Review & Redesign of Adult Services in Caithness
Stakeholder Event: Friday 7th December 2012
Summary of Presentations
Clinical & Care Imperatives
Dr Paul Davidson, Clinical Director, North & West Area, NHS Highland
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Quality needs to be at the heart of any review and redesign process undertaken
in Caithness
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We should adopt the Highland Quality Approach to change management to
ensure that the redesign work meets the needs of the population both now and in
the future
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GPs provided information prior to the event on the key clinical and service issue
areas that they would like to see the review and redesign process address.
These thoughts and comments were thought to be a useful starter on which to
base discussions for the day.
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Today should be about what services the County ‘needs’, not necessarily about
what services the County ‘wants’.
The Demography & Current Service Activity
Bob Silverwood, Area Manager, North Area, NHS Highland (for Dr Cameron Stark,
Consultant in Public Health Medicine)

No age limit on ‘older adult’ services however for statistical purposes, figures
focus on 75+ age group

Figures project an almost 40% increase in the number of adults aged 75+ in
Caithness between 2010 and 2020.

Hospital admission activity indicates that over half of all admissions to both
Dunbar and Town & County hospitals are for people aged 75+. The proportion is
much smaller for Caithness General Hospital (CGH) and other hospitals outwith
the County.

Bed occupancy rates were shown which included occupancy by people classified
as a ‘delayed discharge’ for each of the 3 hospitals in the County.

Figures for the Care at Home service and enhanced telecare were also
presented.
Finance
Ross MacKenzie, District Manager, Caithness & Sutherland, NHS Highland

There is a real term budget deficit in Scottish Government spending (including
health) over the next 16 years

The total NHS Highland budget for Caithness is £34m (more detailed breakdown
of this figure available on the slides)

There are currently 10 delayed discharges in Caithness (23 over Caithness &
Sutherland) which is adding pressure on the financial budget.
Estates/Buildings
Eric Green, Head of Estates, NHS Highland

The Estates strategy needs to follow the clinical strategy not the other way
around. If the clinical strategy changes then the estate needs to change to
support the services the County needs.

There is a maintenance backlog of £87m across NHS Highland which would take
15 years to clear if no further deterioration took place.

£2m of investment is planned for CGH over the next couple of years.

Town & County Hospital and Dunbar Hospital (except physio building) are
generally in good condition

Two most pressing Estate issues for Caithness are the physiotherapy building at
Dunbar and the Queen Elizabeth wing at CGH.
Feedback from Focus Groups
Alexa MacAuslan, Quality Improvement Project Manager, NHS Highland

Focus Groups undertaken with service users at a few different Day
Centres/Lunch Club venues. This is just the start and we intend to continue to
hold focus groups throughout the redesign process

Participants were asked to complete a questionnaire about which services they
had accessed over the past couple of years.

They were then asked to provide comment and feedback on their experiences of
these services (both positive, and less so).

Key themes that came out of all focus groups was the need for a caring and
quality service, and that emotional health and wellbeing was just as important, if
not more so, than physical health, and that this should be considered when
review and redesigning services.
Other Slides Presented on Day
Ground Rules for the Day
(Agreed by all attendees at the event)
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Openness
Honesty
Mutual respect
Trust
Respect diversity
Listen to each other
Positive solutions
Health Care Spend per Head in Different Localities in Highland
(Historical figures provided by Gill McVicar on the day following a query regarding
this)
 Caithness: £1,375
 N & W Sutherland: £1,500
 East Sutherland: £1,450
 Ross & Cromarty: £1,200
 Skye & Lochalsh: £1,375
 Lochaber: £1,450
 Inverness: £1,350
 Nairn & Ardersier: £1,360
 Badenoch & Strathspey: £1,370
Social Care Spend per Head in Different Localities in Highland
(Historical figures provided by Gill McVicar on the day following a query regarding
this)
 Caithness: £1,350
 Sutherland: £2,273
 Easter Ross: £454
 Mid & West Ross: £1,452
 Skye & Lochalsh: £1,880
 Lochaber: £1,835
 Inverness: £1,352
 Nairn & Ardersier, Badenoch & Strathspey: £1,280