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.
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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.
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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
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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. Options will also be discussed with North Skye GPs and the wider community. While this approach has been agreed with community representatives, NHSH have some nervousness around this and ideally would prefer to move towards an inclusive approach, where everyone understands the problem and works towards the solutions via an options appraisal. Noted the need to get dates for meetings into diaries for future meetings at an earlier stage. Noted the need to have information available to describe how to access care for resident population and visitors to the area. GP Practice web sites may need updating. Dr Reed has contacted Visit Scotland and North Coast 500 with a view to making this information available. Noted that visitors account for approximately 30% of ‘drop in’ activity.
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Review of local Know Who to Turn to is being initiated.
David Noble (External Facilitator) Comment: Rating: Amber • A good start has been made towards reaching agreement with SOS North Sky and next steps have been clearly identified. • Proposed action to widen Community involvement is a high priority. • There is a community expectation that 24/7 services will be provided/restored without delays even if this requires and interim arrangement pending a longer term solution.
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Recommendation 2 – Future community bed provision
In-patient bed availability at Portree Hospital must continue until sufficient alternative 2.a resilient provision is provided in North Skye. This transition, which will take time, must be informed and shaped through co-production with the community Difficulty in recruiting nurses and support staff to work in Portree Hospital may be exacerbated by ongoing service redesign uncertainties and the offer of short term contracts 2.b for prospective staff in a facility that is perceived to be closing. This latter policy should be reviewed A rapid review of care at-home and community bed provision for SLSWR should be undertaken, taking account of present requirements, transfer activity to out-of-area secondary care facilities and future socio-demographic factors. Such a review should also 2.c take account of current and potential partnership developments, including statutory and voluntary provision such as contributed by the Howard Doris Centre in Lochcarron and Skye Cancer Care NHS Highland has already committed to provide additional services in the form of a new ten- bedded community unit in the Portree area. We understand that negotiations are underway 2.d to deliver on this commitment. This should be progressed at pace, with any bed capacity and capability revision informed by the above community bed review
NHS Highland plans to locate/co-locate Portree Medical Centre into the present Portree Hospital premises. The timing of this must be subject to the above recommendation about 2.e in-patient beds retention. Such a combined Unit might be renamed Portree Community Hospital and Medical Centre, or similar, to signify its dual and complementary role.
NHSH Assessment Lead: Tracy Ligema Rating: Amber
Group being setup including representation from Independent care home provider, Highland Hospice (Board member retired Portree GP), Portree Medical Practice, NHS Highland Clinical Lead to develop options. 4 July 2018 additional bed to be available in Portree Hospital specifically to support end of life care supported by district nurses and MDT. Standard Operating Procedure to support decision making process. 10 July meeting with nursing home provider to explore options to support end of life care with initial positive response. Need to be considered by Directors of company concerned before any further negotiation e.g. fee rates etc. Meeting arranged with another care home provider for 17 July. NHSH Lead Nurse Alison Hudson and District Manager Kate Earnshaw setting up group looking specifically at end of life care in North Skye. NHS Highland has very positive links with Highland Hospice and there have been initial discussions with their Chief Executive and with a member of a local charity Skye Cancer Care, Dr Charles Crichton.
David Noble (External Facilitator) Comment: Rating: Amber • Timescale for delivering alternative provision needs to be established as a priority. • The one additional bed becoming available for end of life care is a welcome step, but further consideration is needed to ensure that Recommendation 2.a is delivered.
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Recommendation 3 – Closer inter-agency and public participation
NHS Highland must collaborate much more closely on an ongoing, agreed basis with members of the public, public representatives, front line staff and other emergency and urgent care providers. Those who receive and those who deliver services are entitled to shape them. This is a joint endeavour with joint obligations - all must rise to the occasion
NHSH Assessment Lead: Ross MacKenzie Rating: Green
Steering Group set up with independent facilitation. First meeting 13 June 2018 next meeting 18 July 2018 – see recommendation 15. There are plans to draw on useful learning from recent process carried out in Caithness.
David Noble (External Facilitator) Comment: Rating:Green/Amber
Steering group membership and remit expected to be confirmed on 18 July. Discussions for closer inter agency working are still at an early stage, and need to be firmed up as implementation plans start to emerge.
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Recommendation 4 – Collaboration with SAS The Scottish Ambulance Service (SAS) should increase its paramedical staff (paramedic) capacity and capability in SLSWR, in line with its present strategy: Towards 2020: Taking 4.a Care to the Patient. This is particularly relevant for North Skye where SAS staff should be co-located at Portree Hospital as part of the wider Rural Support Team, jointly working within multidisciplinary teams, including the Rural Practitioners based at Broadford. SAS should review the availability, capacity and capability of all units in SLSWR, including 4.b fast response vehicle (FRV) provision.
4.c SAS paramedics should be deployed on-shift rather than present on-call arrangements.
Scottish Ambulance Lead: Graham MacLeod Rating: Amber Service Assessment SAS invited to internal NHSH project team meetings. SAS part of urgent care 24/7 work stream – see recommendation 1 Initial meeting between SAS and NHS Highland arranged to discuss potential options for SAS to be a part of the 24/7 Urgent care team. SAS recruiting Specialist Paramedics – currently an advertisement to identify any interest in a potential role based in North Skye. If recruitment is successful there is a training period between 12 and 18 months if there is no suitably qualified candidates. Links to recommendation 1. Previous early discussions around SAS staff potentially being co located into Portree Hospital have been highlighted SAS have fairly recently undertaken a review of all stations with regards to working On Call taking into consideration demand and capacity. Changes have been taken in Broadford to reduce On Call hours and they have had their shifts changed and resulted in a reduction in On Call worked with more hours on shift.
David Noble (External Facilitator) Comment: Rating: Amber • SAS still not fully involved in the project, although this is in hand. • Specialist paramedic in Skye will be a valuable additional resource in designing OOH solutions.
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Recommendation 5 – Collaboration with NHS24
To optimise utility for staff on OOH shift patterns, dual roles should be 5.a considered and developed with NHS 24. The involvement of SAS paramedics, should also be explored and evaluated. NHS 24 to work with NHS Highland in developing a hybrid staffing role, based at Portree hospital. It has not escaped our attention that working in this way, 5.b appropriately trained staff based in SLSWR could be contributing to the resilience and service provision of NHS 24, helping the urgent care needs of people on a Scotland-wide basis
NHSH Assessment Lead: Dr Antonia Reed Rating: Green
Initial discussion with between Dr Antonia Reed and NHS24. Technology to transfer untriaged call is available however technology may not be able to transfer only Skye calls. Concerns around whether the combined role may affect recruitment but potential to solve this through making all posts rotate through urgent care, NHS 24 and MacKinnon Memorial Hospital in Broadford. Links to recommendation 1.
David Noble (External Facilitator) Comment: Rating: Green • This action is at an early stage, and has a dependency to Recommendation 1. • There are issues over the practicality of implementing the proposal. As it involves novel ways of working it may be that some form of piloting will be needed before ideas are finalised.
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Recommendation 6 – Community First Responders (CFR)
A review of all present first responder schemes in SLSWR to identify 6.a deficiencies, remedies and support requirements That the feasibility of a systematic development plan should be explored for all statutory and voluntary first responders, with a view to ongoing collaborative working and mutual support. This would involve NHS Highland, SAS, SFRS, 6.b Police Scotland, HM Coastguard, the RNLI, Mountain Rescue Scotland, other third sector organisations, including Lucky2BHere and local community representatives.
NHSH Assessment Lead: Evan Beswick Rating: Amber
SAS First Responder road shows scheduled for Skye on 23 and 24 August 2018. SFRS invited to Raasay road show 24 August 2018 to discuss potential for retained fire fighter involvement in first responder roles. Stocktake of current CFR schemes requested from SAS. Discussion held between NHS Skye SOS and NHSH lead to identify potential workstream members. SAS are also currently mapping locations of Defibrillators into their Command & Control system so that in the event of a Cardiac Arrest it will flag up if there is a Public Access Defibrillators nearby that could be utilised until either First Responders or an ambulance arrives on scene.
David Noble (External Facilitator) Comment: Rating: Amber
• A list of all existing First Responders is required. • Potential for SFRS retained fire fighters taking on a First Responder role should be established as soon as possible.
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Recommendation 7 – Workforce capacity and capability
The capacity of the Rural Support Team and the numbers of Rural Practitioners should be reviewed and fully staffed, accounting for new models of joint 7.a working with SAS paramedics and NHS 24, to support 24/7 urgent care, as described above
Going forward, ongoing clinical leadership and engagement will be essential for the development and delivery of future service provision, including a 7.b sustainable OOH service. We are encouraged that clinical colleagues. recognise this imperative and NHS Highland must facilitate and support that.
As indicated for SAS, we suggest that shift working should supplant on-call 7.c working for members of the Rural Support Team. While this External view was asked to focus on OOH services, we recommend that a comprehensive 24/7 Urgent and Emergency Care Workforce Plan should 7.d be developed, including inter-agency working and contractual arrangements which promote recruitment and retention of staff - with sufficient capacity and capability.
NHSH Assessment Lead: Ross Mackenzie Rating: Amber
This links to outcome from recommendation 1. Ongoing recruitment in place. Funding constraints noted. Links to recommendation 8.
David Noble (External Facilitator) Comment: Rating: Amber
• Delivery on this recommendation is critical to the successful implementation of the report.
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Recommendation 8- Housing solutions
Novel staff accommodation solutions should be sought with Highland Council (lead agency for housing), public representatives, housing associations, the independent sector and local communities. This is a pressing matter, which should also take account of temporary accommodation for undergraduate and postgraduate health care worker training, which requires flexibility (see Recommendation 13). Such training accommodation, when not in use for training purposes, might be re-deployed to give temporary accommodation to growing numbers of visitors and tourists, particularly in Skye. These accommodation solutions are also relevant for the resilience of other public sector organisations and should be pursued in common endeavour.
NHSH Assessment Lead: Highland Councillor TBC Rating: Amber
Ross Mackenzie raised with Community Planning Partnership. Eric Green, NHSH Head of Estates has met with local housing association and Highland Council to look at options. Plans for basic accommodation to support NHSH staff have been developed for the Broadford Hospital site but no agreement on how to take forward. Links made to the Highland Small Communities Housing Trust around a new housing development being proposed for Staffin. NHSH are an active member of the local Community Based Housing Solutions Group for Skye and Lochalsh. Links to recommendation 7. Noted that a local housing association is building 11 new houses in Broadford. SAS have contacted housing association in respect of allocation of these homes.
David Noble (External Facilitator) Comment: Rating: Amber
• As a follow on from Recommendation 7, work needs to be done on quantifying the problem. Solutions need to be appropriate in relation to proximity to work bases.
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Recommendation 9 – Road Issues
Expressed concerns about adverse road surfaces and congestion issues should be shared with Transport Scotland and other relevant agencies with transport responsibilities. This should help to inform key road maintenance priorities.
NHSH Assessment Lead: Highland Councillor TBC Rating: Red
NHSH receive local updates from BEAR Scotland around road upgrades this information is disseminated across the teams as appropriate. NHSH to write to relevant agencies and local MSP to seek support for improvements.
David Noble (External Facilitator) Comment: Rating: Red
• Specific problems should be identified by SAS and Rural Support Team. These might include accessibility for ambulances, or road surface quality issues affecting patient transfer.
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Recommendation 10 – Transport and accessibility
The Terms of Reference and membership of the SLSWR Service Redesign 10.a Transport and Access Group should be reviewed in the light of wider inter- agency considerations and the recommendations from this External View. A review of air evacuation services of patients should be considered, involving 10.b inter-agency discussions between NHS Highland, SAS, EMRS and HM Coastguard, to determine whether any improvements can be made.
A review of sea evacuation procedures should be undertaken, involving inter- 10.c agency discussions between NHS Highland, SAS, CalMac and the RNLI.
The Memorandum of Understanding between SAS, HM Coastguard and the 10.d RNLI, recommended in the National Primary Care Out-of-Hours Review, should be finalised and implemented
NHSH Assessment Lead: Highland Councillor TBC Rating: Red
Links to recommendations 1, 3, 4, 6, 7 & 12 MOU with SAS and RNLI being worked on ‘nationally’ and is currently in Draft. SAS have contact numbers with Caledonian MacBrayne Clyde & Hebridean Ferries /Raasay Ferry for in and OOH’s as well as contact via the Coastguard.
David Noble (External Facilitator) Comment: Rating: Red
• Achieving a clear understanding with CalMac on the possibility out of hours call outs for Raasay is a high priority. • Recommendation 10.d should also be pursued. • Solutions for Raasay have a high dependency on the outcome of this work.
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Recommendation 11 – Digital innovation
Ongoing collaboration with the Digital Health & Care Institute should continue to 11.a explore and evaluate emerging digital technology to enable remote monitoring and video consultations from people’s homes. A review of video-conferencing facilities at all relevant care sites should be 11.b undertaken to provide reliable 24/7 professional-to-professional communications.
NHSH Assessment Lead: Clare Morrison Rating: Amber
Links to recommendation 12, 13, 14 NHS Near Me is a NHS Highland service to deliver video consultations at scale maximising use of the newer video consulting platform Attend Anywhere. Work on NHS Near Me began in January 2018, with the first phase focused on developing the service for outpatient appointments (furthest patient travel distances). Testing and refining of a standard process for use of the NHS Near Me service complete May 2018. Scaling up of NHS Near Me across all clinical services for outpatient appointments started June 2018. Business plan for NHS Near Me agreed by NHS Highland in July 2018. National funding for infrastructure to deliver NHS Near Me to Skye (and rest of Highland) applied for in July 2018. Currently awaiting funding decision. Next development phases for NHS Near Me: o 1: Develop NHS Near Me at home model. Initial service involves patients attending local NHS premises for video call to ensure equity of access (where patients do not have the equipment/confidence to connect at home) and to provide clinical support to video calls. Next phase is to develop an at-home model. NHS Near Me has been set up to allow at-home calls now but initial testing identified difficulties with unreliable internet connections at home, therefore a system to test this prior to consultations has to be developed. The pilot phase (from autumn 2018) will involve Skye, see link with recommendation 12. o 2. Develop NHS Near Me for other clinical services, eg, primary and community care services. To begin testing in autumn 2018. NHS Near Me enables professional-to-professional communications 24/7, with instant access and, due to the lower cost of equipment than VC units, easier ability to spread. This is being developed on a clinical service by clinical service basis. Ongoing links with the Scottish Centre for Telehealth and Telecare and NHS2 The ambition is to roll out to use in peoples own homes through use of personal devices. There are some significant limitations around connectivity and these need to be addressed to ensure reliability NHS Highland to raise with local MSPs and Minister
David Noble (External Facilitator) Comment: Rating: Amber
Options based on the use of personal mobile devices should be included in this review.
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Recommendation 12 – Glenelg and Arnisdale
NHS Highland should continue to work with the Glenelg and Arnisdale community to agree jointly and rapidly a solution which is not only desirable, but 12.a feasible and sustainable. Independent external third party facilitation should be considered to help achieve this. The present GP led service at Glenelg should continue to be underpinned by 12.b adequate multidisciplinary support via the Rural Support Team and SAS, on a 24/7 basis Air and sea evacuation procedures for Glenelg and Arnisdale should be kept 12.c under review on a multi-agency basis, given the vagaries of road access in adverse weather conditions - see recommendation 10. The Scottish Fire and Rescue Service (SFRS) has a unit based at Glenelg. 12.d Statutory first responder status should be pursued, in concert with the additional potential of a voluntary first responder scheme - see Recommendation 6. The imminent availability of superfast broadband should be exploited for the succour of the Glenelg & Arnisdale community. This community should be 12.e considered as a potential development site for digital innovation - see Recommendation 11.
NHSH Assessment Lead: Ross Mackenzie Rating: Amber
Independent facilitator selected by local community and appointed in conjunction with NHSH – Dr Miles Mack. Initial meeting between community and Dr Mack 11 July 2018 Initial meeting between NHSH and Dr Mack 17 July 2018 Workshop proposed in Glenelg on 31 July 2018 to look at way forward.
David Noble/Miles Mack (External Facilitator) Comment: Rating: Amber
Although this is a distinct sub stream of the project, any solutions will need to be considered within the overall plans for the area. Broad equity of access and support for all remote communities must be borne in mind.
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Recommendation 12R – Raasay
NHS Highland and other partners should continue to engage with the residents of Raasay in a meaningful way and to rapidly develop an agreed and 12R.e sustainable service on the island that provides safe and resilient care 24/7. Independent external third party facilitation should be considered to help achieve this. As part of the review of sea evacuation procedures in Recommendation 10, Raasay is a key priority. Discussions should take place with CalMac whether the Raasay-Sconser ferry can be deployed on demand for urgent/emergency 12R.f care transfers. Irrespective of these discussions and possible agreements, the ongoing role of the crew of the RNLI Portree Lifeboat is respected and appreciated. The Scottish Fire and Rescue Service (SFRS) has a unit based at Raasay. Statutory first responder status should be pursued, in concert with the 12R.g additional potential of a voluntary first responder scheme - see Recommendation 6.
The present availability of superfast broadband should be exploited for the 12R.h support of the community. Raasay should be considered as a potential development site for digital innovation - see Recommendation 11.
NHSH Assessment Lead: Tracy Ligema Rating: Amber
Last year agreement with community to recruit to Health and Social Care Support Workers (HSCSW) who will be trained as first responders and provide on-call support for the Rural Practitioners based in Broadford. Recruitment ongoing to the final (4th) post. Several rounds of recruitment have taken place. Candidate offered job but unable to accept as partner was unsuccessful in application for another post so cannot relocate to Skye. First Responder Training to be organised. On-Call support OOH from HSCSW will only activated through the Rural Practitioners and protocols are being developed around this. Terms & Conditions supplement agreed by NHS Board and forward to the National Terms and conditions committee. If agreed it is hoped this will make recruitment more attractive. Emergency evacuation procedure is in place and has been shared previously with the community. Initial meeting between David Noble, Independent Facilitator Email received 18 June 2018 from community listing their requirement for on island support during the OOH period.
David Noble (External Facilitator) Comment: Rating: Amber
• As a result of delays in fully implementing the HSCSW solution, the community has lost confidence in the process. Reviving this solution is a high priority. • There are concerns about Emergency Evacuation procedures which should be looked at specifically for Raasay within the over Transport work stream. • A clear resolution on the extent to which Calmac ferry services can be called out of timetabled hours is important for the overall design of services.
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Recommendation 12L - Lochcarron
The Lochcarron Centre (Howard Doris) should continue to be nurtured and supported.
NHSH Assessment Lead: Ross MacKenzie Rating: Green
NHS Highland staff and local community representatives in North Coast (Sutherland) have made a number of visits in order to share good practice for Care Hub development in Tongue. The Howard Doris Centre was also highlighted in NHS Highland board paper on 29 May 2018, “Developing a vision for independent living accommodation for older people in NHS Highland”.
David Noble (External Facilitator) Comment: Rating: Green
There is no recommendation for change here, but the Centre may offer a model of good practice. A meeting with the key players is being arranged for early August.
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Recommendation 13 – Centre of Excellence for learning and training
NHS Highland should engage closely with NHS Education for Scotland (NES), Scottish Ambulance Service (SAS), NHS24, Medical Schools and relevant academic partners, including the University of the Highlands and Islands (UHI)and Highlands and Islands Enterprise (HIE) to optimise these opportunities
NHSH Assessment Lead: TBC Rating: Blue
Links to a number of other recommendations but will be longer term. Opportunities are being explored in developing a Rural Fellowship for Advanced Practitioners. There is the potential to link to the University of the Highlands and Islands. Training could b across a range of professionals.
David Noble (External Facilitator) Comment: Rating: Blue Not applicable at this stage.
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Recommendation 14 – Best use of services – know who to turn to
A programme of assisting the public to make best use of available services, should be developed and implemented, including, Know Who to Turn To. This will need to be done on a systematic and advocacy basis, with the full engagement of local communities and their representatives. Social media may be helpful.
NHSH Assessment Lead: Ross Mackenzie Rating: Amber
Links to recommendation 1 Local intelligence is required to help understand why people don’t access NHS 24. Previous initiatives from both NHS Highland and Portree Practice have not changed the pattern of use.
David Noble (External Facilitator) Comment: Rating: Amber While this could be seen as a later stage of the project, promoting an understanding of the most appropriate pathways to care will be critical to successful implementation of the whole project. Community consultation should aim to identify the causes of current low levels of NHS 24 usage in the area and how this can be improved. Access to services by tourist visitors should also be reviewed as part of this process.
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Recommendation 15 – Making it happen – pulling together
15.a All future service development and delivery must be done in partnership with the people of SLWRS with a focus on co-production. 15.b The National Standards for Cummunity Engagement must be observed by all.
All relevant partners should participate in these sessions including those that 15.c control wider infrastructure. An implementation plan with realistic timescales and adequately resourced, 15.d needs to be robustly governed with clear accountability, reporting to the Highland Health and Social Care Committee. Independent external third party facilitation should be deployed as required and 15.e agreed In view of the aspiration in these recommendations and the Major Service 15.f Redesign Programme underway, Scottish Government should seek regular and robust assurance that satisfactory progress is being made.
NHSH Assessment Lead: Hugo Van Woerden Rating: Amber
David Noble has been identified by the community in Skye as their Independent Facilitator. This has been agreed by NHS representatives. Glenelg & Arnisdale have selected an independent facilitator, Dr Miles Mack. An initial meeting of Steering Group, held on 13 June 2018, was chaired by David Noble. The importance of a co-production approach was highlighted by NHS staff and community representatives. Dr Antonia Reed has been identified as the Clinical Lead for the implementation of Sir Lewis Ritchie’s recommendations. Work is ongoing to develop a governance structure, as indicated in the introduction. Internal NHSH Project Team monthly meetings have been set up, chaired by Ross Mackenzie to monitor progress. First meeting 12 July 2018. A weekly core coordinating meeting is also in place. Links have been made to other redesign work in Skye, Lochalsh and south west Ross. Work has been undertaken on a project website. A draft Project Plan has been produced.
David Noble (External Facilitator) Comment: Rating: Amber
• Progress is being made in developing community involvement through community membership of working groups and representation on the Steering Group. • An implementation plan is in place, but timescales and targets for work groups need to be refined, and resources requirements identified • Project control and reporting arrangements still need to be finalised.
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