North Sutherland 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 Highland 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 Melvich 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 Thurso 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 Bettyhill. (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. North Coast Redesign (Briefing Pack) Page 2 of 13 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, Kinlochbervie, 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. North Coast Redesign (Briefing Pack) Page 3 of 13 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 Skerray (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 North Coast Redesign (Briefing Pack) Page 4 of 13 “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 Scotland Care Home Census 2014 (Statistics on Adult Residents in Care Homes in Scotland) North Coast Redesign (Briefing Pack) Page 5 of 13 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.