1. Quality & Sustainability Caithness
Pulteney Town Peoples Project
Wick
19 March 2018

2. Welcome & Introduction
David Park
Chief Officer
Health & Social Care Partnership

3. No Baggage
Need to get a Grip

4. Key objective Solutions Focussed
Shared understanding of the problem so we can all pull together in same direction
Solutions Focussed

5. Housekeeping

6. PANEL INTRODUCTIONS
Norman Sutherland 6

7. Who Am I? Norman Sutherland, RN, MBA HGHCP Director (Healthcare)
Associate Director (Healthcare Planner)
NHS Head of Capital Projects/Planning
NHS Hospital General Manager
NHS Clinical/FM Services Manager
NHS Modernisation Consultant
Clinical Professional
Independent Facilitator

8. Introduction to the panel
Who you are?
What you do
What involvement you have/have had in service delivery in Caithness?
Why you are here today?

9. Ground Rules
Recognise that we are all here to deliver the best outcomes we can
Respect everyone’s opinion – whether you agree with it or not
Let people speak
Keep questions and comments concise
Don’t get “bogged down” with detail - be prepared to “park” issues if necessary
Respect and recognise the facilitator’s independence and role in managing the discussion

10. HOW DID WE GET HERE?
Norman Sutherland 10

11. How did we get here? A question of time and context
The journey has been longer for some than others!
I am a relative newcomer…
We are not all in the same place?
We will be in a better place – and able to move forward – when we are all in the same place

12. How did we get here?
Meeting 1 (28 August 2017): To discuss future service and facility options in Caithness.
Aired long-standing/historical “trust issues” that were acknowledged by all parties
Highlighted a lack of data making “the case for change”
Underlined a lack of agreement over the need for change
Reflected fears that “changes to local services” meant “reduction in local services”
Further challenged trust by considering future facility options - the physical manifestation of services – anyway

13. How did we get here?
Meeting (2 November 2017): To agree an appropriate way to move the process forward.
Acknowledged past frustrations and concerns
Attempted to find common ground and un-lock the impasse
Identified the principles that should underpin future working
Identified a need for NHSH to come back to the table with the required evidence to make the case for change
Agreed that a significant element of the case for change is the difference between current and future capacity and need in all services
Agreed that we can only develop alternative service options when we understand the capacity required in all services
Agreed that we can only consider alternative facility options when we have agreed a preferred service model

14. David Park / Maimie Thompson
Sustainability ?
David Park / Maimie Thompson

15. Sustainability
Quality / Performance
Finance
Balance

16. Challenges
Demography & Deprivation
Workforce
Money
Innovation

17. Projected population 75 years and over Caithness, 2007 to 2039
5098
Total population down by 14%
Over 85 up by 136%
2391
CHI Practice Population at 31/03/2017

18. So What ? More people will need care and with complex needs
More people will live alone
Less people of working age to .....
Pay taxes
Provide hands on care

19. 23% of Children (Caithness)
Deprivation
12% of Children (Highland) vs
23% of Children (Caithness)

20. Workforce Employ around 600 staff in Caithness
Around half are 50 or over
170 posts advertised in 2017
Only between a half and third of Nursing & Midwifery filled on first advert
Across Highland 30 consultant and 21 GP vacancies
Need to continue to change medical model

21. Money Matters
£810m (£15m)
= 2%
£41m
(£2.7m)
= 6%

22. Rising Costs

23. Rising Costs

24. Budget vs Costs

25. Innovation
Data source: SMR01 (Acute and General Hospital activity for inpatients and day cases) and NRS Mid-year population estimates, * Expected activity calculated by applying age –sex specific rates of bed day use and day case attendance of NHS Highland residents in to mid-year population estimates

26. Data Wall

27. Call to Action Summary
No. 1 challenge is responding to changing demographics
More people to care for but with fewer staff. Already significant workforce challenges
The way we are providing services is not affordable linked to sustainability
£34m on locum and supplementary staffing
Drugs £77m to £94m (5 years)
Adult social care £92m to £125m (5 years)
We need to innovate, think and do differently
Place of care will change

28. DISCUSSION SESSION 1 Sustainability28

29. Service Indicators of Change Data Wall
Michelle Johnstone
Area Manager

30. Demography More older people - less younger people
More need for care – less people to care

31. A&E attendances show increased pressure on key services
An indication of how demographic trends are affecting capacity need

32. Raigmore Appts More people travelling out of Caithness
Across many specialties

33. Plain Film X-ray in Thurso
Very low baseline numbers – poor use of resources
Need to consolidate or increase activity

34. Delayed Discharges
People are currently being cared for in the wrong environment
Resources are not distributed appropriately

35. Infusions by Location LOCATION Of INFUSIONS 2015 2016
Wick Ambulatory Care Unit
14.9%
98.9%
Rosebank
1.0%
Bignold Ward
85.1%
0.1%
The impact of delivering the right care in the right place
An example of how traditional wards are often NOT the right place
A reason why bed numbers can change without any change in service

36. A&E CGH Weekly Performance

37. Call to Action Summary
As we begin to consider service/capacity needs now and in future…
Some capacity needs will go up
Some capacity needs will go down
All capacity needs in different parts of the health and social care system will change
We will need to respond to these changing needs
This does not mean “more of the same”

38. DISCUSSION SESSION 2 Indicators For Change?38

39. Any Final Questions? 39

40. What happens next?
Maimie Thompson

41. What happens next? ? …

42. Close
Thank You