Caithness Redesign Review of Adult Services Dr Paul Davidson Clinical Director North and West Highland
Caithness Redesign Harmful Ignorant Blinkered Unresponsive Haphazard Poorly planned Unknowing Defensive Failing Patients
Caithness Redesign Person Centered Inclusive High Quality Fair Sustainable Efficient Empowering Equitable Effective Reduced Variation Timely Safe Reduced Waste Engagement Reduced Avoidable Harm Needs based
Caithness Redesign
Caithness Redesign Quality
Caithness Redesign Why? Why? Why? Why? Why?
Caithness Redesign Waste o Overproduction – Duplication in tests, services, care within/ out with Caithness o Inventory – Using inpatient hospital beds because no home care available o Time – why do patients wait to be seen, outpatients, A+E, wards? o Transportation - reduce transfers, internal/external. All transport is waste o Defects - why do patients get harmed, mistake proof o Motion – on wards, in homes, in GP surgeries
Caithness Redesign
Caithness Redesign Local Clinical Imperatives o Recent Survey, 5 GP’s responded, 26% total (57% of practices) o Broken down into “Must do”, “Priority”, “ Consider” and “Don’t include” o Must do: Frail Elderly Care, Rehabilitation, Palliative Care o Priority: Emergency Care o Other Clinical Areas (suggested by GP’s) to include in redesign: o Must do: Falls service, falls prevention, Intensive Homecare, Psychiatry o Considered: Dermatology Outpatients
Caithness Redesign Local Service Imperatives o Broken down into “Must do”, “Priority”, “ Consider” and “Don’t include” o Must do: Primary/Secondary interface, Clinical Capability, Extended Primary Care team, Transport (SAS), Transport (Local) o Other Service Areas (suggested by GP’s) to include in redesign: o Must do: Home Care, Elderly assessment (Home and Hospital), Harmsworth reopened.
Caithness Redesign Comments Clinical Areas: o Lack of social work resources o Desperate Lack of support in the community o Training needs of GP’s providing A&E care at Dunbar needs assessed
Caithness Redesign Comments Service Areas: o Problems gaining access to Investigations/Admissions via Medical Consultants o Primary/Secondary Care boundary not working optimally at present o We already have good dialogue with secondary care but this could be even better o Extended primary care team – what is this? o We have serious GP recruitment issues that need to be addressed o If ambulances out of county they can be redirected when in Inverness and not travel straight back to Caithness putting extra strain on services o Worrying low levels of Ambulances
Comments Service Areas: o Harmsworth Unit – Reopening essential as now this patient group often ‘misplaced’ and missing out on proper assessment? o there is a lack of respite beds in the nursing home sector so at times hospital admission is unavoidable – and when patients are discharged we need better guarantees of safe and planned discharges and not just to “care in the community” – we care. o I feel that the “idea” of patients being maintained in their own homes in a safe environment is excellent but the services are not available to support this. I had a lady admitted to Dunbar Hospital yesterday because social services are not able to provide support for this lady. She has no medical reason to be in hospital and is inappropriately placed.
Caithness Redesign Needs Assessment
Caithness Redesign
Caithness Redesign o Needs Assess/Data - today o Wide engagement o Quality Approach – Waste, Variation, Harm o Considerate Implementation o Open evaluation of change
Demography and Service Use Dr Cameron Stark Consultant in Public Health Medicine
Caithness Area Population by Age Group • Caithness – 25,124 population 2010 • 0 – 15 4,392 • 16 – 64 15,786 • 65 – 74 2,787 • 75 – 84 1,655 • 85 and over 504
Population by Age Group Source: NRS Population Estimates 2010
Age Structure, Caithness 2000
Age Structure, Caithness 2010
Projected Age Structure, Caithness 2020
Projected Percentage Change, Caithness and Highland Council Area, 2010 - 2020
Hospital Activity Number of Admissions by Site
Hospital Activity Age on Admission by Site
Hospital Activity Inpatient Length of Stay by Site ALOS = 4.5 days ALOS = 23.1 days ALOS = 22.7 days
Bed Occupancy Caithness General Hospital Caithness General Hospital Percentage of Bed Days Occupied by Month for April 2010 - March 2012 % Occupancy excl. Delayed Discharges % Occupancy Delayed Discharges 100% % Occupied Bed Days 80% 60% 40% 20% 0% 2010/11 2011/12
Bed Occupancy Dunbar Hospital
Bed Occupancy Town and County Hospital Town and County Hospital Percentage of Bed Days Occupied by Month for April 2010 - March 2012 % Occupancy excl. Delayed Discharges % Occupancy Delayed Discharges 100% % Occupied Bed Days 80% 60% 40% 20% 0% 2010/11 2011/12
Number of Admissions by Diagnostic Grouping, 2011/12 Combined for Caithness General, Dunbar and Town and County Hospitals Diagnostic Group Number Percentage Symptoms, signs and abnormal clinical and laboratory findings, 647 12.7% not elsewhere classified Neoplasms 646 12.7% Diseases of Circulatory System 613 12.1% Diseases of Digestive System 504 9.9% Injury, poisoning, and certain other consequences of external 443 8.7% causes Diseases of Respiratory System 401 7.9% Diseases of Genitourinary System 315 6.2% Diseases of the Musculoskeletal System and Connective Tissue 305 6.0% Factors influencing health status and contact with health 250 4.9% services Diseases of Eye and Adnexa 232 4.6% Endocrine, Nutritional, and metabolic Diseases 164 3.2% Disease of the blood and blood-forming organs and certain 154 3.0% disorders involving the immune mechanism Diseases of nervous System and Sense Organs 106 2.1% Mental and behavioral disorders 104 2.0% Disease of Skin and Subcutaneous Tissue 101 2.0% Certain Infectious and Parasitic Diseases 54 1.1% Pregnancy, Childbirth and the Puerperium 37 0.7%
Care at Home Service Number of Clients & Hours of Care Scheduled
Enhanced Telecare Service Number of Clients
Review and Redesign of Adult Services in Caithness Stakeholder Event Finance Ross MacKenzie 7th December 2012
Estimated Scottish Government DEL Expenditure Budget Results (2010/11 Prices) 32,000 16 years 2009-10 2025-26 30,000 £42 billion £ Millions (2010-11 Prices) 28,000 26,000 24,000 22,000 20,000 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21 2021/22 2022/23 2023/24 2024/25 2025/26 2026/27
Caithness Budgets 2012-13 • Caithness General Hospital £12.7m • District Pays £8.6m (of which Social Care £4.1m) • Supplies & Services £5.2m (of which Social Care £3.9m) • General Medical Services £3.4m • GP Prescribing £5.2m • TOTAL £34m
Other £’s (included in the £34m) • District Nursing £1.1m • Town & County £0.8m • Dunbar £1m • Mental Health £0.8m • GP Out of Hours £0.6m • District AHPs £0.5m
Social Care (included in £34m) • Care Homes £3.6m • Care at home (inc DP & ISC) £1.3m • People with Learning Disability £1.3m • People with Physical Disability £0.4m • People with Mental Illness £0.3m • Community Care Assessment £0.5m
Delayed Discharges W/E 30 November 2012 • Dunbar 5 • Town & County 4 • Caithness General 1 • Lawson Memorial 3 • Migdale 10
Feedback from Focus Groups Alexa MacAuslan Quality Improvement Project Manager
Feedback from Focus Groups • Dunbeath Day Centre • CHSS Group, Halkirk • Bayview Day Care Centre, Thurso • Laurandy Centre, Wick
General Details • 29 Service Users (11 men/18 women) • 6 Volunteers • Age Range: 57-95 years (Mean: 77) • 96% had visited GP in past 2 years • 50% had been a hospital inpatient • 46% had used District Nursing service • 38% had used Care at Home service • 46% had Telecare at Home
Comments: Positive Experiences • The Day Care Centres • Voluntary Groups • Care at Home • Telecare • Respite Care • SALT
Comments: Mixed Experiences • Patient Transport Service • Hospital stays • Hospital food
Comments: Less Positive Experiences • Travelling to Inverness for appointments • Care at Home service do not have enough time to spend with you • Poor discharge planning • Lack of Physiotherapists • Transport in Caithness (for service users and their families) • Withdrawal of traditional ‘meals on wheels’ service
Comments: Most Important Things • A Caring Service • The Quality of Service regardless of who provides it • Emotional health and wellbeing • Social Interaction
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