THE NHS HIGHLAND STAFF NEWSPAPER May 2017 HighNOVEMBERlights 2015 CAITHNESS MATERNITY Board approves safe transition to midwife-led unit NHS HIGHLAND board members unani- mously approved a report updating them on the safe transition to a midwife-led Commu- nity Maternity Unit (CMU) at Caithness Gen- eral Hospital. At the meeting on Tuesday 30th May 2017, Dr Roderick Harvey, the board’s medical director re- ported that, as planned, more expectant mothers were travelling to Inverness to give birth and that the changes have resulted in “very significantly lower” emergency maternal and neonatal transfers. The decision to reconfigure the maternity unit at CGH from a consultant-led obstetric unit was made on the grounds of safety in November 2016. The move was made after investigations found that the deaths of two babies born at the Caithness General were "potentially avoidable". Six months on from the decision, Dr Rod Harvey said: “The ‘very significantly lower’ maternal and The Medical High Dependency Unit (MHDU) at Raig- neonatal transfer figures are key indicators that the more Hospital in Inverness had something astonishing to CMU and new arrangements are working as celebrate this month. Turn to page 15 to find out more... Continued on page 2 - - Board approve CMU other by voice, speak regularly, and Continued from front feel comfortable discussing concerns planned.” and enjoying working with each Figures show that eleven women team. The experience and sharing of gave birth at Caithness General be- a wealth of expertise has obviously Contents tween December 2016 to the end of been of great benefit to the overall April – as opposed to 73 women development of the CMU. With ro- during the comparable period from tation of midwifery staff now also 5 Ciaran makes dance final December 2014 to April 2015. underway this will further strengthen Dr Rod Harvey said: “During that the arrangements and enhance sup- 9 At your service: Eric Green time, urgent/emergency maternal port.” 13 Day in the life transfers were halved - from 14 Dr Rod Harvey’s report high- 15 MHDU 10,000 days women to seven - and emergency lighted the progress made on im- 18 Maternity liaison appointed neonatal transfers were reduced provements relating to the provision 19 Nursing excellence awards from six to one. of accommodation on the Raigmore 21 Reach out “The fact that there was only one Hospital Campus, ambulance services neonatal transfer illustrates the fun- and the progress made in the further Comings and going 22 damental reason why we made this development of a Highland-wide 24 Pupils given ‘masterclasses’ change.” ‘Hub and Spoke’ model for maternity 27 Other lives Before the board meeting, Mary and neonatal care. 28 Q&A Pat Douglas Burnside, lead midwife N&W Opera- He said arrangements have been tional Unit, said: “The transition to put in place to increase accommoda- CMU in Caithness has been a huge tion capacity in Inverness and make Keep us informed team effort by the maternity and access for families easier, and that neonatal services network across further work to create additional Do you know of something you NHS Highland - this in turn has family-friendly facilities was planned. think should be featured in High- strengthened the ongoing develop- He added that because maternity lights? An award, an achievement, ment of the ‘Hub and Spoke’ and neonatal transfers compete with a piece of research, an appoint- model in Highland as well as across other calls upon the services of Scot- ment, a retiral … you name it, the Scotland-wide CMU network.” tish Ambulance Service, work to Highlights has a place for it. Please She added: “It’s still early days, support and strengthen the resilience send your articles to but already we have seen an increase of the overall transfer arrangements [email protected] (01463 in interest in vacant posts since mov- between SAS and NHS Highland has 704876). ing to CMU. There are midwives out been made. there who are attracted to this way This included an additional invest- of working as it offers truly midwife- ment of £400,000 to increase ambu- led care.” lance provision in Caithness. He said NHS Highland’s divisional mid- this would be fully on stream in early You can follow wifery manager at Raigmore Hospi- 2018. In the meantime, some addi- NHS Highland on... tal, Caron Cruickshank, echoed this, tional capacity has been put in place. stating that considerable progress Considerable efforts have been WEBSITE had been made since the setup of the made to engage with expectant www.nhshighland.scot.nhs.uk CMU in Caithness and that the new mothers and families and community FACEBOOK arrangements are also working well stakeholders to explain the reasons and as planned from a Raigmore per- for the change. https://www.facebook.com/ spective To date, NHS Highland staff have NHSHighland She said that overall, the closer attended 20 meetings, events and TWITTER working relationship between the one-to-one briefings. These meetings www.twitter.com/NHSHighland or Hub (Raigmore) and Spoke have included Community Councils, @NHSHighland (Caithness) with the development of local councillors, Caithness Health personal daily contact between the Action Team, MSP, MP, Scottish Am- clinical leads and staff in both areas bulance Service and local groups. A “had been truly amazing”. local Caithness Maternity and Gynae- She added: “Not so long ago we cology Group (CMAG) has been could not have named each other’s established, and has now met three team leaders, now we recognise each times. - 2 - QUALITY AND SUSTAINABILITY Efficiency plans agreed NHS HIGHLAND’s board agreed executive for NHS Highland highlighted to an update of the Strategic Qual- that: “The current models to deliver The Case for Change ity & Sustainability document and health and social care across our com- Annual Plan (2017/18) this month. plex and changing environment in High- 1) People are living longer and will re- At the meeting on Tuesday 30th May land are not sustainable. Meeting the quire more support from the health and 2017, board members endorsed a suite needs of the population has become care systems. It is important that our decisions are underpinned by robust of efficiencies and improvement projects increasingly difficult and now requires health intelligence and assessment of that have already been identified for the changes to parts of the service to en- need. current financial year. sure sustainable and affordable models Presenting the report, Deborah are in place for future generations.” 2) 30 per cent of the population are living with one or more long term conditions. Jones, the board’s director of Strategic Ms Mead emphasises that a ‘more of Commissioning, Planning and Perform- the same’ approach is not sustainable. 3) Two per cent of the population use 50 ance, reminded members that over the The strategic document set out the per cent of the total resource, and spend next three years it is estimated that case for change and was peppered with per person differs markedly between areas. NHS Highland will need to deliver cost real life examples from Highland evi- reductions of around £100 million with dencing some of the challenges and 4) There is a difference of 15 years in life around £47million in 2017/18 (around 7 work already underway to redesign expectancy across parts of Highland, per cent of the annual budget). services and the approach to delivering highlighting current inequalities and our commitment to early intervention and The initial strategic approach was quality improvement work. prevention. first discussed at the board meeting held In order to oversee the governance on 28th March 2017. to deliver the board’s annual and longer 5) Every day patients are medically fit to It has now been further developed term plans, the board approved a new leave hospital inpatient care but there are currently 135 delayed transfers of to reflect feedback from that board dis- performance and monitoring frame- care (March 2017) highlighting the need cussion and from other meetings includ- work. to make changes in where we invest re- ing with the Highland Partnership Fo- This will be supported through the sources. rum and the Highland Health and Social Scottish Patient Safety Programme, and 6) Our models including those for Rural Care Committee. NHS Highland’s Quality Improvement General Hospitals, Community Hospitals, Ms Jones told members that for Programme of work across the seven Out-of-Hours, and Outpatients are not as 2017/18, some £32.34 million of effi- key initiatives. Monitoring of a suite of clinically safe or are sustainable as they ciencies have now been identified, split measures are already in place relating to could be and need to change. between: £13.91 million for Highland emergency admissions, length of stay, 7) The care home sector is struggling to Health and Social Care Partnership falls, pressure ulcers and other key indi- meet increasing demand and complexity (HSCP); £6.5 million for Argyll & Bute cators. of need. Integration Joint Board (IJB); and £11.93 Ms Jones told board members that 8) Many of our services are very fragile million for central/corporate. NHS Highland broke even last year due to workforce issues linked to recruit- Savings still to be identified include (2016/17) delivering savings totalling ment and retention including GPs, gen- £13.76 million for Highland Health and £28 million. eral surgeons, some consultant special- Social Care Partnership (HHSCP), plus After the meeting NHS Highland ists, Allied Health Professionals, midwives and care at home workers. £0.9 million for the Argyll & Bute IJB. It chair David Alston said that the meas- is understood that the £0.9 million ures were not about making cuts, but 9) Local health and social care services shortfall in the IJB’s health savings is rather about finding savings and identify- (as well as local authorities) are under likely to be identified by the end of May.