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Newsletter

August 2018 INSIDE THIS MONTH

Quality Improvement Institute... 2 Public choose best Advanced physio appointed… 2 ‘Doctors at Work’ success.. 3 Community thanked for help…. 3 times for redesign Transitions team created……... 4 Portree day service trials…….. 4 Outline business cases……….. 5 HQA awarded to special team.. 6 consultation events Data protection update….…….. 7 LEAN: banishing waste……….. 8 PUBLIC FEEDBACK from the two Pulteney House Care Home or Town and Health & Care Tech demo……. 9 launch events about the consultation County Hospital sites) as part of a num- into the future provision of some ber of improvements to local services. Eliminating the cost of waste…. 10 health and social services in Caith- The care hub/care village would sup- ness has helped decide the timing port more services to be moved beside for future events. each other, across fewer sites and in im- Upcoming events in Wick will now proved facilities. start at 7pm at the Assembly Rooms on Meanwhile, services currently pro- Sinclair Terrace booked for Thurs- vided from GP practices would stay in day 11th October and the Pulteneytown their current towns and villages. In Wick People’s Project, Huddart Street, on and Thurso, however, some may be relo- Tuesday 6th November 2018. cated into the care hubs. Meetings at the Thurso High School , Palliative care would continue to be Ormlie Road, scheduled for Monday 1st delivered in across a range of October and Thursday 8th November settings including at home and in commu- 2018 will also begin at 7pm. nity beds. Altogether over 40 events and meet- The redesign plans also include: ing are already planned during the three- month consultation which will run from A multi-million pound upgrade for You can follow 20th August 2018 to Friday 23rd Novem- Caithness General Hospital NHS Highland on... ber 2018.  Investment in community services WEBSITE During that time, residents will be able  www.nhshighland.scot.nhs.uk to decide on the options of some exciting And funding to improve a number of FACEBOOK redesign proposals that were developed health and care facilities which are no https://www.facebook.com/ following lengthy discussions with local longer considered ‘fit for purpose’. NHSHighland people earlier this year. TWITTER These proposals are for the develop- All this would be brought together in a www.twitter.com/ ment of two care hub/care villages: one business case where NHS Highland would NHSHighland or in Thurso (located on the Dunbar Hospi- look to secure an additional investment of @NHSHighland tal site) and one in Wick (located at the Continued on page 2 - - CAITHNESS Public choose times Physiotherapy Role From front page Town & County site (Wick) (received 683 out of 1,000 (alternative)) around £30m for Caithness from Scot- Option 3, care hub/village located at tish Government and other funders. the Dunbar Hospital site (Thurso) and During the workshops attended by Pulteney House Care Home site (Wick) local people earlier this year, three op- (received 783 out of 1,000 (preferred)) tions were short-listed and scored:

Meanwhile, Caithness General Hospi- Option 1, no change – current ar- tal will require significant investment in rangements continue (received a score order to expand the Emergency and Out of 277 out of 1,000) -patient departments and develop better Option 2, care hub/village located at facilities for the Community Maternity the Dunbar Hospital site (Thurso) and Unit. PATIENTS AT three Caithness practices will soon benefit from an JOINT VENTURE innovative team approach to health- joint venture dedicated to qual- care with an advanced physiother- A ity improvement in health and apy practitioner (APP) working social care was launched in Inverness. alongside GPs. The Highlands and Islands Im- From September, patients at the provement Institute (HI3) is a joint Prof. Hugo Thurso’s Riverbank and Wick’s venture between NHS Highland and van Woer- Riverview Medical Practices, and the the University of the Highlands and den Lybster Medical Centre with muscu- Islands which provides training allow- loskeletal problems (MSK) will be ing quality improvement across the programme approaches, the course able to see specialist physiotherapist NHS benefiting communities, patients includes an emphasis on the critical Mike Flavell instead of a GP. and their families. analysis of improvement methods and By using Mike, Caithness’s first- Professor Hugo van Woerden, di- the use of quality improvement tools ever ‘first contact’ APP, in this role, rector of public health and policy for and techniques to address waste, the practices are expected to reduce NHS Highland is part of the opera- harm and variation in the health and GP workloads by around 20 per cent tional management team behind the social care systems. - freeing up local GPs so they can development of the institute. Delivered online and part-time, the see other patients. He said: “There is increasing inter- course is open to a wide range of indi- Mike said: “My post in Caithness est across the world in innovative ap- viduals including nurses, doctors, allied will enable me to manage people proaches to improving health professionals, care with musculoskeletal MSK problems quality, and reducing workers, health care scien- in primary care rather than a GP. It waste, harm and variation tists, health care managers will reduce the practice’s GP work- in both the public and pri- and administrators, facili- load, help save their time and so vate sector. ties and estates staff. reduce expenditure on locum costs. “With the growing de- It is also suitable for peo- Mike said: “Going forward, the mand for health and social ple working in charities or plan is to embed the first contact care services there is an the independent sector, physio model in these practices. A urgent need to improve and who have an interest similar role funded by an independ- the effectiveness and effi- in, or responsibility for, ent GP practice in Inverness for sev- ciency of services to ensure quality improvement. eral years significantly helped to they meet the current and predicted Professor van Woerden added: reduce the number of patients need- future needs of the population. “This is about developing opportuni- ing to see an orthopaedic consultant “This programme will give those ties in quality improvement and with and/or community physiothera- taking part the opportunity to learn almost 100 people attending this pists.” quality improvement methods and launch, it demonstrates the enthusi- Kath Jones, NHS Highland’s asso- approaches by combining practical asm there is locally for this initiative. ciate medical director North and application with a deep theoretical “Our aim is to create a Centre of West, said: “First contact physio- understanding that can be applied to a Excellence with an international pro- therapists have the clinical expertise wide range of health and social care file in quality improvement, improve- to assess, diagnose and treat pa- contexts.” ment science and innovation through tients with a range of MSK condi- Using several quality improvement practice, education and research.” tions. This is especially useful at a methods, including Model for Im- For more information about HI3 go time when patient demand and GP provement, Lean, and Patient Safety to the website here. workloads are rising.”

- 2 - HEALTH AND SOCIAL CARE SERVICES SKYE Day Service Trials

Transitions team set up TRIALS OF a day service at Portree A NEW TEAM of health and social prises of both Highland Council and Community Hospital could help care professionals has been estab- NHS Highland employees coming to- transform health and care services lished to support young people gether in one team in the same building. provided on Skye. The trial, which began last with a disability who are likely to We will learn each other’s systems and month, sees part of the hospital fa- require planning and support in legislation so we can fully support fami- cility being transformed into a ‘one transition from children to adult lies.” stop shop’ for the assessment and services. Previously, young people would be subsequent support of frail and eld- Young people aged between 14 and referred to adult services at 14 and fol- erly patients living in the north of 25 were traditionally supported by low a joint transitions policy between the Island. Highland Council’s children’s services Highland Council and NHS Highland. Referred by their GP, allied followed by NHS Highland’s adult ser- This process did not always meet health or care professional because vices. the desired outcomes of each individual they are at risk of falling or have complex health problems, the day The new transitions team will pro- and meant that young people and their service will assess patients’ particu- vide a consistent platform for young families could be working with a num- lar health care needs and develop people, parents and carers at what can ber of different professionals during an appropriate care plans for them. be a challeng- already chal- If the trial is successful, NHS ing time in a lenging time in Highland and other stakeholders are young per- a persons’ life. keen to expand the concept and the son’s life. “It’s important approach to cover a wide range of N i c o l a to stress that conditions. Stewart, tran- this isn’t a new Dr Louise Lankston, GP at Por- tree Medical Centre, said: “The sitions team resource,” Practice initiated and has led on the manager, said: Nicola ex- development of this proposed new “The team has plained. “We service and we are working closely been set up in haven’t se- with our community colleagues and recognition cured addi- Dr Karen LeBall, consultant in Medi- that the transi- tional staff. cine for the Elderly. To have it as an tion period We have active trial is a testament to the can be difficult pulled an en- hard work of those involved. for young peo- thusiastic team “The aim of the service is to pro- vide a pro-active planned interven- ple, their fami- from existing tion process where people get the Transitions team managers: Stella Chisholm lies and carers. r e s o u r c e s levels of support they need before (left) and Nicola Stewart. “There are available to something happens, allowing them a lot of both organisa- to remain at home with appropriate changes in a young person’s life during tions. planned support and to provide that period, such as leaving full-time “I think this will be a positive move timely non-hospitalised interven- education and starting employment, and for everyone. We can pull together a tions. we don’t want the process of transition- lot of valuable experience in both chil- “The trial will also ascertain if ing from one service to another to ex- dren’s and adult’s services into one set- such a service is needed; the poten- tial benefits to patients; and how it acerbate that. ting and become a specialist service that could run and be funded.” “The overarching vision for the team provides a high-quality level of care for It will have input from occupa- is to take young people living in the In- young people and their families and car- tional therapy, physiotherapy, com- ner Moray Firth area through the proc- ers.” munity nursing, GP, Pharmacist, ess of transition and to support them in Stella added: “I think it’s a massive Consultant, and third sector partner a more consistent way than has been step in the right direction. It will be bet- organisation Connecting Carers. possible in the past.” ter for young people coming through to Initially, the trial of the North Transitions team manager Stella know that one team will support them Skye Day Service is using patients Chisholm said: “The establishment of through their transition. referred by Portree Medical Cen- tre’s own GPs. the team will provide the opportunity “It will also benefit parents and car- If successful it will cover patients for the one service to support an indi- ers because they will have a consistent referred to the service from the vidual from 14 years of age all the way point of contact with one team and all whole of North Skye, including from through to 25. of the necessary skills and knowledge in the Dunvegan and Carbost medical “This is a fantastic example of joint the one location.” practices. working. Our team of 16 staff com- - 3 - DOCTORS AT WORK NEWS IN BRIEF Skye Steering Group

Programme bears fruit THE PROJECT team implementing Sir Lewis Ritchie’s report into Out-of NHS HIGHLAND’S ‘Doctors at She said: “Universities want to see -Hours (OOH) care in Skye, Lochalsh Work’ programme has come full that you know what it means to be a and South West Ross took a further circle with two pupils from the first doctor and be involved in patient care. step forward at a meeting in Portree group of students that took part in “I was able to discuss what I had when a steering group was formed to 2012 joining seen, learnt and felt during this week of oversee project delivery. this month as foundation doctors work experience in my personal state- At the meeting at Tigh na Sgire, (FY1s). ment and interviews. It certainly gave Portree, on Wednesday 18th July The programme, which is currently me a lot to talk about during the inter- 2018 it was decided that the group in its seventh year, is a five-day place- view.” will be made up of community repre- sentatives, local practitioners, and ment for secondary school pupils in Dr Calum Green, also an FY1 with staff from NHS Highland, NHS24 Highland who are intending to study NHS Highland, said it was his first op- and the emergency services. The medicine. portunity to spend any dedicated learn- Scottish Ambulance Service is work- Those taking part get to experience ing time in the hospital environment. ing with the project and will also be a a variety of clinical settings including He said: “I can still clearly remember key player. wards, theatres and clinics across a the time I spent in theatre observing a The meeting also reviewed pro- whole range of specialities such as surgi- carotid endarterectomy. gress so far, working from the first cal, orthopaedics, diagnostics and medi- “While the technicalities of this op- interim report to the Scottish Gov- cine. eration were obviously lost on me, I ernment. See further details got to the Ritchie Report website here. They also have the opportunity to remember being totally in awe of the

talk to medical students who are work- intricacy of the surgery and the fact that ing in the hospital and can give them an the patient was awake throughout but Positive catering insight on what their medical school life could feel no pain. I was also very THE CATERING department at will be like. pleased to discover that I was not Raigmore Hospital received their Dr Eilidh Urquhart, FY1 with NHS squeamish. unannounced annual environmental Highland, explained that the programme “I would not have had this opportu- health inspection in June. The inspec- was really helpful with her application to nity without ‘Doctors at Work’ and I do tors were very positive and high- medical school as it gave her a real in- believe it would have been extremely lighted a number of areas of good sight into what it meant to be a doctor difficult to secure a place at medical practice. and practice medicine. school without the programme.” A big ‘Thank You’ to the catering management team and all of the catering staff for a very good report. “Due to the fantastic efforts of Well done to all. everyone in attendance, a strategic assessment has been drafted and will HS Highland has thanked the be shared for review over the coming NHS70 celebrations N communities of Lochaber for weeks. their continued engagement in the “This would not have been possi- health and social care redesign taking ble without feedback from the atten- place in the area. dees and their input is greatly appreci- A recent workshop to formally ated. We would ask for their contin- make the strategic case to replace the ued support and engagement through was attended by over the redesign of health and social care 100 representatives from local com- services in Lochaber including our munities, a host of voluntary and third endeavours to recruit staff to the sector organisations, elected officials area.” and NHS Highland staff. In October 2015 Highland Council The feedback gathered at the pub- bought land in Fort William at Blar lic event has played a significant part Mhor from Tesco for £2 million and JERI GUY, a well-known local baker in the process. made it available for a new hospital. in Wick, kindly made and donated Deputy director of operations for Working in collaboration with cup cakes for patients & staff of NHS Highland’ north and west divi- NHS Highland, Highlands and Islands Wick’s Town and County Hospital to sion, Tracy Ligema, said: “On behalf Enterprise, West Highland College have with their afternoon tea and of the Steering Group I would like to UHI and the Scottish Government, help celebrate 70 years of the NHS. thank everyone for attending the pub- the Highland Council acted in an ena- As you can imagine they went lic event held on 9th August in Fort bling role in securing this strategic site down a treat. William. for the new hospital.

- 4 - BUSINESS CASE APPROVALS ‘Big steps forward’ for redesign THE MODERNISATION and re- we recognise this has been unsettling. and landscaping is ongoing. NHS High- design of the community and hos- However, with approval of the Outline land confirmed that it expects to submit pital services in Skye, Lochalsh and Business Case, perhaps we can put the a planning application. South West Ross took a big step recent past behind us. What I have The full business case for the project forward recently. clearly heard is everyone wants to is scheduled to be presented to the The Scottish Government approved move forward together and implement Scottish Government in early 2019, the Outline Business Case for the local sustainable services we can all be proud with the construction of the hospitals project which is being ‘bundled’ with a of.” commencing once this is approved. Fur- redesign in Badenoch and Strathspey. He added: “Following the publication ther work with be required with part- The proposals include investment in of Sir Lewis Ritchie Report we will be ner agencies and local communities to new community hospital ‘hubs’ located working closely with the community develop a business case for any addi- in Broadford and Aviemore with a com- and our partners to implement the rec- tional services as set out in the Lewis bined construction cost of around ommendations.” Ritchie Report. £30m. The wider redesign of community This proposed new hospital in On Skye, there will be alteration services will see an increase in commu- Broadford forms part of a wider redes- and/or refurbishment of existing prem- nity health and care support workers, ign across Skye, Lochalsh and South ises including the Portree Hospital allied health professionals and dedicated West Ross which will see a new, mod- building as well as Broadford and Kyle step up / step down / flexible use com- ern integrated health and social care Health Centres. It will also bring to- munity beds, including in Portree. These ‘hub’ in Broadford and re-design of Por- gether community health and care beds will be located in local care homes tree Hospital, which will house the Por- teams allowing the integrated teams to and provide an enhanced level of sup- tree GP practice and continue to pro- better support the delivery of care in port, reducing the need for people to vide outpatient clinics and other ser- the communities. be in hospital. vices including, Minor/Injury Urgent David Park, chief officer for the Meanwhile the design of the new 24- Care [2] services in and out of hours. Highland Health and Social Care Part- bedded hospital building in Broadford is nership, said: “The redesign of services well advanced with an agreed overall has been difficult for all concerned and layout and work on the detailed design CRITICAL SERVICES UPGRADE

ork on Phase B of Raigmore Hospital’s Critical Ser- W vices Upgrade (CSU) has now been completed. The work provided an opportunity to co-locate wards and ensure that NHS Highland can deliver first-class healthcare in modern facilities for years to come. It brings all critical care services, which includes the Acute Medical Assessment Unit, the Intensive Care Unit, Surgical High Dependency Unit, Coronary Care, Cardiol- ogy and Theatre suite, beside each other over two floors. The new ward areas for acute medical assessment, medical high dependency, surgical high dependency and intensive care are now complete. Patients, staff and equip- The Acute medicine unit as seen before being fully equipped ment were moved into their respective areas during June GRAHAM Construction was appointed main contractor and the beginning of July. to refurbish the critical care and theatre suites at Raig- Surgical high dependency and intensive care are co- more Hospital in Inverness. located and known as the Department of Critical Care; Kevin Minnock, project director for capital projects at which includes two state of the art isolation rooms; and a NHS Highland, said: “NHS Highland is delighted to accept purpose-built relative’s area which also has an area for handover of Phase B of the CSU Project from our Frame- overnight stays. work partner GRAHAM Construction. The operating theatres at the hospital are also being “This phase of the project represents a key milestone in refurbished and an additional theatre will be added to bring the overall delivery of the £28m Critical Services Upgrade the total number of theatres in the suite to 10. Seven of here at Raigmore. The new department of critical care which will be equipped with specialist laminar air flow, en- offers a first-class modern environment for staff to deliver suring the air within the theatre environment is at the high quality critical care services for the patients of North cleanest possible standard. of Scotland.”

- 5 - HQA AWARD WINNERS Special award for “special” team THE LATEST Highland Quality Approach (HQA) award has gone to the acute medical assessment unit based within Raigmore Hospi- tal, Inverness. In the nomination the team were praised for being very inclusive where ‘cleaners, receptionists and housekeep- ers are as valued as nurses and doctors’. The large team not only includes those who work fulltime within acute medicine but also those who contribute from out with, such as the mental health liaison staff, physiotherapy, occupational therapy, pharmacy staff and specialist Some of the team from the acute medical assessment unit accepting their doctors who visit. award. NHS Highland chair David Alston is on extreme left. Senior charge The nomination recognised ‘all the nurse Pam Hodgson is holding the certificate. little instances of wonderful care that are subjective and easily missed’ with land, presenting the team with their quite special. It highlights the great work ‘taking time to care’ being the ‘bedrock award said: “I found this nomination that they all do, how they look out for of what staff of all levels do’. really moving. The number of people in each other and help each other through David Alston, chair of NHS High- the team receiving this award makes it what can be challenging days.”

Since the app became a reality it has won five national AWARD WINNING APP awards, including the ViapathUK Award for innovation in healthcare science. hildren anxious about having an MRI scan are being With enquiries about the app coming in from across C helped thanks to a virtual reality the world Jonathan is pleased that the app developed between the radiology original intentions behind the app are and medical physics and bioengineering being met. departments at Raigmore Hospital. He said: “The app takes you through Principal clinical scientist, Jonathan every step of your MRI journey from Ashmore, who has been with NHS the waiting area, into where the radi- Highland since March 2017, came up ographer sits and then into the scan- with the idea for the app after hearing a ner itself.” number of nervous paediatric patients Adam Scotson, Lead MRI radiogra- becoming more and more upset when pher for NHS Highland, said: they were told to lie inside the scanner. “Feedback from our patients and their He said: “Scans would occasionally parents has been good with parents have to be stopped as the child was just even saying the app has made them too nervous. less anxious about their child’s proce- “Giving children the full MRI experi- dure. I’m delighted it is being so well ence via virtual reality seemed a good received.” way to prepare our young patients for David Wood, chief executive of The what can be a daunting experience.” ARCHIE Foundation, said: “The team Working with a team including radi- has taken a difficult problem and de- ographers, play specialists and a digital Pictured above is the Virtual Reality app in veloped a really clever solution. We content creator from King’s College in use. Developed to help children feel less anx- were delighted to help his idea be- London, an app was developed. ious about having MRI scans, the free app come a reality. When used with a virtual reality gives nervous patients the “full 360 MRI ex- “The ARCHIE Foundation exists to headset, provided by the ARCHIE perience” before they get to use the real thing. make the difference to local sick chil- Foundation, and a standard mobile dren and this project is the perfect phone, it gives the child a full 360 MRI example of how donations from our experience, allowing them to feel as though they are inside wonderful supporters allow us to do just that.” the scanner and be more prepared for what it will be like The ‘My MRI at Raigmore’ app is available for free on the day. download from Google Play Store and Apple App Store.

- 6 - EU GENERAL DATA PROTECTION REGULATIONS Data protection update change in legislation throughout the tion. This must be inbuilt to NHS High- Report by Donald Pe- organisation. This project will be land processes. terkin, Interim Data chaired by the Senior Information Risk Appointment of a Data Protec- Owner (SIRO) and services will be rep- tion Officer – this role is a statutory Protection Officer resented by key managers with respon- requirement of GDPR and the DPO is a sibility to progress the changes through key advisor to managers and staff ON 25TH MAY 2018 the EU Gen- throughout the organisation. NHS High- eral Data Protection Regulations land has appointed an interim Data Pro- (GDPR) became law within the tection Officer (DPO), Donald Peterkin. United Kingdom. The appropriate process is currently The GDPR replaced the Data Pro- However, it has under way to seek and appoint a full tection Act 1998 (DPA). GDPR is sup- been identified time DPO. plemented by the Data Protection Act Reporting Mechanisms – under 2018 which addresses aspects of GDPR that there has GDPR there is a requirement to report derogated down to member states such ‘been a mixed and any apparent Breaches of identifiable as national security, law and order and data to the supervisory authority within the age of consent for the use of online inconsistent re- 72 hours and without undue delay. A services which is now 13 in the UK. sponse to the or- new Data Protection Policy was re- NHS Highland is required by law to cently published. This details the report- comply with GDPR and associated legis- ganisation’s prepa- ing pathways within the organisation lation. However, it has been identified ration for GDPR. that are complaint with GDPR. This that there has been a mixed and incon- must be understood and embraced by sistent response to the organisation’s This will have a di- services. The policy can be viewed on preparation for GDPR. This will have a rect effect on long NHS Highland intranet at; Data Protec- direct effect on long term compliance. tion Policy Although the expectation was that term compliance. Review of Policy, Procedures organisations would be GDPR compli- and SOPs – this must be granular and ant by 25th May 2018 the reality is that will require to be completed by services many organisations still have a long way to ensure that they do not conflict with to go to achieve compliance. The 25th the legislation. May date can be viewed as the ‘end of A Project Manager has been ap- the beginning’ and that the Information pointed and a draft Project Initiation Commissioner’s Office (ICO) are look- their areas of business. Document (PID) has been completed ing for organisations to have robust The changes that must be consid- and is currently pending approval. plans in place to ensure compliance ered and implemented within NHS Members of the Project Board are being over the next few months. Highland to ensure GDPR compliance identified and the Board had its first The Information Assurance & IT include, but are not limited to, the’ fol- meeting in July 2018. Security Team continue to provide sup- lowing: An Information Asset Register has port to services working towards been drafted and an initial exercise is GDPR compliance. Following an internal Accountability – the organisation, underway to gather information about audit report one of the key areas of and services, must actively demonstrate Information Assets within NHS High- weakness that has been identified is the compliance with GDPR. There are a land. This will continue as a key piece of apparent belief that GDPR is an eHealth number of things to be done to achieve work for the project. problem. This is not the case and the this which include: updating Data Pro- The New GP Contract includes a organisation and its services, at all lev- tection Notices, training of staff, crea- section which states: els, must ensure that they understand tion of an information asset register and 21. The Health Board must appoint a GDPR and actively demonstrate ac- the use of Data Protection Impact As- jointly designated data protection officer countability and compliance with this sessments. where it has agreed to do so with the con- and associated legislation. Privacy by Design – this requires tractor. As a result of the identified weak- the organisation to consider privacy, 22. Where a jointly designated data nesses a Project has been commissioned under GDPR, at the start of any piece to manage the implementation this of work or change within the organisa- Continued on page 8

- 7 - EU GENERAL DATA PROTECTION REGULATIONS policies on such matters set out under These include Data Protection No- From page 7 clauses 7.2 and 7.3 of this Schedule tices, which have been published on the More information on this will be NHS Highland internet page. Further protection officer mentioned in sub- made available soon. In addition to the templates will be available, pending ap- paragraph (1) has not been appointed, the local project, work continues at a na- proval. At the most recent Information contractor must nominate a person with tional level. Governance/DPO Forum on Wednes- responsibility for working together with the Information Governance Leads/Data day, 6th June 2018 a number of issues Health Board’s data protection officer in Protection Officers continue to interact around GDPR were discussed. Relevant matters relating to the protection of per- with the Information Commissioners updates will be reported to the project sonal data and the implementation of the Office and a number of national tem- manager and wider team. Health Board’s guidance, templates and plate have been produce.

HIGHLAND HEALTH SCIENCES LIBRARY LEAN: Let’s banish waste

THE LIBRARIAN has a quaint sense of geog- time – if the book is not in place – value is diminished. If the flow of raphy. The view from the Library office is borrow, use, return is blocked by someone not returning an item, then quite parochial. value is lost and waste is created by the customer having to wait and For the Librarian the ‘Near East’ encompasses work getting delayed. Nairn, Forres and Elgin, the Middle East equates to The Librarian however is a pragmatist and he would like to know Keith and Huntly, with Aberdeen and beyond con- why books are kept beyond their due dates. Are, for example, loan peri- stituting the Far East. The Far East fascinates him ods too short? He wants to know. Remember also that defaulted (recommends Mr Selden’s Map of China by Timothy items need to be replaced at additional cost to NHS Highland. Brook, Way of Zen by Alan Watts and The Granite City: We will give the great Mr Ohno the last word on this: a History of Aberdeen by Robert Smith). As part of this fascination, the Librarian es- chewed his mince pie ration (but not the beverages – top marks this year go to a gift of 18 year old Singleton from the Muir of Ord still) over the Fes- tive break and took the opportunity to indulge in finding out more about the LEAN processes cur- rently in vogue in the NHS. The Library holds a collection of materials relating to LEAN so he had not far to look: https://tinyurl.com/ydxkzn94 The Big Man is very possessive and protective of his Library and its work. He and his team play vital roles in the quality process and as the link above shows they provide access to a wide range of re- sources to help with these processes. The Librarian is a worrier and one of his anxie- ties is when people do not bring back items they have borrowed. Perusing through the Lean texts he was thus intrigued to find that some of his concerns were embedded in LEAN. By not returning items borrowed he found that value, flow and waste are impacted. Value consti- Taiichi Ohno, pioneer of the Toyota Production System in the 1950s tutes meeting the needs of a customer at a specific Image courtesy: Toyota Motor Corporation

Also please remember, no matter where you are, whatever your needs the Highland Health Sciences Library exists to help you. Save time and money. Don’t spend more than 10 minutes on a problem you may be having – contact the li- brary instead. Rob Polson ([email protected]) Subject Librarian tel: 01463 279800

- 8 - - 9 - CALENDAR 2018 REALISTIC MEDICINE

SEPTEMBER Waste costs analysed ILM Management Development NHS HIGHLAND’S director of always realise hard cash. Workshops (various dates) Email: [email protected] transformation and quality im- “The calculations from the OECD Tel: 01463 706857 provement, Gill McVicar, says it is and WHO include unnecessary proce- internationally recognised that dures and treatments, excessive drug 4 there is significant waste in health costs, costs from settlements from Drop-in Cervical Screening Clinics for all and care services. avoidable error, duplicate administration NHS Highland staff Highland Sexual Health, Raigmore Hospital, She said the Organisation for Eco- or IT processes and unnecessary delays Zone 14 Clinic 1 nomic Cooperation and Development in hospital, among other factors.” (Every Tuesday during September 20185pm- (OECD) believes that a considerable She said NHS Highland has embarked 7pm amount of the world’s health spending is on a journey aimed at eliminating waste Website: https://www.nhsinform.scot/healthy- probably wasted. and harm and reducing variation in an living/screening/cervical/cervical- The World Health Organisation effort to continuously improve the qual- screening-smear-test (WHO) estimates this between 20 to 40 ity and value of our services. per cent. She said: “We utilise lean methodol- 5 There are fixed costs in health and ogy which views waste as any non-value Free Bike Doctor Drop-in Session Outside Blue Dolphin Canteen, Raigmore care associated with pay and buildings added activity and value is viewed from Hospital which cannot easily be changed, and so the perspective of the customer or pa- (12pm—2pm) any calculation on potential savings tient. A recent example of this work Email: [email protected] would take that into account. includes improving access to drug and Tel: 07584 281936 Email: [email protected] Gill said: “Waste is not simply about alcohol services by reducing the number Tel: 07917 084666 money and attempts to decrease the of patients who do not attend their first amount of waste in a system does not appointment by 50 per cent.” 5 Combined Health Behaviour Change and OCCUPATIONAL HEALTH Motivational Interviewing (also on 26th September 2018) The Lighthouse Christian Centre, Kyle (Two separate days 9:30am—4:30pm) Tuberculosis risk reminder Email: [email protected] NHS Highland Occupation Health If staff have any of these symptoms, Tel: 01599 530945 would like to remind all clinical they should visit their GP and ensure he/

6 staff who may be exposed to tuber- she is made aware where they work and Pre Retirement Course culosis (TB) to keep a careful watch the risk of TB, so the possibility of TB Inverness for symptoms of the infection. infection is considered. It is also essential (10am—4pm) In its weekly report, it warned that staff contact NHS Highland Occupational Email: [email protected] even though staff may have received Health Service on Tel: 01463 704499 or Tel: 01463 723968 BCG vaccination in the past it is not refer themselves online, as soon as pos- 21 necessarily fully protective. Symptoms of sible to ensure prompt investigation, Health & Care Tech Demo TB affecting the lungs may include: treatment and advice on fitness for Jurys Inn, Inverness  cough for more than 3 weeks work. (10am—4pm) Email: nhshigh-  coughing up blood Medical and nursing staff are addi- [email protected]  coughing phlegm or sputum for tionally reminded of their professional Tel: 01463 255911 more than 3 weeks duty to seek such advice if they believe  weight loss not explained by dieting they may have a serious condition that OCTOBER or illness could be passed on to patients and to 4 Health Behaviour Change Module 2 -  Fever, high temperature and/or night follow advice about any changes to prac- Motivational Interviewing (Day 1) sweats tice considered necessary. , Golspie (9:30am to 4:30pm) Email: [email protected] KEEP US INFORMED ings idea, or your own experience Tel: 01463 704875 of change… you name it, the Q&S o you know of something newsletter has a place for it. 4 D you think should be featured Send your articles to Highland Hospitals Carol Concert Choir in the Q&S newsletter? An [email protected] at (01463 Rehearsals Recreation Hall, Raigmore Hospital, Inverness achievement, a piece of research, 704876) or contact Elaine Mead (2pm-4:30pm) a new way of doing things, a sav- directly at: [email protected] Tel: 01463 235635 or 01463 222698

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