North Coast Redesign

North Sutherland Redesign Option Development Briefing Pack

August 2015

This briefing pack provides information to support participants to prepare for the redesign workshops to be held on the 17th of August, 8th September and 15th September 2015. These events are part of the process to develop and appraise residential and nursing home care in north Sutherland. They will be independently facilitated.

Scottish Health Council will be involved in the process and will provide participants with an opportunity to feed-back on the event

Further information is available in NHS website http://www.nhshighland.scot.nhs.uk/news/publicconsultation/northcoastredesi gn/pages/welcome.aspx

If you would like to discuss any matters in advance of the workshop event please contact:

Bob Silverwood Christian Nicolson Maimie Thompson Area Manager, North Quality Improvement Lead Head of PR and Engagement (01955) 880 (01408) 664078 (01463) 704722 [email protected] [email protected] [email protected]

Background

Residential Care 1is provided at Caladh Sona (Talmine and Community Care Units. These facilities are located in relatively close proximity to each other (approximately 25 miles). There are no other providers of residential or nursing care in the immediate area. The nearest are located in to the east (nursing and residential), Golspie and Dornoch to the south east (residential and nursing respectively) and Ullapool to the west (nursing and residential).

Both Caladh Sona and Melvich Community Care Unit are converted Sheltered Housing properties; both contain six beds in total (five permanent beds plus an additional bed which can be used for respite (planned) or as a Bluebell Bed2. Neither facility is entirely suitable for purpose.

Caladh Sona is the older of the two and does not meet Care Inspectorate standards on room sizes. The infrastructure (kitchen, sluice area, toilets, utility areas, staff offices etc) is of poor quality and is generally cramped. Melvich enjoys better resident accommodation but is deficient in terms of common living area space, office accommodation and other supportive facilities. Access to the building is increasingly difficult as there is insufficient parking close to the building.

Whilst the two units share a manager all other staff structures and costs are as per stand alone units. This has an added impact in relation to the recruitment of permanent and relief staff with the two units competing from the same pool of employees. In practice it is very difficult to maintain cover for sickness over the two units and there is little or no ability to cross cover the units. Both units though have been highly flexible in meeting the needs of their communities and have led the way in working with community nursing staff and local GPs to provide step up, step down and palliative/end of life care facilities as an alternative to hospital care (see Bluebell Bed).

Melvich Community Care Unit provides a Registered Day Care service operating from 9:00am – 5:00pm, Monday to Friday.

The North Coast is served by two GP Practices (Tongue and Armadale) and one Community Nursing Team, which is based in . (See appendix 1 for staffing information)

The welcome announcement by the Highland Council to release capital to replace Caladh Sona has provided the opportunity to give wider consideration as to how to meet the needs of the area as a whole.

1 Residential Care homes provide accommodation, meals and personal care, as would be provided in nursing home care. Where residential care differs from nursing home care is that in a nursing home the team on duty will always include at least one qualified nurse (the number will depend on the number of residents) and can therefore cater for people with a medical condition that requires nursing attention. Residential care homes can call in medical support from other agencies such as local GPs, community nurses and so on. Assessment of needs will determine the most appropriate setting for people.

2 A Bluebell Bed is a GP led bed with support from community nursing staff. Bluebell beds are used to avoid admission to acute care; support early discharge from hospital back to the community and for end of life care.

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In April and May 2015 a series of informal meetings and semi-structured discussions took place with local communities, groups, councillors, GPs and staff in North, West and Central Sutherland. Emerging from these discussions was a good understanding from all areas of the issues faced and an acceptance of the need to look at all the services in the area. Agreement was reached to move to the next steps. Involved in these next steps it was agreed would be the communities of Scourie, , Durness, Tongue, Bettyhill, Strathy, Armadale and Melvich, staff working in both units. Other relevant stake holders will include service providers and partner agencies.

This briefing pack will provide you with information regarding occupancy (by permanent residents, respite and bluebell bed), staffing, demography and GP Practice.

Occupancy

The information provided below covers the period from 2009 onwards.

. Residential In total over the period there were eight permanent residents at Caladh Sona and 14 at Melvich (figures include people who were in both units prior to 2009). Both units have high occupancy rates with average occupancy figures of 89% (Caladh Sona) and 81% (Melvich). The reasons for admission vary.

Caladh Sona Melvich

100 100 98 90 88 92 90 93 82 65 68 55

2009/2010 2010/2011 2011/2012 2012/2013 2013/2014 2014/2015

Figure 1.1 highlights the occupancy breakdown per financial year for Caladh Sona and Melvich.

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Admissions Per Year

Calahd Sona Melvich

3 1 1 2 2 1 2 2 2 1 1 1 1 0 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16

Figure 1.2 highlights the number of new admissions to residential care p/y (note 2015/16 figures to end June ’15)

As at the time of writing (August ’15) residents at Caladh Sona came from Scourie (1), Tongue (1) and Bettyhill (1). There are two short-term placements from (1) and Talmine (1). For Melvich they came from Reay (1), Strathy (1) and Lybster (1). There were two vacant beds.

Caladh Sona Melvich Residents "from" Residents "from"

Tongue Skerray Strathy 1 1 Vacant 1 2 Reay Scourie Talmine 1 1 1 Lybster Bettyhill 1 1

Figure 1.3 highlights where geographically residents in both Caladh Sona and Melvich have “come from”

Age Profile: The youngest residents at Caladh Sona and Melvich are aged 70 and 82 respectively. The oldest are aged 91 and 92.

Length of Stay: The Scottish Care Home Census calculates length of stay in two different ways – “complete” or “incomplete”. A “complete” length of stay is calculated for any resident who left the care home during the year prior to the census point. An

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“incomplete” length of stay is calculated for every who is resident in the care home on the census date and calculates the length of time the individual has been resident in the care home up to the census point. The figures are based on the length of stay within a particular care home and will not take account of length of stay in previous care homes.

The Scottish average length of stay (months) for 2014 in a residential care home is:

“Complete” 27 months (mean) 16 months (median) “Incomplete” 36 months (mean) 26 months (median)3

Average length of stay (months) in a care home (Independent Sector) in Highland (area covered by the Local Authority) for 2014/15 is based on discharges and is shown below:

“Complete” 35 months (mean)

The length of stay varies for both units with Caladh Sona having had a more static group of service users. The longest residing client in Caladh Sona will have stayed there for a period of over 10 years. With regards to Melvich, their longest residing client has been in placement for over 6½ years.

The average length of stay for Caladh Sona and Melvich (incomplete data is shown below

Caladh Sona 32 months (mean) Melvich 34½ months (mean)

. Respite / Bluebell Bed As noted previously both Caladh Sona and Melvich have one bed allocated for respite (planned) or bluebell bed use.

In 2014/15 Caladh Sona had 11 respite placements. This year, to date, there have been two. Melvich had 22 admissions for planned respite in 2014/15. This year there have been five so far.

In 2014/15 there were six bluebell bed admissions to Caladh Sona totalling 71 days bed use, while at Melvich there were five admissions totalling 17 days bed use.

Those who use Caladh Sona and Melvich for respite come from a wide geographical area, the Highland Council area. The map below highlights where people have come from to use respite.

3 ISD Care Home Census 2014 (Statistics on Adult Residents in Care Homes in Scotland)

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Figure 1.4 highlights geographical spread of respite “users” at Caladh Sona and Melvich

. Day Care There are 11 service users attending day care in Melvich; three attending five days per week, the others between one and three days. There are three people who attend the lunch club. The service users live between Bettyhill and Reay, with one in Strath Halladale.

Staffing

As reported previously Caladh Sona and Melvich share a manager but all other staff structures are stand alone. Both units are staff by a number of full and part time staff. The number or level of staffing is decided using a process called an establishment review. The current establishment reviews indicate that Caladh Sona should have13.68 whole time equivalent (wte) staff while Melvich should have 17.14wte. Vacancies are covered by relief staff. There are staff who not only work set hours in each of the units but also have “relief” contracts, supporting where they can in times of staff shortage.

Interviews took place this month (August ’15) for the two vacant posts at Caladh Sona (2 x 10½ hours p/w General Assistants). The posts have been offered subject to references etc. In Melvich there are currently vacancies (2 x 11½ hours p/w (annualised) Social Care Workers).

Staff sickness has been an issue at both units, although a number of staff who were off work long term due to illness have recently returned. There remains though at least one member in each of the units who is on long term sickness absence.

For more information regarding staff and travel to work see appendix 2.

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Budget

For the financial year 2015/16 the two units had total budgets of:

. Caladh Sona = £580,777 o Pay = £528,972 o Non Pay = 51,805

. Melvich Community Care Unit = £580,777 o Pay = £528, 972 o Non Pay = £51, 805

Care at Home

Care at Home enables people to remain at home by supporting them with personal care e.g. showering, dressing, support with meal, collecting of prescriptions, support with basic health care e.g. applying creams, elastic stockings, catheter care taking medication etc. The service operates from 7:00am until 10:00pm. Packages of care are based on assessed need and therefore can involve one or more visits per day.

The North Sutherland Care at Home Team covers the area from Durness to Melvich. Care at Home Officers (those who co-ordinate service) are based in the team office at Bayview House in Thurso.

There are currently 16 clients, receiving in total of approx 80 hours of care per week. It should be noted that this can fluctuate significantly.

Of the 15: . Four male / 12 female . The youngest client is aged 71, the oldest is 96. . 11 live alone . The primary reason for receiving Care at Home is recorded as “problems arising from infirmity due to old age” for 12 clients, for two the primary reason is “dementia”, and for one it is recorded as “physical disability” . Seven clients receive support with medication

Demographics

GP Practice Profiles

The background section of this report indicates the next steps and those to be involved. The communities highlighted in that section are served in the main by four GP Practices, namely Armadale, Tongue, Durness and Scourie/Kinlochbervie.

All information correct as at 01/10/14

Armadale GP Practice has a total practice population of 817 (397 female and 420 male). The age profile of the practice shows that there are 98 patients aged 0-14, 66 aged 15-24, 135 aged 25-44, 285 aged 45-64, 135 aged 65-74 and 98 aged 75+

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Tongue Practice has a total practice population of 523 (266 female and 257 male). The age profile of the practice shows that there are 49 patients aged 0-14, 49 aged 15-24, 85 aged 25-44, 200 aged 45-64, 74 aged 65-74 and 66 aged 75+

Durness Practice has a total practice population of 294 (135 female and 159 male). The age profile of the practice shows that there are 31 patients aged 0-14, 21 aged 15-24, 60 aged 25-44, 106 aged 45-64, 44 aged 65-74 and 32 aged 75+

Kinlochbervie/Scourie has a total practice population of 640 (291female and 349 male). The age profile of the practice shows that there are 77 patients aged 0-14, 60 aged 15-24, 112 aged 25-44, 242 aged 45-64, 95 aged 65-74 and 58 aged 75+

GP Practice Age Profile

Armadale Tongue Durness Scourie/KLB

242

106

200 112 95 73 60 44 58 85 74 32 31 60 285 66 49 4921 98 66 135 135 98 0-14 15-24 24-44 45-64 65-74 75+

Figure 1.5 age profiles by GP Practice

Health Profiles (Sutherland District)

The Scottish Public Health Observatory produces information regarding health and inequalities. This is produced on an area basis. The Sutherland District includes North West (2), East (1) and South Sutherland (3). The December 2013 Sutherland District Profile points to the following:

. “Hospitalisation rates per 100,000 following a fall (65+) in the home are high in this District with Sutherland East (1213), Sutherland North West (1080) and Sutherland South (1012) whereas NHS Highland (892) and Scotland (710)” . The proportion of the older population at high risk (over 40%) of hospital admission (SPARRA) is slightly higher in Sutherland (7.1%) than NHS Highland (6.5%), but lower than Scotland (8.1%). This is reflected in the comparable hospitalisation rates for 65+ with multiple admissions and 65+ emergencies”

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Appendix

Independent Sector Nursing Care Homes

Independent Sector Care Home service agreements for the North were reviewed and the homes listed below were identified as, of relevance to the North Coast Redesign project.

Achvarasdal House (Reay) Castle Gardens Nursing Home (Invergordon) Catalina House (Alness) Fairfield Nursing Home (Inverness) Kintyre House (Invergordon) Meadows Nursing Home (Dornoch) Mo Dhachaidh Nursing Home (Ullapool) Mull Hall Care Home (Invergordon) Oversteps Eventide Home (Dornoch) Pentland View Care Home (Thurso) Redwoods Nursing Home (Alness) Riverside House Nursing Home (Wick) Seaforth House (Maryburgh) Seaview House Nursing Home (Wick) Wyvis House Care Home (Dingwall)

Filtering service agreements per service user’s home town allowed for identification of the number of clients who we are admitting to Independent Sector Care Homes within the North area, this is detailed in figure 3.1.

From 2009 to 31st March 2015 at total of 32 clients (from the area covered by Caladh Sona and Melvich) were placed in Independent Sector Care Homes. The majority of were to Pentland View Care Home in Thurso.

15

10 15

5 6 7 2 1 1 0

Figure 3.1 Number of North (Sutherland) Coast Service Users placed into Independent Sector Care Homes (April 2009 to March 2015)

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Geographic Profile

The geographic analysis of the 32 clients placed into Independent Sector Care Homes is shown in figure 3.2.

Skerray -1 Forsinard - 1

Melvich - 4

Reay - 6 Talmine - 3

Bettyhill - 5 Forss - 2

Tongue - 3 Durness - 1 Strathy - 6

Figure 3.2: Geographical profile of Independent Sector Care Home Clients (Nursing & Residential)

Penland View Riverside

Tongue Skerray

Melvich

Strathy Talmie Bettyhill Tongue

Reay Bettyhill

Forss

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Achvarasdal Seaview

Strathy Talmine Melvich Reay

Reay Forss Forsinard

Mo Dhachaidh Oversteps

Durness Tongue

Figure 3.3 Geographic profile of Independent Sector Care Home Service Users (North Coast Postcodes)

Age Profile

6 Age Profile 5 4 Figure 3.4: Age Profile of 3 Independent Sector Care Home 2 Service Users 1 0 64 69 72 74 76 81 82 83 84 85 86 87 88 89 90 91 92

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Appendix 1

Staffing

Caladh Sona

(Permanent & Fixed Term Contract) Relief

Melness (incl. Talmine) 8 3 Tongue 3 1 Skerray/Borgie 1 3 Hope 1 Bettyhill 1

Aged 65+ 1

Melvich (Permanent & Fixed Term Contract) Relief

Melvich (incl. Port Skerra) 4 5 Bettyhill/Strathy 4 1 Thurso 5 1 Reay 1 1 Forsinard 1 Berridale 1 Skerray 1 1 Melness (incl. Talmine) 1

Aged 65+ 0

Travel

Mileages and timings are approx and are taken from RAC

Travel to Melness

Miles (approx) Time (approx) Scourie to Melness 55 1:36 Kinlochbervie to Melness 48 1:25 Durness to Melness 30 0:54 Tongue to Melness 06 0:12 Bettyhill to Melness 17 0:35 Armadale to Melness 23 0:46 Strathy to Melness 27 0:52 Melvich to Melness 30 0:57 Reay to Melness 36 1:05 Thurso to Melness 47 1:21 Lairg to Melness 43 1:19

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Travel to Melvich

Miles (approx) Time (approx) Scourie to Melvich 79 2:15 Kinlochbervie to Melvich 72 2:04 Durness to Melvich 54 1:33 Melness to Melvich 30 0:57 Tongue to Melvich 25 0:45 Bettyhill to Melvich 13 0:21 Armadale to Melvich 6 0:10 Strathy to Melvich 3 0:4 Reay to Melvich 6 0:10 Thurso to Melvich 17 0:26 Lairg to Melvich (via Tongue 58 1:39 & Bettyhill)

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