Health Care for People in Moray

Health care for people in Moray: planning to meet the needs of a 21st century community

Consultation overview paper

1. Introduction

NHS Grampian wants to hear the views of people in Moray on a package of health projects designed to create a modern local health service for the changing needs of Moray’s 21st century population.

The re-design package presented here has been developed by the Moray NHS team, in partnership with Moray Council, the Scottish Ambulance Service and other key local organisations.

Over recent years there has been much consultation with interest groups, voluntary organisations, communities, patients and interested members of the public on individual elements of this package. This paper explains how these all fit together, and how to give us further views, comments and suggestions.

This paper:  outlines the vision and plan  explains what this means for individual facilities and services, and what is already happening  gives details of how to comment

2. Why do we need to re-design health services in Moray?

Moray is experiencing increasing demand for health services. This includes both healthcare which is planned, and also the ‘unscheduled’ care that people need in an emergency, or if they require urgent attention out of normal surgery hours.

The reality is that not all of the area’s ageing hospital and surgery buildings are still up to the job of providing modern, efficient, and effective health care. In addition, these old buildings are becoming increasingly expensive to maintain, which means using precious NHS money which could otherwise be spent on more modern forms of patient care.

We believe that patients would benefit from new purpose-designed premises, which would also involve new ways of using the valuable skills of the Moray team of health professionals.

1 The plan outlined below is an ambitious, inter-related package which involves investing in modern new facilities, and creating sustainable health services in Moray.

3. What is the plan and what does it aim to do?

The plan is to create a modern local health system designed to meet the needs of people in Moray - today and tomorrow - through three linked components. In a nutshell, these are:

 Re-designing inpatient services in Moray

Within Moray, we plan a shift from traditional use of community hospitals to more effective use of all hospital beds in Moray. This will make best use of Dr Gray’s Hospital and hospitals in Aberlour, Dufftown, Keith, Buckie and Forres. We have recently upgraded community hospitals in Buckie, Keith and Aberlour.

We envisage a ‘virtual medical ward‘ across Dr Gray’s Hospital and linked community hospitals for people who need to be in hospital. Patients would be ‘streamed’ into an appropriate bed, based on the severity and complexity of their medical problems. This may be a short-stay assessment bed, an intermediate care bed or an acute medical bed. The total bed capacity in Dr Gray’s and community hospitals would be used more effectively, with people being transferred earlier to local units closer to their home.

This will consolidate inpatient and support services over fewer sites, but deliver shorter hospital stays with more effective outcome for the patient. A new inpatient facility will be provided in Forres, and Stephen Hospital in Dufftown will be upgraded.

We also plan to invest in more care home places for frail elderly patients who would benefit from residential care but do not need to be in hospital.

 Modernising primary care (community) services

This includes three new premises for GP practices, designed as one-stop gateways to healthcare. The projects will provide improved access for people in Elgin, Forres and Lossiemouth to an appropriate range of modern, integrated health and social services delivered from local buildings. Local GPs will work in a team from modern, multipurpose premises alongside nurses, pharmacists, therapists, midwives, dentists and social care staff. Additionally plans are being developed to further develop primary care premises in Keith, Cullen, Lhanbryde and Elgin.

 Creating a unified system for emergency and ‘unscheduled’ care in West Grampian

2 NHS Grampian will work with the Scottish Ambulance Service, Moray Council and NHS 24 to create a ‘managed’ system designed to respond efficiently and effectively to emergencies and to people who need urgent attention ‘out-of-hours’. At the centre, or hub, of this system will be a purpose-designed emergency care centre at Dr Gray’s Hospital, based on the existing A&E Department.

The principle is that the patient should be seen by the right professional, at the right place, and at the right time, according to their clinical need.

4. What does this mean for individual services and facilities?

4.1 Dr Gray’s Hospital and Inpatient services in the Elgin area

In Elgin, the NHS would like to consolidate all hospital-based care on one site, Dr Gray’s. This will include:

. By late Summer 2004: A new Emergency Care Centre, expanding the remit of the existing A&E Department. This will accommodate six short-stay (23 hour) beds so that staff can assess the needs of the patient, and the services/treatments that could be put in place to avoid people having to stay at Dr Gray’s Hospital unnecessarily.

. By Autumn 2004: Additional hospital beds will be made available at Dr Gray’s, making these beds an integral part of the virtual medical ward described earlier, with many benefits for patients.

 More services at Dr Gray’s, and better access for patients: Additional doctors have been appointed in general surgery, orthopaedics, gynaecology, general medicine and emergency care. An enhanced opthalmology service will be introduced, and Dr Gray’s will also introduce Elgin-based Ear, Nose and Throat (ENT) surgery for the first time in 2004.

 Investment in IT: This supports better communication between different health professionals in different parts of Moray. The system is already linked up by telemedicine (video technology) between Elgin, Forres, Buckie, Keith, Aberlour and Dufftown. Recent investment also allows for the electronic transfer of X-rays.

 A Day Hospital at Dr Gray’s: This will enable certain individuals to benefit from the expertise and resources at Dr Gray’s Hospital whilst remaining in their own home or a more homely setting.

 Introduction of new diagnostic equipment to speed up the assessment of people with heart difficulties: New point-of-care test machines will be procured to speed up diagnosis processes for people with acute medical problems.

 Dentistry: In March 2004, a dedicated NHS dental unit was opened, the West End Dentistry Unit. We plan to further enhance this service and link it to the development of NHS dentistry elsewhere in Moray.

3  More Car Parking spaces for the patients and visitors to Dr Gray’s Hospital.

 Spynie Site: Once the site is no longer needed for its present purpose, it will be declared surplus to requirements. Thereafter NHS Grampian and Moray Council will consider alternative health and community care uses for the site.

4.2 Community-based services

A substantial investment is planned in community-based health and community care services in Moray. This is required as a consequence of:

 Demographic changes: more people living to older age in our communities  The relatively poor health status of Moray’s population – Scotland’s health is amongst the worst in the western world. Within Grampian, Moray’s population is assessed as being relatively poor in relation to key indicators of health.

GP practices and primary care teams will be doing more to promote better health and introducing more intensive ways of managing continuing illnesses and disease, an example would be the care of people who have diabetes. A wider range of care and support will be needed within our communities, and these plans make way for these changes:

 By April 2004: More appropriate ways to care for elderly people who have been staying in a hospital for non-medical reasons. This includes boosting primary care and community care services, so that we can provide extra services for people living at home. An additional 50 care home places will be available in Elgin, with further expansion of the care home sector planned across Moray.

 Better patient and relative transport: A three-stage plan will be implemented by the end of 2004 to introduce better out-of-hours patient transport and improve transport for visitors.

 Specialist support for Older People: Two new consultant posts, and an increased number of dedicated nurses, care managers and Allied Health Professionals (AHPs) will be available across Moray.

 Enhanced support for Palliative Care: The Oaks Palliative Care Day Centre has recently opened in Elgin. Additional investment in staff and facilities across Moray will further develop our palliative care services.

4.3 Inpatient services at Stephen Hospital, Dufftown

As part of the creation of the virtual medical ward across Moray, Stephen Hospital in Dufftown has been developing a close working relationship with Dr Gray’s orthopaedic department, which is making it possible to improve the rehabilitation environment in Stephen Hospital. It is proposed to further develop the rehabilitation environment within the hospital.

4 4.4 Forres Health Centre and Leanchoil Community Hospital

Combining health and social care activity onto one site in Forres will enable best use of the limited resources available in this area. We propose one new building to accommodate a range of general medical, community health, inpatient care, social care and associated services. The new building will enable closer working between all health professionals, and enable services to be provided in an accessible and local way. The new building will provide the services currently provided at Leanchoil Hospital in Forres and Forres Health Centre. Once the new building is complete, Moray Council and NHS Grampian will review the use of vacated buildings in line with other health and community care requirements in the Forres area.

4.5 Lossiemouth – Joint Civilian and Military Health Centre

The Ministry of Defence and the Laich Medical Practice will procure a new joint health facility in Lossiemouth. This will expand the range of services provided in Lossiemouth and will include a therapy suite and two NHS dental treatment rooms.

4.6 Maryhill Health Centre, Elgin

A new facility will be built to replace the existing health centre. This will also accommodate clinical departments and staff presently accommodated on the Spynie site. Again, additional NHS dentistry will be provided from this site.

5. Background documents

Detailed service and business cases have been previously agreed within NHS Grampian to substantiate individual components of this package. All these documents are available on request.

A) Initial Agreement – Elgin Inpatient Services Review (2002)

B) Initial Agreement – Dr Gray’s Unplanned and Emergency Care (2003)

C) Elgin Health Centre – Business Case (2001)

D) Laich Medical Centre – Business Case (2002)

E) Forres Health Centre – Business Case (2002)

F) Outline Business Case – Modernisation of Health and Social Care Services In Forres (2003)

G) Business Case - Stephen Hospital Dufftown (2003)

H) Moray LHCC – Personal Medical Services Plus Business Case (approved by the Scottish Executive 2002)

5 6. We want your views

NHS Grampian and its partner organisations are keen to receive views on this plan.

If you would like further information, including copies of the documents listed above, or if you have any other queries, please contact::

Andrew Fowlie Lead General Manager Moray Collective Spynie Hospital Duffus Road Elgin IV30 5PW Tel: 01343 567832 Email: [email protected]

Comments should be sent in writing to Andrew to arrive by Saturday 1 May 2004.