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11.2 Bhbcbv Status Update Argyll & Bute CHP Committee Date of Meeting: 22 December 2010 Item No: 11.2 BETTER HEALTH, BETTER CARE, BETTER VALUE- PROJECT ARGYLL AND BUTE CHP STATUS UPDATE NOVEMBER 2010 Report by Stephen Whiston Head of Planning Contracting and Performance The CHP Committee is asked to: • Note the information contained in this status report • Consider any further actions required 1. Introduction The Core management team on the 28 th February 2010 and the CHP Management Team and Committee in April of this year approved and endorsed the outputs of the CHP conference “Better Health, Better Care, Better Value” and it was agreed that a number of short life “Tasks Groups” should be established within a formal project structure and remit to take forward the key aims and specific objectives identified in the project on five of the CHP hospital sites as detailed below: 1) Lorn & Isles Hospital Service Redesign at LIH Oban in General Medicine and Surgery- to increase occupancy levels, maximise Day Case/ day attendee activity and modelling activity to trends and future demand, ensuring national HEAT Targets. Outcome - Rationalising Bed/Ward numbers and reviewing / redeploying workforce Timetable - complete by October 2010. Surgical Services LIH - Redesign and modernise planned care pathways to stream and manage elective care, maximising performance and resource utilisation (staff and facilities) Outcome – Benchmarked to NHS Highland and national standards re performance targets and asset utilisation. Timetable - complete by October 2010 timing with new consultant appointment. 2) Dunoon Community hospital - Reviewing the case mix and activity profile and level of transfers from Dunoon to NHSGG&C, including a review of medical operating model and ward configuration and bed numbers. Outcome – to ensure local service offered matches national Core Community Hospital profile and is benchmarked to consistent service provision and performance in the rest of the CHP. Putting in place arrangements to ensure that the service is cost effective in terms of medical and nurse staffing and ward utilisation, maximising local access to services Timetable - complete by December 2010 3) Rothesay Victoria Hospital - Urgently progressing the review of Rothesay Hospital estate and infrastructure re Health and Safety, Fire and Estate condition survey and the future model of care Outcome – Ensuring a safe environment maintaining the local hospital provision in 2010/11 and developing a service model re progressive care & acute for the future. Timetable – December 2010 1 Two additional projects were also identified (below) and it was agreed that these would be progressed independently within the existing locality Management work streams and the current Mental Health project implementation programme. 4) Review of bed numbers in Campbeltown, and Mid Argyll and Islay- based on activity trends and need Outcome – new service model integrated wards re GP acute medical and elderly assessment Timetable – October 2010 5) Mental Health options for location of facility to be identified. Argyll and Bute Council to be formally approached re delivery model for elderly continuing care and dementia. Outcome - include in option appraisal Timetable – align with Project Implementation plan Increasing the efficiency of the use of our hospitals is an integral component of NHS Highland Strategic Vision and shifting the balance of care. As a partnership with Argyll and Bute Council we are working to continually reduce the number of emergency hospital admissions and to ensure that those admitted are discharged as soon as their hospital treatment has concluded. Therefore, in tandem with the work of the “Task Groups” is Getting Community Care Right in Argyll and Bute work. The focus of this is about ensuring that self care, anticipatory care, crisis prevention, enablement and rehabilitation underpins the work of extended community care teams working across health and social work. This model is currently being developed and tested in Isle of Bute and will then be rolled out across the CHP. 2 Current Situation Lorn & Isles hospital o Agreement reached to reduce wards from 4 to 3. Ward C and Cruachan Ward will merge in May 2011 to form a combined Intermediate/Elderly Care unit. o Exact ward configuration with bed number and profile of service in development but will consider hospital geography, ward geography, HEI considerations, potential capital costs etc. Proposal will be available for consideration at the next LIH Task Group meeting scheduled for 8 December 2010. o Patient pathway work is still proceeding to deliver consistent process re assessment, more responsive diagnostic services and the achievement of improved efficiency in other areas e.g. pre-assessment, patient accommodation, day case rates and patient transport. o General Surgery redesign and Theatre utilisation making progress with increase in day case rates and improved theatre session utilisation o As the CHP has been unable to recruit a General Surgeon with a Urology sub specialty, the current profile of Urology Surgical activity will change at the end of December 2010 when the locum contract ends. • Over the last 6 months the CHP has been working with NHSGG&C to agree and redirect urological referrals to GG&C from Jan 1st as well as redesign the service to retain appropriate urological activity locally. • Replacement General Surgeon commences in February and subject to further training and assessment a proportion of the original Urological work estimated 25- 35% may be reinstated at Oban- circa 100 cases 2 Argyll & Bute CHP Committee Date of Meeting: 22 December 2010 Item No: 11.2 • Reduction in Urology activity will clearly impact on the number and profile of beds required in the hospital. The Oban Lorn and Isles locality/CHP will also face a SLA charge from NHSGG&C for undertaking this extra activity and there is also a potential impact on the SAS re an increase in demand for ambulance transport which could have resource implications. This is to be quantified. o Staff partnership and public involvement processes and communication operating well. o Cost improvement resource as a result of ward rationalisation and reduction has not yet been finalised Cowal Community Hospital Redesign project now up to speed covering all aspects of patient pathway key issues/ areas of work include: o To develop a Business Plan for Cowal with Redesign of Health & Social Service provision, including voluntary organisations/third sector within 18 months. To include: o Service Profile. o Workforce Profile. o Financial Requirements, Capital & Revenue Costing. To develop and appraise options for the provision of out of hours service to Tighnabruaich, Strachur and surrounds- implement by 17 th March 2011 To define the admission criteria and bed configuration for Cowal Community Hospital, to maintain the safe and sustainable provision of healthcare for the Cowal Locality. To undertake Bed modelling to identify appropriate bed number, configuration and profile for GP acute ward- complete by Dec/Jan 2011 To review the palliative care service provided in the Community Hospital and determine the role of Cowal hospice within this by- Dec/Jan 2011 To review and redesign Medical staffing service for hospital with agreed plan by October 2011. Staff partnership and communication process operating well. Public involvement processes and communication needs strengthening due to negative media and considerable local and political distrust as to future of hospital and perception of it running down. Cost improvement target has not yet been finalised Rothesay Community Hospital & Annexe To develop an integrated Implementation Plan for the new model of care which will include 4 discrete work streams/sub groups which will examine the following over a 12 month timeline commencing in October. o Single point of access/referral o Joint generic assessment and care planning Inc Anticipatory Care Plans o Admission. Transfer and Discharge Plan o Workforce development based on the needs of the new model 3 Current work Work proceeding on programme the upgrade and refurbishment of Rothesay hospital to comply with fire and HAI regulations- complete March 2011. • Revised number of GP Acute Beds to reflect demand/capacity profile of new model of service • Transferring care into the community as per national policy and partnership agreement the long stay continuing care beds/service in the Rothesay annexe • Cost Improvement of £53k declared £132 outstanding with plans in place to achieve balance • Comprehensive staff partnership and public involvement processes and communication operating well Campbeltown Community hospital To progress redesign of service to achieve ward/bed rationalisation • Service option appraisal and bed modelling group established- • First iteration of options and revisiting of bed modelling assumptions re 25 beds combined ward undertaken Nov 2010, further iteration in 6 months time to allow for new arrangements to be undertaken. • Completion of Option Appraisal process and further iteration incorporating review of patients LoS, Elderly continuing care plans from A&B council etc planned December 2010- • Implementation of new arrangements Jan/Feb 2011 • Staff partnership and public involvement processes and communication need further development/strengthening. • Cost improvement- to be confirmed. Mid Argyll ICC Progressing redesign and rationalisation of Elderly and GP Acute wards in new hospital and inclusion of Elderly dementia service in hospital; •
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