Argyll and Bute CHP SERVICE OPTIONS For Radiography Out of hours Service in Argyll and Bute Radiography Out of hours – Service Options 1 Version 7 (15/03/13) Contents Page No. 1 Strategic Context 3 2 Background 4 3 What are the Issues 4 4 Project Objectives and boundaries 4 5 What is the current service 6 6 Options or ways of providing these services 8 7 Comment Log - Comments to date on the Options 22 8 What Happens Next? 23 9 Appendices 24 o Core services in Community Hospitals o Radiography Review steering group membership o Feedback Form 10 Glossary 29 Radiography Out of hours – Service Options 2 Version 7 (15/03/13) 1 Strategic Context The review of radiology services within Argyll and Bute takes account of NHS Highlands vision, strategic plan and quality approach as illustrated below: NHS Highland’s Vision Quality care to every person, every day NHS Highlands Mission • OptionBetter 3 Health – improving the health of the population • OptionBetter 4 Care – enhancing the experience of care for individuals • Better Value – controlling the per capita cost of care The Highland Quality Approach • Safe • Clinically Effective • Person-centered • Efficient STRATEGIC PLAN - OVER THE NEXT 5 YEARS WE WILL: 1. Promote good health, self care and independence 2. Provide services that are high quality, integrated, equitable, needs and evidence-based, and cost-effective 3. Become more community based with hospital beds preserved for the most acutely ill and those with specialist needs 4. Integrate with, and complement local authority, voluntary and independent sector care 5. Be run by healthy, flexible, well-motivated and well-trained staff working to their maximum potential and capability 6. Use modern, flexible, efficient, green assets to maximum effect 7. Zero waste and inefficiency across all services and reduce overheads Radiography Out of hours – Service Options 3 Version 7 (15/03/13) 1 Background Argyll and Bute CHP has 6 Community Hospitals (CH) which provide an on site routine and out of hours plain film X-Ray service. The RGH in Oban also provides a number of other radiology services e.g. Ultrasound, CT etc. The RGH and 5 of the Community Hospitals are designated non bypass hospitals (999 - A&E/Casualty and inpatient service- Appendix 1 details the core services provided in our CH) and as such has operated a 24/7 on-call radiography service to support these core services. The Argyll and Bute CHP Radiography Steering group (Appendix 2 membership) review of radiology services within the area has identified a burgeoning and future service need to sustain an out of hours X-Ray service. The group has identified the need to conduct a specific appraisal of service options to assess the best method to provide an X-Ray out of hours service to support the services provided in our Rural General Hospital and Community Hospitals. The option appraisal process will therefore involve representatives the public, clinicians, managers, stakeholders (e.g. SAS, NHSGG&C) with the intention of identifying a preferred service option for recommendation to the Steering Review group by summer 2013 for consideration. This will then be presented to the Argyll and Bute CHP management team and committee to consider the findings and agree what action needs to be taken. 1.1 What are the reasons for the review? The main reasons for the review can be summarised as follows: o Unacceptability in modern working practices of a 1 in 2 on-call rota for radiography staff and its non-compliance with the European Working Time Directive o Difficulties in attracting new recruits into X-Ray service in view of the high on call commitment required, o Recent changes to national pay agreement for on call making the remuneration for out of hours work unattractive for staff e.g. weekend sessional rate (Friday – Monday £82.50) plus call out time. o Ensure we are planning to maintain the Core Service provision of RGH & Community hospitals in terms of: o Clinical quality of service o Profile of radiology services available o Provide good access for patients to the service o Ensure the service is safe o Examine the different levels of out of hours X-Ray service provided in our hospitals with regard to appropriateness and consistency o Examine any variation in clinical practice between hospital sites requesting x-ray -? need/appropriateness Radiography Out of hours – Service Options 4 Version 7 (15/03/13) o Enhance team approach to working between the radiographers and assess any cross site/location cover options o What do we mean by an X-Ray out of hours service? o Is it just radiographers or other staff? o What grade/level staff and explore options e.g. remote support o Time of response – not always an immediate medical need? o On call competencies for staff – IRMER and other regulations o What is the amount and type of X-Ray activity out of hours o What patient conditions is it used for o How does it vary overnight and through the day at weekends and bank holidays in terms of volume and time o Staff working rotas and profile of out of hours demand e.g. up to midnight, day time weekends o Best Value o Staff numbers, their skills and capacity o Equipment replacement plans and current utilisation In undertaking a review of the service the service objectives and boundaries need to be identified and these are detailed in the next section. 3 Service Objectives for Radiography Out of Hours Service The Radiography Out of Hours Service has the following service objectives and boundaries: Table 1 Radiography Out of Hours Service Objectives No. Description 1 To provide a safe and responsive service out of hours which meets patient’s needs and the service standard and performance targets. 2 To provide a sustainable service that is sized to meet the forecasted demand in the next 3-5 years. 3 To provide services that have the necessary flexibility to meet the requirements for out of hours Radiography service 4 To acknowledge “access” and rural geography constraints and as far as possible/practical ensure accessibility for patients to the accepted performance/clinical standards 5 To provide ‘a fit for purpose’ services for use by staff 6 To attract and retain high quality staff 7 To ensure efficient and cost effective use of resources Radiography Out of hours – Service Options 5 Version 7 (15/03/13) Table 2 Radiography Out of Hours Service Boundaries Constraint Description 1 Services must be compatible with existing service strategies and principles 2 Service must provide sufficient flexibility for future needs of the service – responsiveness, meeting peaks in demand, continuity and sustainability etc 3 Service must make best use of existing resources (staff, skills and capacity) as there are no new financial resources. 4 Service must meet the identified and defined service need and performance standards 5 Service must offer value for money and produce cost efficiencies 6 Staff must be fully involved in the redesign process 7 Service users and stakeholders are communicated with and involved in the service review and any subsequent redesign. 8 Service exclusions – • Routine (in hours) General X-Ray service • Ultrasound service • CT service • Fluoroscopy service Radiography Out of hours – Service Options 6 Version 7 (15/03/13) 4 What is the current Radiography Out of Hours Service and what does it do? 4.1 Table 3 X-Ray Service Profile and Workforce at each hospital (March 2013) Number of radiography staff General X- Mobile Permanent wte Bank or A&B Hospital and operating times Ray X-Ray (staff) locum wte Campbeltown Community Hospital 1.7 wte Radiographers Locum use 24/7 Service Yes Yes (2 staff) for cover Cowal Community Hospital, Dunoon 2.0 wte Radiographers Locum use 24/7 service Yes Yes (3 staff) for cover 1 fixed term until 31.1.14 shared with Mull Community Hospital, Isle of Mull LIH - 234 hours per year (part 0.2 wte time Mon and Thu 0830-1300; on call Radiographer annualised) thereafter Yes No (1staff) Islay Community Hospital, Islay 0.6 wte Mon-Fri 0900-1300 Radiographer On Call 1300-1800 Yes No (1 staff) 1 bank staff 1 bank staff and 1 Lorn and Isles Hospital, Oban 5.2 wte shared fixed Radiographers term – see 24/7 Service Yes Yes (6 staff) Mull. MACHICC, Lochgilphead 1.6 wte Radiographer Locum use 24/7 Service Yes Yes (2 staff) for cover Victoria Hospital, Rothesay, Isle of Bute Mon-Fri 0900-1700 Only 1 wte On call Friday 1700 - Monday 0900 Yes Radiographers Locum use . Yes (2 staff) for cover Victoria Integrated Care Centre, Helensburgh (No A&E or Inpatient beds) Via SLA serviced Tues/Thurs 0900-1700 Yes No from GG. The out of hours portion of the radiography service is as follows: o Monday to Friday – 5.00pm to 9.00am o Saturday, Sunday & statutory holidays – 24 hours Radiography Out of hours – Service Options 7 Version 7 (15/03/13) 4.2 What is the amount of out of hours activity Table 4 X-Ray out of hours activity profile by hospital site 2011/12 Argyll & Bute CHP Radiology Out of Hours Activity (01/11/11 - 31/10/12) Total Out of hours Activity by time period Calls Weekday Sat Sat/Sun Sun Sun/Mon Total Calls 1700-2400 0001-0830 0830-2400 0001-0830 0830-2400 0001-0830 OBAN 319 55 308 22 248 11 963 COWAL 405 68 280 17 322 1 1093 MID-ARGYLL 151 30 128 15 125 5 454 CAMPBELTOWN 156 21 82 9 87 3 358 ROTHESAY 29 5 88 3 82 2 209 MULL 127 11 35 1 16 2 192 Average Out of hours Activity by time period Average Calls Weekday Sat Sat/Sun Sun Sun/Mon Total Calls 1700-2400 0001-0830 0830-2400 0001-0830 0830-2400 0001-0830 OBAN 1.22 0.21 5.92 0.42 4.77 0.21 12.76 COWAL 1.55 0.26 5.38 0.33 6.19