NHS Highland Board 24 July 2018 Item 4.11 CHIEF EXECUTIVE AND DIRECTORS REPORT – EMERGING ISSUES AND UPDATES Report by Elaine Mead, Chief Executive The Board is asked to: • Note the updates provided in the report. Chief Officer Argyll and Bute Health and Social Care Partnership It is with much regret to report that Christina West has resigned from the post of Chief Officer for Argyll and Bute Health and Social Care Partnership with a leaving date of 30th September 2018. Integration of health and social care has been one of the most significant changes in the public sector for decades. Under Christina’s Leadership she leaves Argyll and Bute’s Health and Social Care Partnership in a positive position to move forward, with plans in place to redesign services not least to meet the demographic challenges. Christina takes with her our grateful thanks, for her hard work, determination and commitment to developing health and social care services for the people of Argyll and Bute. She embraced the Highland Quality Approach and has been an invaluable member of NHS Highland’s Senior Leadership team. The recruitment process is underway to secure a new Chief Officer. Dr Grays Temporary Service Model for Women and Children’s services A new temporary service model for Women and Children’s services at Dr Gray’s Hospital is to be put in place to allow maternity and paediatric service to continue in Elgin. The change comes after NHS Education for Scotland said initial indications were that only two trainee doctors had elected to work at Dr Gray’s at the next intake in August – six less than the number required. The current obstetrician consultant staff will remain in place and all ante and post natal care will still be available at Dr Gray’s. Low risk pregnancies will be able to give birth at the new midwife- led service Community Maternity Unit at Dr Grays. If births don’t go as planned and there is a need for transfer in labour (intrapartum transfers) these will be taken to Raigmore Hospital as it is a shorter journey for a woman in labour. It is estimated that this would amount to around 20 trasnfers per annum. All medium and high risk pregnancies who require consultant-level care will be referred for birth to Aberdeen Maternity unit The new interim arrangements will begin on 18th July and it is expected that they would be in place for up to 12 months to allow work to progress with staff partners and the community to find a sustainable long term solution. Report on Joint Inspection of Adult Support and Protection The Report on the Joint Inspection of Adult Support and Protection Services was published on 3 July 2018. The Inspection carried out between January and March 2018 by the Care Inspectorate and Her Majesty’s Inspectorate of Constabulary, took place in six Partnerships across Scotland. The Inspection confirmed that adult support and protection was well established as a high priority in Highland. It also found that staff were knowledgeable, skilled and highly motivated to carry out adult support and protection work, which is complex and challenging”. The Inspectors found evidence of the benefits and value of the integration through the Lead Agency model, highlighting that: “Conversations between police and health, which would not have happened under the previous structure, were happening regularly now. The single budget, single management model has created shared responsibility and while adult support and protection was previously viewed as a social work issue, this was now a shared adult services responsibility.” The Highland Partnership representatives also reflected back to the Care Inspectorate, its disappointment and concern that the Inspection was almost entirely limited to the city of Inverness. NHS Highland is the Partnership lead for Adult Support & Protection, following the integration of health and social care services in 2012. Key partners include Highland Council, Police Scotland, Scottish Fire & Rescue, and many third sector agencies including Highland Advocacy. Update on Major Service Change Redesign Projects Badenoch & Strathspey and Skye Lochalsh and South West Ross T The Outline Business Case for Major Service Redesign of services across Badenoch & Strathspey and Skye Lochalsh and South West Ross has been approved by the Scottish Government on 24 May 2018. The board has now been invited to progress to Full Business Case which is due to be submitted by the end of the year. Steady progress is being made across both redesign projects to progress the out of hospital elements of the redesign. Design work on the new hospital in Aviemore has also reached a milestone with the planning application due to be submitted by the 13th of July. The internal design for the new hospital in Broadford is also now broadly agreed and the design team are working through the detail of the external site layout and landscaping to allow submission of the planning application in early August. The Outline Business case was initially considered by the Capital Investment Group in December 2017 but additional information was requested relating to the Skye Lochalsh and South West Ross element of the bundle. Since the initial submission Lewis Ritchie has also completed his Report into urgent care out of hours. When the Public Petitions Committee met on 7th June 218 the petition on Major redesign of healthcare services in Skye, Lochalsh and South West Ross (PE 1591) was on the agenda. The Committee has written to the (now former) Cabinet Secretary noting: The Committee recognises that it is unlikely that the Scottish Government would reverse its decision in terms of the major service redesign, as called for in the petition, but agreed to keep the petition open until Sir Lewis Ritchie completes his review of the key themes. The Committee further agreed to seek your views on the findings of the review and, in particular, how the Scottish Government will seek “regular and robust assurance that satisfactory progress is being made”, as highlighted in the report’s recommendations. Progress with implementing recommendations will be a consideration as part of the sign off process for the Full Business Case and in addition regular updates will be provided to the Scottish Government North Coast Redesign Work continues to progress with the North Coast (Sutherland) Redesign with a Design Statement Workshop with stakeholders held in Tongue village hall 4th July 2018. Discussions were very positive, with broad agreement on the principles which will underpin the new design. The proposals are to replace existing six-bedded care homes Caladh Sona in Talmine (Melness, near Tongue) and Sinclair Court (Melvich) with a single health and social care ‘Hub’ in Tongue which will be built on the same site as the Health Centre and day care facilities. The Care Hub will be a mixture of community beds and assisted living housing solutions. Staff and community representatives have visited the Howard Doris Centre in Lochcarron to look at their set up with a view to sharing learning. Lochaber Health and Social Care Redesign Local communities and staff across the Lochaber district are being invited to play a key role in planning the replacement for the Belford Hospital in Fort William. An initial workshop has been arranged for Thursday, 9th August 2018 to discuss the redesign which will look at the appropriate balance between services provided at home, in the community, in care homes and in the replacement for the Belford Hospital. The event is an important step in the business case process where the board is required to carry out a strategic assessment of the issues and requirements and what this will mean for services in the future. The event will be facilitated by an external healthcare planner. There has long been a strong local ethos of trying to provide as much care out of hospital settings unless there is clinical need to do so. Being able to demonstrate what has already changed in the past ten years in terms of shifting the balance will be very important when we come to make the business case for investment. The status of the redesign in terms of whether it is ‘major’ is still to be determined. In October 2015 Highland Council bought land in Fort William at Blar Mhor from Tesco for £2 million and made it available for a new hospital. Realising Realistic Medicine Conference Dr Catherine Calderwood, Chief Medical Officer (CMO) for Scotland, launched realistic medicine in her first report CMO Report in 2016. In line with her ambition, the NHS Highland aim is that by 2025 everyone who provides health and social care in Highland will demonstrate their professionalism through the approaches, behaviours and attitudes consistent with Realistic Medicine. Realistic Medicine proposes a model which promotes better health, better care and better value. It is tailored to individuals, delivered with empathy and by greater sharing in decision making. This model is in line with our Highland Quality Approach. Over the past two years the concept has been developing across NHS Highland. At a showcase event on 29 June examples of where patients have been much more involved in decision making with clinical colleagues were shared. Around 100 people attended the event from across Highland, Argyll and Bute with speakers on the day including Dr David Caesar, national clinical advisor to the Chief Medical Officer; Helen Mackie, national clinical advisor on realistic medicine, as well as NHS Highland’s medical and associate medical directors. In May this year Rebecca Helliwell was appointed as NHS Highland’s clinical lead for Realistic Medicine. Rebecca is a GP in Lochilphead. The Highland Midwife The second series of the Matchlight produced documentary series is now being shown on Channel 5.