Title: Shaping Up For the Future
1Shaping Up For the Future
- Isles Workshops
- December 2007
2Introductions
3Purpose of Tonight
- Brief overview of CSSP recommendations and
savings identified to date - Feedback the themes from the pre consultation
meetings in September - To get further ideas and community feedback on
the emerging options
4Why NHS Orkney are doing it?
- Health services in UK cant continue the way that
they are- - An increased older population
- A reduced working population
- Long term conditions (diabetes, heart problems
etc) are becoming the main challenge (MaryHill) - Changing expectations from patients for more
personalised care, delivered closer to home - Current services arent affordable, building up
layers of new service but not stopping out of
date ones - More people, with more complex problems, wanting
a higher level of service and less people and
less money to provide it
5Big Changes by 2016
- Most caused by changing age profile and long life
expectancy in Orkney - 185 more people will have cardio vascular
diseases (24 increase) - By 2020 we will be dealing with 128 more cancer
cases per year - 15 rise in cases of diabetes (115 more cases)
resulting in more need for services like dialysis
- 15 rise in dementia suffers
- 262 more new osteoporosis and 1200 more serious
back pain cases resulting in more need for physio
services - Cant just hope that existing services will
stretch, tried that before. NHS Orkney must be
proactive and plan for change with communities
6The Bottom Line.
- This isnt an Orkney issue, its a national issue
- NHS Orkney feeling it sooner because we have more
older people - NHS Orkney feeling it harder because finances are
already tight - No change isnt an option
- Started Creating Sustainable Services project to
tackle these problems in a planned and thoughtful
way
7Why Should NHS Orkney Bother?
- Taking control of the situation and putting a
stop to moving from one crisis to the next - Facing the fact that NHS Orkney are not going to
get money from Scottish Government Health
Directorate in the short term therefore need to
find own solutions - Need to solve own problems for own community or
it will be done to them - Committed to doing their part in making Orkney a
thriving and sustainable community
8Creating Sustainable Services Programme Aims
- Creating a clear understanding of what services
NHS Orkney can and will provide. These services
must be appropriate, safe and sustainable and
enable NHS Orkney to balance its budget. This
will involve making choices as a community about
what we want - Communicate a clear understanding of services to
all stakeholders (including staff, mainland and
island communities, GPs, Scottish Ambulance
Service and Health Department) - Saving Financial 3m - 4m of ongoing savings
9CSSP Recommendations
- CSSP has made recommendations, following
engagement with staff, for improving service and
reducing costs in the following areas - Hospital
- Pharmacy
- Support Services
- Income Generation
- Primary Care
10Summary of Savings
11Hospital Recommendations
- Create a unit where all emergency patients coming
into the hospital will be seen, treated and then
either sent home, transferred to a ward or,
transferred to the mainland - The unit will be situated between the male and
female wards and will be used as the base for the
primary care out of hours doctor and Minor Injury
Service - Invest in Day Surgery Services so that more day
cases will be carried out reducing the need for
patients to stay in hospital overnight - Improve the pre-assessment arrangements so that
patients do not need to come into hospital the
night before surgery as well as to ensure
patients are as fit for surgery as possible
12Hospital Recommendations
- Invest in physiotherapy services by providing
additional staff to see patients before they are
referred to the orthopaedic consultant so only
those requiring a Consultant Orthopaedic Surgeon
are referred on - Appoint a third consultant surgeon
- Integrate the current inpatient rehabilitation
service on to the acute wards and provide a new
allied health care professional area in one of
the day rooms - Re-configure the current rehabilitation team to
enable more community rehabilitation outreach - Move to managing the two acute wards as one
nursing team - Retain Piper Ward to be used as an overflow area
13Pharmacy Recommendations
- NHS Orkney currently spends 3.2m on medicines in
the community. Have identified three ways to
reduce this spend- - Introducing a preferred medicine list
(implemented) - Going out to tender for wholesale buying
(implemented) - Introducing a buying scheme that allows all the
dispensing GPs to join together to buy their
medicines, which reduces the total cost (under
discussion with GPs)
14Support Service Reviews
- Looked at all of the support services (estates,
finance, health promotion) looking at ways of
doing them differently - Focus on core job of providing health care to the
people of Orkney - Joining up with OIC to reduce management and
service costs - Reduce the number of people employed
- Starting at the top by reducing number of
management roles
15Primary Care
- Primary Care is everything that isnt done in the
hospital - 2 types of GP practices, ones run by NHS Orkney
and ones that are run by private contractors
16Practices
- Board Run
- Scapa
- Heilendi
- Shapinsay
- Sanday
- Rousay (currently)
- Contractors
- St Margaret's Hope
- Skerryvore
- Dounby
- Evie
- Stromness
- Hoy
- North Ronaldsay
- Stronsay
- Eday
- Westray
17Primary Care
- NHS Orkney get 4.4m from Government to provide
GP services and it costs up 5.4m. - Funded on a per head basis
- Based on 2005 / 2006 data it costs an average of
235,000 per annum to keep a GP on the inner and
northern isles - Limited choice of male or female GPs
- In some smaller locations could be harder for GPs
to stay up to date because they are not seeing
the variety that colleagues with larger numbers
of patients would see - Increasingly hard to recruit to island practices
18Pre Consultation What You Said and How NHS
Orkney Have Responded
19Reminder of the Process
- Carried out 8 focus groups in September 2007 to
identify concerns and ideas - Focus groups took place on every island with a
resident GP - Independently run by VAO
- Used random sampling to select a group of people
who represented the age and gender profile of the
community (criticism, ve, part of a wider
process) - 152 people attended - 62 turnout rate (NR /
Westray) - Reports for each island were issued shortly after
the meeting
20In addition.
- NHS Orkney have received comments by phone,
email, letters and at the sessions from - - MSP
- Stronsay Development Trust (formal and informal)
- Hoy Development Trust
- Westray Community Council
- Rousay Residents
- Hoy Residents
- Sanday residents
- Westray residents
- Isles GPs and nurses
- Individual councillors
21What NHS Orkney Have Heard
- The clear community preference is to retain all
the existing GP services. NHS Orkney does not
believe that it can meet this in all cases but
want to work with communities to find some middle
ground - The need for NHS Orkney to recognise that the
role of GPs in the isles is not simply a narrow
medical issue but seen as key to the economic and
social sustainability of islands - The need to recognise that solutions need to
tailored to the individual needs of individual
isles communities - Lack of confidence in the air ambulance response
time - Lack of transparent performance data to allow the
community to judge the success of the air
ambulance response times
22What NHS Orkney Have Heard
- Genuine belief that there is more Government
money available for services and that NHS Orkney
just needs to ask more forcefully - Belief that better use could be made of GPs who
serve smaller populations without removing them
for islands - Lack of trust and confidence in NHS Orkneys
desire to listen to and work with communities to
find the right solutions Desire to understand
more about the roles of nurses, paramedics and
first responders - Desire to understand why the services are so
expensive / a belief that NHS Orkney was not
presenting the real costs
23What NHS Orkney have done
- Revised the options to include ideas coming out
of the sessions - Auditing the air ambulance data
- Shared a break down of headline isles costs
- Changed the criteria that are being used to judge
options by - Plan to start working with each island to more
clearly understand the unique factors that we
need to take into account to tailor options - Have a greater recognition that GP services to
the isles will never be financially viable and
accept, to some extent, that they will cost more
24Headline cost of GP Services
- Based on 07/08 figures, just including headline
cost categories, not all costs (housing, enhances
services) - 14,000 on IT
- 127,000 on upkeep and running of surgeries
- 614,000 on Locums and Associate, or which
20,000 is accommodation and 9,000 is car hire
and ferry costs - 1,000,000 payment to GPs. This is not salaries,
this is payments made to their business from
which they have to meet a wide range of business
costs such as employing staff etc - Cant break down by island (income, DPA v FOI)
25Criteria That Will Be Used To Assess Options
- Is the option safe?
- Does the option meet the broad clinical needs of
the community? - Is the option proportionate in terms of the size
of the population? - Is there safe and reliable transport to support
the option - Does the option make the GP services more
financially viable? - Does the option make the recruitment of GPs
easier in the future? - Is the option sensitive to the wider economic and
social needs of the community? - Does the option move towards a more modern team
based approach to primary care? - Does the option allow NHSO to move towards less
single handed GPs?
26Emerging Options
- No change
- Providing a visiting GP service / twinning
- Resident GPs funded from other sources
- Isles GP working on mainland or other isles as
part of their work - Isles GPs being part of other practices
- Delegating a budget to the community
- Increased governance arrangements
- The options are not exclusive and there is the
opportunity to respond to the needs of individual
communities
27No Change
- Retain existing Primary Care Services
- Under this option there would be no change to the
existing services on Hoy, Shapinsay, Rousay,
Westray, Stronsay, Sanday and North Ronaldsay
28Providing Visiting Service from Mainland /
Twinning with another island
- Create more financially viable GP practices by
sharing a GP across two or more isles (similar to
Westray and Papa Westray) - GP to be resident on the island with the largest
population and providing a visiting service to
others - Nurse resident on smaller island
- Immediate response to emergencies provided by a
resident nurse backed up by guaranteed phone and
or video conference link into on call GP on
mainland Orkney
29Access Money from Outside NHS to Support GP
services
- Recognised that GP does not simply fulfil a
narrow medical role but has a role in the social
and economic viability of the community - Retain existing set up with NHS Orkney funding
part of GP costs on a per head basis - Seek alternative funding to top up the funding
to pay for the current set up
30Retain Existing GP set up but make more use of
GPs outside their island
- GP remains resident on island
- GP provides other services to NHS Orkney (e.g.
working in the hospital) - Emergency cover provided in their absence by
nurse and or First Responders backed up by
guaranteed phone and or video conference link
into on call GP on mainland Orkney
31Maintain resident GP but make them part of other
practices
- GP remains resident on island
- Practice would be merged with another practice
32Delegate Community Budget to Community
- NHS Orkney delegates healthcare budget to
individual communities to design and commission
their own primary care services
33Strengthening Governance Arrangements
- Strengthen existing governance arrangements to
respond to political concerns about single handed
practices - Could include recruiting more stable relief cover
such as regular locums and associates, creating
more formal networks, creating peer review,
rotation and strengthening GP appraisal systems - clinical accountability
34Primary Care Next Steps
- Working at individual island community level to
look at options for each island - Identify transport requirements for each option
- Any proposals other than the status quo are
major service changes and must go through a
statutory consultation process - Very likely that the Cabinet Secretary for Health
will ask an Independent Scrutiny panel to review
the Primary Care options to ensure that all
options have been taken into account - NHS Orkney welcomes this because its such an
important issue but it does means the timetable
will change - Start a 3 month Independent Scrutiny process in
March 2008 - Start formal consultation in June 2008
- Scottish Health Council review and approve
consultation work between Sept 2008 and December
2008 - Board makes final decision on changes early 2009
- Cabinet Secretary grants approval for changes mid
2009
35Thank you for attending