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Report on Progress to Implement the Recommendations in the Independent External

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Report on Progress to Implement the Recommendations in the Independent External Report on progress to implement the recommendations in the independent external view of Skye, Lochalsh and South West Ross Out of Hours Services by Sir Lewis Ritchie in May 2018 Introduction David Alston, chair of NHS Highland, requested a review of Out of Hours Services in Skye, Lochalsh and south west Ross from Sir Lewis Ritchie in November 2017. A report with recommendations was provided by Sir Lewis in May 2018, which has been accepted by all concerned. The work undertaken by Sir Lewis was particularly helpful in enabling all concerned to drawn a line under previous differences and move forward with greater clarity on next steps. Actions to Date This report provides the first update on the work being taken toward implementing 15 recommendations make by Sir Lewis Ritchie. The report follows a format that has been requested by Sir Lewis, and is in line with a format used to update on other reviews. The format is based on a self report using black, red, amber and green (BRAG) categories. There are different definitions of each colour in different versions of the BRAG tool, but the definitions used in this report are: Green - "active and on-track"; Amber - "active but some concerns and needs to be monitored closely"; Red - "Active but major concerns and needs corrective action;" Blue - "on-hold"; Black - “closed”1,2. A self assessment has been provided by staff from NHS Highland, NHS 24, and the Scottish Ambulance Service against each of the 15 recommendations made by Sir Lewis. An assessment of “risk and readiness” has also been provided by an Independent Facilitator in relation to each recommendation. An implementation project has been initiated involving a growing range of stakeholders to take forward the implementation of the recommendations in Sir Lewis Ritchie’s report. The key first step was agreeing independent facilitation. The local community have identified David Noble, an Independent Consultant, former Chief Executive for Skye & Lochalsh District Council and former Chief Executive of the Highlands of Scotland Tourist Board, as the Lead Independent Facilitator for the project3. The community in Glenelg and Arnisdale Skye have also identified Dr Miles Mack, a Highland GP and former Chair of the Scottish Committee of the Royal College of General Practitioners, to lead facilitation for their component of the wider project. There has been initial work to set up a governance structure for the project, with an early planning workshop held on 4 June; a first meeting of an emerging Steering Group held in Portree on 13 June; a core coordinating group meeting weekly since 25 June; and a project management group meeting monthly from 12 July 2018. Sir Lewis has recommended that the project is accountable to the Highland Health and Social Care Partnership, but there will also be lines of accountability into the Scottish Ambulance Service and 1 Softools. What do the status colours (RED / AMBER / GREEN / BLUE / BLACK) mean? Available from: https://support.softools.net/hc/en-gb/articles/211393723-What-do-the-status-colours-RED-AMBER-GREEN-BLUE- BLACK-mean- Accessed 14 July 2018. 2 NHS Tayside. NHS Tayside Transformation Support Team Second Progress Report. Available from: www.gov.scot/Publications/2018/02/2882/2 Accessed 14 July 2018. 3 NHS Highland. Outline Business Case for Skye, Lochalsh and South West Ross redesign approved. Available from: http://www.nhshighland.scot.nhs.uk/News/Pages/OutlineBusinessCaseforSkyeLochalshandSouthWestRossredesignap proved.aspx Accessed 14 July 2018. Version 4; 16/07/2018 2 NHS 24. Steps are being taken to ensure that there is effective read across between this Out of Hours Project and the Project Board for the Redesign of Community Health and Care Services in Skye, Lochalsh & South-West Ross, which has been in operation for a number of years and which has a wider remit. There is also a need to interface with programmes within the Scottish Ambulance Service, NHS 24, independent primary care services, and partner organisations such as Highland Council, third sector organisations and the Skye, Lochalsh & West Ross Community Partnership4. There is widespread recognition that effective communication between all partners and stakeholders is key to a jointly indentifying and implementation the recommendations in Sir Lewis report. This requires regular use of email, phone, and face to face meetings. It is proposed that a key component of communication will be a website, which is being set up to facilitate regular updates on each of Sir Lewis Richie’s recommendations. A summary of the current status for each of the 15 recommendations is provided below, with detailed responses provided against each recommendation later in this report. BRAG Progress Rating Summary NHS Facilitator Recommendation Rating Rating Rec 1 - Portree Hospital - Urgent and emergency care Rec 2 - Future Community Bed Provision Rec 3 - Closer Inter-agency and public participation Rec 4 - Collaboration with SAS Rec 5 - Collaboration with NHS 24 Rec 6 - First Responders Rec 7 - Workforce capacity and capability Rec 8 - Housing solutions Rec 9 - Road issues Rec 10 - Transport and accessibility Rec 11 - Digital Innovation Rec 12 - Glenelg and Arnisdale Rec 12R - Raasay Rec 12L - Lochcarron Rec 13 - Centre of Excellence for Learning and Training Rec 14 - Best use of services - Know who to turn to Rec 15 - Making it Happen - pulling together 4 Highland Council. Skye, Lochalsh & West Ross Community Partnership. Available from: www.highlandcpp.org.uk/skye-lochalsh--west-ross-community-partnership.html Accessed 14 July 2018. Version 4; 16/07/2018 3 BRAG (Black, Blue, Red, Amber, Green) Definitions RED Active but major concerns and needs corrective action AMBER Active but some concerns and needs to be monitored closely GREEN Active and on track BLUE On hold BLACK Closed Next steps Some early progress has been made around implementation, but it is recognised that many aspects of the project have moved forward slower than anticipated, due to a large number key individuals having holidays during the summer. The identification of work stream leads for each recommendation, who can pull relevant individuals into work groups, is almost complete. This will allow a greater pace, with work to be undertaken simultaneously by different groups over the coming months. It is anticipated that follow up reports will be provided to the Scottish Government on a regular basis and made available on the project website. Report submitted by: Hugo van Woerden, Director of Public Health, NHS Highland Laura Ryan, Medical Director, NHS24 James Ward, Medical Director, Scottish Ambulance Service 16 July 2018 Version 4; 16/07/2018 4 Recommendation 1 – Portree Hospital Urgent and Emergency Care Out-of-hours urgent care access at Portree Hospital should be provided 24/7 -- there should 1.a be no closure of Portree Hospital in the out-of-hours period Enhanced, and sustainable models of urgent care should continue to be developed and 1.b delivered in the Minor Injury Unit at Portree Hospital, involving combined teams and other agencies (see also Recommendations 3-6 below). The Minor Injury Unit services at both Broadford and Portree Hospitals should continue to 1.c work synergistically together to add resilience and to provide optimal services, provided by multidisciplinary teams with for the whole of SLSWR. It is essential that in the event of acute illness services are used properly – dial 999 in the event of an emergency (time-critical, immediate response required). If urgent care is required contact NHS 24 through the 111 service (care that requires a response that cannot 1.d wait until the next routine service is available). Only in this way will the safest and most effective care be delivered and received. This must be clearly understood by the public of SLSWR. The excellent care provided by clinical and support staff at both sites must continue to be 1.e nurtured and supported Possible confusion about the nature and level of urgent and emergency care services provided at Minor Injury Units and Community Hospitals is unlikely to be confined to 1.f SLSWR. We offer a supplementary recommendation here for consideration by Scottish Government to review nomenclature, service definitions and signage of Minor Injury Units, throughout Scotland. NHSH Assessment Lead: Ross Mackenzie Rating: Amber Ross Mackenzie has met with representatives from SOS NHS Skye and from Portree Medical Practice and agreed next steps including options to be developed around 24/7 Urgent Care. On 27 June 2018 Ross Mackenzie briefed Skye, Lochalsh and West Ross Community Planning Partnership on the project. 27 June 2018 Ross Mackenzie met with Jo Ford from Skye Lochalsh Council for Voluntary Organisations to request 3rd sector involvement along with other community representatives in reviewing options. Meeting 9 July 2018 chaired by Hugo van Woerden originally to look at data but useful discussion around the communities expectation of seeing action to open 24/7 imminently. Noted that key individuals were not available as we have been in peak holiday season. Also discussed was benefit of patients phoning ahead, rather than turning up at Portree Hospital when accessing the service. It was agreed that NHS 24 and SAS would be asked to support this area. It was agreed that NHSH look to replace signage in Portree Hospital to refer to “Urgent Care” as opposed to “Minor Injury”, in line with discussions with Sir Lewis. We understand that there is wider work being undertaken by Scottish Government around terminology in different sized hospitals. It may be worth exploring why use of 111 is low in Skye. Consider case for commissioned clinical leadership (nursing/medical) in Portree to provide local overview. Meeting arranged by Ross Mackenzie for 16 July, including Dr Antonia Reed – NHSH Clinical Lead for OOH, and Graham MacLeod – Head of Service Highland Scottish Ambulance Service to develop initial options.
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