Developing a Safe and Sustainable Model for Urgent and Emergency Care in partnership with the communities of West

The Proposal SAS, NHS and Highland and Islands Fire and Rescue Current model

• Two community nurses living and working in , covering 24/7, 365 days per year • Ambulance from • GPs based in , covering both primary care response and BASICs (immediate emergency care) The need for change

• Current model is no longer safe or sustainable • Safe rota minimum of 1 in 3, additional staff based locally not feasible • Low activity means that skills cannot be maintained, not clinically sound • One nurse retiring in February • Ambulance needs to remain based in Strontian – 50 minutes away • Kilchoan Fire and Rescue service receives very limited number of calls So far….

• Listened to community concerns, these recognised and acknowledged • Partners jointly committed to finding a safe and sustainable model that will enhance community resilience • Desire to work with local community to develop and agree model • Model developed, discussed and agreed by Partners as a safe and workable solution • Viewed as a significant opportunity to enhance community resilience and protect local services Co Responder Model

A partnership response to provide safe local services for the future – designed around the needs of West Ardnamurchan “This Co Responder model is not a substitute for ambulance or access to other services but immediate support until road or air ambulance arrives”

Pauline Howie, Chief Executive, SAS Co Responder Model

• Effective initial and immediate response to emergency and urgent situations • Participants will be paid for training & call outs • Builds on retained fire service • Embraces existing local nursing skills • Co-responders fully trained to enhanced level • Fully equipped, including vehicle • Need minimum of 6 but ideally 8 to 10 on rota • Operate a minimum of 1 in 3 rota, with 2 people responding (24/7) • In future will explore use of technology Nursing and GP Cover

• A post will be advertised in October as part of the West team to ensure skills maintenance and support

• NHS Highland Nursing Base in Kilchoan will be maintained

• The advert will describe West Ardnamurchan and encourage consideration of living there

• The advert will also describe the Co Responder model and encourage participation

• All nurses in West Lochaber will be encouraged to undertake First Person on Scene training including having tracking devices in vehicles

• Health Visiting and School Nursing will be separated out and provided from the West Lochaber team.

• BASICs GPs will continue to be supported through NHS Highland How it will work

• Immediate Call for Help – NHS24 and 999 control based together – Calls triaged and response dispatched – Co Responders dispatched

• But also backed up … Back Up

• In direct communication with Paramedic advisor and use of technology in future • Enhanced SAS Air Ambulance Response for life threatening conditions • SAS Road Ambulance from Strontian • BASICS GP (enhanced immediate care skills) when available to respond to 999 calls • Community Nurses trained up to First Person on Scene (Intermediate) responding as nearest resource to 999 calls In Hours Enhanced clinical training

• Competency based, co responders will need to demonstrate skills and receive regular updates • First Person on Scene intermediate level training • Qualification is validated and widely recognised • Robust clinical governance framework Monitoring

• All incidents will be recorded on a Patient Record Form • All reviewed post incident by a Para medic • Learning from these form basis for ongoing training Community resilience- all agencies and communities working together is crucial for future sustainability of remote rural communities.

‘Community resilience is the capability to anticipate risk, limit impact, and bounce back rapidly through survival, adaptability, evolution, and growth in the face of turbulent change.’ (Community and Regional Resilience Institute)

‘Together we are stronger’ (Community Resilience UK) Christie Commission –Future Delivery of Public Services Some key messages

• Maximising scarce resources by utilising all available resources from the public, private and third sectors, individuals, groups and communities • Working closely with individuals and communities to understand their needs, maximise talents and resources, support self reliance, and build resilience • Concentrating the efforts of all services on delivering integrated services that deliver results • Prioritising preventative measures to reduce demand and lessen inequalities Remote Communities Emergency and Urgent Response – Community Resilience Model

Co Responder Air Ambulance Community Response Technician Default Retained Firemen, Nurses Intermediate FPOS training Cat A Response

Enhanced training Vehicle Co responder and updating

Kit

HIFRS Road BASICS Primary Care Ambulance Principles GPs/ Dual Unscheduled •Community sustainability •Co production Community nurses Response Care Service SAS staff •Partnership BASICS or Intermediate FPOS Linked into •See and Treat Vehicle tracking, in hours •Admission avoidance Coast Guard Practices •Flexible approaches •Best use of all available First Aid Life boat Resource Red Cross Supported Expert Cost sharing St John’s Self care patient •Working differently Community Questions and Suggestions