NHS Orkney Shaping Up For The Future

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NHS OrkneyShaping Up For The Future

• Community Stakeholder Briefing
• December 2007

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Purpose of Today

• Provide you with a summary of all the changes
  coming out of NHSOs Shaping Up Project
• To let you know about changes in the primary care
  work timetable
• To discuss and agree how we keep working together
  over the next 6 months

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Re Cap on Why We Started CSSP

• Health services in UK cant continue the way that
  they are-
• An increased older population
• A reduced working population
• Long term conditions are becoming the main
  challenge
• Changing expectations from patients for more
  personalised care, delivered closer to home
• Current services arent affordable
• Not just an Orkney issue its a National one.
  More people, with more complex problems, wanting
  a higher level of service and less people and
  less money to provide it

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What we get and how we spend it
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Health Needs Assessment Highlights - Big 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

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Where Do We Want to Be in The Future?

• NHS Orkney aims to become the best provider of
  remote and rural healthcare in the UK, in doing
  so we will offer our community safe, appropriate
  and sustainable care. We will do this by-
• Having patients needs and interests at the heart
  of what we do
• Working with and listening to the community
• Working in multi disciplinary teams where
  everyones skills are valued
• Creating healthcare facilities that are fit for
  purpose for patients and staff
• Creating an environment people enjoy working in
• Constantly improving by aiming high, using best
  practice, encouraging innovation and driving out
  waste where ever we find it
• We cant get here by doing what we have always
  done, we need to make some changes

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Hospital 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 we can
  carry out more day cases 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

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Hospital 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

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Primary Care Pre Consultation What We Have Heard

• The clear community preference is to retain all
  the existing GP services. We do not believe that
  we can meet this in all cases but we 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

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Primary Care Pre Consultation What We 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 we could make better use of GPs who
  serve smaller populations without removing them
  for islands
• Lack of trust and confidence in NHS Orkney 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

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What we have done

• Revised the options to include ideas coming out
  of the sessions
• Audited the air ambulance data
• Shared a break down of headline isles costs
• Changed the criteria that we are using to judge
  options
• Working with each island to more clearly
  understand the unique factors that we need to
  take into account to tailor options (e.g. Hoy)
• Greater recognition that GP services to the isles
  will never be financially viable and that we will
  need to accept, to some extent, that they will
  cost more

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Primary Care Options Under Development

• No isles GPs
• Twinning islands
• Providing a visiting service
• 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

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Primary 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
• We welcome 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

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Pharmacy Recommendations

• We currently spend 3.2m on medicines in the
  community. We have identified three ways to
  reduce this spend-
• Introducing a preferred medicine list which
  will save 180,000 per annum
  (implemented)
• Going out to tender for our wholesale buying,
  saving 72,000 per annum (implemented)
• Introducing a buying scheme that allows all the
  dispensing GPs to join together to buy their
  medicines, which reduces the total cost and would
  save 271,000 per annum (under discussion with
  GPs)

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Support Service Recommendations

• Four proposed areas of change-
• Create joint services with OIC to reduce
  management and service costs
• Redesigning Public Health and Health Promotion
• Redesigning Estates and Facilities
• Redesigning Payroll services

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Support Services Recommendations Joint Services
With OIC

• Proposing to create joint services in the
  following areas to reduce management costs and
  improve access to specialist resources
• Health and safety
• Training and development
• Moving and handling
• Property maintenance
• IMT
• Communication
• HR

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Support Service Recommendations Redesigning
Services

• Reducing the number of people that we employ in
  Health Promotion and Public Health specialist
  functions, recognising that promoting health is a
  core part of all health professionals roles
• Separating out the buildings and equipment side
  of estates from the hotel services side
  (domestics, portering, catering and laundry) to
  allow a real focus on reducing hotel service
  costs
• Exploring opportunities for parts of our payroll
  service to be provided by another health board

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Support Services Savings

• These changes will save 475,00 per annum
• A 8 roles are at risk of redundancy (all in
  support services, 5 are management roles) and a
  further 4 are likely to become at risk
• We will need to reduce the number of people that
  we employ in support services over the coming 12
  24 months

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Income Generation Recommendations

• Aggressively targeting income generation work in
  Lab covering food, milk and water testing
  (generating up to 140,000 per annum)
• Increase in canteen prices
• Increase occupational health external work prices
• Starting to charge undertakers for use of
  mortuary
• Targeting 156,000 from new income and savings
  from stopping loss making work

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Management Structure Changes

• Moving to a shared Head of HR with OIC
• Removing Hospital Manager role and transfer
  management responsibility to CHP
• Looked at a shared Finance Director with OIC and
  merging Director of Nursing role with Medical
  Director role to create a single Clinical
  Director, however all are statutory roles and we
  cannot change them
• The changes will save 97,000 per annum and
  result in 2 existing management roles being made
  redundant

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Summary of Savings
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Any Questions?
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Discussion Points

• Given the delay caused by Independent Scrutiny do
  you want to go ahead with the second round of
  meetings now or do them in the New Year?
• How do we best keep you up to date through this
  process?