During 2013/14, NHS Highland has embarked on a series of service redesigns, including proposed changes in two areas that were classified as major redesign. The Health Board has actively encouraged members of the public from Badenoch and Strathspey and Skye, Lochalsh and South West Ross to continue to give their “welcome and useful” input into the modernisation of local health and adult care services. At a special Board meeting in March, the move to a formal three month consultation during 2014/15 was announced. While the Board also endorsed the recommendations of a steering group workshop on a proposed new ‘hub’ facility, comprising a community resource centre and hospital, be located in Broadford; NHS Highland’s north and west operations manager, Gill McVicar, was keen to stress that this is not solely an issue for Skye, but one which also affected the mainland communities of Lochalsh and South West Ross. Gill said: “We have had welcome and useful contributions from members of the public and local stakeholders during the extensive engagement exercise that’s been an important part of the redesign process. “As we now work towards starting formal public

consultation, I would hope that this participation

continues and indeed is widened to involve more

people.”

In Badenoch and Strathspey, meanwhile, the preferred

option is to develop a new hospital and health and social

care resource centre in Aviemore, with four possible

sites having been shortlisted.

There would be a wider redesign of services which would include the Aviemore Health Centre being located in a new facility, investment in care-at-home services and community transport and the development of local care homes. If this proposal is implemented, it would mean closing Ian Charles Hospital in Grantown-on-Spey and St Vincent’s Hospital in Kingussie. Nigel Small, director of operations for NHS Highland’s South & Mid operational unit, said: “I would like to re-iterate my previous assurance that identifying a preferred option with possible sites does not in any way prejudice the outcome of the consultation.

Annual Review 2013/14

“The result of this whole exercise has not

been pre-determined and the public consultation will be key to the future shape of services in the area. I hope as many people as possible take part.” Other redesigns of services include the

reconfiguration of Ward 11 in Raigmore

Hospital to develop a new children’s

outpatients department and upgraded

inpatient ward. The project, which will also

feature a play facility and family room, is

being developed with the Archie

Foundation, who surpassed funding of £1million during the year.

New Health Centre’s in Tain, Dingwall and Drumnadrochit have also been given the green light

this year. Work began in Tain last April and the project is part of the first ‘Design, Build, Finance

and Maintain contact in Scotland, involving three projects across two Health Boards. Due to open

its doors this summer, it is being taken forward under the Scottish Futures Trust hub delivery

process.

As well as the development of Ward 11 at Raigmore, there has been a number of refurbishment works taking place. A fire upgrade is required across the hospital and is underway. This has provided an opportunity to review the layout of the hospital, with the work taking place over the next three years and linking in with the work to develop the Greater Inverness Master Plan. The overall vision is to reconfigure the main tower block to allow all critical care units to be co-located. The patient accommodation at Kyle Court on the Raigmore campus also underwent a major refurbishment during the year and was completed at the end of April. The work cost approximately £300,000 and has seen a huge improvement to the facility which has been very well received.

Other developments included a £560,000 investment in new, state-of-the-art sterilising equipment and a new GE HD Discovery CT scanner installed; the first of its kind placed in Europe. At a cost of over £800,000, it represents a significant step forward for patients in Highland. This scanner allows for a 40% reduction in radiation dose compared to its predecessor. The new scanner and associated software also allows local clinicians to deliver improved cardiac imaging as well as specialist imaging of the colon, with the latter now having virtually replaced the need for barium imaging.

A UV radiation monitor was installed on the roof of the hospital’s Emergency Department, making

it one of three sites in Scotland to host such a device. The monitor allows the detection of the

sun’s strength, intensity and duration.

Here is a summary of the further re-design and development work that has being undertaken

across NHS Highland during 2013/14

Oban Dental Centre & Macmillan day bed unit Work on the new Oban Dental Centre and

refurbishment of the Macmillan Day Bed unit was

completed.

Lochgilphead in-patient mental health facility A re-design of mental health services is ongoing

which will see a significant increase in the

community mental health services and a new

inpatient facility in Lochgilphead.

Mental health services in New Craigs Hospital (Inverness)

A range of re-design initiatives were progressed

including two in-patient pilot wards testing the

Scottish Patient Safety Programme prior to a

national roll out in September 2013.

Improvements for cancer patients A new unit in Mid Argyll Hospital, Lochgilphead

dedicated to delivering treatments including some

chemotherapy regimes and supportive therapies

for cancer patients was completed. The service

was developed in collaboration with specialist

colleagues in Glasgow. It was primarily funded

from Macmillan with the additional monies being

provided from significant local fundraising.

Highlands Rheumatology Unit/ Ross Memorial Hospital (Dingwall)

Work is progressing to re-design Rheumatology

and Rehabilitation services. This will look at more

flexible use of beds at Ross Memorial, refurbishing

parts of the building and the recruitment of an

additional Consultant Rheumatologist to further

develop an out-reach model.

Redesign of Community Services, Inverness The re-design of services across the Royal

Northern Infirmary (RNI) Community Hospital, York

Day Hospital and Mackenzie Day Centre is

ongoing.

Review of services in Islay A comprehensive assessment of healthcare

services and future needs for Islay residents is

underway.

Re-shaping care for older people A significant programme of work aimed at

delivering services to enable older people to live

healthily and independently within their own

communities is gaining momentum. The work is

being progressed through a partnership of NHS,

Local Authority, Housing Associations,

Independent and Third sector organisations as

well as service users. Review of Caithness Services Re-design

A programme board, consisting of prominent local

community members and a representative from the

third sector was established. Work streams include

models of service within Caithness General

Hospital, palliative care, home-based services,

community rehabilitation, and dementia care and

services. Co-ordinators/facilitators have been

identified for all the groups and work is now

underway.

Belford Hospital Work is underway on the business case for the

possible replacement of the Belford Hospital. This

is at a very early stage with initial work looking at

what type of facility and services would be

required in the future for a new hospital.

The Health Board continues to take huge energy efficient strides and can boast being the top performing Board in Scotland in terms of the achieving improvements in carbon reduction table. Work to install a biomass boiler at Raigmore Hospital got underway in September 2013, providing up to 80% of the hospitals heating and hot water demand. The new installation, which comprises of wood pellet boilers provided by Weiss, will save the hospital about £1million a year on energy costs. John Hornby, capital planning manager for NHS Highland, said: “This is a huge project in more ways than one. It has taken over 18 months to plan and the completed works will cost a little under £3million. “However, this cost will be recovered very quickly by the savings made on reduced fossil fuels and Renewable Heat Incentive (RHI) payments.” Once up and running by early 2014/15, the boiler will support a 40% reduction in carbon emissions. Other initiatives during 2013/14 included completing the installation of biomass boilers in

Islay and Campbeltown and connecting Caithness General Hospital to the Caithness

District Heating System.

Early Years Collaborative The earliest years of life represent the single greatest chance to make a lasting impact on a child’s future. Practitioners across Highland are involved in ‘tests of change’ and this is resulting in various improvements, including:

Improving the ante-natal planning and services to vulnerable/ ‘at risk’ pregnant mothers.

Increasing the uptake of Healthy Start vouchers and vitamins. Developing an understanding about brain and child development and using this

to support the building of positive relationships (‘attachment’).

Family Nurse Partnership Over the past 12 months, 82 young first time mums (aged 19 and under) have joined the programme. The approach is proving invaluable with a higher than national average of uptake of the programme in early pregnancy. The current babies being born on the programme will start to reach one year old in July 2014 and outcomes for the children are

being closely monitored. Highland Council is the Lead Agency with strong links with NHS

Highland Midwifery teams.

Green Matters

Best Start in Life

During 2013/14 further steps were taken to fully integrate health and adult social care across the Highland Council area took place. The Operational Units have been developing an Integrated District Team model. These teams were rolled out from April 2013 and will provide a single point of access and assessment within a district or locality. 2013/14 also saw the appointment of a senior practitioner who is overseeing work to help drive down incidence of pressure ulcers specifically within the care homes, care-at-home and third sector A five year improvement plan for adult care was approved by the Board. The plan included work streams on strategic commissioning, co-production, co-location of services, self care, anticipatory care and Self Directed Support. A number of inspections (Care Homes, Care-at-Home, Day Care) took place which were the first to be issued since the services came under NHS Highland in April 2012. Meanwhile in Argyll and Bute, Partnership working has been ongoing to progress a body corporate model.

NHS Highland continues to step up efforts to provide a more pro-active approach to promoting news, events and the wider work of NHS Highland through the local media and other outlets. With over 300 media releases issued during 2013/14, and with support from the Board to increase our use of social media, we have adopted a wider strategy to strengthen communications and engagement. “It is vitally important that we connect and communicate with the people who use our services,” said head of public relations and engagement, Maimie Thompson. “Alongside our media releases, we have a thriving social media community on Facebook, Twitter and Patient Opinion and through these; we can continue to engage with the public about any feedback or concerns they may have.

NHS Highland becoming more pro-active

“In addition, we have also embraced digital media with a number of short films to promote key work, campaigns and recruitment. All of these are available on our own NHS Highland YouTube Channel.” During the year, we issued three (16-page) newspapers entitled ‘NHS Highland News’ to all homes in the area we cover. Plans are in place for another edition to be issued this autumn. Other documents published during the year

included Board Briefing Notes – a four page

summary of Board Papers; Review of the Year

and a Forward Look, promoting some of the key

priorities and plans for 2014. All media releases,

social media and key publications are available

on our website at

www.nhshighland.scot.nhs.uk . From March

2014, Board Meetings are now webcast, with

minutes from meetings archived on our website.

Health and Adult Social Care Integration

Wider Public Health The health and wellbeing of children and young people was the focus of the 2013 annual report by NHS Highland’s director of public health, Dr Margaret Somerville. The wide-ranging report set out some of the challenges faced by NHS Highland in providing for 19% of the Board area’s population. “Supporting and nurturing the youngest members of our population is an essential part of our society and is the best approach to improving population health,” said Dr Somerville. “In April 2012, Highland Council became the employers for community-based child health staff as part of the integration of health and social care between the NHS and the Highland Council. “NHS Highland now commissions integrated child health services from Highland Council and is developing an approach to the design and delivery of services for children, young people and families that is based on need and focussed on outcomes for children and young people.” Dr Somerville continued: “The early years (0-5 years) are where we can have the greatest impact on the future health and well-being of children. “Maintaining healthy development for older children and adolescents ensures that they are able to achieve their full potential through learning, education and later employment. “Our practitioners from across Highland are

involved in ‘tests of change’ and this is resulting

in various improvements, including ante-natal

planning and services to vulnerable/’at risk’

pregnant mothers, increasing the uptake of

Healthy Start vouchers and vitamins and

developing an understanding about brain and

child development.”

The department of Public Health covers a wide range of services from smoking cessation to violence against women, and undertook some fantastic work throughout the year. Here are some snapshots:

Screening The Health Board continues to have good uptake across the pregnancy screening and bloodspot programmes. The Newborn Hearing Screening programme also delivers to a high standard across the Highland Council area with work in progress to further improve the service in Argyll and Bute. In addition, pre-school vision screening maintained good coverage, while uptake of bowel, breast and cervical cancer screening within Highland is above the National average. Work remains ongoing to support the Detect Cancer Early programme, which focuses on bowl, breast and lung cancer.

Healthy Weight A dietetic led specialist weight management service has been established which offers support to over 100 patients with severe and complex obesity per year. Patients are given specialist dietary advice from NHS Highland public health experts, focusing on health gain rather than weight loss. “Being overweight doesn’t mean you are unhealthy,” says NHS Highland senior health promotion specialist, Fiona Clarke. “People’s experiences are that they have lost weight, only to put it all back on again. “They believe that they have failed a diet but we think, and evidence shows, that the diets have failed them.”

The Well Now and Counterweight groups have

been delivered in workplaces and communities

by trained facilitators and plans are in place to

increase the reach of these groups over the

next year.

Physical activity Physical activity continues to be highlighted in its important role for patients and staff. 2013/14 saw progress made across a number of fronts. Towards the end of the year, a NHS Highland wide staff survey on Physical Activity and Active Travel was undertaken, with over 1200 responses providing valuable insights for the ongoing promotion of Physical Activity among staff. Work with High Life Highland has continued to build a better understanding among health professionals of local facilities and increased confidence in signposting. Considerable work was progressed by our Community Development Officers around physical activity opportunities to promote active ageing and raise awareness that falls are not an inevitable consequence of ageing.

Highland Alcohol and Drug Partnership

Waiting times have improved with almost 90% of people accessing treatment within 21 days from referral. Highland is the first area in Scotland to pilot administration of intranasal naloxone as an additional option to the intramuscular route and early indications suggest that those apprehensive about injecting may be encouraged to administer naloxone intranasally. Progress on embedding alcohol brief

interventions involved meeting and superseding

government targets. A report on alcohol

overprovision was also produced.

Violence against women NHS Highland continues to support actions to tackle violence against women in Highland as part of the multi-agency partnership. The Multi-Agency Risk Assessment Conference (MARAC) is a risk management process whereby those affected by domestic abuse and those assessed as very high risk, are discussed at a multi-agency meeting where plans are developed to improve safety.

Since October 2012 there has been MARAC co-ordinators covering Lochaber, Inverness and Ross-shire, and now all areas in Highland are covered by a co-ordinator. During 2013/14 there was also greater focus on prevention initiatives to help children and young people and the wider community.

Person-centred approach to behaviour change

Highland Public Health Network provided

training throughout Highland to staff from all

agencies in taking a compassionate and

strength-based approach to supporting people

to make changes in their lives.

Infection Prevention and Control Throughout the year, infection rates across NHS Highland have continued to show a steady decline in the number of Staphylococcus aureus bacteraemia (SAB), Clostridium difficile (CDI) and surgical site infections. It should be noted, however, that the rate of decline in the number of SAB and CDI has slowed. 2013/14 also saw the appointment of a third and fourth consultant microbiologist and a new infection control manager. A Healthcare Associated Quality Improvement Facilitator (HAI QF) has also been secured as part of a National scheme to bridge the gap between theory and best practice through the use of quality improvement tools. Healthcare Environment Inspectorate visits took place in five hospitals in 2013: Lorn & Islands (Oban), Raigmore (Inverness), Belford (Fort William), Caithness General (Wick), and

Mackinnon Memorial (Broadford). In the main,

the reports were favourable and all recommendations for improvement have been acted upon. With the recent implementation of the PMS

Trakcare system, work is ongoing to establish

links between laboratory systems and the

patient administration system, which will aide

better tracking of patients with an infection

throughout their stay in hospital.

Our work to engage with service users, patients and partners continues across all areas of our service. Partnership working is embedded in the way that we work here in NHS Highland and we liaise closely with organisations such as Highland Alcohol and Drug Partnership, High-Life Highland and Violence against Women. These are just a few excellent examples of where we are collaborating with strategic partners. Some more are outlined below: Progress towards establishing a strategic commissioning plan for adult health and social care services continued during 2013/14. NHS Highland is one service provider but there are many others, including charities, third and the private sector. It is the process of bringing everyone together that provides the best chance of identifying and meeting needs and improving outcomes. Highland was chosen as one of five pilot areas in Scotland to take part in a research and development programme entitled Delivering Assisted Lifestyles at Scale (DALLAS). The initiative, which is investing up to £10million, will involve 10,000 people and aims to find innovative solutions to support people with long term conditions in their own home. It is being taken forward in partnership with both Highland and Argyll & Bute Council. Let’s Get on With it Together is a partnership of voluntary organisations, NHS Highland and Local Authorities which is developing a self management

strategy for Highland. Last year also saw the appointment of our first volunteer services manager. The Highland Health and Social Care Services is underpinned by nine District Partnerships which all got up and running throughout the year. They are made up of staff from NHS Highland and Highland Council, community representatives and voluntary and independent providers and meet in public four times a year. At the end of last year, NHS Highland was selected as one of a small number of pilot sites to test implementation of Scotland’s National Dementia Strategy (2013-16). The focus will be on strengthening the ongoing work to establish a Dementia Friendly Community in East Sutherland. A Health Inequalities event took place in April 2013, with then Chief Medical Officer, Sir Harry Burns, as our key note speaker. During the year, we hosted a wide range of other events and visits covering mental health, older people, integration and the annual cardiology event ‘Heart of the Matter’. The Cabinet Secretary for Health and Wellbeing saw some of our work on integration first hand as part of our 2012/13 Annual Review, held in July last year. NHS Highland also hosted visits from the Health and Sport Committee and Cabinet Secretary for Finance, Employment and Sustainable Growth in September 2013. Significant consultation with carers and carer

organisations took place during the year to

develop a new Carers strategy.

Wider engagement

By now, every NHS Highland employee has no doubt seen the HQA symbol on every poster, letterhead and presentation made by the Health Board. But what does it mean? “The Highland Quality Approach is more than just a corporate logo; it captures the spirit of how NHS Highland is working to improve care and better outcomes for people in Highland and describes our way of working, values and behaviour,” said NHS chief executive, Elaine Mead. “By finding the best way to do things and then standardising efficient and effective practices, we will eliminate the potential for harm. “In a nutshell, the HQA sets out to eliminate waste, harm and unwarranted variation at all levels. It is a rigorously enforced way of working, executed in a consistent manner to put a person’s health, safety and well-being first. “Our focus to deliver excellent, timely health care can only be achieved by working in partnership and by being more open and responsive; listening to feedback and acting on it to ensure we can continue to deliver outstanding care.” At the heart of this way of thinking lie NHS Highland’s values: teamwork, excellence, integrity and caring and NHS Highland places great emphasis on ensuring all of these are being met to achieve our mission statement of improving the quality of care to every person, every day. NHS Highland director of quality improvement, Linda Kirkland said: “We partly based the HQA on what we learned from our visit to the Virginia Mason Medical Centre in Seattle in 2012. “We took great care to ensure this model made sure the patients was always first, focused on delivering the highest standard of quality and safety and to engage all employees in order to strive for the highest satisfaction levels. The health and happiness of our staff is of paramount importance. “By doing so and implementing the other outcomes in the HQA, we hope to deliver a successful economic enterprise; thus allowing practitioners to spend more of their times caring for people and improve the quality of care these people receive. “It’s still early days, but we are on a journey and are committed to improving.”

Highland Quality Approach

Over the course of 2013/14, NHS Highland was pleased to receive a number of local, national and UK achievements and awards. Reflecting the hard work, dedication and skill of many people from across the Health Board, awards included staff being awarded MBE’s, Honorary Professor and several individual and team honours.

Many of the accolades reflected the work being underpinned by the Highland Quality Approach and while these awards were too numerous to mention; some are set out

below:

Awards

Patient Safety Awards NHS Highland’s focus on improving patient safety, especially around medicines, was awarded first and second place at two National awards. In particular, NHS Highland was recognised as the second highest Health Board in Scotland for reporting adverse drug reactions by the Yellow Card Centre for Scotland. Such recognition from the organisation responsible for helping to make medicines safer was a fantastic achievement, given that the figures taken from April 2012 until May 2013 are in stark contrast to national statistics, which show the number of reports have been on the decline since 2008. The report indicated that NHS Highland’s reporting figures increased slightly from 80 in 2011/12 to 84 the year after and that the reporting rate per 100,000 population was significantly higher, at 27, than the Scottish average of 16.

NHS Highland medicines management development nurse, Ruth Miller, said on behalf of the Medicine Management Safety subgroup for NHS Highland: “This is a very positive result for NHS Highland as reporting side effects impacts on patient safety and assists the Medicines and Healthcare products Regulatory Agency (MHRA) in monitoring the safety of the medicines and vaccines that are on the market.”

Hospital staff praised A National review of Older People in Acute

Care (OPAC) at Raigmore saw staff being

commended for the care they provided to

older people. Ward 3A was also shortlisted

for the best acute care initiative category of

the Scotland’s Dementia Awards.

Self Management Award NHS Highland was named the ‘Self Management Supporting Health Board of the Year’ at this year’s ALLIANCE Self Management Awards. This was in recognition of the commitment shown to help people with a long-term health condition to manage their condition themselves.

Recognition at NHS Scotland Event NHS Highland’s Microbiology Team, based at Raigmore Hospital, was awarded the winning poster on ‘efficiency’ at the 2013 NHS Scotland event poster exhibition. Two other teams had their work highly commended at the event.

Scottish First for Caithness Team NHS Highland’s community nursing team in East Caithness became the first in Scotland to complete a National programme entitled ‘releasing time to care’, aimed at improving the way they work and delivering better care for patients. Mike Flavell, NHS Highland’s district manager for Caithness, said: “This was a large piece of work by the team and the fact that they are now seen as an exemplar by other teams speaks volumes for their efforts.” ‘Releasing Time to Care’ is a UK-wide initiative aimed at helping NHS staff to examine how they operate with a view to making improvements. Teams are encouraged to make positive changes, eliminating waste and efficiencies and releasing more time to provide direct patient care.

A new scheme aimed at combining specialist nursing skills with the latest Smartphone technology to help improve the quality of life of people with Crohn’s disease won first prize for best Commercial Collaboration at this year’s Scottish Life Sciences Awards.

The innovative project, which NHS Highland is running as a pilot, allows specialist nurses to interact with patients on a daily basis to help them keep up to date with the latest treatments, track their daily health and potentially predict when they might become unwell.

The project has received the financial backing of Crohn’s and Colitis UK – the leading British charity for those living with Inflammatory Bowel Disease (IBD) – and the IT is supplied by Forress-based Company, Open Brolly.

There are 250,000 people across the UK who live with Crohn’s disease, with 25,000 in Scotland and some 600 in Highland.

One of those is Evonne Stewart, a 42-year-old social care worker from Lentran, who was diagnosed with Crohn’s five years ago. She feels that since signing up to take part in the pilot, it has given her a huge boost in self-confidence.

“To know that there is somebody at other side of the phone has helped me 100 per cent with my confidence,” said Evonne.

“I suffered really badly for over 10 years and I required major surgery. The thought of falling back into being that ill is just terrifying.

“Now I feel so much confidence and reassurance that there is somebody at the end of the app who really cares about how I feel each day.

“It has also made me look more at my health and has provided me with a greater understanding of my condition.”

The pilot is the brain-child of NHS Highland Consultant Surgeon, Professor Angus Watson; who has become the first in Scotland to use Smartphone technology for patients in this way.

Angus said: “When we spoke to patients as part of the research programme, they told that they want immediate access to knowledge and to be and feel cared for.

“By using this new approach, we don’t need to put patients to the inconvenience of having a routine check up because we know on a daily basis how they are feeling. We believe this approach has much wider application and in time will transform the need for some traditional outpatient services.

“The big break through is being able to pull across all the data securely and have it logged into the NHS clinical record. It is based on mobile technology and internet banking security. The technology does not replace staff but it allows them to have a better therapeutic relationship based on lots of data which doesn’t rely on the patient having to remember how they have been feeling.”

Scottish Life Sciences Award