Caithness Redesign Review of Adult Services Dr Paul Davidson - - PowerPoint PPT Presentation

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

• Overproduction – Duplication in tests, services, care within/ out with

Caithness

• Inventory – Using inpatient hospital beds because no home care

available

• Time – why do patients wait to be seen, outpatients, A+E, wards?
• Transportation - reduce transfers, internal/external. All transport is

waste

• Defects - why do patients get harmed, mistake proof
• Motion – on wards, in homes, in GP surgeries

Caithness Redesign

Local Clinical Imperatives

• Recent Survey, 5 GP’s responded, 26% total (57% of practices)
• Broken down into “Must do”, “Priority”, “ Consider” and “Don’t

include”

• Must do: Frail Elderly Care, Rehabilitation, Palliative Care
• Priority: Emergency Care
• Other Clinical Areas (suggested by GP’s) to include in redesign:
• Must do: Falls service, falls prevention, Intensive Homecare,

Psychiatry

• Considered: Dermatology Outpatients

Caithness Redesign

Local Service Imperatives

• Broken down into “Must do”, “Priority”, “ Consider” and “Don’t

include”

• Must do: Primary/Secondary interface, Clinical Capability, Extended

Primary Care team, Transport (SAS), Transport (Local)

• Other Service Areas (suggested by GP’s) to include in redesign:
• Must do: Home Care, Elderly assessment (Home and Hospital),

Harmsworth reopened.

Caithness Redesign

Comments

Clinical Areas:

• Lack of social work resources
• Desperate Lack of support in the community
• Training needs of GP’s providing A&E care at Dunbar needs

assessed

Caithness Redesign

Comments

Service Areas:

• Problems gaining access to Investigations/Admissions via Medical

Consultants

• Primary/Secondary Care boundary not working optimally at present
• We already have good dialogue with secondary care but this could

be even better

• Extended primary care team – what is this?
• We have serious GP recruitment issues that need to be addressed
• If ambulances out of county they can be redirected when in

Inverness and not travel straight back to Caithness putting extra strain on services

• Worrying low levels of Ambulances

Caithness Redesign

Comments

Service Areas:

• Harmsworth Unit – Reopening essential as now this patient group
• ften ‘misplaced’ and missing out on proper assessment?
• 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.

• 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.

Needs Assessment

Caithness Redesign

Caithness Redesign

• Needs Assess/Data - today
• Wide engagement
• Quality Approach – Waste, Variation,

Harm

• Considerate Implementation
• Open evaluation of change

Caithness Redesign

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 = 22.7 days ALOS = 23.1 days

Bed Occupancy

Caithness General Hospital

0% 20% 40% 60% 80% 100%

2010/11 2011/12

% Occupied Bed Days

Caithness General Hospital

Percentage of Bed Days Occupied by Month for April 2010 - March 2012

% Occupancy excl. Delayed Discharges % Occupancy Delayed Discharges

Bed Occupancy

Dunbar Hospital

Bed Occupancy

Town and County Hospital

0% 20% 40% 60% 80% 100%

2010/11 2011/12

% Occupied Bed Days

Town and County Hospital

Percentage of Bed Days Occupied by Month for April 2010 - March 2012

% Occupancy excl. Delayed Discharges % Occupancy Delayed Discharges

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, not elsewhere classified 647 12.7% 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 causes 443 8.7% 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 services 250 4.9% 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 disorders involving the immune mechanism 154 3.0% 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)

20,000 22,000 24,000 26,000 28,000 30,000 32,000 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 £ Millions (2010-11 Prices) 2009-10 2025-26

16 years £42 billion

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

“First Class Service” (Day Care Centre) “It gives me the confidence to stay at home” (Telecare) “They can be rushing” (Carers) “It’s good for the family, so that they can get away and know that I’m safe” (Respite Care) “Why do we have to go to Inverness for things?” “Care at Home lets me stay at home” “I can have a good laugh here” (Day Care Centre) “It would be nice to get out a bit more” “It would be good to have somebody that had an overview

• f everything that is going on”