by Mike Ponton, Director, Welsh NHS Confederation
Hospitals with rows of beds - for many people this remains the traditional image of the NHS. But will the NHS in Wales look like this in 2015?
The fact is that even in 2006 this image is becoming out of date. For example, did you know that over 80% of encounters between patients and the NHS don't take place in hospital at all? And in Wales we've had falls in waiting times, while the number of hospital beds is going down, not up?
So a 21st century NHS is not just about beds and hospitals. This is perhaps the biggest change from what we're used to. It's already happening, and by 2015 it'll mean the NHS looks very different from the traditional image many of us have.
Why is the NHS changing?
The short answer is that it has to keep up with a fast-changing world. The world of 2006 - let alone 2015 - is very different from the world of 1948, when the NHS was set up.
For starters, people are now living longer. Wales has the highest percentage of over-65s in the UK, and one of the highest levels in Europe.
Most of the work these days is managing 'chronic conditions' such as diabetes, respiratory diseases and arthritis. These account for around 60% of hospital bed-days and a staggering 80% of GP appointments. It's no wonder they have been called "the 21st century healthcare challenge".
Wales has the highest percentage of over-65s in the UK, and one of the highest levels in Europe
Medical progress is another huge change. As our knowledge grows, so too does the list of treatments that can be provided.
Advances in technology mean that X-Rays and scans can be e-mailed, speeding things up. And patients, doctors and nurses can talk to each other via video links, often saving lots of travel.
Today's public rightly expect the NHS to meet much higher standards. Patients are better informed about health issues, and they want greater involvement in their care.
These are just some of the changes in the world around us - and the NHS has to keep pace.
So what will the future look like?
We've picked out three key trends, and some examples here in Wales of where this future is already happening:
Improving health, as well as treating sickness
It is a national Health service after all. Supporting people to stay healthy is better for them. And problems such as obesity, smoking and binge drinking put a huge burden on the NHS.
How are we supporting people to improve their health? One example is in Ceredigion, where school nurses have set up a text messaging service for young people, the first of its kind in Wales. Huw Williams, from Ceredigion NHS Trust, says, "It gives pupils a contact point with health professionals on subjects they may have found embarrassing to discuss, and it makes best use of the technology that many teenagers use every day".
More services closer to home
Hospital care is coming out of the hospital building. The vast majority of NHS care is already provided locally, and the trend is for more to follow.
In Conwy and Denbighshire nurses can deliver chemotherapy to cancer patients in community clinics, or even in their own home. Sister Pat Pilkington says "In the last year, 80 patients have chosen to have their treatment delivered in this way, saving each patient 24 hospital visits. It allows patients more time at home with their families, improving their quality of life".
Digital cameras and internet links between GPs in Cardiff and the Vale and University Hospital Wales mean that patients with a skin complaint can get a specialist opinion more quickly, without having to go to hospital.
Examples like these show how the trend in most cases is for care to come closer to the patient.
Hospital care - in for a day not for a stay
If you do need to go to hospital, developments such as keyhole surgery mean it's increasingly likely you'll be in for a day, not for a stay.
In Powys, patients who need cataracts removed can be seen by the consultant and have their assessment on the same day. The follow-up work is done by a local optometrist. It means patients are in hospital for a day, not for a stay. And they can be treated in Brecon or Llandrindod Wells - previously they had to travel to Abergavenny or even Hereford.
All these trends are already happening - by 2015 they will be even more widespread. It means the future will be very different from the "beds and hospitals" image we are used to. But one thing is clear - it's a change that has to happen if we are to deliver 21st century care for the people of Wales.
