The Future Plan for Health and Medical Care takes a comprehensive grasp of the healthcare system in Stockholm County Council. New construction and renovations will modernise the premises of healthcare to provide more beds, better care, lower energy consumption and provide conditions for new ways of working in healthcare. With more e-health services, healthcare shall become more accessible for both the employees and the patients. Healthcare shall thereby become more patient-centred, effective and equal. Implementation began in 2014 and continued unabated in 2015.
One of the principles of the Future Plan is that healthcare at the emergency hospitals shall be directed at the patients in the greatest need of the emergency hospitals’ specific areas of expertise and resources. At the same time, care providers outside the emergency hospitals are increasing their offering.
Healthcare outside the emergency hospitals
Healthcare outside the emergency hospitals is strengthened in part through patient choice and procured care at private and County Council-run care providers. Patient choice is one of the strategies for streamlining the emergency hospital’s assignment and moving care to other care providers. In 2015, two new areas were added to the existing patient choice:
- multimodal rehabilitation for long-term aspecific pain (MMR1) in the general practitioner mission
- rehabilitation for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, ME/CFS, as a supplemental assignment for two different patient choices; patient choice for long-term pain and fatigue syndrome, MMR2, and patient choice for planned specialised rehabilitation, neurology.
In 2015, the introduction of two new patient choices as of 1 January 2016 was also prepared:
- Acute specialised neurology rehabilitation in in-patient care after emergency hospital care
- Acute specialised surgical rehabilitation in in-patient care after emergency hospital care
In 2015, the County Council decided on a more extensive revision of the general practitioner (GP) patient choice with basic home healthcare. The starting point is the adaptations that need to be made due to the Future Plan. The proposed new compensation model shall stimulate the GP clinics to focus to a greater extent on patients who need more resources and have the weakest health.
In 2015, a revision was begun or prepared for developing the assignments for patient choice in orthopaedics and hand surgery, physician efforts in special housing for the elderly, advanced medical care in the home and specialised palliative in-patient care.
E-health to develop participation and support new ways of working
Strengthening the offering of e-health services provides advantages for both patients and healthcare personnel. The patient gains knowledge about his or her own health status and better possibilities to participate in and contribute to his/her own care and treatment, while healthcare employees gain considerable opportunities for knowledge transfer and better collaboration when information on a patient can be shared by several care providers. The processes in healthcare are made more efficient and the staff avoid some administrative work. Follow-up and quality audits can also be facilitated through a broader use of e-health services.
In November 2015, the introduction began of e-free cards, an electronic handling of the high-cost ceiling exemption card for patient fees in out-patient care in Stockholm County. When the e-free card is fully introduced, the patient will no longer have to stamp their own paper high-cost card to reach the free-card limit.
During the year, a broad introduction was also prepared of the Journal e-service where patients can access their medical records over the Internet. In 2016, all care providers in Stockholm County Council will have the opportunity to join the shared e-service. The patients will be able to log in over the 1177 Healthcare Guide Vårdguiden to read their own medical records and be involved in their own treatment.
Together with several other county councils and regions, the County Council is participating in the work of formulating requirements and standards for a future national environment for healthcare information support. Regionally, this work also includes the municipal level.
The County Council’s ambition is that all patients will receive care on time. A minimum is that no patient will need to wait longer for an appointment or treatment than prescribed by the healthcare guarantee.
The measurement of waiting time for a GP appointment in spring and autumn 2015 shows that 80 per cent of the population received an appointment with a GP within five days (the figures shall however be interpreted with some caution as a new method has been introduced which on the long term can provide more reliable results).
On average, 68 per cent of the patients, who needed to see a specialist in 2015, received an appointment with a doctor within Stockholm County Council’s healthcare guarantee of 30 days. This is two percentage points lower than 2014. In terms of the County Council’s healthcare guarantee for treatment (90 days), on average 88 per cent of the patients received treatment within the healthcare guarantee. This is somewhat lower than last year. Of the County Council’s inter-county patients, 3 per cent waited for an appointment, while 5 per cent waited for treatment.
More information on accessibility in healthcare is available in the Annual Report 2015.
Increased patient safety
Patient safety work spans many areas and disciplines, and within healthcare, great importance is assigned to preventing avoidable injuries. Both patients and healthcare staff participate in this work.
The County Council’s point prevalence measurement of healthcare-associated infections (HAIs) in autumn 2015 showed an occurrence of 9.5 per cent in somatic care, which is close to the 9.4 per cent target. Healthcare-associated infections remain a priority focus area for the County Council. With private rooms, the possibility for more patient-safe care is improved. The risk of infection – and thereby subsequent possible infections and complications – is lower if the patient is cared for in his or her own room than in shared rooms. At Södertälje Hospital, Danderyd Hospital, Söder Hospital and New Karolinska Solna, private rooms, in part or in whole, are a part of the modernisation or new construction.
Development of resistance in bacteria is still growing in an alarming manner, and an unnecessary prescription of antibiotics contributes to this. The residents of Stockholm County receive the most antibiotics in the whole country, but the number of prescriptions taken out has decreased over several years, including 2015. The County Council continued its efforts and collaboration with GP clinics, hospital wards and special housing to slow the prescription of antibiotics. In procurements of food, the County Council also requires a conservative use of antibiotics for livestock.
Reinforcements in cancer care
In 2015, the County Council prepared a strengthening of the assignment in non-surgical cancer treatment, which will be conducted at Karolinska University Hospital Solna, Söder Hospital and St. Göran Hospital. This decision is related to the work with the breast centres at these hospitals, which opened in January 2016. The objective is to create an equal and equivalent care with a high level of quality where research and development also have a strong position.
In 2015, the County Council worked successfully with the state effort for shorter waiting periods in cancer care. For this work within the Regional Cancer Centre, the County Council receives a performance compensation of SEK 93 million for 2015.
The efforts done in 2015 were to increase the number of beds for children with cancer at Karolinska University Hospital. These efforts meant, among other things, that the proportion of patients in paediatric cancer care who receive care in another county council decreased.
The County Council finances research, development and innovation work
The research shall support the County Council’s core operations and provide a long-term and concrete benefit to the residents. In the future, it will become even more important that research and education can follow the patient’s route through the entire care chain, from primary care to highly specialised care. More and more care can be provided outside the emergency hospitals and this affects the conditions for research, education and development. When research is integrated as a part of the care, it is faster to convert innovations to new approaches and treatment methods. For this to work, a cohesive and strengthened infrastructure is needed, including quality registers, biobanks, IT support and healthcare information centres. Access to reliable and relevant information is necessary in order for significant research to be conducted. As a part of the implementation of the Future Plan for Health and Medical Care, education and innovation are integrated into the entire care chain and thereby support the development towards a more patient-centred, effective and equal care.
The Stockholm Medical Biobank was inaugurated in October and will continue to be expanded in the next few years. In terms of strategic biobanking, the County Council has chosen to focus on the four diagnoses covered by the 4D Programme: breast cancer, arthritis, type-2 diabetes and heart failure. These four diagnoses are a few of our most common widespread diseases.
Hospital by hospital - how medical care is being expanded in Stockholm
New Karolinska Solna
The work to complete the first healthcare premises in New Karolinska Solna is continuing. Some smaller buildings are already finished and in operation, such as the carpark and the technology building. The hospital is being prepared to accept the first patients in autumn 2016. Work is proceeding on schedule. The thorax and paediatric units are the first to move in to the newly built hospital, which will be finished in stages.
St Göran Hospital
St. Göran Hospital consists mainly of an emergency hospital and an extensive psychiatric unit. The emergency hospital is being renovated and expanded and planning is under way for a future building for the psychiatric unit.
In 2016, a new emergency ward will open with more capacity to handle the effects of New Karolinska Solna gradually being commissioned. In addition, new construction and renovations are being done of care and treatment buildings, enabling an obstetrics unit for around 4,000 deliveries per year.
For the psychiatric unit, technical improvements are planned on existing premises and detailed development plans are being prepared that will enable future new construction for psychiatric care on the hospital campus.
The renovation projects at Södertälje Hospital were among the first to begin back in 2013. At Södertälje Hospital, a new treatment building is being completed right now and is scheduled to open in 2017. In the first stage, a new obstetrics unit and emergency ward will open. Two existing buildings for care wards with support functions are being renovated to improve the possibility for care in the southern part of the County.
Karolinska University Hospital Huddinge
For Karolinska University Hospital, new construction and renovations are under way for surgery and radiology, which will be co-located with intervention (scope and radiology led treatments). To retain critical connections, a renovation is being done of other units, such as obstetrics. In connection with this, there is an opportunity to increase the childbirth capacity at the hospital by another unit in existing premises.
With renovations, capacity of in-patient psychiatric care is increasing, for which Healthcare Provision Stockholm County is responsible in the hospital.
For Danderyd Hospital, new construction is under way on a new treatment building that houses an emergency ward. The new emergency ward has been delayed. It is expected to open at the end of 2018 and measures are planned to minimise the effects of the delay. Continuous renovation and technical improvement of the buildings are planned to create efficient flows and modern care wards. Geriatric care currently conducted by Healthcare Provision Stockholm County at Danderyd Hospital will move to Sollentuna Hospital.
Södersjukhuset (Stockholm South General Hospital)
Södersjukhuset is being equipped for the future with a new treatment building with a larger emergency ward and new operating theatres, a new medical building and a new building for operations and maintenance. The preparation work began in 2014 and the new construction is estimated to be complete around 2019-2020. The new buildings will grow forth on the western part of the hospital campus. They will house an emergency ward, operating theatres and a sterilisation unit.
Norrtälje Hospital (within Tiohundra AB)
Norrtälje Hospital is retaining its mission as an integrated emergency hospital with geriatric operations. At the hospital, there is a possibility to accept more patients. This capacity can be utilised to accept patients from surrounding municipalities, and as auxiliary capacity during the transition period.
St Erik Eye Hospital
St. Erik Eye Hospital is the only hospital in Sweden to offer a complete range of eye care. Today, operations are primarily located in Kungsholmen in Stockholm. The intention is to move the operations to new premises close to New Karolinska Solna.
The smaller hospitals
According to the Future Plan, the possibilities of care conducted close to the patients shall be developed at the smaller hospitals in the County. Geriatrics, psychiatry or somatic specialist care are a few areas where the care at the smaller hospitals will be strengthened. The idea is that the patients shall be able to receive their care on site, sometimes through cooperation between several care providers. There are several smaller hospitals in every part of the County. Preparations for modernisation and new construction and renovations are under way in several places. Notable among the projects are:
For Sollentuna Hospital, extensive renovations are under way for out-patient and in-patient care. When the hospital is finished, there will be 230 beds, mainly for geriatrics but also other somatic in-patient care and palliative care. Geriatric care currently conducted by Healthcare Provision Stockholm County at Danderyd Hospital will move here and be expanded.
Preparations are under way to modernise Nacka Hospital, which houses a number of different care areas and care providers. Nacka Hospital shall strengthen its offering, mainly in psychiatry and geriatrics.
An extensive technical improvement is under way at the hospital to raise the standard and provide better conditions for care. Besides a better environment for patients and staff, the hospital is becoming more energy efficient. Löwenströmska Hospital will strengthen its offering in geriatrics and psychiatry, but will also continue to house somatic specialist care.