Draft Action Note

DRAFT ACTION NOTE

Skye, Lochalsh & South West Ross (SLSWR) Redesign Steering Group
Thursday 7 December 2017– 13:30 – 15:30
Broadford Hotel
PRESENT:
Tracy Ligema, Deputy Director of Operations, NHS Highland (Chair)
Al Innes, Lead Rural Practitioner, Skye, Lochalsh & Wester Ross, NHS Highland
Catriona Leslie, Portree & Braes Community Council
Chrisann O’Halloran, Senior Charge Nurse (Dr MacKinnon and Portree), NHS Highland
Finella MacKinnon Struan Community Council
Gill McVicar, Director of Transformation and Quality Improvement, NHS Highland
Hamish Fraser, Broadford & Strath and Community Council
Isobelle Macleod
Kate Earnshaw, District Manager, Skye, Lochalsh and West Ross, NHS Highland
Maimie Thompson , Head of PR & Public Engagement, NHS Highland
MaryanneMacFarlaneSkeabost Community Council
Marjorie Jagger, Young Carers
Martin Waller, SOS- NHS
Ross Mackenzie Area Manager West, NHS Highland
Julia Rudram , Senior Occupational Therapist, Skye, NHS Highland
Willem Nel, Rural Practitioner & Clinical Lead Skye, Lochalsh & Wester Ross, NHS Highland
IN ATTENDANCE:
David Park, Chief Officer, Highland and Health and Social Care Partnership, NHS Highland
APOLOGIES:
Alistair MacPherson (AM), Broadford & Strath Community Council
Jo Ford Senior Officer Skye and Lochalsh Council for Voluntary Organisations
Kate Stephen, Councillor
Kirsty Shaw (KS), Dunvegan Medical Practice
Peter Richell (PR), Crossroads Care
1 / WELCOME, APOLOGIES AND INTRODUCTIONS
Tracey welcomed everyone to the meetingand reminded members that the purpose of the Steering Group was to support the Programme Board overseeing the development of thebusiness case,and in particular, provide a local sense check on key issues or suggestions.
2 / NOTES OF MEETING HELD ON 8th JUNE 2017
The Notes of the meeting were approved.
Catriona Leslie again expressed her frustration around it taking too long for draft notes to be issued. It was agreed that this was not acceptable. Maimie agreed tocirculate notes within c 7 days. Thiswas supported by the group.
Although the distribution list had beencheckedand strengthened, Finella said she was still not receiving the information direct. This will be addressed ASAP.
AP 1 / Draft notes to be circulated within seven working days – Maimie
AP 2 / Action : Oversee the accuracy of the distribution list- Maimie & Ross
3 / PROGRAMME BOARD MEMBERSHIP
Maimie confirmed that, following an open invitation to all members of the Steering Group, two new members to the programme board had been confirmed bringing the non NHS Highland representatives to four. The new members are Martin Waller NHS- SOS,based in Staffin, and Cllr Kate Stephens, South West Ross.
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4 / OUTLINE BUSINESS CASE (OBC)
Gill updated the Group that NHS Highland Board had approved the OBC on 28th November 2017, available on NHS Highland website, board meetings 28th November 2017HERE
She reminded member's that the OBC was combined for both SLSWR and Badenoch & Strathspey redesign projects. This reflected the financial benefit from procuring both new builds through one contract.
The next stage in the process is for the Scottish Government Capital investment Group to consider the OBC. It was confirmed that the proposal for the new hospital is for 24 inpatient hospital beds which will be single ensuite rooms and there will also be a safe place.
There was a discussion on hospital bed numbers, end of life care and general issues relating to recruitment and workforce. Some community representatives were particularly concerned around the number of beds feeling there were not enough and what happened if there was flu or need for more beds.
The impact of the reduced bed numbers in Portree and the closure of the Haven were discussed. While Chrisann stressed that reduction in beds in Portree was due to staffing issues the impact had forced new ways of working and different attitudes to risk. Al explained some of the smarter working with better joint working, communications and planning that had been implemented over recent months. Key points summarised as follows:

• The redesign is based on less reliance on hospital beds linked to greater investment in community services; more anticipatory care with fewer people admitted to hospital. Consistent with Scottish Government Policy.
• In addition improved joint working leading to reduced reliance on hospital beds and fewer people in a delayed discharge situation; modern medicine which prevents admission and reduces length of stay; and single en-suite roomswhich mean that all beds will be available where at present some can often be closed due to the need for single sex wards and isolation due to infection.
• At the start of the consultation there were 32 hospital beds (20 Dr MacKinnon and 12 in Portree). Bed modelling work indicated the need for 19 to 27 and so taking the above into account, 24 was thought to be the right number of beds.
• Currently working with 22 hospital beds
• Reduction in Care Home beds due to closure of the Haven. 11 of 12 people were relocated on the island
• Confirmed that nobody is waiting in Raigmore due to lack of hospital bed in Skye
• Into the future it is predicted a need for more capacity in Nursing Homes, more local housing solutions, more care at home but reduced residential care
• Noted that NHS Highland has history of building hospitals that are too big and with too many beds.
• Feasibility study on creating choice at the end of life being taken forward in Badenoch & Strathspey and will be rolled out across SLSWR redesign area and wider NHS Highland but important to note that currently primary and integrated teams in the locality care very well for people at end of life in their own homes and in care homes. Symptom control, including pain can be well managed in all settings and there are medication ‘just in case’ boxes in use at present.
• Hamish stressed the importance of the redesign and emphasis on adult social care.
• Al explained some of the planning exercise carried out for dealing with situations where demand increases capacity for whatever reason.

AP 3 / Steering Group to be updated about feedback from Scottish Government on Outline Business Case and next steps – Gill
5 / OPERATIONAL & WORKFORCE PLANNING
The OBC includes a workforce plan to support the redesign. It includes additional investment in community services including recruiting more health and care support workers. This will be scrutinised as part of the Business Case process.
Kate explained that there continue to be challenges with recruitment. The move to having inpatient services onto one site is in part a response to recruitment.
Gill highlighted that we have to acknowledge that there continues to be wider recruitment challenges. Therefore we need a collaborative approach with partners to address some of the challenges such as affordable housing solutions and accommodation for staff moving into the area, as well positive marketing of the area and local opportunities.
Wil highlighted some of the wider discussions around investment to support infrastructure on the island and there be some opportunities to explore.
5.1 / PREMISES AND DESIGN UPDATE
PORTREE SPOKE
Clinical discussions are ongoing to finalise the specification of the ‘Spoke; and how best to redesign the hospital to make best use of the space aligned to clinical and care requirements.
It was confirmed that Portree Medical Practice will move into the hospital. There will continue to be outpatients, minor injury unit and urgent care centre. Additional services will look at how all GPs in the north and integrated teams will work together to reduce people being admitted as hospital inpatients where possible and more generally reduce the need to reduce travel.
There was a discussion on outpatient services. Ross clarified that there would
continue to be outpatients delivered from Portree and some from Broadford. X-ray facilities are not expected to be available in Portree but some additional outpatients may be provided from Portree. It was confirmed that there will still to be access to physiotherapy in the north.
The condition of Portree Hospital was raised. It was noted that while the hospital was generally in good condition the inpatient facilities do not meet future requirements. As part of the business case process investment in the estate is planned. The landlocked nature of Portree site was highlighted.
There was also discussion about car parking with a need for additional spaces.Gill confirmed that work is ongoing to look at the site with the possibility of taking down some of the redundant outbuildings to create more car parking space.While NHSHighland is comfortable with plans for the site this would not necessarily rule out a new build in the future.The offer of free land in Portreefor new hospital during public consultation was reiterated by community representative.
AP 4 / NHS Highland to confirm detailed provision for outpatients as part of Full Business Case including greater roll out of technology such as endoscopy pillcam and Attend Anywhere - Ross
AP 5 / NHS Highland to confirm capital investment for Portree 'Spoke' as part of the business case – NHS Highland Estates
AP 6 / Update on site plan for 'spoke’ including car parking and access - NHS Highland Estates
5.2 / BROADFORD HUB
The design process was briefly described including outputs from four stakeholder workshops. This includedsignificant input from front line clinicians, patient and public reps, local access panel members and others. A further stakeholder event was planned for 12th December 2017.
Chrisann explained that through the process the design has significantly evolved including from the building being on one floor to a two floor design: outpatients, diagnostics and emergency departments on the ground floor, and on the upstairs 24 single en suitebeds. Work is ongoing to complete the detailed specification for each of the rooms and other space. There will still be opportunity for minor changes.
There will be a public opportunity to view plans in Broadford Hotel on Thursday 13th December. This forms part of the planning process and the arrangements were circulated to Steering Group mailing list and promoted in WHFP.
Community Representatives felt there should also be an opportunity to view the designs in Portree and mainland. Maimie said NHS Highland agreed and that confirmed that further events will be planned.
AP 7 / NHSH to liaise with architects and arrange drop in sessions in Portree and mainland - Estates.
AP 8 / NHSH to arrange design boards to be available on request and drawings to be available on website.
6 / DESIGN STATEMENT AND AEDET ASSESSMENT
As part of the formal design process a Worksop will be required to evaluate the current designs against what was originally agreedby stakeholders. This is a requirement of the business case process.
It was clarified that this was over and above the drop in events which are part of the planning process.
AP 9 / NHS Highland to arrange Workshop and feedback any outputs to Steering Group – Estates and Gill
7 / INDEPNDENT TRANSPORT AND ACCESSSTUDY
The Independent Report from Aberdeen University is now available for comment and wider discussion.Maimie confirmed that the specific issue that NHSHighland is required to address are the implications associated with the loss of inpatient hospital beds in Portree.
While some of this will be mitigated due to the wider redesign of care at home and community services any transport any outstanding transport concerns will need to be addressed.
The study has confirmed that most people use their own car because in general transport infrastructure is poor. They also identified wider issues linked to getting shopping and social isolation. There was a discussion around how these were not matters solely for NHS Highland to address. It was agreed that the Transport and Access Group should be restarted to consider the report and next steps. It was agreed that transport issues were not peculiar to accessing health and care and so a wider perspective was essential.
There was a wider discussion on how local clinicians work with Scottish Ambulance Service to make best use of resource and ensure emergency resource protected for the local area if at all possible.
Gill also updated that the work to secure and fund new helipad for Broadford is progressing positively and is an excellent example of partnership working. Wider issues of accessibility linked to getting into and around the new hospital ‘Hub’ are being considered through the design process with ongoing work with architects, local access panel, clinicians and NHS Highland estates.
AP 10 / Maimie / Gill to circulate report by Aberdeen University and make available on-line
AP 11 / Hamish and Maimie to reconvene Transport and Access Working Groupand keep Steering Group informed.
8 / CLINICAL PATHWAYS
Focus will be on emergency care, minor injury and out of hours, with a particular focus on access for people in the north of Skye. To take this forward there will be an external expert view from a visiting team who will meet with all stakeholders and review data, clinical pathways and public concerns.
Some of the changes inmedicine and terminology were touched on by clinicians present (e.g. A&E vs Emergency Medicine).
Alastair Innes described how clinicians approached initial stages of management and how they are focussed on getting people better and that means getting people to the right place in the most timely manner. He explained why sometimes stopping off en route is not the best course of action as it builds in unnecessary delay in treatment.
Wil Nell commented that as a clinical lead he is responsible for making sure the redesign of services is safer. However, he alsohighlighted that as a father of three children living in the area (with two in high schools) and someone who will use services in the future, that it’s in everyone’s interest to get the redesign right. Overall services should be specialised as necessary and as local as possible'
Maimie highlighted that for a variety of reasons it had not been possible to come to consensus or common understanding of pathways past, present and future regarding A&E/ Minor Injury unit (in hours and out of hours) and that this continues to be a cause of concern for some. Although there was wider discussion and various views expressed at the meeting, Maimie pointed out it was not for Steering Group members to persuade one another but now need to let the external team carry out their work without prejudice.
She clarified that a range of stakeholders would be involved including local clinicians, SOS NHS, other community representatives, Scottish Ambulance Services and others are required.
Wil Nell supported this piece of work andfelt it had been 20 years in the making and needs to be resolved with all parties signing up to the recommendations. There was general support for the approach.
In terms of clinical pathways, in general, , Hamish felt there also needed to be a focus on Scottish Ambulance Service. Maimie and Ross updated that they had met with councillors and SAS on 6th October and an update was provided in newsletter.
Catriona Leslie asked for an update on recent media announcement on x2 mobile intensive care units and when they would be available for Skye. Gill explained this was still early daysand at this stage needed to cover areas where there would be sufficient volume of work to prove concept.
POST MEETING NOTE
Link to the recent media coverage
AP 12 / NHS Highland to update Group on Terms of Reference for external view and to confirm when work will get underway.
AP 13 / NHS Highland to continue to work closely with Scottish Ambulance Service and share any updates with SteeringGroup
9 / PUBLIC AND STAFF ENGAGEMENT AND ONGOING COMMUNICATION
There has been ongoing stakeholder engagement to support the redesign of the new Hospital Hub and also the independent study on transport and access.
Following the meeting of community councils in Kilmuir in 9th August 2017 it was agreedthere was a need to strengthen engagement, especially in the north to oversee the next phase of work. Theexternal view is one of the actions in response to this.
A Working Group will also be established for the north and this was supported by the Steering Group. A commitment to facilitate a meeting of clinicians and elected members has also been proposed. This maybe specific to the external view of out of hours and emergency care or wider across a range of issues.
Maimie updated that the strengthening distribution list andmembership of programme board, ongoing dialogue with elected members, community councils, and newsletter distributed to everyone home were all actions to support ongoing communications and engagement.
CatrionaLeslie fed back that everyone she had spoken to was critical of the newsletter of what they assumed was a very costly exercise. She also commented that it didn't tell people anything they didn't already know.
Hamish said he felt in part responsible for encouraging more direct communications as there had been a lot of misinformation.
AP 14 / NHS Highland to share Terms of Reference when available
AP 15 / Establish a Steering Group to oversee redesign from perspective of the North and agree Terms of Reference – Project Team
AP 16 / Facilitate a meeting for clinicians and elected members
10 / AOCB
Martin commented that from perspective of NHS SOS there remains significant concerns that the redesign is fundamentally flawed and highlighted that it is still being considered by the Petitions Committee.
Marjorie asked if there could be a review of discharge policy from the Carers Perspective. Under new legislation Carers entitled for Assessment. This was agreed and it was reported that there would be staff training on Carer assessments
AP 17 / Marjorie and Chrishann to meet and feed-back
PROPOSED MEETING DATES 2018:
Thursday 21 June 201813:30 – 15:30 in Portree (venue tbc)
Tuesday 11 December 2018 13:30 – 15:30 in Broadford (venue tbc)
AP 18 / NHS Highland to confirm venues

Maimie Thompson