MID HIGHLAND COMMUNITY HEALTH PARTNERSHIP
Public Engagement Exercise
Skye and Lochalsh Health Services
Overview Report
Introduction
This overview report provides a summary of the key issues which were identified in the
Highland Community Care forum’s public engagement on service development carried out
for the Mid Highland Community Health Partnership (Skye and Lochalsh) in September and
October 2009.
Full details can be found in the full report of this public engagement which is available at
www.hccf.org.uk and http://www.slcvo.org.uk.
The Purpose of the Public engagement
Mid Highland CHP (Skye and Lochalsh) are keen to engage with members of the public,
community groups and partners around the future configuration of health provision in the
area. The Highland Community Care Forum (HCCF), as an independent agency, was asked to
take the lead in facilitating, collating, analysing and submitting a final report on the findings
from this exercise.
Aim
The aim of the public engagement is:
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To involve a wide range of members of the public, partners and health staff
Establish views on use, importance and any improvements required to the
existing provision
To identify the barriers people with long term conditions experience in being
able to remain living at home and what has helped people remain in their own
homes
Key Findings
This section of the report summarises the key messages from the public engagement and
highlights illustrative quotes, in boxes below.
Many people expressed praise for current services but also stressed the need to safeguard
against future withdrawal of services or support.
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“Generally services are excellent but should not be allowed to diminish or deteriorate”.
“It is vital that medical services are kept locally. The beds should be reinstated in Portree
Hospital and Broadford Hospital before there is a major tragedy…it will be too late”.
“I understand that transport is not a CHP issue, but it is the main cause of difficulties in
accessing health services on Raasay”.
Which aspects (from the range specified below) of the health services used, did people say
were most important to them?
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Speed of appointment
Speed of treatment
Location of care or treatment
Manner and attitude of staff
Quality of care or treatment
Involvement in care decisions
Information given about condition
Cleanliness of the clinic or other treatment area
Involvement of your carer/s
Other
The online survey results showed that people found all of these issues important. Over
84% of people scored every aspect as 4 or 5 on a scale of 1 to 5 in which 5 was most
important. Quality of care or treatment came top of the list with 93.9% of people feeling
that it was important or very important, but location, in 8th place, achieved 84.3%.
People in the workshops often found it difficult to prioritise, and gave equal weighting to
many of the aspects. In 5 of the 8 workshops, speed of appointment was the most
important aspect of the range considered.
There was no clear pattern or indication of priorities across the different focus groups.
However, speed of appointment was a clear high priority for both the survey and
workshop participants. Speed of appointment was also in the top 3 aspects of services that
people most wanted to improve. Also some groups indicated specific priorities, e.g. young
people rated manner and attitude relatively highly and carers valued being involved.
The survey didn’t generate good results on the importance of the involvement of carers.
This was due to the low sample size of carers ( only 14 out of the 401 people that took part)
and we do not know how many people taking part had unpaid carers. However, in the focus
group of parent carer’s involvement of carers was rated equal top with a range of other
aspects.
What 3 aspects of health services provided did people say most needed to be improved?
Both the workshops and the survey identified location of treatment and speed of
appointments as two of the top issues that needed improvement.
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The survey identified 3 clear aspects that participants felt most needed to be improved:
Location of the care/treatment 57.2%
Speed of treatment 53.5%
Speed of appointment 43.7%
Quality of care was fourth with 27.3%
The workshops also clearly identified 3 aspects that most needed improvement:
1. Speed of appointments (top for 5 workshops and second for 2 workshops)
2. Location of care (top for 5 of the workshops and second for 1 workshop)
3. Information about condition (top for 2 of the workshops and second 1 of the
workshops)
Quality of care was fourth, and speed of appointment fifth.
What difficulties did people say they had experienced in receiving services or support that
enabled them to remain living at home?
The dominant issues given were around availability and accessing services. This included the
availability of services such as weekend or evening emergency services, dentistry,
community nursing support, physiotherapy, occupational therapists, maternity services and
chiropody services. The physical accessibility of some buildings and parking were also issues.
Many of the comments were about the great distances people have to travel to receive
treatment and the problems this brings in costs and lack of available public and patients
transport.
“Hospital transport is impossible to get…depends on you being independent transport wise”.
“Women having their first baby have to leave the island for up to a fortnight before the baby
is due”.
Many people found the availability of GP appointments restrictive, especially if they were
working during the day and the waiting times for appointments too long.
“I had to wait for a year to see a chiropodist”.
Another strongly identified issue was poor, or lack of, out of hours services.
“NHS 24 staff do not have local geographic knowledge….I was left waiting much longer than
necessary”.
“Public have to use overstretched ambulance services which results in long periods of no
999 cover in North Skye”.
Poor communication and insensitive attitude of some staff was a concern to some people.
One person with learning difficulties said: “There is not much information that I understand
about health…it is important for me to know about heart disease but I don’t”.
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A young carer said: “Young carers need to be treated as significant regarding their parents
care, and talked to”.
Another person said: “There is a lack of communication, especially when trying to organise
services when leaving hospital between the NHS and Social Work”.
What did people say would have made a difference?
The main thing that people said would have made a difference was the availability of a wider
range of local services and trained staff to be able to support the services. Improvements to
out of hours care were also consistently highlighted. The range of suggestions included:
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A 24 hour A &E Hospital in Portree - even nurse led would be an improvement
Having an acute Hospital in Skye with all specialist facilities
Emergency GP appointments at the weekend
Telephone appointments with GP’s ... use email to make appointments
Making appointments at sensible times so that people can get there
X-Ray facilities in Portree
Enhance services provided in Skye to eliminate the need for transport
Better training of staff
Frequency of clinics to be increased by having more consultants visiting
Maternity services at home
Skye based hospice
Other key areas for improvement identified were: better patient transport and an easier way
of claiming expenses for patient transport; and better communication and provision of
information. Some of the suggestions included:
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More contact with people is needed
Greater interaction between disciplines would reduce waiting times
Cooperation with each other is what makes it all work
Lack of dental treatment was also highlighted. Many people felt frustrated at the “non
existence” of dental services.
One person said “You cannot get dental treatment unless it is an emergency”.
What 3 changes did people say they wanted to see?
78% of people responded to this question on the online questionnaire. The high response
rate indicates that this is a key question which many people wanted to voice an opinion on.
In general the difficulties people identified with services or support and their ideas of what
would have made a difference are strongly reflected in their responses to what 3 changes to
heath services locally they would like to see.
Both the survey and the workshops reflected very similar priorities. The three major
changes identified were:
1. More local services and facilities - particularly a local general hospital with modern
medical facilities, regular specialist clinics and funding for staff.
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2. Better emergency/24 hour cover –Many people wanted to see a return to GP cover rather
than NHS 24 and a better resourced ambulance service.
3. NHS Dentist - this was perceived as non-existent but very much needed as people could
only receive emergency treatment.
In addition, 3 other key areas with potential for improvement were identified:
Appointments which require travel should be given at appropriate times so that people can
get there, GP appointments should be more flexible and available in the evenings and
weekends, and waiting times for appointments should be shorter.
Communication - more information about management plans, better attitudes to people
when being treated, more information about condition, involvement and consultation.
Improvements in communication between different heath sectors and the social work teams
are also needed.
Some specific suggestions for improvements within these areas include:
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More support for people remaining at home to prevent un-necessary travel to
appointments and admission to hospital
Local GP to be available 24 hrs
Improved parking at MMH and Lochalsh Health Centre
Better thought going into timing of appointments for people who have to travel long
distances
More help and support when you get to Raigmore to reach your clinic e.g. someone
available with a wheelchair
Improve communication with the Scottish Ambulance Service
Greater emphasis on community nursing and investment in resources, staff and
equipment to allow this
Greater use of technology for preventative care e.g. telehealth
Availability of a prescription delivery service for the elderly, some of whom do not
have their own transport
To have an up-to-modern-standard chemotherapy unit. Money is available through
Macmillan Cancer Support fundraising over the last 5 years
Local hospitals, particularly Portree, could be used more effectively
Review of outpatient clinics to ensure consultants time and clinic space is utilised
fully
Reinstate the beds in Portree and Broadford Hospitals
There is too much confusion about transport arrangements, especially to Inverness,
Fort William or beyond. A leaflet with all appointment letters to explain what
assistance people can get and how to get it
Easier way of claiming travel expenses
Carry out more local surgical procedures on Skye to minimise travel
Flexible appointments to take into account travel time
Funding for frontline and voluntary staff that ‘keep people well’
More activities and social support
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What did we do?
The public engagement time was limited to 5 weeks commencing 21st September 2009.
A variety of methods were used to get people’s views:
1. Semi-structured focus groups with between 3 and 15 people across the 9 groups
identified below:
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Pilot focus group with adults with physical disabilities, and volunteers who work with
them, in North Skye to inform the public engagement process
Older people in Raasay
Adults in South Skye with mental health problems and service providers
Adults with Learning difficulties in South Skye
Young People under 18 in North Skye
Older people in Portree
Young people in North Skye
Parent carers in North Skye
Adults with physical disabilities and carers in North Skye
2. Online Questionnaire. This survey was widely publicised via newsletters, e- bulletins and
WHFP.
3. Hard copies of the survey distributed around all stakeholder groups. Health and Social
Care Forum members disseminated it around their members/agencies. This included the
Mental Health Associations, Voluntary Organisations.
In total 401 replies were received from the online and hard copy questionnaires.
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