Health & Social Care Services

Transforming

Health & Social Care Services

Annandale and Eskdale

This 3 month public engagement will run from

20th November 2017 to 20th February 2018

Your Chance to Comment

on proposals for

Beattock & Moffat area

Please submit your views no later than20th February 2018

This document provides information, ideas and proposals to modernise health and social care services across Annandale and Eskdale. You are invited to respond with your views.

If you would like this information in large print or audio form, require any assistance with responding to the engagement or would like to request a meeting please get in touch. Contact details are available on the back page.

Introduction

We are currently reviewing Health & Social Care services in the area with a view to modernising the way that services are delivered in Annandale and Eskdale. The need for change and some of the initial ideas and proposals are set out in this document.

The review will cover the whole locality of Annandale and Eskdale but there will be more specific plans and options drawn together for each of the four areas of :-

Moffat andBeattock,
Annan,
Esk Valley and Gretna,
Lockerbie, Lochmaben and Ecclefechan

The review and development process will take place over the course of the next 3 years with the first phases being Moffat & Beattock and the Langholm area. New models of care may result in a change of use of current community facilities and assets, including our Cottage Hospitals and GP Practices. Having significant funds tied up in buildings across the locality means less money to invest in community services which would benefit a higher number of local people. All of the service changes will focus on providing more person centred care, more effective use of local resources and assets and take account of the fact that current service provision is not sustainable or fit for the future.

Development of our local facilities will also allow for greater co-location of health and social care services in the area and reduce the impact of some of our key challenges, thus leading to more sustainable models of care.

Why is there a need for change?

Across the country Health and Social Care Services need to change to make sure they meet the future needs of the population. By far the biggest challenge is how to provide care to scattered communities with fewer people of working age and a high percentage who are 75 or over.On top of this there are general challenges around recruitment and careful forward planning is required to ensurewe can delivercommunity based and GP services in the future.

Change is also required because we know that:-

People want to live independently for as long as possible in their own homes and community
The current Health and Social Care system is not a sustainable option given the changing demographics and growth in our aging population
We have GP vacancies and problems recruiting GPs
We have people delayed in hospital beds when they do not require medical care, both in DGRI and our Cottage Hospitals
Currently there is no‘intermediate care’available – between hospital and home and home and (acute) hospital. This type of care and support is often much more appropriate to a persons wellbeing and recovery.
We must make best use of our assets and resources as well as meet increasing demand due to demographic changes.
We need to support and encouarge people to take more responsibility for looking after themselves as much as possible.

Overview of current Health and Social Care Servicesin the Beattock & Moffat area

The case for change in Moffat and Beattock is driven by the needs of people in relation to providing appropriate services and support at the right time using a person centred sustainable model of care.

There are2 GP practicesin Moffat andthey are struggling to cope with increasing demand. They also have challenges around recruitment and premises that are restrictive and often not fit for purpose.

There is a Cottage Hospital with 12 beds.

Occupancy of the hospital is high however many people using a hospital bed do not require medical care and could be receiving more appropriate support in in a more homely setting. Hospitals are set up to provide clinical support and care.They are often not being used efficiently or appropriately and may not meet peoples’ needs.

We have been monitoring use of the beds using a tool called the ‘Day of Care Audit’ over a period of time and we know that the Cottage Hospitals are not being utilised in the most cost effective way. In the most recent Day of Care Audit of cottage hospitals, 34% of patients did not meet the criteria for being in hospital at that time (information correct at 09/10/17).

A hospital bed costs around £1400 per bed per week compared to general Residential Care at £574.42 per bed per week, Nursing Home care £667.09 per bed per week or EMI (Dementia care) £669.57 per bed per week.

It cost £868,443 in 16/17 to run Moffat Hospital, not including any building maintenance

costs.

There are 2 Residential care facilities in the area. Bankfoot House currently has 21 beds but is building an extension that will increase the number of beds to 26.Singleton Park offers both residential and nursing care to 45 residents. It is at Courance on the road to Dumfries.

In 2016/17 40% of the number of days lost to delayed discharge were people waiting for a Residential or Nursing home place. Residential care facilities very often have a waiting list.

Care at Homeis provided mainly by Annandale Bed and Bath Service (ABBS) and Stewartry Care. The Dumfries & Galloway Council Care and Support Service covers the whole region and frequently support more remote/rurally isolated service users. Although the increase in the minumum wage has helped recruitment, population figures suggest that the increase inolder people will not be matched by an increase in those of working age.

There are 2 Sheltered Housing options in Moffat, Meadow Place run by Dumfries and Galloway Housing Partnership and Dowding House run by the Royal Air Force Association. The former has 13 units which are fully occupied, the latter has 26 units 5 of which are currently unoccupied (figures correct on 07/11/17). Dowding House is for former armed forces personnel or their spouses aged 65+ and places are allocated nationally. There are currently no other alternatives for people who cannot live independently or who require short term support to get back onto their feet. We are currently exploring the possible development of extra care housing in Moffat.

There is a vibrant and committed Voluntary Sector that greatly contributes to Health and Social Care and general well-being in Moffat, Beattock and the surrounding areas. Strengthening our local communities is crucial if we are to meet the needs of the local population and every effort must be made to work in partnership to ensure we invest in developing resilient communities and support people to manage their own health as much as possible. For example in Moffat The Friday Club, held in the Town Hall supports older people by providing 4.5 hours of good company, entertainment and a meal every Friday.

A large proportion of our budget is spent on Prescribing. Although Annandale and Eskdale GP’s and Pharmacists have made some progress in reducing the cost of prescribing, the cost in Moffat alone is likely to excede £1.1m this year – some of this cost is avoidable, such as paracetamol, which costs considerably more on prescription. Another major issue is wasted medicines, the cost of which is estimated at £100,000+ per annum in Moffat, the regional figure is around £3m.There is also evidence to suggest that often drugs maybe prescribedbecause of difficulties in sourcing other forms of support for people.
We need to support people to improve their Mental Health & Well-beingRecent figures from the Scottish Primary Care Information Resource (SPIRE) tell us that anxiety and depression are the most common reason for visiting a GP. In a traditional model of care there is a tendency for patients to be very reliant on healthcare professionals for information, diagnosis,medicines and referral, with interventions often decided by healthcare professionals. Evidence tells us that the future model of care is one that focuses on early intervention and future planning with informed and empowered individuals taking responsibility, utilising their personal assets and being involved in shared decision-making.

The District Nursing Serviceis currently available 7 days per week, between the hours of 8am and 6pm. The service is based within Moffat Hospital hub and provides Nursing Care to housebound patients in the Moffat/Beattock area and Singleton Park care home.

Here are some suggestions and ideas aboutthe way care is provided in the future. These are based on our Health & Social Care locality plan, local data and information. Please answer the question below each one or or provide your answers on-line by going to:

Investigate merging the 2 Moffat GP Practices and support the development of the workforce to meet the existing and future needs of the local population. This could include exploring the change of use of the Cottage Hospital to become a Community Health & Well-being Centre, housing General Practice and a variey of other community services, support and activities.