SUMMARY NOTES
Meeting of Steering Group:
Redesign of Health Services in Skye, Lochalsh & Wester Ross
Tuesday 19th February (2.00pm – 5.00pm)
Day Case Room, MacKinnonMemorialHospital, Broadford
Present: / Tracy Ligema, (TL) Area Manager, WestPaul Davidson, (PD)Rural Practitioner/Clinical Director North & West Operational Unit
Kate Earnshaw (KE), District Manager, Skye, Lochalsh, Wester Ross
Alan Knox, (AK) Area Manager, SAS
Councillor Audrey Sinclair,(AS) ,Chair Public Participation Forum, West Ross
Christine Barwick (CB) Acting Theatre Team Lead
Dr Charles Crichton (CC) General Practitioner, Portree
Campbell Dreghorn (CD) Staff Side Unison Representative
Councillor Drew Millar (DM), Highland Council, (Skye)
Councillor Hamish Fraser (HF)Highland Council(Skye)
Councillor, Biz Campbell (BC) Highland Council (Skye)
Alistair Innes (AI)Rural Practitioner
Councillor Isabelle Campbell (IC)Highland Council,(Lochalsh & west Ross)
Councillor John Gordon (JG)Highland Council (Skye)
Callum Macdonald(CM) Business Support Officer, (Skye District)
Fiona McGeachan (FM)Business Support Manger, West Area
Dr Stephen McCabe (SM) General Practitioner, Portree
Dr Leo Murray (LM) Rural Practitioner, MacKinnonMemorialHospital
Dr Willem Nell (WN) Rural Practitioner, MacKinnonMemorialHospital
Chrisann O’Halloran (CO)Senior Charge Nurse, MacKinnonMemorialHospital
Ross Mckerlich (RM)Chair. Skye & Lochalsh Public Participation Form
Dr Kirsty Shaw(KS) General Practitioner, Dunvegan Medical Practice
Maimie Thompson (MT) Head of Public Relations & Engagement, NHS Highland
Dr Lesley Unwin (LU) General Practitioner, Kyle Medical Practice
Dr Angus Venters (AV) General Practitioner, Sleat Medical Practice
Apologies:
Summary Notes
1 / Welcome and Apologies
Dr Paul Davidson welcomed everyone to the inaugural meeting of the Redesign of Health Services in Skye, Lochalsh & Wester Ross
steering group.
2 / Current position and background
PD gave an overview of the current position in relation to hospital and community services and the need for change.
One of the main remits of the steering group would be to generate focus around engagement and to take forward the project initiatives.
It will be important for the group to progress the case for change
A further aim for the group will be to improve the future vision that will be sustainable into the future. PD highlighted that in previous discussions it had been divisive due to focussing around the site, and therefore it was important not to do this.
Why do we need to do this?
•The current provision is not fit for purpose and has potential to harm.
•Capabilities- 2 hospitals with different services, facilities and 2 groups of staff
•Standards
•Financial burden, e.g maintenance backlog , fuel costs
•Aging community
•Staying the same will result in service downgrading
There are considerable threats to some of our existing services e.g diagnostics and theatre, radiology and ultrasound. Due to the change in demographics we are aware we cannot go on the same way, so we need to change the way we deliver healthcare provision locally
through a safe and modern facility.
Appendix 1–Project Charter
Currently no pharmacy support across two hospitals, limited technology no Wi-Fi, PD highlighted emergency and elderly care is our future. It will be important to create a vision statement that supports the future services for our area.
We have opportunities
•To design a modern purpose built facility
•Plan for future and current needs.
•To be efficient in service delivery and energy use
•Safe
•Links with a community integrated approach
•Pharmacy, Rehabilitation, use of technology
•Need to build in the specification for areas that we are currently challenged with
•To create an educational hub
We need to create a Vision Statement and agree the vision where we get to the point where Hubco can take over to move towards an Initial Agreement. (IA)
Scottish Government Investment Manual Process
TL explained the Scottish Government Investment Manual which was the process in which we are to develop our case for change.
This includes four stages:-
- An Options appraisal
- The initial agreement
- Outline business case
- Full business case
We have to demonstrate we have looked at all the options to prepare for the initial agreement.
Scottish Government Investment Manual requires us to evidence broad thinking initially, and no options are ruled out, including those that may appear extreme or obvious.
This is part of a bigger piece of work in partnership with Badenoch & Strathspey. They are undergoing a similar process and in order to ensure this is a viable investment, the two projects will be developed in parallel. The timescales for this process are very tight, but still to be confirmed.
Terms of Reference
The Terms of Reference paper was discussed, and it was agreed to include the Team Manager for Social Work and an Estates Manager in the membership. Maimie Thompson will draft a note to all to explain the Hubco process and a explanation of the Hubco/Scottish Capital Investment Manual process.
Communications
MT gave an overview of the communications process and remit and focus of the group
MT highlighted that we would need to have:-
•Clarity of purpose and process
•Engender good relations and trust within the group.
•Need for clinical engagement and leadership for political consensus.
•Ensure everyone is fully familiar with timeframes and role and remit of the group
•Important to have consistency of messages.
•Need to have clarity on the role of Hubco
•Need to ensure that we have a process to deal with unexpected incidents, and how to manage conflict.
A media release summary of the discussions and agreements to be drafted by MT or representative.
Develop positive relations with the press, communications should be little and often
Important to identify different groups to communicate with, needs to be reasonable. Managers need to be out and about, attend Community Council meetings, GP Practice meetings. The proposal will not please everybody, therefore we need to ensure we did everything reasonable that we could. It is a big responsibility of everyone on this group to progress this positively.
Breakout Group sessions
Group 1- Single Site Services, facilitated by PD
Group 2- Community Services, facilitated by KE
Group 3- Connections: Transport/Technology, facilitated by CM
Appendix 2 Feedback Summaries
Gill McVicar, Operational Manager had previouslyadvised managers on the need for public engagement and that the initial process be completed by the end of March. There will be more engagement for the Initial Agreement starting in April with project support from the Scottish Government. Timescale for completion of the project is 2- 3 years.
The meeting closed.
4 / Dates of Next Steering Group Meetings:
Tuesday 19th March 2013: Meeting Room, PortreeHospital
Tuesday 16th April 2103: venue to be confirmed
Tuesday 14th May 2013; venue to be confirmed
Tuesday 11th June 2013: venue to be confirmed
5 / Dates of Next Core Group Meetings:
Wednesday 6th March 9.00am (Before SMT Meeting)
1
1
Appendix 2
Skye and Lochalsh Single Site Hospital Working Group – 19 Feb 2013
Workshop No 1 SingleSiteHospital Services
Attendees:
Dr Paul Davidson, Rural Practitioner/Clinical Director (facilitator)
Dr Charles Crichton, GP Portree Medical Practice
Dr Leo Murray, Lead Clinician, MMH
Dr Wil Nel, Rural Practitioner and Endoscopist, MMH
S/N Christine Barwick, Acting CN Theatres, MMH
Maimie Thomson, Head of Engagement, NHS Highland
The group discussed the following aspects of clinical care which should be considered as applicable to all age groups:
Acute Care
- Outpatient
- Ambulatory care (minor illness/injury)
- Primary care OOH (including a visiting service)
- A+E level care (minor to major trauma)
- Stabilisation and transfer service (including escorted transfers)
- Custody and minor forensic service for Northern Constabulary
- Assessment of psychiatric patients (liaison with MHO/New Craigs)
- Advice/assistance for Midwifery Patients
- Inpatient
- Non-operative surgical assessment and inpatient care
- Medical assessment and inpatient care
- Paediatric assessment and short term care (liaison with Raigmore)
- Support for community midwifery unit (incl. Neonatal resus)
- Place of safety for acute psychiatric evaluation
Elective Care
- Outpatient
- Visiting consultant/service area for various clinics
- Local clinics (fracture, minor ops, substance misuse, alcohol, pre-op assessment, review)
- Chemotherapy (nurse led, doctor supported)
- Physiotherapy
- Occupational Therapy
- Midwifery (antenatal/post delivery)
- Dietician
- Community Nurse/GP liaison
- Inpatient
- Step down from Raigmore/Other
- Pre/Post investigation
- Palliative care
- Rehabilitation/Re-enablement
- Longer duration chemotherapy
- Alcohol detoxification
The group acknowledged that to provide the above the following diagnostics would be required:
- X-ray facilities – suitable for A+E care (CT scanner becoming essential)
- Ultrasound (weekday service)
- Near patient testing / lab services
- Diagnostic scope (UGIE/Colonoscopy/Flexible Cystoscopy)
- Suitable diagnostic provision for A+E including slit lamp/A+E ultrasound
All services require appropriate staffing and surroundings with a view to no less than current total Skye bed complement, although acknowledgement that if single/en-suite adopted this would allow greater bed efficiencies.
Skye and Lochalsh Single Site Hospital Working Group – 19 Feb 2013
Workshop No 2 – Community Services
Attendees:
Kate Earnshaw, District Manager SL&WR (facilitator)
Dr Angus Venters, GP
CClr Biz Campbell
Dr Steve McCabe, GP
Tracy Ligema, Area Manager
Community Services Feedback
Current community service provision – please refer to attached slides.
The group discussed the future vision:
- For community services to be integrated in the community resource “hub” with in-patient and out of hours care.
- Staff who could be flexible across services.
- To access opportunities to co-locate but to acknowledge that there will need to be accessibility across the geographical area.
- To support the development of extended primary care teams e.g. GP practice integrated into the community hub.
- To ensure our 3 community nursing Teams link closely with EPCT and Hospital provision
- North Skye
- NE Skye
- NW Skye
- Raasay
- South Skye and Lochalsh
- South Skye
- Mainland
- South West Ross
- Lochcarron
- Torridon
- Applecross
- For a physiotherapy and OT hub based in the new resource centre but to enhance provision in patients homes
- To develop appropriate rehabilitation services
- Cardiac
- Pulmonary
- To have our Social Care teams based in the community resource
- Social Work
- Care @ Home
- Podiatry services were felt to be effective under the current model e.g. clinic based in practices and health centres
- Scottish Ambulance Service must be part of the Extended team with the site to support partnership approaches to delivering care
- Support Services could be based on the site e.g.
- CAB
- Counselling Services
- Training and Education Facilities – both staff and for the public – taking forward a population health approach
- Beds and spaces – need to think about intermediate beds and or step up step down facility
- Midwifery CAU
- Radiology/Sonography provision – CT Scanner
- Out of Hours provision – must be available across the area – MDT approach e.g. Rural Practitioners, Nurse Practitioners, Basics Doctors, First Responders
- Mental health Services – this is an opportunity to develop:-
- Drug and Alcohol Clinics/Services
- Recovery Services
- Place of Safety
Throughout the conversation we highlighted the importance of transport:-
- Public Transport needs to be strengthened
- Hospital Car
- Partnerships with other providers e.g. Red Cross, Community Car Schemes
Skye and Lochalsh Single Site Hospital Working Group – 19 Feb 2013
Workshop No 3 – Connections: Transport/Technology
Attendees:Cllr Hamish Fraser, The Highland Council
Cllr Audrey Sinclair, The Highland Council
Alan Knox, Scottish Ambulance Service
Callum Macdonald, NHS District Office (facilitator)
The group discussed:
Parking
Adequate, future-proofed parking must be provided, bearing in mind that many staff, patients and visitors may choose to travel to the site by private motor vehicle. A separate area should be provided for staff parking and a further area identified for SAS parking.
Deliveries
An access route and unloading area should be provided for service deliveries, NHSH delivery and maintenance vehicles and oil and gas tankers supplying goods and services to the site.
Public Transport
Any new site must have direct access to/from public transport and a dedicated bus stop and turning area/through road identified to facilitate these services. It was recognised that local subsidies are difficult to access at the present time and any subsidy has to be justified in terms of usage and need. Options such as a Community Car Scheme, SAS Patient Transport or other ways of achieving improved patient and public transport links to/from the site need to be investigated. It was acknowledged that negotiations with funding bodies would be made easier if there was one site.
The group thought that provision of public or other form of transport to/from the site was very important in trying to “sell” the idea of a single site to members of the public when a specific location had been agreed.
Patient Transport
It was felt that this needs to be integrated with ambulance services in terms of co-ordination and availability. Forthcoming development of services from SAS crews will perhaps improve the co-ordination aspects of patient transport. It was acknowledged that the current lack of public transport makes SAS Patient Transport a vital service for an area such as Skye, Lochalsh and South West Ross.
Air Ambulance
The working group would review potential mobile air ambulance landing site(s), this would of coursebe based upon where the new facility site is going to be located, and assuming that new facility location would have anadjoining dedicatedpermanent helicopter landing site on the proposedplans. Once potential landing site(s) have been identified, a further request to Air Ambulance Team / MOD for site assessment for medicalevacuations in day time & night time operations would be made.
Suitable organisations are identified, e.g. Coastguard / Fire & Rescue Service for managing night time mobile lightsandMOUs are developed and training is delivered
Local SAS
A single site with appropriate facilities is very important to the SAS in terms of costs, skills and equipment. There was an acknowledgement that the local ambulance service needs to be better integrated and local personnel trained and up-skilled. Benefits in terms of education, clinical pathways, clinical standards and infection control would flow from a single site with good communications and facilities for crews. There would still be a need for other bases throughout the area but a central or dedicated site would enable better co-ordination, education, team-working and morale.
The SAS in South Skye and Lochalsh will be based in MackinnonMemorialHospital in the coming months and would obviously be looking to re-locate to the new single site when this has been identified and built.
Information Technology (IT)
As more and more technological developments and equipment comes on stream it is vital that internal and external communications are improved in terms of better broadband, satellite, N3 connections.
Telehealth will play an increasingly important role in the future and the SAS representative gave an interesting insight into planned current and future developments in terms of preventive and proactive care for patients in their own community or in their own home. Good access to faster communications would enable SAS personnel to access their learning system (ATSAS) to develop or improve skills and knowledge.
Compatible systems can lead to less paper and more “on-line” information and services.
IT Equipment
It was recognised that modern, up-to-date hardware and software was available and that there be a rolling program of renewing and replacing these systems and hardware to ensure that work and services are delivered as locally as possible, be that in the community, in the home or on this site.
Other Facilities
A multi-purpose Meeting Room with Video Conferencing facilities should be built on-site.
Other
During the course of the workshop it was highlighted that the Working Group needs to get correct information into the public domain and that there is an urgent need to get the Press “on board”.
1