www.nhshighland.scot.nhs.uk

Working with you to make the healthy place to be... Full Article page 14 the right treatment in the right place by the right person... Full Article page 3

more reducing the time people wait local care... to receive services... Full Article page 4 Full Article page 9

improving health... Full Article page 9 launch of staff awards scheme... Full Article page 14

working with you to make highland the healthy place to be... Chairman’s Foreword contents – The need page 2 achievements 2005-6 for change overall health of the Highlands. The smoking page 3 fighting heart disease Chairman - Garry Coutts ban introduced earlier this year is giving a huge page 3 improving services This has been a good year for NHS Highland. number of people the for stroke patients We have seen hospital waiting times incentive they were looking dramatically reduced from where they were a for to kick the habit. All of few years ago. More and more people are our schools now have page 4 investing in advanced surviving heart attacks, strokes and cancer. healthy school meals and diagnostic technology Through the skill of our consultants, GPs, promote healthy lifestyles nursing staff, therapists and countless others, to our children. We are page 5 the integration of Argyll working in the background, people suffering working with many and Bute from all kinds of medical conditions are employers to promote enjoying a far higher quality of life than could healthy lifestyles at work have been dreamed of a few years ago. and there are many other page 6 extended nursing roles These and many other improvements have been initiatives aimed at achieved through a variety of ways. Not least increasing exercise, page 7 Mid Highland Community we have had large increases in funding over the improving diet and reducing drinking amongst Health Partnership last few years. We are now responsible for spending over half a billion pounds a year all of our population. which works out at almost £1,700 for every If, in the Highlands, we page 8 reducing the time people man women and child in the area. could become as healthy wait to receive services But improving services is not just about as other parts of Europe, it spending more money it is also about using the would free up a lot of page 9 South East Highland money we have as wisely and as efficiently as resources to help us Community Health Partnership possible. Often this means we have to change provide improved services. the way we do things to make sure we are While that is a nice making best use of all our resources including thought, it is only the tip of the iceberg. It would also mean increasing life expectancy of everyone by page 10 dental services our staff, buildings and equipment. around 4 years and improve the quality of life for thousands of people. Now that’s worth striving for. Making changes is not easy. People really page 11 North Highland appreciate and value the services they get and “The NHS in needs to change…. to meet future challenges” Community Health Partnership the way they get them at the moment and are Delivering for Health 2005 understandably concerned when they hear that things might change. But if we don’t change we Delivering for Health is a Scottish Executive Health Department paper that sets out page 13 improving health will really struggle to introduce the latest in practical terms what action we will take to turn our vision of the health service technologies, make sure we can buy the into reality. It builds on the National Framework for Service Change to set out the page 14 working in partnership newest drugs, train our staff to the highest level future of NHS Scotland, which for the first time focuses explicitly on providing safe and make sure we are providing the quality of and sustainable services that will support rural communities. health service we all want. page 15 external reviews There are many drivers for change currently facing NHS Highland; not least the An important part of our job is to explain to changing demography and the associated changes in epidemiology of our everyone what our plans are and the population; the impact of changes being introduced with the agenda underpinning page 16 complaints improvements in service they can expect in the modernisation of clinical careers; and the implications of new contracts such as return. We must also listen to what our GMS, Consultant Contract and Agenda for Change. Add to all this, the integration of communities are saying, so we can be as page 17-20 financial statements CHP into the new Highland family. Delivering for Health now gives us flexible as possible and endeavour to put in focus and enables us to work on developments with clear agreement around the place services that give everyone confidence in future care needs and methods of care delivery. page 19-20 auditors report NHS Highland. I know my board genuinely wants to be part of Current view Evolving model of care an open discussion about the future of health page 21-22 waiting times •Geared towards acute conditions •Geared towards long-term conditions services in the Highlands. There are great •Hospital centred •Embedded in communities opportunities for improving services and I •Doctor dependent •Team based back page annual review genuinely believe that working in partnership we can really make a difference. •Episodic care •Continuous care •Disjointed care •Integrated care back page other languages Improving services, however, is only part of our job. As important, is aiming to improve the •Reactive care •Preventative care •Patient as passive recipient •Patient as partner •Self care infrequent •Self care encouraged and facilitated •Carers undervalued •Carers supported as partners •Low tech •High tech

1 working with you to make highland the healthy place to be... NHS Highland’s Summary of Achievements 2005-6 Better Services Pay Modernisation Corporate Objectives & More Local Care & Role Development • Opening of a new NHS24 Satellite • The development of enhanced in GP services for 2005/2006 • Opening of a new 23-bed Stroke Unit • Preparation for the implementation of the • To improve health of people in the Highlands and to reduce the inequalities in and Neurovascular Clinic new Pharmacy Contract health outcomes between different sections of our community. • Opening of Heartbeat Centre, Raigmore • Agenda for Change Implementation • Opening of the Renal Unit at • New posts of Sure Start Community • To reduce the time people wait to receive services. Midwifes • To reduce the transmission of infection and ensure our hospitals are clean. • The development of keyhole surgery in Wick • Training of Community Nurses in • To ensure services delivered are of high quality and clinically effective • Agreement of plans for a new Chemotherapy drug administration • To treat people with chronic conditions sooner, nearer to home and earlier in the Nairn Hospital and Palliative Care course of their disease. • The extension and refurbishment • To modernise our services. of on Skye. Improving Health • £400,000 bed replacement This report will tell you about the progress we have made. • Introduction of Smoking Policy and the across Highland development of Smoking Cessation services reducing ill-health year. Maternity Unit • Appointment to Consultant posts in Wick • Healthy Weight Management caused by smoking has achieved UNICEF baby friendly • All schools in Highland achieved Health A number of Smoking Cessation status and a breastfeeding adviser is to Faster, more Promoting status in 2005 Adviser posts have been created in be appointed to provide specialist efficient Treatment Highland to provide core specialist expertise and support for all staff • Achievement of the 26 week Involving the Public, cessation services in the community across Highland. waiting times target for a first consultant Staff & Partners and 714 individuals are known to have a healthier workforce outpatient appointment or for • Launch and development of Highland’s used the service during 2005-6. An elective admission The number of SHAW (Scotland Health Public Partnership Forum – HealthVOICES additional 15 community pharmacists • Significant reduction in delayed at Work) registered workplaces now • International collaboration on rural health received smoking cessation training discharges sits at 104, which means that just over • Collaboration on the development during this period, and 11 are now • Significant reduction of diagnostic of a Centre for Health Science providing a pharmacy based smoking 43% of the Highland workforce are now waiting times • Launch of a new Staff Awards Scheme involved with this national programme, • Installation of £1M 64 Slice cessation service. for NHS Highland which aims to improve the health of VCT Scanner – a first in Scotland • Launch of a new quarterly Staff Magazine The smoking cessation helpline working people. • Use of Mobile Theatre for Daycase received 81 calls during the year, a • Participation in National Staff Survey reducing hospital infection Surgery large number of these leading up to the • Installation of a new IT theatre introduction of NHS Highland’s Alcohol gel is installed in numerous management system Organisational & Policy Change Smoking Policy in line with the national places across Highland hospitals for • Upgrade of remote base computer systems • Integration of Argyll and Bute health smoking ban in public places in March both staff and visitors and this is a very services with NHS Highland 2006. important barrier to the transmission of • Development of the local Delivery Plan infection. and Clinical Strategy a better start for all babies • Review of NHS Highland’s Smoking during pregnancy is harmful The rate of MRSA in Highland is below Communication Strategy to both mother and baby, and is the Scottish average and below the associated with increased risk of rates of other Scottish divisions of miscarriage, stillbirth and Sudden Infant comparable size and complexity, and Death Syndrome. Most recent figures Highland has succeeded in maintaining show 26.4% women in Highland were the level for post-operative surgical site recorded as smoking in early infections after a hip or knee pregnancy. Smoking cessation training replacement in Highland at less than has been provided to Community 1%. Plans are in place to maintain Midwives and we have recruited a progress, including the appointment of specialist smoking cessation midwife to an Infection Control Manager, a new set up and run a service giving support integrated care pathway for patients and appropriate treatment to pregnant and new information leaflets. Members women and their families. of the patient council have been joining staff in undertaking structured The health benefits of breast-feeding cleanliness surveys in all clinical areas. are well documented. Latest figures To date there are 274 NHS Highland suggest that breastfeeding rates in staff registered to undertake the Highland, for babies aged 6-8 weeks, cleanliness champions initiative training are just above the national average of and training facilitators have been in Working in partnership - NHS Highland and the Highland Council 40%, a small increase on the previous post since October 05. receive national recognition for Health Promoting Schools success.

A dh’ ionnsaigh Gaidhealtachd sla`n, fallain 2 the right treatment, in the right place, by the right person...

NHS Highland aims to in the coming year. Cardiac Services Specialist are being developed as a dedicated provide high quality, specialty and new criteria are being specialist services, in Services drawn up to enable GPs to refer patients directly to the the most appropriate fighting heart disease… echocardiography service for a place, for those who Coronary heart disease is still the screening echo. largest cause of death in the Highlands. need them. Sometimes Her Royal Highness, The Princess However, death rates for Coronary Royal, officially opened the Highland Stroke Unit Open day this must be in a highly Heart Disease have been falling both Heartbeat Centre, Raigmore Hospital, in locally and nationally since the late illness, it provides crucial social specialised setting, November 05, in a ceremony attended support and builds confidence.” 1970s and this trend continues. For by many of those involved in the but, where possible, people under 75 years in Highland, Highland Heartbeat Appeal, from the improving services for deaths have fallen by 42 % in ten very beginning. stroke patients … diagnosis, treatment years. Improvements to date include The centre is the first cardiac A new 23-bed Stroke Unit and a rapid provision of Community Thrombolysis, and care will rehabilitation and research centre of its access Neurovascular Clinic for a Rapid Access Chest Pain Clinic, One kind in Highland and is the result of a Highland became fully operational in be provided Stop Clinics and Cardiac Rehabilitation major fundraising appeal by the British June 2005. It is located in Raigmore classes across Highland. by trained Heart Foundation and NHS Highland. Hospital, with a multi-disciplinary Team, staff, in a A Healthy Weight Strategy, launched in The total cost of the development, led by Highland’s first Stroke Physician, 2005 and the development of smoking including a dedicated gym, a seminar Dr Paul Findlay. community setting, cessation services are just some of the room and consulting rooms, was The one-stop Neurovascular Clinic, closer to initiatives aimed at improving health approximately £1.1million. provides for patients with a TIA and reducing heart disease. Funding Cardiac rehabilitation is vital for patients (Transient Ischaemic Attack) or new the patient. has been secured to establish a Heart recovering from a heart attack, it minor stroke to be assessed and Failure Nurse service in Highland. This includes an exercise programme, receive their investigations within The Specialist Services will be jointly funded by British Heart information regarding lifestyle and National Guidelines. The vision is to Foundation and NHS Highland. There support for the patients who use the develop the unit into a centre of Unit for the Highlands is has also been a review undertaken of rehabilitation programme. Helen excellence supporting enhanced care Raigmore Hospital in all CHD and Stroke literature, using Corrigall, Cardiac Rehabilitation stroke across Highland. This will take patient focus groups and Coordinator, says, “For those time and require excellent joint working Inverness. However recommendations will be taken forward struggling to come to terms with their with community colleagues in Health specialist and Social Services. services are also The Scottish Minister for Health, Andy Kerr, visited staff and patients in the provided when Stroke Unit in July 2005. He appropriate from commented, “I have seen acute stroke units and seen the difference they make other specialist to both patients and staff. Having an centres in integrated team, trained to deal specifically in stroke, makes a real Scotland. NHS difference both to outcomes and gives Glasgow extra confidence to patients and their provides families.” Service development for Stroke also specialist includes Community Rehabilitation services, when Teams in North West , and East Highland, and 3 they are needed, Chest Heart & Stroke Nurses, who to patients living provide a follow up service for all patients, as well as a health education in Argyll and role. The service has also seen stroke Bute. clinical lead posts in Speech and Language Therapy, Physiotherapy and A new dialysis technique called haemodiafiltration has been introduced to the Renal Unit at Raigmore Hospital. This removes more toxins than haemodialysis alone and reduces the risk of low blood pressure during dialysis, as well as the risk of some of the Occupational Therapy. long-term side effects of dialysis such as damage to the joints. Another new innovation in the Renal Unit is a special exercise bike, which has a positive impact on both physical and mental well- being. Blood results have shown that more toxins get dialysed if a patient is exercising during the dialysis, so it is a better and more successful dialysis. Picture: Patient Mrs Irene Reid, with Sister Julie English (Clinical Nurse Educator), Dr Stewart Lambie (Consultant Nephrologist), and Staff Nurse Heather MacRae

3 working with you to make highland the healthy place to be... investing in advanced diagnostic technology… developing Choose information Life technology… – Suicide Prevention in Highland A high-tech theatre management system has been installed in Raigmore, General and Suicide rates in Scotland have Belford Hospitals. The new increased over the last thirty years, TheatreMan system is an outcome mainly due to an increase in male of the theatres review project, suicide rates. The reasons for the which highlighted this as an higher Highland rates are unknown, important improvement. Medical but possible reasons can be the staff can now access laboratory isolation of remote communities, results and other operational access to support services, levels of systems while in theatre. The same system is also accessible to deprivation, access to lethal means, Consultants’ secretaries for alcohol use. Installation of VCT Scanner at Raigmore Hospital operation lists and booking A national programme “Choose Life” A new 64 Slice VCT (Volume Computed Tomograph) Scanner was installed in March patients. has been created to help tackle 2006. This is the first of its type in Scotland and one of the most advanced of its The system is quicker and easier to suicide in Scotland, and in response kind in the world. The £1M scanner was partly funded by the North of Scotland use and has lots of potential for to this the Highland Choose Life Cancer Network. The new technology is fast and highly detailed, capable of development, with touch screens Group has launched the most scanning the whole body in only ten seconds, which can be crucial for patients with and new washable silicon ambitious staff training programme in extensive injuries or stroke, enabling rapid treatment to begin. It is also of great value keyboards, which aid the control of Scotland, with NHS, Council and in managing cancer patients. infection in theatres. voluntary organisation staff trained in Dr. David Goff, Consultant Radiologist welcomed the new technology, “Because it is Accurate data is now more STORM (a skills-based suicide so quick and accurate, the machine can do a total heart investigation in under five accessible and further prevention package for frontline staff) beats of the heart. This can help doctors immediately determine the most life- developments could include patient so far. Combined with training in threatening critical conditions in chest pain, including the diagnosis of coronary checks using a barcode on identity ASIST (a suicide intervention skills artery disease and pulmonary embolism.” bracelets. package for caregivers), this is a major effort which is being continued for at least the next three years, together with a number of other initiatives. and more local care….. (http://www.chooselife.net/web/site/h We want to treat people with chronic conditions sooner, nearer to home and earlier in the course of their disease ome/home.asp ) A delayed discharge occurs when a patient, clinically ready for discharge, cannot leave the hospital because the other necessary care, support or accommodation for them is not readily accessible or funding is not available to purchase a care home place. Concentrated efforts, in partnership with the local authority, resulted in significant reductions in the numbers of delayed discharges in 2006. The total number of patients ready for discharge at April 2006 was 10, representing a sustained reduction from the high point of 91 in September 2005. In achieving these results, the Highland Partnership has identified a number of significant issues, which require to be addressed to ensure that the position is sustained. Key to this is the sustained use of the and the little Admission and Discharge protocol and the use of the Scottish Executive Guidance on Patient Choice. The latter guidance is clear that patients cannot “choose” to remain in hospital once their clinical episode is complete and it is not desirable to keep people comforts…. in a hospital setting when there is no clinical need. By the end of April 271 beds and The rate of recurrent emergency admission among the elderly has been increasing in recent years. Recurrent admissions put mattresses across NHS Highland will pressure on acute inpatient beds and appropriate responses are required to meet the needs of elderly people, often with chronic, have been replaced with state of the multiple conditions. art beds, at a cost of almost An initiative to develop a strategy for the effective management of chronic disease across Highland is underway. This is being £400,000. The beds are completely tackled in partnership with Social Services and Scottish Ambulance Services, and is supported by the national Unscheduled adjustable, allowing patients to have Care Programme and Managed Clinical Networks for Cancer, Diabetes, CHD and Community Hospitals. Work will be developed more independence and staff to do with GP Practices to identify people with chronic conditions and pro-actively manage their condition. This will include developing less manual handling. hospital at home services, community rehabilitation, augmented home care and Community Rehabilitation and support for improved self-management. Enhanced GP Services for Multiple Sclerosis, Depression and Diabetes have been negotiated and are being further developed and a programme of work to develop Falls Prevention underway.

A dh’ ionnsaigh Gaidhealtachd sla`n, fallain 4 Community the integration of Health Argyll and Bute

that our first priority was always to help communities to feel safer as well Partner maintain provision of high-quality as healthier. clinical services for patients. The Community Development The role of the new CHP is to promote 1st of April 2006 saw Argyll and Bute Programme has resulted in a number of i and improve the health and well being sh ps service changes and new become part of NHS Highland following of the community and to lead on a public consultation and the decision developments including: Community Health community planning and partnership by the Minister of Health and • Full implementation of the new model Partnerships are responsible working with the Argyll and Bute Community Care to dissolve NHS Argyll of maternity services for Argyll and Council and other agencies. Public for the management of all and Clyde and merge it with NHS Bute, with Community Maternity involvement is a critical role of the CHP health services within Highland and NHS Greater Glasgow. Services in all localities, led by single and it will establish a Public Partnership localities in Highland. The public consultation process over role midwives. The new service Forum for the area to ensure the the redrawing of the new board’s responds to and meets the needs of all Three of these were continued provision of high-quality boundaries emphasised repeatedly the women as locally as possible and has established in 2004 and clinical services for patients throughout importance of maintaining local access led to an increase in local births and Argyll and Bute became the period of change. and local decision-making within the increased satisfaction levels among all Highland’s fourth communities, as well as strengthening service users. Active involvement of Community Health patient pathways, which followed developments in Argyll service users in each locality has Partnership in April 2006. natural community and transport and Bute during 2005/6 provided support and increased They are also responsible infrastructure links to specialist Dr Erik Jespersen was involved in collaborative working between the public and the midwives. for improving health and services in Glasgow. helping formulate the chapter on rural The NHS Highland Board considered • Start of £1.8 million building work in local public health issues. health care within Professor Kerr’s that the integration of Argyll and Bute benchmark report, which became the Nov 2005 of on the Isle of Jura Care They have devolved with the rest of NHS Highland was very basis for the future shape and direction Centre, which will provide a range of supported accommodation and decision making for local much a natural fit, with both areas for Scotland’s health services. “Within services to allow its older people to services and priorities and a addressing the same challenges of Argyll and Bute we were immediately providing high-quality patient focused remain on the island as their key role in community able to consider and bring forward his health services to remote and isolated dependency needs change. This outcomes into developing a modern planning. Health and health rural communities. progressive care service model is one rural health service for Argyll and Bute services cannot be seen in The integration plan, which included of the key components of the old through the Community Development isolation, as many other extensive involvement and consultation people’s care strategy currently being Programme. This aims to sustain and factors have an impact on with staff and the public, saw the developed and agreed between Argyll modernise rural health care services health and well-being. establishment of Argyll and Bute and Bute council and the Community Community Health Partnership (CHP) with an approach that has at its heart, Health Partnership. The NHS has to work as an integrated operational unit of NHS public involvement and a consensus • The Healthy Communities closely with its partners in Highland in April 2006, with driven approach. Local redesign groups Collaborative Project in Bute and Cowal are drawn from the public, voluntary is a project, which aims to empower social work, education, responsibility for all health services serving a 91,000 population. It has sector, community groups, councilors, local communities to address health housing and with patients, delegated authority for a budget of managers and health professionals.” issues, focusing on falls prevention in carers and community £152 million and responsibility for The Community Development older people. This joint project with the groups. The aim of the managing 2500 staff, across the Programme has at the core of its focus, council has already had considerable Community Health geographical area of 6700 square the need to address health inequalities success in increasing and maintaining Partnership model is to kilometers, covering six towns, remote and health improvement for the older people’s independence and health villages and hamlets and 26 inhabited population of Argyll and Bute. It and reducing the number of falls, ensure that health services islands. Each Community Health specifically aims to tackle the negative especially for those in residential care are delivered as locally as Partnership is governed as a impact of alcohol misuse and improve settings. possible and integrated with Committee of the Board. mental health and wellbeing, as well as Within Argyll and Bute we were also other services to achieve Dr Erik Jespersen, Clinical Director of reduce the incidence of coronary heart successful in obtaining European Union maximum benefits for the Argyll and Bute CHP, explained that the disease, stroke and cancer. It also aims funding as part of a Sustainable Rural organisational change, which would to reduce health inequalities, through Health Care Network Project, which is health of local communities. affect Argyll and Bute, was balanced by the development of social care and looking at developing services specific the dedication and focus of all staff health care services and improved to the needs of rural populations in within NHS Argyll and Clyde to ensure partnership working, with a desire to northern Europe and Scandinavia. The

5 working with you to make highland the healthy place to be... Other new developments in 2005/06 include: Extended nursing roles NHS Highland has achieved substantial providing the right care in the •Opening of the new Stroke Unit in developments in extending and Lorn and Islands Hospital in July 2005 developing nurse roles with specialised right time in the right place… •Opening of the £835,000 Kilcreggan training and leadership programmes. The Out of Hours service is very SHAW Bronze Award Medical Centre in October 2005 Board Nurse Director, Heidi May, was appointed in 2005 to lead this area of expensive and may not be sustainable, project involves developing and piloting •Significant improvements in the care work including the development of with total reliance on one professional the case management approach, to of patients with CHD, stroke and nurse prescribing. Lead Nurses have group. A number of solutions may focus the efforts of health professionals mental health through a Quality and now been appointed to all the include integrating A&E services, in Campbeltown and Oban on to outcome framework performance of Community Health Partnerships and increasing the professional mix of staff patients with chronic diseases, who are GP practices. and working with the Scottish most at risk of having frequent and Early Years Workers have been •Redesign and expansion of palliative appointed in several areas of Mid Ambulance Service over role planned admission to hospital. The development. Work is also underway to project also involves establishing an care workforce Highland CHP, supporting families of pre-school children. Emergency Nurse tackle emergency hospital admissions expert patient network to support •24 health care assistants from Practitioners are working at several and shift the emphasis to preventative people to manage their chronic health across Argyll and Bute undertook sites in NHS Highland with the aim of measures. conditions better thereby preventing nurse training through the Open reducing unnecessary acute The new NHS24 Inverness-based symptoms dominating their lives and University in collaboration with admissions. satellite service for Highlands and the helping them have better health. University of Paisley. Islands went live in November 2005. Developing a mental health strategy and The training of Community Nurses in The new satellite will improve patients’ implementation plan has been a key Chemotherapy, drug administration and access to services by increasing the priority for Argyll and Bute in 2005/6. New developments Palliative Care has improved local number of nurses available at peak The culmination of this work has seen delivery of services for patients across planned in 2006/7 times and improve local knowledge as broad agreement with the local Highland. The new post of Sure Start Community Midwife will support these nurses will be based in the local authority and with users and staff on •To reduce the negative impact of vulnerable women and families in the area. the future shape of hospital and alcohol misuse Ross and Cromarty area. community services. This will see older – our Health Improvement priority Inverness-based triage nurses work people’s dementia services relocated Nurse-led Pre-assessment Clinics have alongside the NHS Highland out-of- into the localities of Argyll and Bute, •Opening of the £18.4 million been operational for some time in hours hub, which has re-located to the with a smaller acute admissions unit New Mid Argyll Hospital and Highland and have helped reduce the Scottish Ambulance Service’s (SAS) based in Lochgilphead, providing a Integrated care centre patient’s length of stay and improved Emergency Medical Dispatch Centre on range of specialist assessment and •A&E refurbishment at Dunoon theatre utilisation and control of the Raigmore Hospital campus. treatment services various models of Community Hospital to provide infection. Planning for the local out-of-hours psychotherapy. a modern department with its Nurses from the medical receiving satellite service for Highlands and the Implementation of the new Mental own entrance. ward, Raigmore Hospital and the Islands has been carried out in Health Act has been a particular Intermediate Care Team at the RNI, partnership between NHS Highland, the •Appointment of a third surgeon in challenge, involving staff and the have collaborated together to reduce Scottish Ambulance Service, the NHS Lorn & Islands Rural General public. This has required a change in emergency admissions. Their Boards for Orkney, Shetland and the Hospital to enhance the quality of the approach and attitudes with an innovative work has led to a change in Western Isles, and NHS 24. service and make it more sustainable expansion of patient’s rights. Argyll and practice, with senior nurses taking GP The service operates at peak times Bute has invested in providing facilities •Appointment of new Dentists calls in the Mecical Receiving Ward. during the out-of-hours period when GP to improve the areas in which patients and development of a dental They have developed a detailed surgeries are closed and call demand is have to wait on transportation is being modernisation plan directory of community hospital at its highest – during the evening, at services as patients are more likely to arranged. •A&E refurbishment at weekends and on public holidays. It be admitted or have an increased has been agreed with NHS24 that the length of stay if staff are not fully aware Satellite will shortly be taking Serious •Attainment of the SHAW Hospital of the range of local community and Urgent calls and some national awards for Dunoon and services available. They have also overflow calls. Campbeltown hospitals piloted nursing staff rotation to allow People in Highlands and the Islands increased training opportunities. •Start of building work on the new should continue to phone NHS 24 on £1.4 million Garelochhead health 08454 24 24 24 if they are ill when Argll & Bute C.H.P. Committee Meeting centre including integrated local their GP practice is closed. Calls will authority social work services. still be answered at one of the main •Implementation of the Hospital at NHS 24 contact centres then, where night service at Lorn and Islands appropriate, some calls will be from the transferred to the Inverness-based 1st August 2006. nurses for a clinical assessment.

Mid Argyll Community Hospital Nursing Conference Oban

A dh’ ionnsaigh Gaidhealtachd sla`n, fallain 6 Mid Highland Sexual Community Health Partnership Mid Highland Community Health Partnership (CHP) provides health services to around 93,400 people across 4,950 square miles, covering Lochaber, Skye and Lochalsh, Ross, Cromarty and West Ness. The CHP Committee is made up of members Health from health services, both clinical and managerial, six local Councillors, a public member and staff members. All are involved with planning, monitoring and governance, and, local multi agency events are held on specific themes. National, Strategy regional and local issues and targets have been used as the basis for the CHP's Development Plan. One of the major joint initiatives is the Review of Services for Older Adults in Lochaber. Committee Chair of the CHP, Ann Bethune says, "I became chair at the beginning of April and have been impressed by the enthusiasm and commitment of the entire team towards The Highland Sexual Health providing high quality care in the ways most appropriate to health needs in each locality. The willingness of our partner Strategy is a multi-agency agencies and members of the public to engage in debate around the planning of health services for their communities has document, with input from been particularly encouraging. An example of this is our consultation on the planning of services for older adults in Health, Local Authority, Prison, Lochaber, which included interviews and focus groups with patients, relatives and carers, members of the public, staff, Faith, Voluntary sector and the service partners and community leaders, culminating in a 2-day workshop event to identify the way forward." public. The Strategy, in line with the National Sexual Health strategy, “Respect and Developments over 2005-6 development this year. The new Responsibility”, published last The £600,000 Renal Satellite Unit in Glencoe, Mallaig, Spean Bridge, as well Belford Hospital, Fort William opened to as a lot of activity in Fort William. There facilities in Portree have been designed year, aims to encourage a wide its first patients in May 2005, improving has been a particular focus on to incorporate the services previously variety of agencies throughout the lives of renal patients in the providing assistance to pregnant used at Gesto Hospital, but in a far Lochaber area. women to give up smoking and support more up to date, modern building, Highland to work towards a Staff Nurses from Belford Hospital, those patients who are undergoing conducive to current high quality health culture that is increasingly at underwent training in the Renal Unit at procedures in acute care. service practice. The number of beds ease with sexual matters and to Raigmore Hospital for several months An initiative to motivate people to eat available in Portree have increased from 13 to 18, bringing the total bed raise the profile of sexual health, in preparation for the opening of the healthier and to increase their exercise unit at the Belford. Five patients resulted in a recent Food, Fitness and complement on the island to 42. with improved access to previously had to make a long journey Fun Day in Fort William. Some health The locality as a whole has welcomed education, advice, information 3 times per week to Inverness for their checks were available and the additional beds and improved out- treatment. It has provided a very professionals were on hand to give and support. patients department at Portree Hospital. valuable service both to the community dietary, exercise and health advice. The With the addition of a comfortable of Lochaber, but also to holidaymakers activities being demonstrated and tried relative’s room for relatives of The Strategy has undergone an visiting the area who are dependent on out included Kick boxing, Thai Chi, terminally ill patients to stay over, the intensive consultation and dialysis. Yoga, Scottish and Salsa dancing. hospital is able to offer a high standard development process and many Work on rendering and windows began Work is progressing on the new Fort of facilities for patients and staff alike. in 2006 to give the Belford Hospital a William Health Centre, which will house of the recommendations An allocation of £1.8m, targeted at facelift and increase energy efficiency. the three GP surgeries that serve Fort developing modern facilities to improve contained are already being A new Computed Radiography system William together with many community health outcomes, will be used to fund implemented, with increased has also now been installed, funded health services. Completion is expected two projects in Highland. Broadford through the Scottish Executive as part in May 2007. funding from the Scottish Community Health Service Centre on of their drive to implement a Scotland Additional funding has been received the , which serves a Executive. A new challenge will wide Patient Archive and from the Scottish Executive to increase population of approximately 2,000, has be providing a sexual health Communication System. The images the service to people with addiction received £1m of this money. The are produced in a digital format that will problems. An additional Community present practice requires modern implementation plan in be eventually stored on a network, Psychiatric Nurse for addictions has premises of sufficient size to deliver the partnership with Argyll and Bute. which will enable anyone with now been recruited. In addition some full range of primary care services, as appropriate authorisation to see extra resource from Social Work has well as additional services, in line with Implementation will continue in a patients images and reports from been made available to increase the national and Highland policies. clinics and hospitals anywhere in Care Management activity in the team The extension to Portree and more focussed way now that the Scotland. and this has also enable an extra subsequent refurbishment of the Mental Health Officer to be recruited by Strategy has had formal Smoking cessation activities have MacKinnon Memorial will provide the team. approval by NHS Highland and commenced across Lochaber to enable excellent, modern facilities for patients people to stop smoking. The smoking The completion of the 18-month the Highland Council. on Skye. This together with the cessation advisors have been running development programme at Portree planning of Kyle Health Centre, will help clinics in Ardnamurchan, Kinlochleven, Hospital, has been a major to ensure an integrated approach with

7 working with you to make highland the healthy place to be... Reducing the time people wait to receive services rural general The national waiting times targets were nurse or other healthcare professional show the overall NHS Highland Cancer achieved by the end of December 2005, within 48 hours. It is a key priority for Waiting Times performance at 75%, hospitals with nobody waiting longer than 26 NHS Highland to reduce waiting times improved from the October - December weeks for a first outpatient appointment for cancer diagnosis and treatment. The 2005 figures of 55%. in the north or for an operation. Actual performance national target for patients needing The national target is for women who at the end of December 2005 was 88% urgent cancer treatment to be treated have breast cancer and need urgent A national group has been set up as and 94% respectively for elective within 2 months, came into effect in treatment to be treated within 1 month. A part of the Health Department's admissions and outpatients waiting less December 2005. There has been a huge replacement Breast Physician took up implementation of "Delivering for than 18 weeks, against the target of amount of effort during 2006, to reduce post, in March 06, and actions to Health", and chaired by NHS Highland 85%. waiting times for cancer diagnosis and improve the identified delays are in Chief Executive, Roger Gibbins, to All Highland GP Practices intend to treatment, to bring NHS Highland into progress. The appointment of a third agree a core set of activities that would deliver the 48-hour access target, which line with national targets and to improve Chest Physician in October 2005 is be safe and sustainable in rural means that anyone contacting their GP services for cancer patients. hoped to have a positive impact on Lung hospitals in Scotland. The group will surgery should have access to a GP, The January to March 2006 figures Cancer diagnosis. The challenge of also address the challenges of training, achieving more timely access to continuous professional development of diagnostics has benefited from staff, recruitment and retention as well appropriate services close to people’s HMS Sutherland. The event significant recent investment through the as possibilities of networking with homes. The re-design of a number of acknowledged the naval history Diagnostics Waiting Times Initiative. teaching hospitals. The group will Overall, the longest wait for CT scan has services is underway, including out- attached to the old County Hospital, produce a report, which will begin to moved from 30 weeks in October to just patient services, radiography services which was built by the Navy during the define the core activity of these 8 weeks with requests for suspected and a multi-disciplinary approach to first world war. hospitals. It has been helpful to be able cancer patients always prioritised. In unscheduled care. There is also a move Work to sustain and modernise to bring primary care and hospital towards further integration of maternity services will see the redesign order to support early diagnosis Colorectal Cancer, priorities identified clinicians together to discuss joint community health services, in order to of double duty nursing teams to provide approaches to supporting robust and respond effectively to the need for single duty services in West Ross. include increasing the number of Nurse Endoscopists and improving the sustainable clinical services in the area. anticipatory care, particularly the Midwives from Argyll and Bute and Endoscopy facilities available. The need There are ongoing discussions about management of long-term conditions. Skye & Localsh will visit to share their to improve surgical capacity is also a collaboration with Lorn and the Isles. The distance to specialist hospitals is knowledge with the West Ross team priority for colorectal cancer, with new The Rental Unit has been made always a challenge for the remote and around midwifery caseload staff roles to support this. available to Argyll patients, although no rural areas and working with our management across a large one has taken up the offer as yet and Scottish Ambulance Service is vital to geographical area. Building on the work undertaken in both Ultra Sonographers from Belford have service development. Lung Cancer and Colorectal cancer, an GPs and practice teams across area been working in Lorn and the Isles. The Community Planning Partnership is have been participating in national action plan to address Urology Cancer providing an excellent forum for projects, which are focussing on waits is now being implemented, The possibility of audiology being made partnership working between statutory, access to primary care services and including new referral guidance for GPs available to Lochaber patients and voluntary and private sector agencies improvement in the care provided for for suspected Prostate Cancer, an potential for developing endoscopy across Skye & Lochalsh and an those with long term conditions, such additional Urology Nurse specialist and services are being explored. opportunity for more detailed as Coronary Heart Disease and Staff Grade Urologist, additional partnership working between Health, Diabetes. ultrasound sessions, and improved Voluntary Services and Social Work, coordination between out-patient with a focus on health improvement appointments and diagnostic tests across the locality, ensuring that health Experiences using the tracking systems improvement is embedded in everyday that were in place in both Colorectal and practice across all sectors. Lung Cancer have helped the During the past year, there has been an development of a new web-based increase in the services provided from Cancer Tracking Tool for all Cancers for the County Community Hospital in use by key staff across the organisation. This should provide reliable, 'Real-time' Invergordon, which opened in February Invergordon Hospital 2005, with a nurse led minor injury information and the earliest identification service, ultrasound service, and sexual of patient delays at all key milestones in health services. There are ongoing the pathway (eg first consultation, discussions to increase this range, diagnostic tests, treatment) and lead to including consultant led obstetric improved patient and carer experience of outpatient clinics. Integrated community cancer services. and mental health teams and the health Premature cancer mortality has been centre for the Alness/Invergordon generally decreasing and figures show a practice are based here. The hospital decrease of 4% on the previous year, had its official opening in October 05 partly due to screening programmes, Renal Unit , Belford Hospital by Commander Haslam, RN, earlier detection, speedier diagnosis and accompanied by crew members from Portree Hospital improved treatment.

A dh’ ionnsaigh Gaidhealtachd sla`n, fallain 8 South East Highland Community Health Partnership “Staff have demonstrated an ongoing Caley Thistle Stadium MOT for men: Men's Health checks have been commitment to made available across Highland and are very popular. providing the highest possible service standards and I commend and thank them for their efforts.”

South East Highland Community Staff from Raigmore Hospital and the won an award for innovation in reducing Health Partnership (CHP) serves unnecessary hospital admissions. a population of around 90,000 patient and public groups to ensure need for patients to be admitted to across three main geographical the patients’ voice is heard at all an acute bed. The project involved a areas including Inverness, level. Arrangements are also in GP and community Nurse being & Strathspey and place to recruit a voluntary sector based on the Ward and exploring Nairn & Ardersier. Each locality representative to the committee. options for patients to be looked has developed its own A major development, which after at home or in a local setting constitution to enable local requires the CHP to work closely such as a community hospital. We decision-making and has its own with a range of partner intend to build on the success of the locality management group, organisations, commenced during pilot during 2006/07.” including front-line staff, patient 2005/06. Getting It Right For Every Nigel went on to say “We’ve also representatives and Child is a major Scottish Executive kicked off a piece of work to representatives from other initiative and the Inverness locality is improve patient care with closer agencies such as the Highland a “pathfinder” site. This aims to working between A&E and Out of council. ensure a seamless, joined up Hours Services which are both Ian Gibson, new CHP Chairman, approach to the delivery of all based in the Emergency Department says “After a period of preparation children’s’ services and the at Raigmore Hospital.” and development, the CHP has arrangements being tested in Increased Occupational Therapy and begun to deliver on its key aims, Inverness, will be rolled out across Physiotherapy Services to provide particularly in relation to Public Scotland in due course. better rehabilitation options across Involvement, working in partnership We are also working closely with Badenoch and Strathspey and the with other agencies and service medical and nursing staff at finalisation of the plans for the new delivery”. Raigmore Hospital says Nigel Small, community hospital in Nairn are A Public/Patient representative has CHP General Manager. “We piloted a other examples of how the CHP is been appointed to the CHP study on the Medical Admissions improving services for its patients. Committee and the management Ward to look at ways of avoiding the Staff have been working hard to team are working closely with local improve discharge arrangements

9 working with you to make highland the healthy place to be... and more patients than ever were able to leave hospital at the appropriate time without unnecessary delay. Dental South East Highland hosts the management of Dental and Inpatient Mental Health and Learning services Disability Services for the whole of NHS Highland. Nigel Small confirmed that 2005/06 had been a particularly busy year for New Craigs Hospital and Mental Health Services with the additional challenge of the new Mental Health Act coming into effect on October 2005. ure a seamless, joined up approach to the delivery of all children’s’ services and the arrangements being tested in Inverness, will be rolled out across Scotland in due course. Dunoon Dentist Staff award for introducing Cognitive Behavioural Therapy to treat depression in men on the Black Isle. A significant development for long stay learning improving access disability patients is now underway. The work began to provide a large number of patients with to dental services their own home and staffing support to allow NHS Highland has been implementing them to live a normal life in the community. This the ‘Action Plan for Improving Oral is part of the Scottish Executive’s “Same as Health and Modernising NHS Dental You” initiative. Services’, which was published by the Scottish Executive in 2005. Over the Ian Gibson summed up “2005/06 has been a last year, we have developed the busy year for the CHP and its hosted services. nursery tooth-brushing programme “Staff have demonstrated an ongoing with the result that we now have more commitment to providing the highest possible than 81% local authority and 38% service standards and I commend and thank voluntary and private nurseries them for their efforts. Throughout 2006/07 our brushing. The emphasis over this aim will be to build on this success and coming year will be on supporting the roll out of the programme to primary implement the requirements contained in RNI Hospital Staff schools, particularly those with highest “Delivering for Health”. need. NHS Highland has prioritised the Nairn is to get a new hospital and development of a Dental Property health centre in the grounds of the Strategy and was successful in Nairn Hospital plans agreed existing Town & County Hospital, obtaining £1.37 Million from the including a centre, staffed by GPs and Primary Care Modernisation Premises other health care staff, and a base for Fund for dental premises development. Social Workers. The new buildings will Much of our activity over the last year provide a 20 bedded hospital together has been spent in planning with a day hospital, minor injury unit developments in each Community and outpatient accommodation. The Health Partnership area. New premises integrated community health service will be opening in Wick and Inverness centre will provide extensive General in August 2006, which will provide Medical Services including GP minor increased access to NHS dental injuries; the full range of community services. nursing services; community mental During the latter part of the year, health services; chiropody; additional funding was allocated for occupational therapy; speech therapy; 'committed' NHS dentists, the full physiotherapy services; social work impact of these allowances cannot yet services; NHS dental services and be determined. One additional practice paediatric services. has been established in Highland with Once approval to proceed with the support from the Scottish Dental development is given the Design, Legal Access Initiative grant funding, which and Planning Agreements will take has provided 1500 people with access. approximately six months, followed by Nairn Hospital a construction period of 12 months.

A dh’ ionnsaigh Gaidhealtachd sla`n, fallain 10 North Highland Community Health

Enhanced Highlands, by bringing care to patients Partnership in more remote and rural areas. She has taken specialist care into North North Highland Community Health recently travelling to Inverness. Highland communities by setting up Partnership (CHP) provides a mixture of Several patients in Caithness have now teams of dieticians and podiatrists who GP acute, primary care and community benefited from specialist keyhole run clinics, providing care to patients services in Caithness and Sutherland surgery for hernia operations. This is a where they need it most - in their local for around 40,000 people across 7,800 great stride forward for rural hospitals areas. Services Healthcare staff across the North square km and some of the most as it means that patients who have this Enhanced GP Services are rugged and remote parts of the operation recover more quickly and Highland community have also benefited from multi-disciplinary aimed at ensuring an Highland terrain. Services are provided with less discomfort that they would from four community hospital sites, have had with conventional surgery. education and training programmes, enhanced level of service rural bases and a rural general hospital. service re-design developed by Pamela. She is also above the routine GP or “The development of a Community Considerable work, with close co- currently developing group education practice input for certain Health Partnership for the north operation between health and social schemes, which will bring people with types of patient problems, Highlands is allowing us to deliver the work colleagues, has resulted in diabetes from remote Highland areas such as depression, multiple National Health Service at local level, reducing the number of patients together, to learn more about their condition and share experiences with sclerosis, minor surgery, adapted to the particular needs of the delayed in hospital to between 2 and area,” says David Alston, Chair of the 10 at any one time. At the start of the healthcare professionals. minor injuries or alcohol North CHP Committee. process there were 38 patients delayed related illness. developing local services in hospital beds for a variety of The North CHP has participated in the reasons, some waiting several months. There are national specifications, Scottish Primary Care Collaborative, New procedures and systems were put which dictate the type and quality of which has focused on increasing in place that enabled a co-ordinated service plus the level of payment. In access to primary healthcare approach to be taken by both social some cases we have agreed a local professionals, and tackling two major work and health with significant impact. variation and these are then Local conditions, diabetes and coronary heart During 2005 there was a period of Enhanced Services. disease. Four out of the five practices extensive consultation involving involved in the first phase of the project professionals, service users and have achieved advanced access, which communities to develop a viable future is defined as a patient being able to model for maternity and gynaecology have an appointment whenever they services. wish. Posts were developed and promoted in Work is well underway in developing partnership with the community for 3 Staff from Caithness and Sutherland services for older adults in Sutherland. Consultant Obstetricians with a remit to were recognised in the NHS Highland We are looking at redesigning current develop maternity services across the Staff Awards 2006. The Mental services in partnership with colleagues whole of Highland. Two of the posts Health/Learning Disability Award went in Social Work to better meet future have now been filled, with the new to Beverley Halmahamade, a needs. The work has focused on a appointees taking up their posts during Community Psychiatric Nurse who range of hospital and community September 06. One of the posts has a provides a service for substance developments that meet the needs of leadership role to develop the service in misuse clients in the Caithness area The ESCRO software sits on the GPs patients close to home. the CHP and within the wider highland and has been at the forefront in system, used by the majority but not The plans for the replacement of context. The 3 locum consultants have improving the lives of children living all Practices across Highland, and in Bonar Bridge have had their contracts extended to the end within these families. Beverley also can be used when the patient is in been moved forward with funding for of September to ensure that there is no picked up the Overall Individual Award. further investigations into the preferred disruption to the local service. the consulting room. It is a series of Staff Nurse Karen Macleod and the site. The proposal for the new hospital Caithness General has re-applied for screens which guide the GP through Town & County Hospital Team were has been developed in collaboration their certificate of commitment to the given the public Involvement Award for specific requirements, ensuring the with the Highland Council, and other baby friendly initiative and an action their monumental efforts to improve patient receives the full specified partners, in order to take full advantage plan has been submitted to UNICEF. facilities for palliative care patients. enhanced service. of any opportunities for shared used of staff at the heart of innovation and They involved and inspired the local the site and integrated facilities. quality community to raise over £30,000 to It has been operational throughout The expansion of the Renal Unit at Diabetes specialist nurse, Pamela build two new Palliative care suites at 05/06 and will provide full activity Caithness General allows up to 16 Campbell from Caithness, won a the Town and County Hospital in Wick. data for all practices, which can be patients. It is now running 6 full days a prestigious honour at the Scottish The rooms also provide well thought- aggregated to give valuable week, with 7 trained staff and treating Health Awards 2005, for revolutionising out facilities for the families of patients. information about activity across 13 patients, one of whom was until community diabetes services in the A new palliative care room with en suite Highland.

11 working with you to make highland the healthy place to be... facilities has also been developed in the with donations from the local community. These purpose-designed rooms will promoting health Work provide an enhanced level of care for the end of life days of some local patients. in schools force Linda Sinclair took up post as the Lead Nurse for North Highland Community PLANNING Health Partnership September 2005. The role is to provide professional nursing advice and support to the The structure of Highland management team identifying and population is changing developing appropriate new roles, whilst continuing to enhance current significantly, which will affect the practice and monitoring the quality of patient services required in the nursing services and nursing care. future, as well as the labour pool Linda is an experienced nurse and has previously worked in Caithness as a from which NHS Highland staff community nurse, midwife, health are drawn. visitor and nurse manager. Over the past year all charge nurses across the The development and CHP have enrolled on the Cleanliness implementation of Workforce Champions programme putting learning Planning in the context of into practice within their areas to minimise the incidence of hospital National and Regional priorities acquired infection. Several nurses have and the Equality and Diversity undertaken training as independent and agenda is a key priority, ensuring supplementary nurse prescribers, enhancing patients’ access to that NHS Highland has a modern appropriate medicines in their areas. and appropriate workforce Minutes of the CHP Committee meetings are capacity and capability now and published on the NHS Highland website in the future, that is fit for www.nhshighland.scot.nhs.uk Working purpose in line with changes anticipated in service delivery. with Key to the success of this is to work in partnership with Partners Highland Well Being Alliance All 222 schools in Highland are Partners including local authority officially recognised as ‘Health Promoting Schools’. This was achieved and voluntary organisations to at the end of 2005, two years ahead of jointly plan future workforce the Scottish Executive’s target of 2007. requirements. The Highland Health Promoting Schools Endorsement Team (NET) and was Scheme has been jointly managed and considered to be a robust, well Planning will respond to Staff from Town & County – Wick funded by NHS Highland, Public Health structured scheme with evidence of emerging issues that will impact Team and The Highland Council, close partnership working and a clear upon the workforce such as Education, Culture and Sport. The philosophy of recognising the schools Scheme in Highland achieved national as part of a wider community and NET "Delivering for Health"; targets, recognition with Highland Council congratulated the Highland standards and legislation, winning the local authority award of the Council/NHS Highland partnership in epidemiology, patient and public year at the annual Scottish Education having all schools achieve ‘health Awards, in June 06, for its partnership promoting schools’ status by 2005. expectation, technological working with NHS Highland in securing A Healthy Weight Management strategy advances, staff aspirations, pay health promoting school status for has been developed to tackle the modernisation, large scale every school in Highland. growing problem of obesity. This builds service redesign, and In addition to this good news, the on the work already achieved in Highland Health Promoting Schools Highland in raising activity levels and demographic changes. N CHP Team Meeting Scheme was examined by the National promoting healthy eating in schools.

A dh’ ionnsaigh Gaidhealtachd sla`n, fallain 12 improving health From many achievements over the past National funding has been secured for a year there are four main areas of work: community food project, men's health Tackling smoking - The work leading up initiatives and active referral schemes to implementing the new legislation to in Highland. Highland Schools achieved ban smoking in enclosed public places, 100% success rate in achieving targets has not only reduced the effects of for implementing 'Hungry for Success'. 'second hand' smoke but also MMR - One of the crucial issues in promoted non smoking as the norm promoting the health of children is and encouraged smokers to think about immunisation, probably the most stopping. effective, specific, preventative measure Alcohol - A shared recognition of available to us. I am therefore pleased alcohol as one of the next major public to report there has been a gratifying health priorities is a significant step upturn in uptake.However, it will still Jennifer Larsen forward. It is an example of a priority take some time to reach the optimum area in which a multi-agency effective level. Recent evidence has shown that partnership, the Highland Drug and Dr Eric Baijal smoking is responsible for around 20 in Director of Public Health Alcohol Action Team, has made every 100 deaths from coronary heart supporting significant progress. disease. Obesity - The work around nutrition, Giving up smoking reduces the risk of physical activity and healthy weight is heart disease. This is particularly of crucial importance given our self care important for those with other risk increasing awareness of the ill health factors such as family history, high due to the epidemic of obesity. New developments are underway in blood pressure, raised cholesterol or high street pharmacies, which diabetes. Blood is less likely to clot and recognise the unique contribution is pumped around the body more freely, pharmacists make to patient care and which relieves stress on the heart. opportunities to develop this to ensure Within a year the risk of a heart attack making highland a health gain, particularly where falls to about half that of a smoker. medicines are used. Equally, better use Within 15 years the risk of a heart healthier place to be... needs to be made of pharmacists’ attack is the same as that of a non- expertise in planning and delivering smoker. “Stopping smoking reduces the risk of complications services. “Stopping smoking reduces the risk of during surgery. Healing and recovery improve as carbon From 1 April 2006, there will be a new complications during surgery. Healing contract for community pharmacies, and recovery improve as carbon monoxide and nicotine clears from your body within with the contract changes phased in monoxide and nicotine clears from your days.” over a period of at least 12 months. body within days.” It will also help support and develop “National No Smoking Day” on 8 March 2006 was chosen for NHS Highland’s new Tobacco Policy to come into the role of pharmacists, recognising Jennifer Larsen, Smoking Cessation effect, ahead of national Smoking Ban in public places, which came into effect on 26 March. Officer, advises, “It’s important to they are members of the primary care remember that it’s never too late to give The delivery of Tobacco Control and Smoking Cessation Services is a key priority for team who readily are accessible and up smoking. So, the good news is that the NHS and an allocation of £224,000 per annum over 3 years will support the have skills which are often under whatever a person’s age, the body work of NHS Highland’s Tobacco Strategy and the delivery of two health utilised. These can be developed to starts feeling the benefits as soon as improvement targets in the NHS Highland’s Corporate Objectives. “The targets are help improve patient care and to you’ve smoked your last cigarette. basically to reduce rates of smoking in adults, with a particular focus on deprived ensure that the skills within the communities and smoking during pregnancy,” explained Janet Williams, Health primary care team are utilised most Trisha Morrison, Smoking Cessation Promotion Specialist for Tobacco. “Our Strategy proposes a number of actions appropriately. Advisor in Alness, firmly believes that around: implementing tobacco prevention and education through the Health the carbon monoxide monitor is a Initial work, underway at present, Promoting Schools; developing a network of smoking cessation advisors; targeting strong motivator to give up smoking. relates to the provision of a robust services on priority groups including adults and pregnant women in deprived areas; "Smokers can see their carbon infrastructure so that community and implementing our NHS Highland Tobacco Policy and supporting staff to stop monoxide levels drop form around 40- pharmacists and their staff can use smoking.” 50 to 2-3 in just days. It is a catalyst computers to manage and store the that can make the difference. Personal Janet reported that work is well underway to fill the Smoking Cessation Advisor necessary information about patient support and encouragement is very posts and that 15 Pharmacists are now providing smoking cessation services registrations and provision of important also." across Highland. contracted services. If you need help to stop smoking or Jennifer Larsen, Smoking Cessation Advisor at Raigmore Hospital says, “Most The new contract stems from would like more information about people associate cigarette smoking with respiratory problems and lung cancer. It is The Right Medicine Report (a Strategy for support in your area, contact: generally less well known that smoking is also a major cause of heart disease, Pharmaceutical Care in Scotland) which is the single most common cause of death in the UK amongst the under 65’s. published in 2002. Highland Smoking Cessation Service on 0845 757 3077

13 working with you to make highland the healthy place to be... working in partnership… ...with international colleagues... Over 200 international delegates attended the Making it Work Conference in TromsØ in September, which was a collaborative project between NHS Highland, NHS Grampian and Helse Nord, Norway. Conference delegates heard about a wide range of international remote and rural health projects on a number of themes, including maternity services, NHS Highland Staff Awards Ceremony in May 2006 chronic disease management and ...with staff mental health. Key note speakers included Karen Guilliland, CEO New NHS Highland has a very strong commitment to working in partnership with staff. Zealand College of Midwives, Dr The Employee Director and Chief Executive jointly chair the Area Partnership Forum and staff representatives are invited to be Denise Coia, Chair of the Royal involved in all major groups and committees. College of Psychiatrists and Dr John NHS Highland wants to recognise the importance of its entire staff and the part everyone plays in the delivery of high quality care in Highland. One way of highlighting the value of NHS staff is the launch of our first Staff Award Scheme in February 2006. Wynn Jones, Director of the Rural Sharing success recognises individuals and benefits the whole organisation. Nominations were from patients, carers, the public, Health Institute. and from colleagues over ten categories. A ceremony was in May 06 at UHI Executive Offices, with the presentation of awards to George Bruce, Joint Chairman of the staff. (some of the winners are pictured on the cover page). Maternity Action Team, (Caithness The new NHS Highland Staff Magazine “in-touch” was launched in March 2006. The magazine, which is fully funded by & Sutherland) and Kerry Mackenzie, Endowment funding and private sponsorship for advertising, will be quarterly and will be distributed throughout the Highland Public Representative, were funded Board area and published on the intranet and website. by the Project to attend the NHS Highland achieved a good response rate in the national staff survey, which is designed to gather views from employees conference. about their working environment. NHS Highland staff demonstrated a 39% return, well above Scottish average of 33%, and an improvement on previous years. 2005-06 was a year of considerable progress in the implementation of the Agenda for Change Several Highland delegates also had strand of Pay Modernisation. the opportunity to visit the Maternity NHS Highland has been at the forefront of this activity, being the first mainland Board to submit jobs for consistency checking Unit of the Northern Norway and amongst the first Boards to assimilate staff onto new pay scales. University Hospital in TromsØ, during their stay. adopt the name Highland HealthVOICES Highlands. Anyone living in Highland, Midwife, Avril Andrews and Project ...with you Network for the Public Partnership Forum. with an interest in health, is welcome Manager Noelle O’Neill were two of to join – details are in the ‘Getting During this development year, Involved’ section on NHS Highland’s five Highland delegates enabled to membership of Highland HealthVOICES Website or you can telephone the participate in the conference Network has grown to more than 150 and HealthVOICES office on 01463 through Endowments funding. lots of members are already involved in 704702. the work of NHS Highland with plans for The Conference Report, with members to be elected to the Community NHS Highland also was awarded findings and recommendations, was Health Partnerships and Specialist Runner-up Winner of the NEXUS presented to Scottish Health Annual Report Awards for the 2004-5 Service Unit Committees. Minister Andy Kerr in November Report in December 2005. (Winner of A key part of NHS Highland’s Patient NHS Highland is commended in a this category for the previous year.) 2005. This is published on the Focus and Public Involvement agenda for national report, published June 05, for Making it Work conference website 2005/6 was the planning and its work in involving staff, patients, which is linked to our website. development of a Public Partnership carers and the public in decisions about Forum. One of the early decisions was to the future of healthcare in the

A dh’ ionnsaigh Gaidhealtachd sla`n, fallain 14 External Reviews Review of 2004 / 2005

NHS Highland’s Food, Fluid and Nutritional Care Clinical Governance (October 2005) During 2005/06, NHS Highland was NHS Highland was reviewed against Communication reviewed by NHS Quality three of the six Food, Fluid and Improvement Scotland and Her Nutritional Care Standards. As part Majesty’s Inspectorate for of the review a highland-wide Education. Feedback notes clinical audit was undertaken which Strategy strengths and challenges across a involved auditing practice in every range of indicators. ward in all our hospitals. Feedback NHS Highland serves a population NHS Highland’s Communications on the day was very positive. covering the largest geographical region Strategy and its objectives and action Learning Disabilities for Adult and of any NHS Board in the UK. This plan need to be continually responsive to Children services Review Maternity Services (March 2006) (April 2005) increased in geographical area and size policy changes, new developments and NHS Highland was reviewed against of population with the integration of continue to put patients, carers and staff The review team met many groups the maternity clinical standards. Argyll and Bute. A widely dispersed staff at the heart of the Strategy. The of staff from across Highland and Feedback on the day highlighted the of around 10,000 staff work in a wide importance of good communication in visited many of our facilities for following strengths and challenges: range of different locations, with varying the clinical setting, backed up by written children and adults with a learning • Strengths: Development of access to email and intermittent mobile information is crucial to the quality of disability. The national and local Women’s Health Network, Early phone service. Many staff work a variety patient care. As such, a review of the report was published in February Pregnancy Guidelines, One to one of shifts and this together with the Strategy has now resulted in a revised 2006. geographical difficulties, presents Strategy and an action plan for 2006-7. midwifery care, Telemedicine for • Strengths: Excellent engagement enormous challenges for staff Each Community Health Partnership and paediatrics and representation with children and communication. the Specialist Services Unit will be • Challenges: Development of fully families, development of ASD developing their own local integrated Maternity Service, Prompt services and support including Communications Action Plans in line with access to ultrasound facilities, autism co-ordinator (children only), the strategy. Emergency theatre for obstetrics impressive in-patient services for children The Provision of Safe and Effective • Challenges: Accessible Primary Medical Services information (easy read/short simple Out-of-Hours (January 2006) forms), Equity of provision in rural NHS Highland was reviewed against areas, Aspects of physical the Out-of-Hours Standards and environment (sparse furniture, level awarded a registration status of 2. of beds). (Provider has achieved partial compliance with the standard) Pilot Child Protection Inspection (November 2004) • Strengths: Relations with NHS 24 and SAS, Extensive initial public Highland was asked to take part in consultation and recognised a pilot multi agency/multi ongoing local consultation, professional inspection of the new West Ross nursing pilot, Robust Child Protection Standards issued transfer of communication to by the Scottish Executive. The patient’s own GP findings of the inspection conclude that: overall, children and young • Challenges: Limited collaboration people in Highland are well with Social Services, Patient protected. Generally, professionals information regarding intervene appropriately to prevent, care/treatment, differing drug or take early action against, abuse procedures across Board areas or neglect when there are risks in families. Effective help is also provided to most children and young people recovering from abuse or neglect.

see our website for the full review... www.show.scot.nhs.uk/nhshighland/

15 working with you to make highland the healthy place to be... NHS Highland Changes made Analysis of Complaints: April 2005 - March 2006 as a result of

NHS Highland complaints 2005/06 2004/05 We need to know when things go wrong, so that we can put them right. Complaints are viewed positively, as a 373 338 way in which we can learn and Answered in less than 4 weeks 187 234 improve what we do. Here are two examples of how we have used Answered in more than 4 weeks 186 104 complaints to improve services and % resolved in 4 weeks 50.1 69 procedures. Main Issues Raised Example 1. A patient’s blood samples were temporarily mislaid in Raigmore Staff Hospital. Following this complaint Attitude/behaviour 47 52 procedures in the Biochemistry Department have been tightened up Complaint handling so that specimens and request forms Communication (written/oral) 121 45 can be tracked as they go through the Shortage/availability 8 8 laboratory. Any discrepancy between forms and specimens will be Waiting Times investigated as soon as staff are Delays at clinic 9 7 aware of it. Delays in admission/discharge/transfer 8 3 Example 2. Result of tests 9 2 A complaint was received about a patient who had to wait over 6 months Date of appointment 75 42 for a MRI scan. The waiting time Date for admission/attendance 17 8 problem in MRI was thoroughly investigated. Waiting times for an MRI Environmental / Domestic scan have now been improved dramatically with the current waiting Catering 12 14 time now 4 – 6 weeks, and waiting times are very carefully monitored. Patient privacy/dignity 3 2 We recognize that the number of Equipment / environment / premises 34 35 complaints resolved in 4 weeks is Cleanliness 9 4 unacceptable. This is being tackled by the introduction of a new NHS Patient property 12 4 Highland complaints procedure and a Bed shortage 2 2 new monitoring system for the year Personal Records 2 1 April 2006 to March 2007. Response times are much better as a result. Treatment New NHS Scotland complaints procedure A revised Scottish Health Department Clinical Treatment 131 98 NHS Scotland Complaints Procedure Other 711was introduced in 2005. This revised procedure is now a 2 part process. An Outcomes investigation into a complaint is Upheld 78 103 undertaken by NHS Highland. If the complainant is not satisfied with the Partly upheld 158 133 outcome of the investigation she/he Not upheld 137 102 can take the complaint to the Scottish Public Services Ombudsman. There is now no Independent Review procedure.

A dh’ ionnsaigh Gaidhealtachd sla`n, fallain 16 Financial Information for the Annual Report Finance Financial Year 2005-06

Commentary Table 1 - Consolidated Operating Cost Statement for the year ended 31 March 2006

The Scottish Executive sets three Restated financial targets for Health 2005/06 2004/05 Boards: £m £m • To operate within the given revenue budget (the Revenue Clinical services costs Resource Limit) Hospital and Community 254.6 230.2 • To operate within the given Family Health 87.6 81.8 capital budget (the Capital Total Clinical Services Costs 342.2 312.0 Resource Limit) Other Non Clinical Costs 13.6 11.7 • To operate within the given Gross Operating Costs 355.8 323.7 cash allocation Less: Miscellaneous Income 11.5 10.9 Net Operating Costs 344.3 312.8 In 2005/06, Highland Health Board met all three targets and, in addition, the Board was able to operate with a surplus of £1.4 million underspend on the Table 2 - Summary of Resource Out-turn revenue budget. This was mainly achieved due to technical 2005/06 2004/05 accounting entries where we £’000 £’000 were able to take advantage of recording expenditure of £1 Net Operating Costs 344.3 312.8 million as Capital Grants where it had been previously classed as Less: Capital Grants (to) Other Bodies (1.0) 0.0 revenue expenditure, together Less: FHS Non Discretionary Allocation (14.0) (11.6) with receiving some additional Less: Local Health Council Allocation/Expenditure 0.0 (0.2) funding. Net Resource Outturn 329.3 301.0 The £1.4 million underspend is Revenue Resource Limit 330.7 302.8 available to carry forward into 2006/07 and will be utilised as Saving against Revenue Resource Limit 1.4 1.8 part of the accounting treatment savings plan. Capital funding of £334k has been banked with the Scottish Executive for use in 2006/07 and supports the capital expenditure plan approved for 2006/07.

Full copies of the financial statements can be obtained from The Finance Department NHS Highland Assynt House Beechwood Park Inverness IV2 3HG

17 working with you to make highland the healthy place to be... Table 3 - Balance Sheet as at 31 March 2006

Restated 2005/06 2004/05 £m £m

FIXED ASSETS Intangible Fixed Assets 0.3 0.0 Tangible Fixed assets 179.5 169.0 Total Fixed Assets 179.8 169.0 Debtors falling due after more than one year 2.9 2.4

CURRENT ASSETS Stocks 3.3 2.8 Debtors 9.8 9.5 Cash at bank and in hand 1.0 0.8 14.1 13.1 CURRENT LIABILITIES Creditors due within one year (38.6) (34.6) Net current (liabilities) (24.5) (21.5)

Total assets less current liabilities 158.2 149.9

CREDITORS DUE AFTER MORE THAN 1 YEAR (12.4) (13.0)

PROVISIONS FOR LIABILITIES AND CHARGES (6.2) (5.7)

(18.6) (18.7)

139.6 131.2

FINANCED BY: General Fund 92.6 92.2 Revaluation Reserve 42.7 35.4 Donated Asset Reserve 4.3 3.6 139.6 131.2

A dh’ ionnsaigh Gaidhealtachd sla`n, fallain 18 Independent Table 4 - NHS Highland Board Members Auditor’s Review Salary Benefits (Gross Pay + Er’s) in kind Report on the Superannuation (rounded to financial statements (Ban ds of £5,000) nearest £’000) extracts included in Remuneration of: the Highland Health Executive Members Board Annual Report Chief Executive: R Gibbins 115 – 120 5 Director of Public Health: E Baijal from 09/05/05 110 – 115 8 Director of Finance: Malcolm Iredale 85 – 90 4 To the Members of Other exec: Elaine Mead 100 – 105 0 Highland Health Board Other exec: Alison Graham 130 – 135 2 We have reviewed the extracts from the financial Other exec: Heidi May from 25/07/05 50 - 55 0 statements (tables 1 to 5 on page 17 to 20) of Highland Health Board’s annual report. This report is made solely to the parties to Non Executive Members whom it is addressed in accordance with The Chair: G Coutts 30 – 35 0 guidance issued by the Scottish Executive Health Department and the Code of Audit Practice J Cooper to 31/03/06 5 – 10 0 approved by the Auditor General for Scotland S Whiteford to 31/03/06 5 – 10 0 and for no other purpose, as set out in paragraph C McIntosh to 30/09/05 0 – 5 0 43 of the Statement of Responsibilities of Auditors and of Audited bodies prepared by Audit K J Fraser 5 – 10 0 Scotland, dated July 2001. I Johnston to 10/02/06 5 – 10 0 Respective Responsibilities of the P Courcha 5 – 10 0 Board and the Auditor Highland Health Board is responsible for M Foxley 5 – 10 0 preparing the extracts from the financial D Alston 5 – 10 0 statements. Our responsibility is to report to you M C Davidson to 31/03/06 5 – 10 0 our opinion on any apparent misstatements or inconsistencies with the audited financial H Sheerin 20 – 25 0 statements of Highland Health Board. W S McKerrow 5 – 10 0 Basis of Review D Graham to 31/03/06 5 – 10 0 The extracts from the financial statements have been prepared by the Board on the basis of the A Bethune from 11/07/05 5 - 10 0 audited financial statements of Highland Health I Gibson from 11/07/05 5 - 10 0 Board and in accordance with guidance issued R Stewart from 01/10/05 0 – 5 0 by the Scottish Executive Health Department. The Auditors’ Report on the financial statements of the Board describes the basis of the audit Other Snr Employees opinion and reports the auditors’ opinion on the H Johnston to 25/05/05 30 – 35 3 financial statements. A review consists principally of making enquiries of management, H Johnston from 01/06/05 10 – 15 1 applying analytical procedures to the extracts A E Gent 80 – 85 3 from the financial statements, assessing whether accounting policies and presentation have been D S Leslie 80 – 85 5 consistently applied, unless otherwise disclosed, M P Lister 70 – 75 0 and checking on a sample basis the process of J M Baird 60 – 65 1 the preparation of the extracts from the financial statements by agreeing the amounts used back to the audited financial statements. A review excludes audit procedures such as tests of control and verification of assets and liabilities and is substantially less in scope than an audit performed in accordance with Auditing Standards. Accordingly we do not express an audit opinion on the extracts from the financial statements.

19 working with you to make highland the healthy place to be... Review Conclusion Table 5 - Other employees whose renumeration fell within the following ranges On the basis of our review, the financial information presented in these financial statements for Highland Health Board for the Number of year ended 31 March 2006 has been properly Employees prepared from the original audited financial statements. However, in giving this review opinion we have not considered the effects of Clinicians any events between the date on which we gave £ 50,000 to £ 60,000 65 our audit opinion on the audited financial statements of Highland Health Board and the £ 60,001 to £ 70,000 36 date of this statement. For completeness of understanding, we include £ 70,001 to £ 80,000 34 the qualifications on the original audited financial £ 80,001 to £ 90,000 9 statements as follows: £ 90,001 to £100,000 18 Qualified Opinion arising from disagreements about accounting £100,001 to £110,000 11 treatment £110,001 to £120,000 21 Financial statements £120,001 to £130,000 23 (1) As is disclosed in note 25 to the accounts, the Board have entered into an agreement with a £130,001 to £140,000 20 contractor to provide and service a Primary Care Resource centre in Invergordon. The Board have £140,001 to £150,000 18 accounted for the property concerned as an £150,001 and above 40 operating lease and therefore there is no related asset or liability included on the Balance Sheet. In our opinion, the Board should have accounted for this asset as a finance lease and included a Other fixed asset and a related liability on the Balance £ 50,000 to £ 60,000 27 Sheet. Had the Board adopted this treatment it would have increased the fixed assets by £8.4m £ 60,001 to £ 70,000 15 and long-term liabilities by a similar amount. As a result operating lease charges would reduce £ 70,001 to £ 80,000 4 by £0.98m, depreciation would increase by £ 80,001 to £ 90,000 1 £0.192m, and finance charges increase by £0.926m, resulting in a net additional charge of £ 90,001 to £100,000 2 £0.138million being made in the Operating Cost statement. £100,001 to £110,000 0 (2) As is also disclosed in note 25 to the £110,001 to £120,000 1 accounts, the Board entered into an agreement with a contractor to provide a hospital at New Craigs, which opened in July 2000. The property element of the agreement meets the definition of and has been accounted for as a finance lease. However the total finance charges inherent in the finance lease element of the agreement have been allocated on an equal basis each year over the 25 year lifetime of the lease This is not in accordance with the Statement of Standard Accounting Practice 21 (SSAP21), which requires the finance charge element to be allocated so as to produce a constant periodic rate of charge on the remaining balance of the obligation for each accounting period. Had the board adopted this treatment it would have increased the net liability disclosed in note 25 by £2.6m. The charge to the operating cost statement for the year would have increased by £0.4m, with the balance being accounted for as a prior period adjustment.

Tenon Audit Limited 10 Ardross Street Inverness IV3 5NS 6th September 2006

A dh’ ionnsaigh Gaidhealtachd sla`n, fallain 20 Fig 1. Inpatient Activity

Waiting 2002-2003 2003-2004 Raigmore 30981 31526 North 3524 3596 Times West 3624 3671 38129 38793 Waiting Times for 2004-2005 2005-2006 Raigmore 32498 32702 Admission North 3452 3346 The current maximum wait for West 4008 3990 admission to hospital is 26 weeks for 39958 40038 patients with a guarantee. This target is to reduce to 18 weeks by the end of December 2006. The 26 week target was was maintained from December 2005 and significant progress was also made in reducing the number of patients waiting over Fig 2. Day Case Activity 18 weeks for admission, from 571 at March 2005 to 253 at March 2006.

2002-2003 2003-2004 Waiting Times for Raigmore 9491 10353 first Outpatient North 1919 1957 West 1545 1677 Appointment 12955 13987 The current maximum wait for first 2004-2005 2005-2006 outpatient appointment is 26 weeks Raigmore 11019 11589 for patients with a guarantee.. North 2106 2242 West 1704 1924 Progress towards the target of 18 14829 15755 weeks which is to be achieved by the end of December 2007 has also been made with a reduction in the number of patients waiting over 18 weeks from 1097 at March 2005 to 691 at March 2006.

Fig 3. New Out Patient Activity

2002-2003 2003-2004 Raigmore 38504 39646 North 7079 7286 West 4859 4988 50442 51920 2004-2005 2005-2006 Raigmore 40178 41356 North 6668 7263 West 4678 4632 51524 53251

Theatre nurses with Donna Janssens, Day Case Unit Manager, who were delighted with the mobile theatre facility, which was used for 3 weeks in March 2006 to drive down waiting times. The theatre, adjacent to the Day Case Unit, was successfully used for three types of surgical procedures, hernias, varicose veins and vasectomies, with General Surgeons performing an extra 140 operations over the period.

21 working with you to make highland the healthy place to be... Fig 4. Accident & Emergency Performance

2002-2003 2003-2004 Raigmore 24110 25877 North 5610 5581 West 10117 10849 39837 42307 2004-2005 2005-2006 Raigmore 30978 27686 North 7719 8801 West 13811 15492 52508 51979

Fig 5. Number of Patients waiting for inpatient or day case treatment, split by band of wait 0-18 Wks 19-26 Wks 27-39 Wks Mar 05 3296 488 83 Mar 06 3395 253 0

Mar 05 85% 13% 2% Mar 06 93% 7% 0%

Figure 5 Shows that by March 2006 there were no patients waiting over 6 months, with 93% of patients waiting less than 18 weeks

Fig 6. Waiting Times for Admission Note Figures for the last two Quarter 1 Quarter 2 Quarter 3 Quarter 4 quarters may be incomplete and 2005/06 2005/06 2005/06 2005/06 should be treated accordinly

Scotland 70.2 70.1 69.9 69.2 % admitted within 3 months Highland 66.4 67.5 65.9 58.6

Scotland 89.4 90.4 90.4 92.5 % admitted within 6 months Highland 88.3 91.0 90.6 92.5

Scotland 96.5 96.7 97.1 97.2 % admitted within 9 months Highland 97.0 97.6 98.2 97.4

Fig 7. New Outpatients seen within 26 weeks

Quarter 1 Quarter 2 2005/06 2005/06 Highland 85.0% 87.0% Scotland 88.5% 91.0%

Quarter 3 Quarter 4 2005/06 2005/06 Highland 91.4% 97.7% Scotland 90.1% 97.7%

A dh’ ionnsaigh Gaidhealtachd sla`n, fallain 22 working with you to make highland the healthy place to be...

NHS HIGHLAND ANNUAL REVIEW 2005-6 “HEAT” represents the four main objectives for The Annual Review was held in their willingness to our Local Delivery Plan public in Inverness on 8 August give up time to 2006. A letter from the Minister for speak so frankly for 2006-7. Health and Community Care, Andy and constructively Kerr, records the main points about their Health improvement for people of covered and key actions agreed experiences. Scotland – improving life expectancy during the process. I was impressed by and healthy life expectancy A summary of the letter follows. the enthusiasm and dedication of the fficiency and Governance The full letter can be seen on our E NHS staff I met at improvements – continually improve the website the Royal Northern efficiency and effectiveness of the NHS www.nhshighland.scot.nhs.uk in Infirmary and was glad to have the the publications section. opportunity to meet patients. It was clear to Access to services – recognising I should first thank you, Roger Gibbins and me that there were real benefits for patients patients need for quick and easy use of the rest of your team for organising a very in the intermediate care model that has Patient, Mr Adam Mackenzie, with Andy Kerr NHS services successful and productive visit. The group been developed, enabling preparation for a + return to independent living in a more healthcare associated infection of officials from the Health Department and • continue to evaluate critically the impact of supportive environment than would easily reatment appropriate to individuals I thoroughly enjoyed the opportunity to health improvement to enable better targeting T be achieved in a busy general hospital. – ensure patients receive high quality speak to a range of NHS staff and patients, of investment service that meets their needs and the positive tone of our discussions at •develop ideas for undertaking an anticipatory the various meetings impressed us all. Annual Review Meeting care pilot Prevention 2010 There are 28 targets, with a particular emphasis on key areas Meeting with the Clinical Forum, Area You summarised the discussion by saying • continue to work with remote and fragile such as smoking cessation, Partnership Forum and staff at the that you were confident that NHS Highland communities in developing sustainable, cost- immunisation, waiting times and Intermediate Care facility, Royal Northern was a more efficient and focused effective primary care out of hours services in delayed discharge. Performance Infirmary organisation than ever before. partnership with Scottish Ambulance Service on the targets will be reported Clinicians felt included in the work of the I agreed and pointed out that your view was and NHS 24 regularly to the Board. Board and had the opportunity to contribute effectively confirmed by the discussion I • make further progress in taking services our to its thinking on key issues. They rightly had had in the morning with the partnership of the acute hospital setting and into the regarded the expanded NHS Highland as and clinical forums. community • build up mental health crisis and out of hours having a leading role in developing Looking forward, I wanted the Board to services Other Languages approaches to rural healthcare. continue to evaluate critically the impact of • increase day case rates further while A translated version of this document Ray Stewart and his Partnership Forum its health improvement work so as to better safeguarding clinical quality is available. If you require it please colleagues gave me a clear picture of strong target investment: to make further progress • reduce significantly cancer diagnosis and phone 01463 704839 interest in and support for the work of the in taking services out of the acute hospital treatment waiting times; Board and its objective of maximising the setting into the community; to develop, in Ma tha sibh airson fiosrachadh • achieve all national waiting times targets, health of the communities it serves. consultation with communities, more including cancer targets and elimination of fhaighinn ann an Gaidhlig, cuiribh fios sustainable out of hours primary care I wanted to hear directly from people about Availability Status Codes gu Catriona Nicaoidh, 01463 704938 services; to build up mental health crisis their experience of the NHS in the Highlands • reduce and subsequently remove reliance on and out of hours services; to increase day Portugese and I am very grateful to all those who up non-recurring in line with Board’s financial case rates as quickly as possible while Uma versão traduzida deste original time to come and speak to me. We covered plan. a broad spectrum of issues – services for safeguarding clinical quality; and to reduce está disponível. Se você a requerer por patients with heart failure, support for significantly cancer diagnosis and treatment Andy Kerr favor phone 01463 704839 waiting times. carers looking after a severely disabled Cantonese younger person, mental health services, I have set out the main action points arising Your Views maternity services, and issues around from the Review patient travel. There was strong support for • work with Area Clinical Forum to develop If you would like further 01463 704839 information or to comment on this the quality of care provided by staff in NHS range of ideas from members for further Polski annual report, please contact: Highland and I was struck by how positively exploiting digital technology for the benefit of Umaczona wersja? the patients described their care and patients Ruth Cleland, telefonowa 01463 704939 bo treatment with the request that they be • ensure delivery of Agenda for Change targets Head of Internal Communications [email protected] followed up. in terms of assimilating posts and making NHS Highland I thanked the patients whom I met at the payment to staff An audio version of this document • continue to scrutinise progress and Assynt House is available. time, but I would be very grateful indeed if Beechwood Park you would pass to them my appreciation of performance against selected targets for Please phone 01463 704938 Inverness IV2 3HG [email protected] [email protected]

NHS Highland . Assynt House . Beechwood Park . Inverness . IV2 3HG . Tel: 01463 717123 . Fax: 01463 235189 www.nhshighland.scot.nhs.uk

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