to carry out a few simple tests (such as checking your blood pressure); - offer professional advice if need on such matters as diet, exercise, smoking and drinking.

In other words, your GP can advise you on how to look after yourself. This may include recommending that you attend one of the practice's health promotion clinics.

GPs will be encouraged to provide more health promotion clinics. These may include clinics giving detailed advice on diet, blood pressure, smoking, diabetes, heart disease, drinking and stress.

Family planning services

Family planning services are available from most GPs and from family planning clinics, which also make services available to men. You can choose where to go for family planning advice.

If you prefer to get advice from a GP about contraception, you may choose to see a GP other than your own family doctor. Information about whether particular GPs provide contraceptive services is now more readily available (see "More Information for Patients" on page 9).

Details of family planning clinics in your area are available from your local Health and Social Services Board (see the list of addresses at the end of this booklet). In addition to general sessions, you may find that some clinics offer sessions to deal with particular methods of contraception or for particular groups.

Family planning services are provided free of charge to encourage all those who wish to use the services to do so.

For women
Cervical screening (smear tests)
About 40 women die from cervical cancer every year in Northern Ireland. Many of these deaths could be avoided if more women had regular smear tests (known as cervical screening or cervical cytology).

Improvements are being made to the cervical screening services. How will these affect you? - all women between the ages of 20 and 64 are to be invited for screening (by March 1993). - the new system will ensure that all women in this age group are offered a test at least once every five years.

Your doctor will be able to give you advice and encourage you to have a smear test if appropriate.

The aim of the test is to detect conditions that could develop into cancer. If these conditions are found in good time, treatment is usually straightforward and almost always effective.
Breast cancer screening
Breast cancer is the most common form of cancer among women. An entirely new province-wide breast cancer screening programme run from specialised centres is being introduced. How will this affect you? - all women between the age of 50 and 64 are to be invited for screening by breast X-ray by March 1994. You will then be invited for screening every three years; - screening for older women (over 64) will be provided on request every three years.

This service is being targeted at women over the age of 50 because there is as yet little evidence that routine screening is of benefit to younger women.

Your Health and Social Services Board (see the list of addresses at the end of this booklet) will be able to give you advice on local services, or our doctor can advise you.

Women registered with a GP will get invitations for cervical and breast screening if appropriate. So please make sure that your GP has your correct address, especially if you have moved house recently.

Well-women clinics

GPs will be encouraged to provide more well-women clinics which deal with many issues to do with women's health.

For children

Child health

Your GP may offer a programme for following the development of your young children (under five years old). That means checks, in your GP's surgery, on the height, weight, growth, development of the senses and other essential features in the first five years of your child's life. Where your GP does not do this work, it will still be provided at local community clinics.

Childhood immunisation

If you don't get your children immunised against childhood diseases such as measles and whooping cough you are putting them at risk. These illnesses can be very distressing and sometimes dangerous. Your doctor will encourage you to make sure that your children get the protection of safe immunisation.

The table below shows when you should get your child immunised (but if your child is older and has not been fully immunised it is not too late to see your doctor).

If you are over 75

Each year your doctor will offer you an assessment of your health and circumstances to make sure that all is well.

You can have this check-up done in your own home or at the doctor's practice or surgery. In any event, your doctor will offer to visit you at home, or arrange for one of the professional practice staff to visit you, to make sure you are well and able to cope.

These services are strongly recommended. They offer the chance to get advice on how to deal with the problems everyone faces in old age. Failing eyesight, hearing difficulties, trouble with your feet and similar problems can often be helped once they have been identified.

A BETTER FAMILY DOCTOR SERVICE

Greater convenience for patients

Changes are taking place in the way your doctor's surgery is run. Over the next few years you may find: - more convenient surgery hours; - more comfortable waiting rooms; - minor surgery available on your doctor's own premises, to save having to go to hospital.

Will your doctor be able to spend as much time with you? - Yes. There are now more family doctors than ever before. As practice teams develop, you may be able to see not only the doctor, but the nurse, chiropodist and physiotherapist.

More information for patients

More information is now available to help you know more about the services your doctor provides.

- Health and Social Services Boards now produce directories of local family doctors, giving information about each doctor and the service the practice provides. You can find the address of your Health and Social Services Board on page 20 of this booklet.

- Each GP practice is now producing leaflets telling you about the range of health services available from the practice.

- Moving to another doctor if you want to is now easier. All you have to do is go to the surgery of the doctor of your choice and ask to be registered. If your new doctor agrees to put you on his or her list, that's it. Different doctors may offer different types of services and their leaflets will help you choose.

General Practice funding scheme

Family doctors already play a vital role in the health and social services and they will play an even greater role in future. From April 1993, bigger practices will be able to choose to take control of funds to finance a range of local services for their own patients Ð including certain hospital treatments, and the cost to the services of prescriptions and some staff needed for the practice.

If your GP chooses to join the practice funding scheme, what will it mean?

- The level of funds will be agreed between your GP and the Department of Health and Social Services. It will take into account the health care needs of all the patients on the practice list Ð for example, the extra requirements of elderly people, patients with special needs, the hospital services likely to be used and so on.

- Your GP will be able to use the fund to arrange the right treatment for you speedily and effectively. For example, your GP should have greater flexibility to look around for treatment in hospitals which offer the shortest waiting times. The aim is to improve the choice of good quality services available to you and your GP.

- The practice will be able to use any savings from the fund for your benefit Ð for example, in employing another nurse or buying new diagnostic equipment for the surgery.

So if your doctor has a practice fund, will you still get the treatment you need?

- Yes. GPs will get sufficient funds to enable them to provide full and proper treatment for their patients. Even if the practice overspends its funds, there is no question of people not getting the treatment they need.
