SUMMARY NOTES
Meeting of Steering Group:
Redesign of Health Services in Skye, Lochalsh & Wester Ross
Tuesday 19th February (2.00pm – 5.00pm)
Day Case Room, MacKinnon Memorial Hospital, Broadford
Present:
Tracy Ligema, (TL) Area Manager, West
Paul Davidson, (PD) Rural Practitioner/Clinical Director North & West Operational Unit
Kate Earnshaw (KE), District Manager, Skye, Lochalsh, Wester Ross
Alan Knox, (AK) Area Manager, SAS
Councillor Audrey Sinclair,(AS) ,Chair Public Participation Forum, West Ross
Christine Barwick (CB) Acting Theatre Team Lead
Dr Charles Crichton (CC) General Practitioner, Portree
Campbell Dreghorn (CD) Staff Side Unison Representative
Councillor Drew Millar (DM), Highland Council, (Skye)
Councillor Hamish Fraser (HF) Highland Council (Skye)
Councillor, Biz Campbell (BC) Highland Council (Skye)
Alistair Innes (AI) Rural Practitioner
Councillor Isabelle Campbell (IC) Highland Council,(Lochalsh & west Ross)
Councillor John Gordon (JG) Highland Council (Skye)
Callum Macdonald(CM) Business Support Officer, (Skye District)
Fiona McGeachan (FM) Business Support Manger, West Area
Dr Stephen McCabe (SM) General Practitioner, Portree
Dr Leo Murray (LM) Rural Practitioner, MacKinnon Memorial Hospital
Dr Willem Nell (WN) Rural Practitioner, MacKinnon Memorial Hospital
Chrisann O’Halloran (CO) Senior Charge Nurse, MacKinnon Memorial Hospital
Ross Mckerlich (RM) Chair. Skye & Lochalsh Public Participation Form
Dr Kirsty Shaw(KS) General Practitioner, Dunvegan Medical Practice
Maimie Thompson (MT) Head of Public Relations & Engagement, NHS Highland
Dr Lesley Unwin (LU) General Practitioner, Kyle Medical Practice
Dr Angus Venters (AV) General Practitioner, Sleat Medical Practice
Apologies:
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Summary Notes
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Welcome and Apologies
Dr Paul Davidson welcomed everyone to the inaugural meeting of the
Redesign of Health Services in Skye, Lochalsh & Wester Ross
steering group.
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Current position and background
PD gave an overview of the current position in relation to hospital and
community services and the need for change.
One of the main remits of the steering group would be to generate focus
around engagement and to take forward the project initiatives.
It will be important for the group to progress the case for change
A further aim for the group will be to improve the future vision that will
be sustainable into the future. PD highlighted that in previous
discussions it had been divisive due to focussing around the site, and
therefore it was important not to do this.
Why do we need to do this?
• The current provision is not fit for purpose and has potential to
harm.
• Capabilities- 2 hospitals with different services, facilities and 2
groups of staff
• Standards
• Financial burden, e.g maintenance backlog , fuel costs
• Aging community
• Staying the same will result in service downgrading
There are considerable threats to some of our existing services e.g
diagnostics and theatre, radiology and ultrasound. Due to the change in
demographics we are aware we cannot go on the same way, so we
need to change the way we deliver healthcare provision locally
through a safe and modern facility.
Appendix 1 –Project Charter
Currently no pharmacy support across two hospitals, limited technology
no Wi-Fi, PD highlighted emergency and elderly care is our future. It will
be important to create a vision statement that supports the future
services for our area.
We have opportunities
• To design a modern purpose built facility
• Plan for future and current needs.
• To be efficient in service delivery and energy use
• Safe
• Links with a community integrated approach
• Pharmacy, Rehabilitation, use of technology
• Need to build in the specification for areas that we are currently
challenged with
• To create an educational hub
We need to create a Vision Statement and agree the vision where we
get to the point where Hubco can take over to move towards an Initial
Agreement. (IA)
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Scottish Government Investment Manual Process
TL explained the Scottish Government Investment Manual which was
the process in which we are to develop our case for change.
This includes four stages:
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An Options appraisal
The initial agreement
Outline business case
Full business case
We will be allocated Scottish Government Business Support from April
2013. This Project Manager will support the delivery of the options
appraisal initial agreement.
We have to demonstrate we have looked at all the options to prepare
for the initial agreement.
Scottish Government Investment Manual requires us to evidence broad
thinking initially, and no options are ruled out, including those that may
appear extreme or obvious.
This is part of a bigger piece of work in partnership with Badenoch &
Strathspey. They are undergoing a similar process and in order to
ensure this is a viable investment, the two projects will be developed in
parallel. The timescales for this process are very tight, but still to be
confirmed.
Terms of Reference
The Terms of Reference paper was discussed, and it was agreed to
include the Team Manager for Social Work and an Estates Manager in
the membership. Maimie Thompson will draft a note to all to explain the
Hubco process and a explanation of the Hubco/Scottish Capital
Investment Manual process.
Communications
MT gave an overview of the communications process and remit and
focus of the group
MT highlighted that we would need to have:• Clarity of purpose and process
• Engender good relations and trust within the group.
• Need for clinical engagement and leadership for political
consensus.
• Ensure everyone is fully familiar with timeframes and role and
remit of the group
• Important to have consistency of messages.
• Need to have clarity on the role of Hubco
• Need to ensure that we have a process to deal with unexpected
incidents, and how to manage conflict.
A media release summary of the discussions and agreements to be
drafted by MT or representative.
Develop positive relations with the press, communications should be
little and often
Important to identify different groups to communicate with, needs to be
reasonable. Managers need to be out and about, attend Community
Council meetings, GP Practice meetings. The proposal will not please
everybody, therefore we need to ensure we did everything reasonable
that we could. It is a big responsibility of everyone on this group to
progress this positively.
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Breakout Group sessions
Group 1 - Single Site Services, facilitated by PD
Group 2 - Community Services, facilitated by KE
Group 3 - Connections: Transport/Technology, facilitated by CM
Appendix 2 Feedback Summaries
Gill McVicar, Operational Manager had previously advised managers on
the need for public engagement and that the initial process be
completed by the end of March. There will be more engagement for the
Initial Agreement starting in April with project support from the Scottish
Government. Timescale for completion of the project is 2- 3 years.
The meeting closed.
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Dates of Next Steering Group Meetings:
Tuesday 19th March 2013: Meeting Room, Portree Hospital
Tuesday 16th April 2103: venue to be confirmed
Tuesday 14th May 2013; venue to be confirmed
Tuesday 11th June 2013: venue to be confirmed
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Dates of Next Core Group Meetings:
Wednesday 6th March 9.00am (Before SMT Meeting)
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Single Site Facility
Process
Owner
Kate Earnshaw
Clinical Service / Service
Lead
Paul Davidson
Rachel Hill;
Clinical
Effectiveness
Manager
Position Statement
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Executive
Lead
Tracy Ligema
Existing hospital facilities in Skye & Lochalsh are not sufficient to deliver appropriate levels of healthcare services - Why?
- Current provision is based on historical exigencies, going back to the 1960s.
- People understand need for and benefits of hospital services from one site, but community so far unwilling to compromise or give.
The current hospital facilities in both Portree and Broadford require significant upgrading to meet the robust clinical standards necessary of modern
healthcare facilities. Despite considerable investment over the years the ergonomics of the buildings are not conducive to achieving this.
The current facilities are potentially causing harm to patients as we will never be able to meet the quality and clinical standards expected
The current facilities are not efficient or cost effective to maintain
There is a strong possibility that we will lose services as we cannot meet the clinical quality standards which may lead to an enforced down grading of
our local facilities.
As a result of this, there would be a strong possibility that we will loose highly trained and qualified clinicians.
Benefits / Patient / internal impact
Goals
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A modern quality health care facility
Enhanced clinical facility and healthcare hub for the area
Retain local services and develop opportunities to improve local
options
Retain well qualified personnel
Enhanced partnership working with other health and social care
providers
Sharing of skills and expertise
Patient safety and quality maintained.
Unscheduled care services maintained across the area.
Pursuit of NHSH Quality Approach and reduction of avoidable harm
Key Performance Measures
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Baseline
Target
Key Performance Indicators – for development project -
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Steering group convened
Needs assessment carried out
Delivery of case for change
Progress towards Initial Agreement
A modern single site hospital designed to meet the clinical needs.
Identifying/agreeing site – following needs assessment/feasibility
study.
Political/managerial commitment – Discussions with local
stakeholders e.g. elected members, MSPs.
Identify resources and timescale.
Merging two sites’ services in advance of a single site.
To update the District Partnership and Ward Forums.
To engage with the wider public
To complete a clinical brief, feasibility study and needs assessment
by July 2013, preferably using an outside agency to ensure
independence of review.
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Actual
Comments
Appendix 2
Skye and Lochalsh Single Site Hospital Working Group – 19 Feb 2013
Workshop No 1 Single Site Hospital Services
Attendees:
Dr Paul Davidson, Rural Practitioner/Clinical Director (facilitator)
Dr Charles Crichton, GP Portree Medical Practice
Dr Leo Murray, Lead Clinician, MMH
Dr Wil Nel, Rural Practitioner and Endoscopist, MMH
S/N Christine Barwick, Acting CN Theatres, MMH
Maimie Thomson, Head of Engagement, NHS Highland
The group discussed the following aspects of clinical care which should be considered as applicable to all age groups:
Acute Care
 Outpatient
o Ambulatory care (minor illness/injury)
o Primary care OOH (including a visiting service)
o A+E level care (minor to major trauma)
o Stabilisation and transfer service (including escorted transfers)
o Custody and minor forensic service for Northern Constabulary
o Assessment of psychiatric patients (liaison with MHO/New Craigs)
o Advice/assistance for Midwifery Patients
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Inpatient
o Non-operative surgical assessment and inpatient care
o Medical assessment and inpatient care
o Paediatric assessment and short term care (liaison with Raigmore)
o Support for community midwifery unit (incl. Neonatal resus)
o Place of safety for acute psychiatric evaluation
Elective Care
 Outpatient
o Visiting consultant/service area for various clinics
o Local clinics (fracture, minor ops, substance misuse, alcohol, pre-op assessment, review)
o Chemotherapy (nurse led, doctor supported)
o Physiotherapy
o Occupational Therapy
o Midwifery (antenatal/post delivery)
o Dietician
o Community Nurse/GP liaison
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Inpatient
o Step down from Raigmore/Other
o Pre/Post investigation
o Palliative care
o Rehabilitation/Re-enablement
o Longer duration chemotherapy
o Alcohol detoxification
The group acknowledged that to provide the above the following diagnostics would be required:
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X-ray facilities – suitable for A+E care (CT scanner becoming essential)
Ultrasound (weekday service)
Near patient testing / lab services
Diagnostic scope (UGIE/Colonoscopy/Flexible Cystoscopy)
Suitable diagnostic provision for A+E including slit lamp/A+E ultrasound
All services require appropriate staffing and surroundings with a view to no less than current total Skye bed
complement, although acknowledgement that if single/en-suite adopted this would allow greater bed efficiencies.
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Skye and Lochalsh Single Site Hospital Working Group – 19 Feb 2013
Workshop No 2 – Community Services
Attendees:
Kate Earnshaw, District Manager SL&WR (facilitator)
Dr Angus Venters, GP
CClr Biz Campbell
Dr Steve McCabe, GP
Tracy Ligema, Area Manager
Community Services Feedback
Current community service provision – please refer to attached slides.
The group discussed the future vision:
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For community services to be integrated in the community resource “hub” with in-patient and out of hours care.
Staff who could be flexible across services.
To access opportunities to co-locate but to acknowledge that there will need to be accessibility across the
geographical area.
To support the development of extended primary care teams e.g. GP practice integrated into the community
hub.
To ensure our 3 community nursing Teams link closely with EPCT and Hospital provision
o North Skye
 NE Skye
 NW Skye
 Raasay
o South Skye and Lochalsh
 South Skye
 Mainland
o South West Ross
 Lochcarron
 Torridon
 Applecross
For a physiotherapy and OT hub based in the new resource centre but to enhance provision in patients homes
To develop appropriate rehabilitation services
o Cardiac
o Pulmonary
To have our Social Care teams based in the community resource
o Social Work
o Care @ Home
Podiatry services were felt to be effective under the current model e.g. clinic based in practices and health
centres
Scottish Ambulance Service must be part of the Extended team with the site to support partnership approaches
to delivering care
Support Services could be based on the site e.g.
o CAB
o Counselling Services
o Training and Education Facilities – both staff and for the public – taking forward a population health
approach
Beds and spaces – need to think about intermediate beds and or step up step down facility
Midwifery CAU
Radiology/Sonography provision – CT Scanner
Out of Hours provision – must be available across the area – MDT approach e.g. Rural Practitioners, Nurse
Practitioners, Basics Doctors, First Responders
Mental health Services – this is an opportunity to develop:o Drug and Alcohol Clinics/Services
o Recovery Services
o Place of Safety
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Throughout the conversation we highlighted the importance of transport: Public Transport needs to be strengthened
 Hospital Car
 Partnerships with other providers e.g. Red Cross, Community Car Schemes
Skye and Lochalsh Single Site Hospital Working Group – 19 Feb 2013
Workshop No 3 – Connections: Transport/Technology
Attendees:
Cllr Hamish Fraser, The Highland Council
Cllr Audrey Sinclair, The Highland Council
Alan Knox, Scottish Ambulance Service
Callum Macdonald, NHS District Office (facilitator)
The group discussed:
Parking
Adequate, future-proofed parking must be provided, bearing in mind that many staff, patients and visitors may choose
to travel to the site by private motor vehicle. A separate area should be provided for staff parking and a further area
identified for SAS parking.
Deliveries
An access route and unloading area should be provided for service deliveries, NHSH delivery and maintenance
vehicles and oil and gas tankers supplying goods and services to the site.
Public Transport
Any new site must have direct access to/from public transport and a dedicated bus stop and turning area/through road
identified to facilitate these services. It was recognised that local subsidies are difficult to access at the present time
and any subsidy has to be justified in terms of usage and need. Options such as a Community Car Scheme, SAS
Patient Transport or other ways of achieving improved patient and public transport links to/from the site need to be
investigated. It was acknowledged that negotiations with funding bodies would be made easier if there was one site.
The group thought that provision of public or other form of transport to/from the site was very important in trying to “sell”
the idea of a single site to members of the public when a specific location had been agreed.
Patient Transport
It was felt that this needs to be integrated with ambulance services in terms of co-ordination and availability.
Forthcoming development of services from SAS crews will perhaps improve the co-ordination aspects of patient
transport. It was acknowledged that the current lack of public transport makes SAS Patient Transport a vital service for
an area such as Skye, Lochalsh and South West Ross.
Air Ambulance
The working group would review potential mobile air ambulance landing site(s), this would of course be based upon
where the new facility site is going to be located, and assuming that new facility location would have an adjoining
dedicated permanent helicopter landing site on the proposed plans. Once potential landing site(s) have been identified,
a further request to Air Ambulance Team / MOD for site assessment for medical evacuations in day time & night time
operations would be made.
Suitable organisations are identified, e.g. Coastguard / Fire & Rescue Service for managing night time mobile
lights and MOUs are developed and training is delivered
Local SAS
A single site with appropriate facilities is very important to the SAS in terms of costs, skills and equipment. There was
an acknowledgement that the local ambulance service needs to be better integrated and local personnel trained and
up-skilled. Benefits in terms of education, clinical pathways, clinical standards and infection control would flow from a
single site with good communications and facilities for crews. There would still be a need for other bases throughout
the area but a central or dedicated site would enable better co-ordination, education, team-working and morale.
The SAS in South Skye and Lochalsh will be based in Mackinnon Memorial Hospital in the coming months and would
obviously be looking to re-locate to the new single site when this has been identified and built.
Information Technology (IT)
As more and more technological developments and equipment comes on stream it is vital that internal and external
communications are improved in terms of better broadband, satellite, N3 connections.
Telehealth will play an increasingly important role in the future and the SAS representative gave an interesting insight
into planned current and future developments in terms of preventive and proactive care for patients in their own
community or in their own home. Good access to faster communications would enable SAS personnel to access their
learning system (ATSAS) to develop or improve skills and knowledge.
Compatible systems can lead to less paper and more “on-line” information and services.
IT Equipment
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It was recognised that modern, up-to-date hardware and software was available and that there be a rolling program of
renewing and replacing these systems and hardware to ensure that work and services are delivered as locally as
possible, be that in the community, in the home or on this site.
Other Facilities
A multi-purpose Meeting Room with Video Conferencing facilities should be built on-site.
Other
During the course of the workshop it was highlighted that the Working Group needs to get correct information into the
public domain and that there is an urgent need to get the Press “on board”.
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