Argyll and Bute CHP - NHS Highland

Radiography Out of hours – Service Options Version 7 (15/03/13)

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Argyll and Bute CHP

SERVICE OPTIONS

For

Radiography Out of hours Service in

Argyll and Bute


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Contents Page No.

1 Strategic Context 3

2 Background 4

3 What are the Issues 4

4 Project Objectives and boundaries 4

5 What is the current service 6 6 Options or ways of providing these services 8 7 Comment Log - Comments to date on the Options 22

8 What Happens Next? 23

9 Appendices 24

o Core services in Community Hospitals

o Radiography Review steering group membership

o Feedback Form

10 Glossary 29


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1 Strategic Context

The review of radiology services within Argyll and Bute takes account of NHS

Highlands vision, strategic plan and quality approach as illustrated below:

NHS Highland’s Vision

Quality care to every person, every day

Option 3 Option 4

NHS Highlands Mission

• Better Health – improving the health of the population • Better Care – enhancing the experience of care for individuals • Better Value – controlling the per capita cost of care

STRATEGIC PLAN - OVER THE NEXT 5 YEARS WE WILL:

1. Promote good health, self care and independence 2. Provide services that are high quality, integrated, equitable, needs and

evidence-based, and cost-effective 3. Become more community based with hospital beds preserved for the most

acutely ill and those with specialist needs 4. Integrate with, and complement local authority, voluntary and independent

sector care 5. Be run by healthy, flexible, well-motivated and well-trained staff working to

their maximum potential and capability 6. Use modern, flexible, efficient, green assets to maximum effect 7. Zero waste and inefficiency across all services and reduce overheads

The Highland Quality Approach

• Safe • Clinically Effective • Person-centered • Efficient


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1 Background Argyll and Bute CHP has 6 Community Hospitals (CH) which provide an on site routine and out of hours plain film X-Ray service. The RGH in Oban also provides a number of other radiology services e.g. Ultrasound, CT etc. The RGH and 5 of the Community Hospitals are designated non bypass hospitals (999 - A&E/Casualty and inpatient service- Appendix 1 details the core services provided in our CH) and as such has operated a 24/7 on-call radiography service to support these core services. The Argyll and Bute CHP Radiography Steering group (Appendix 2 membership) review of radiology services within the area has identified a burgeoning and future service need to sustain an out of hours X-Ray service. The group has identified the need to conduct a specific appraisal of service options to assess the best method to provide an X-Ray out of hours service to support the services provided in our Rural General Hospital and Community Hospitals. The option appraisal process will therefore involve representatives the public, clinicians, managers, stakeholders (e.g. SAS, NHSGG&C) with the intention of identifying a preferred service option for recommendation to the Steering Review group by summer 2013 for consideration. This will then be presented to the Argyll and Bute CHP management team and committee to consider the findings and agree what action needs to be taken. 1.1 What are the reasons for the review? The main reasons for the review can be summarised as follows: o Unacceptability in modern working practices of a 1 in 2 on-call rota for radiography

staff and its non-compliance with the European Working Time Directive o Difficulties in attracting new recruits into X-Ray service in view of the high on call

commitment required, o Recent changes to national pay agreement for on call making the remuneration for

out of hours work unattractive for staff e.g. weekend sessional rate (Friday – Monday £82.50) plus call out time.

o Ensure we are planning to maintain the Core Service provision of RGH &

Community hospitals in terms of: o Clinical quality of service o Profile of radiology services available o Provide good access for patients to the service o Ensure the service is safe

o Examine the different levels of out of hours X-Ray service provided in our hospitals

with regard to appropriateness and consistency o Examine any variation in clinical practice between hospital sites requesting x-ray -?

need/appropriateness


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o Enhance team approach to working between the radiographers and assess any cross site/location cover options

o What do we mean by an X-Ray out of hours service?

o Is it just radiographers or other staff? o What grade/level staff and explore options e.g. remote support o Time of response – not always an immediate medical need? o On call competencies for staff – IRMER and other regulations

o What is the amount and type of X-Ray activity out of hours

o What patient conditions is it used for o How does it vary overnight and through the day at weekends and bank

holidays in terms of volume and time o Staff working rotas and profile of out of hours demand e.g. up to midnight, day time

weekends o Best Value

o Staff numbers, their skills and capacity o Equipment replacement plans and current utilisation

In undertaking a review of the service the service objectives and boundaries need to be identified and these are detailed in the next section. 3 Service Objectives for Radiography Out of Hours S ervice The Radiography Out of Hours Service has the following service objectives and boundaries: Table 1 Radiography Out of Hours Service Objective s

No. Description

1 To provide a safe and responsive service out of hours which meets patient’s needs and the service standard and performance targets.

2 To provide a sustainable service that is sized to meet the forecasted demand in the next 3-5 years.

3 To provide services that have the necessary flexibility to meet the requirements for out of hours Radiography service

4 To acknowledge “access” and rural geography constraints and as far as possible/practical ensure accessibility for patients to the accepted performance/clinical standards

5 To provide ‘a fit for purpose’ services for use by staff

6 To attract and retain high quality staff

7 To ensure efficient and cost effective use of resources


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Table 2 Radiography Out of Hours Service Boundari es

Constraint Description

1 Services must be compatible with existing service strategies and principles

2 Service must provide sufficient flexibility for future needs of the service – responsiveness, meeting peaks in demand, continuity and sustainability etc

3 Service must make best use of existing resources (staff, skills and capacity) as there are no new financial resources.

4 Service must meet the identified and defined service need and performance standards

5 Service must offer value for money and produce cost efficiencies

6 Staff must be fully involved in the redesign process

7 Service users and stakeholders are communicated with and involved in the service review and any subsequent redesign.

8 Service exclusions – • Routine (in hours) General X-Ray service • Ultrasound service • CT service • Fluoroscopy service


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4 What is the current Radiography Out of Hours Serv ice and what does it do?

4.1 Table 3 X-Ray Service Profile and Workforce at each hospital (March 2013)

Number of radiography staff

A&B Hospital and operating times General X-Ray

Mobile X-Ray

Permanent wte (staff)

Bank or locum wte

Campbeltown Community Hospital 24/7 Service Yes Yes

1.7 wte Radiographers

(2 staff) Locum use for cover

Cowal Community Hospital, Dunoon 24/7 service Yes Yes



Mull Community Hospital, Isle of Mull Mon and Thu 0830-1300; on call thereafter Yes No

0.2 wte Radiographer

(1staff)

1 fixed term until 31.1.14 shared with

LIH - 234 hours per year (part

time annualised)

Islay Community Hospital, Islay Mon-Fri 0900-1300 On Call 1300-1800 Yes No


(1 staff) 1 bank staff

Lorn and Isles Hospital, Oban 24/7 Service Yes Yes


(6 staff)

1 bank staff and 1

shared fixed term – see

Mull. MACHICC, Lochgilphead 24/7 Service Yes Yes



Victoria Hospital, Rothesay, Isle of Bute Mon-Fri 0900-1700 Only On call Friday 1700 - Monday 0900

Yes . Yes

1 wte Radiographers


Victoria Integrated Care Centre, Helensburgh (No A&E or Inpatient beds) Tues/Thurs 0900-1700 Yes No

Via SLA serviced from GG.

The out of hours portion of the radiography service is as follows:

o Monday to Friday – 5.00pm to 9.00am o Saturday, Sunday & statutory holidays – 24 hours


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4.2 What is the amount of out of hours activity Table 4 X-Ray out of hours activity profile by hospital site 2011/12

Argyll & Bute CHP Radiology Out of Hours Activity (01/11/11 - 31/10/12)

Total Out of hours Activity by time period

Calls Weekday Sat Sat/Sun Sun Sun/Mon Total Calls 1700-2400 0001-0830 0830-2400 0001-0830 0830-2400 0001-0830 OBAN 319 55 308 22 248 11 963 COWAL 405 68 280 17 322 1 1093 MID-ARGYLL 151 30 128 15 125 5 454 CAMPBELTOWN 156 21 82 9 87 3 358 ROTHESAY 29 5 88 3 82 2 209 MULL 127 11 35 1 16 2 192

Average Out of hours Activity by time period

Average Calls Weekday Sat Sat/Sun Sun Sun/Mon Total Calls 1700-2400 0001-0830 0830-2400 0001-0830 0830-2400 0001-0830 OBAN 1.22 0.21 5.92 0.42 4.77 0.21 12.76 COWAL 1.55 0.26 5.38 0.33 6.19 0.02 13.74 MID-ARGYLL 0.58 0.11 2.46 0.29 2.40 0.10 5.94 CAMPBELTOWN 0.60 0.08 1.58 0.17 1.67 0.06 4.16 ROTHESAY 0.11 0.02 1.69 0.06 1.58 0.04 3.50 MULL 0.49 0.04 0.67 0.02 0.31 0.04 1.57 NOTES: Weekday = 261 Weekend = 104 Sat =52 Sun=52 Mull activity includes day time work weekdays Rothesay has no on call provision Mon-Thursday evenings:

Data Source: Argyll & Bute Hospital Radiology Infor mation System (RIS) Nov 2012


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5 Options or ways of providing the Radiography Ou t of Hours Service

An initial “long list” of options or alternatives was identified to provide the out of hours X-Ray service and these are detailed in the table below

Options Description

Viable Option

Option 1 Do nothing – Existing Out of hours X-Ray service

Y

Option 2 No Out of hours X-Ray service in Community hospitals

Y

Option 3

Provide the Out of hours X-Ray service via another staff group

N – legal requirement in NHS only provide by

radiology staff Option 4

Provide the Out of hours X-Ray service via an alternative site Y

Option 5 Provide the Out of hours X-Ray service via mobile arrangements

Y

Option 6 Change the availability of the Out of hours X-Ray service

Y

Option 7 Change Radiographers roles to support non- traditional role

development

N – not applicable to out of hours

Option 8 Change Radiographers roles to support traditional role

development

N – no applicable to out of hours

Option 9 Provide an on duty Out of hours X-Ray service in Campbeltown,

MAICC, Bute, Cowal and Oban 24/7

Y

A review of these options by the Radiology Steering group on the 24/01/13 identified 3 options which were either not viable or not relevant to the provision of an out of hours service and therefore these have been deselected. On the following pages is a list of the 6 short listed options or ways of providing the service; These options are presented in diagram form and in words. Some of the key advantages and disadvantages of each option are highlighted. These options are listed to enable discussion and debate between professionals and stakeholders. There are a number of them to encourage a broad look at what is deemed pragmatically possible. There are very many ways the services could be arranged. These options do not cover them all and comments are welcome. Feedback from the professionals and stakeholders as well as discussions at the Steering group will be used to appraise the options. The scoring will result in a decision about which would be the best option. The scoring process scores each option against the following

� Benefits ( not financial but to patients etc) � Risks � Value for Money � Affordability

More information about this process and timescale is available in section 5.


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Descriptions of short listed options Option 1 Existing X-Ray out of hours Service

Pathway

Description

� The service responds to all out of hours requests by authorised clinician-

ENP/GP/Hospital Doctor

� Radiographers called in from home or hospital accommodation

Advantages

� 24/7 service

� Historical confidence in service

� Very good response times and quality of service is high

� System well known and understood by clinicians

Disadvantages

� Untenable and onerous on-call rota majority of sites 1 in 2 (except Oban &

Dunoon (1-3)

� Not compliant with EWTD

GP/ENP/ hospital Dr phones On-Call Radiographer for locality

Radiographer assess request

Radiographer attends and conducts radiological exam

Radiographer obtains image and clinical interpretation of test

Radiographer completes documentation closes department and leaves


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� May not be attractive in remuneration for new staff or role terms and national

pay agreement has accentuated this

� Difficulty to recruit

� Is not be an equitable service as not available to Bute and Islay 24/7

� Risk element to non compensatory rest issue

� Over time increasing risk of radiographer not available and difficulty in getting

locum cover.

� There would be a reduction in service which would be unplanned and

unmanaged

� This would increase patient transfers and put pressure on the existing SAS

resource


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Option 2 – No Out of hours X-Ray service in Communi ty hospitals

Pathway

Description

• No radiography out of hours service provided at any community hospital

• LIH in Oban would continue to provide a 24/7 service

• Patients requiring X-Ray which cannot wait until next working day are

transferred to NHS GG&C or RGH in Oban

Advantages

Acceptable working conditions for Radiographer staff – no longer on-call

� Improves recruitment and retention and would require provision only at LIH for

compliance with EWD

� Overall cost of service will be within operating budget for radiography

� Day time service meets vast majority of demand (On average 1-2 week day

and 1.to 6 weekend calls out of hours per week across all community hospitals)

Disadvantages

� Impact on core role of hospitals as a non bypass hospital

� More patients transferred into NHS GG&C

� Impact on SAS resource including capacity and capability and likely increase

in SAS cost

� Transferring patients during the night may increase clinical risk and their

outcomes

� May be delays in decision to transfer patient which could increase clinical risk

to patient and their outcomes

GP/ENP/ hospital Dr identifies X-Ray required And it cannot wait until next working day

Patient transfer arrangements made with SAS to take patient to DGH in GG&C or RGH in Oban for X-Ray

Patients X-Ray and any subsequent treatment provided in DGH/RGH


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� Reduction in local access to services for public

� Political and public concern re loss of service and impact on status of

community hospital

� Radiographer loss of out of hours income as no longer opportunity for on-call

working in Argyll and Bute

� Reduce threshold for the type of patient you would look after on wards in

hospitals


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Option 4 – Provide the out of hours X-Ray service v ia an alternative site

Pathway

Description

Out of Hours service – patients who require an X-Ra y are transferred to

another site where there are on duty radiographers

• Islay – As current

• Mull - As the Islay service

• Bute – service provided at IRH (NHS GG&C)

• Cowal - Service provided at Cowal CH day time only 7 days a week by on

duty radiographer based on level of activity. Outside this time service

provided at IRH or RAH if cannot wait until next day.

• MAHICC & Campbeltown service provided at LIH after 5pm, 7 days a week

where LIH has an on duty radiographer service 24/7 or as clinical

appropriate patient transferred to NHS GG&C

And

GP/ENP/ hospital Dr identifies X-Ray required and it cannot wait

until next working day

Receiving site assess need for attendance


Patients X-Ray and any subsequent treatment provided in

DGH/RGH

On-Call Radiologist provides advice if necessary


Patients X-Ray and any subsequent treatment provided in

DGH/RGH

Cowal, MAICC, Ctown, LIH Islay, Bute & Mull


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o MAHICC & Campbeltown have a on duty sessional service part of

the day (e.g. 9am- 1pm) Sat & Sun and Bank holidays (BH)

• Patient Transport is provided by SAS for patients with relevant clinical

condition or patient makes their own way to DGH/RGH in Oban or NHS

GG&C

Option 4 Hospital

Locality Sat, Sun &

Bank Holiday

9am-1pm

Sat, Sun &

Bank Holiday

9am-5pm

Out of hours

Mon-Sun

Mid Argyll MAHICC LIH

Kintyre Campbeltown LIH

Bute IRH

Cowal Cowal Comm.

Hospital

IRH

Islay As current service

Mull Mull as Islay

Oban, Lorn

and Isles

LIH LIH

Advantages

� Not reliant on on-call arrangement in LIH or community hospital

� Would improve recruitment & retention of staff

� Fast response time - in hours

� No impact on next day patient service

� No impact on inpatient in hours services

� Quick response time when there is a duty radiographer on in designated

sites

� Marginal impact on SAS re level of transfer activity out of hours should be

able to cope with demand

� Reduces the un-sustainability of radiographer staffing risk in designated

services

Disadvantages

� On duty radiographer staff in LIH out of hours would be underutilised as

activity low


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� On duty radiographer staff in Community hospital during weekends and

Bank holidays would be underutilised as activity low

� Increased ambulance transport activity for SAS may mean increase in cost

and impact re next day due to compensatory rest

� Would not be an equitable service as islands not covered out of hours

� Transferring patients during the night may increase clinical risk and their

outcomes

� May be delays in decision to transfer patient which could increase clinical

risk to patient and their outcomes

� Will be seen as a reduction in local service by the public

� Could change status of non bypass hospital all or part of time (note not the

case in Islay and Bute at present)

� Reduce threshold for what type of patient you would look after on wards in

hospitals

� Possibly be an Increase in cost of this service model

� Patients would have to travel further for an X-Ray out of hours

� Patient who have to go elsewhere for an out of hours x-ray, experience a

worse service as X-Ray is delayed


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Option 5 – Provide the Out of hours X-Ray service v ia mobile arrangements

Pathway

Description

• This option provides a mobile response to out of hours demand via an on duty

radiographer based at a hospital in the CHP assumes Lochgilphead as

geographically central to CHP

o Excludes islands outside ferry times

o 24/7 service

• CT out of hours service required at LIH so separate arrangements in place

• Transport is provided by the Radiographer themselves or via a taxi/driver

• Islay – As current

• Mull - As the Islay service

GP/Hospital Dr phones on duty radiographer (mobile)

Radiographer assess need etc

Consultant Radiologist available for advice

Radiographer makes own way or takes taxi to hospital

Radiographer arrives at hospital and undertakes diagnostic test

Radiographer obtains image and report

Radiographer closes department and returns to base


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Option 5 Provider Hospital

Locality Out of hours Mon-Sun &

Bank holidays

Return Drive Times from

MAHICC

Mid Argyll MAHICC NA

Kintyre MAHICC 2 hours

Bute MAHICC 4hours 15 mins*

Cowal MAHICC 3 Hours

Islay

Mull

As current service

Mull as Islay

Not applicable

Oban, Lorn

and Isles

LIH

* Excludes ferry travel times

Advantages

� Targeted service at times of lowest demand

� Patients continue to have local access to service

� Would improve equity in service for Bute during ferry times

� Larger pool of radiography staff as on duty staff recruited within a CHP wide

team

Disadvantages

� Response time would be very much poorer due to delay in radiographer

travelling to requesting site

� Possibly not attractive to Radiography staff i.e., safety, lone worker, poor

weather and winter etc

� Significant travel times from Lochgilphead to other sites introduces delays in

service provision

� Restricted radiographer operating time window on Isle of Bute related to ferry

timetable

� May be seen/portrayed as a reduction in service

� May affect non bypass status of hospital

� Radiographer will at times be required at more than one site at a time:

� Duty staff would require induction in operation of equipment at all sites and

refresher/regular use of local equipment to maintain competency

� Reduce threshold for what type of patient you would look after on wards in

hospitals

� Simultaneous calls and conflict of priorities possible when travelling.


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Option 6 – Change the availability of the service

Pathway

Description

• This option limits the X-Ray out of hours service to Day time hours Mon to Sun

9am to 5.00pm for all sites with the exception of LIH

• In some Community Hospitals there would be an on-call service 9am-5pm at

weekends and bank holidays

• After 5pm there would be a delay in patients X-Ray until radiographer available

at the next working day

• Patient who required an urgent X-Ray would be transferred to another hospital

either in Argyll and Bute or Glasgow subject to their clinical condition e.g.

Orthopaedics would go to NHSGG&C


Locality Sat, Sun & Bank

Holiday 9am-5pm

Sat, Sun & Bank

Holiday 5pm-9am

Mid Argyll MAHICC- on-call LIH/GG&C

Kintyre Campbeltown – on-call LIH/GG&C

GP/Hospital Dr/ENP phones radiographer (9-5 Mon-Sun)

Radiographer assess call

Radiographer attends department and conducts X-Ray etc

Radiographer completes diagnostic paperwork

Consultant Radiologist available For advice


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Bute Rothesay – on-call IRH/RAH

Cowal Cowal Community

Hospital – on-call

IRH/RAH


Mull As Islay service

Oban, Lorn

and Isles

LIH LIH

Advantages

� Targeted service at time of highest demand

� Would be an improvement in equitable service for Bute as similar level of

service available to mainland

� Improves recruitment and retention of Radiographer staff

� May offer more opportunity for staff to cross cover CHP wide service e.g.

annual leave, sick leave etc

� Could allow re profiling of routine workload from 5 day to 7 day working

Disadvantages

� Doesn’t provide a full 24 hour service

� Impact on the non bypass status of hospitals this could/would change to all or

some hospitals 999 status

� More patients transferred to NHS GG&C

� May be small impact on SAS resource including capacity and capability and

possible increase in SAS cost

� Would be seen as a reduction in service

� Reduce threshold for the type of patient you would look after on wards in

hospitals


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Option 9 – Provide an on duty X-Ray service in Camp beltown, MAHICC, Bute,

Cowal and Oban

Pathway

Description

• The service is provided by on duty radiographer staff in some locations

• Islay and Mull service remain unchanged


Locality 24/7 on duty cover

Mid Argyll MAHICC

Kintyre Campbeltown

Bute Rothesay

Cowal Cowal Community

Hospital


Mull Mull service as Islay

Service

Oban, Lorn

and Isles

LIH

GP/Hospital Dr/ENP phones on duty radiographer

Radiographer – conducts investigation

Image and report passed to referring clinician

Consultant radiologist available for advice


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Advantages

� Provides a 24/7 response

� Quick and responsive to patient need

� Radiographer could take on extended role during very quite periods- e.g. basic

plain film reporting

Disadvantages

o Not Attractive to staff re recruitment and retention as on some sites level of

activity will see significant periods of “no work” – underutilisation

o Underutilisation of staff makes maintaining skills very difficult

o Financial not offer best value for money as very underutilised resource based

on activity and likely demand

o Will cost more as more radiographers needed to staff an on duty rota


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6 Comments Log – Comments to date on the Options

Comment/ Question

Answer

We have 7 community hospitals, have you excluded Helensburgh as it is staffed from NHS GG&C?

Yes does not provide an out of hours service

Service Exclusions Are these exclusions to be picked up in the wider aspect of the review as these are all affected by the OOH service and also cause real problems for the in hours service at LIH

Agreed at last meeting focus on out of hours for Option Appraisal - in hours impact considered elsewhere in the review

There appears to be different levels of core services for the Community hospitals – inequitable?

Yes- there is some variation based on the size and capability/capacity However there is a common menu of core services detailed in- Appendix 1

What clinical conditions require x-rays to be taken out of hours and what are the consequences if it is not available

The review group is undertaking a clinical audit of activity over the next 2 months to assess this. It will also look at what if scenarios to ensure previous activity are taken into account.


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P r e f e r r e dO p t io n

N o n - F in a n c ia l B e n e f i t s

R is k sV a lu e f o r

M o n e yA f f o r d a b i l i t y

S h o r t - L is t e dO p t io n s

L o n g L is t o f O p t io n s

T o d a y ’s e v e n t

P r e f e r r e dO p t io n







S h o r t - L is t e dO p t io n s

L o n g L is t o f O p t io n s

T o d a y ’s e v e n t

7 What Happens next

o Short list of option is taken out for consultation and feedback to staff, and

stakeholders via a variety of communication methods in April 2013 (feed back form Appendix 2)

o Feedback considered at Option Appraisal workshops in May

o Option Appraisal briefing session – WHAT IS IT? 22nd April 2013

o Option appraisal workshops 3rd & 9th May 2013 (All Day 9.30 – 4.30pm)

• Non financial benefits scoring • Risk Assessment

o Affordability & Value for money workshop - 16th May 2013 (All Day 9.30-

4.30pm) • Include Identification of preferred option

o Review Steering Group Review outcome report and identify a preferred

option – 6th June 2013 o Preferred option is put out to consultation with staff and stakeholders in

June

o Review Steering Group consider feedback and make recommendation/s - 18th July 2013

o Once the Review Steering Group has identified a preferred option this will

be presented to the CHP Management Team and CHP Committee for them to consider the findings, examine any implications and to agree what the next steps will be.

o This will include if necessary further formal public engagement and

consultation if a significant change in service is identified.

OPTION APPRASIAL PROCESS


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Core Function Campbeltown Cowal CHDunaros ( move to Mull PCC Dec 12) Islay Hospital MAHICC Rothesay Victoria Hospital

Anaesthetic Support N N 1

Surgical Support N N 2OOH GP Y Y 3

In Hospital GP Y Y 4

Receive & assess all 999 (non bypass) Y Y 5

Wound management Y Y 6

ATLS management NY - some but not all GPs have been on this course 7

ALS managementnurses will have ALS

experience +/-

Y - some but not all GPs have been on this course 8

Pediatric Advanced Life Supporttrained, all will be

aware of protocols

Y - some but not all GPs have been on this course 9

Ventilate ‘dead’ Y 10

Ventilate ‘live’ Y 11

Acute cervical spine (ACS) management

Yes -but only able to

undertake 'in-hours'

due to lack of OOH

Yes but limited ability to admit to ward 12

Chronic Cardiac failure assess/management Y y 13

Asthma mx Y y 14

Road Traffic injury management Y y 15Elderly management Y y 16

Paeds managementYes but limited ability

to admit to ward y 17Anaphylaxis Y y 18

Rehab Y Y 19

Palliative Y Y 20

Abdo Pain mxanagement Y Y 21

Use X-Ray Y Y 22

Reduce # /disclocation (simple)Yes, but again only

'in-hours' due to Y 23Diabetic mx Y Y 24Dialysis N N 25

Chemo N N 26Stroke lysis N N 27

Support midwives Y Y 28

Neonatal resus Y Y 29

Instrumental Obstetrics N N 30

Acute Psychiatry

Yes, as place of

safety and emergency

management pending Y 31

KeyYes YNo NTBI - Mull PCC opening DecSource

Core activity of A&B CHP 6 Community Hospitals (Hel ensburgh Vic Excluded) - October 2012

NHSScotland Remote & Rural Group's Framework for t he Sustainability of Services and the Medical Workf orce in Remote Acute Care Community Hospitals, Dec 2010)

8 Appendices Appendix 1 - Argyll and Bute Community hospitals Co re Services


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Appendix 2

Argyll and Bute Radiography Review Steering Group M embers March 2013. Membership Designation Name General Manager Derek Leslie - Joint Chair Clinical Director Dr Mike Hall - Joint Chair Locality Manager Christina West - Vice Chair Locality Manager Veronica Kennedy

Viv Smith Professional Lead for Radiography, NHS Highland

Katherine Sutton

AHP Lead Argyll and Bute Mary Wilson Lead Radiographer Jayne Morton Consultant Radiologist Maggie Brooks General Practitioner Dr Adrian Ward , Dr Robbie Paterson,

Dr John Lyon Clinical Services Manager Lorraine Paterson Senior HR Advisor Angela Dewsnap Head of Planning Contracting & Performance Stephen Whiston Service Planning Manager Kristin Gillies Society of Radiographers Representatives Elizabeth Stow

Sheila Preston/ Barbara MacGilp/Caroline Renton Finance Representative Stella Cockburn

Argyll and Bute X-Ray Out of Hours Appraisal Member s Membership Designation Name Clinical Director Dr Mike Hall - Joint Chair Locality Manager Christina West - Vice Chair Locality Manager Veronica Kennedy

Viv Smith Professional Lead for Radiography, NHS Highland Katherine Sutton AHP Lead Argyll and Bute Mary Wilson Lead Radiographer Jayne Morton Consultant Radiologist Maggie Brooks General Practitioner Dr Adrian Ward , Dr Robbie Paterson,

Dr John Lyon Clinical Services Manager Lorraine Paterson Senior HR Advisor Angela Dewsnap Head of Planning Contracting & Performance Stephen Whiston Service Planning Manager Kristin Gillies Society of Radiographers Representatives Elizabeth Stow

Sheila Preston/ Barbara MacGilp/Caroline Renton Finance Representative Stella Cockburn Public Partnership Forum Representatives Susan Patterson, Robin Dodman SAS Representative – Area Services Manager Mark Benton


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Argyll and Bute Community Health Partnership (CHP) is undertaking a formal review of local X-Ray services and conducting a specific appraisal of service options to assess the best way to provide a radiographer service out of normal hours (Out of Hours) in its hospitals.

GIVE US YOUR VIEWS! The CHP wants your views on the best way to provide an X-Ray service Out of Hours in the future. To do this you can:

Complete the feedback form and post it to us FREEPOST to the address at the end of this form

Complete the feedback form online at http://www.nhshighland.scot.nhs.uk/OurAreas/Argylla ndBute/Pages/ReviewofOutofHoursRadiologyServices.aspx

Email your completed form or share your views or comments to [email protected]

Forms must be returned by Monday 22 nd April 2013

Please rank the options from 1- 6. Your preferred choice = 1, next best = 2, etc with least favourite = 6

Options Rank 1 - 6 Option 1 Existing Out of hours X-Ray service

Option 2 No Out of hours X-Ray service in Community hospital s

Option 4 Provide the Out of hours X-Ray service via an alter native site

Option 5 Provide the Out of hours X-Ray service via mobile arrangements

Highland Quality Approach

Review of Out of Hours X-Ray Service March – July 2013

OPTIONS FEEDBACK FORM

WE WOULD LIKE YOU TO LOOK AT THE 6 OPTIONS AND THIN K ABOUT WHAT, IN YOUR OPINION, WOULD WORK BEST You might want to take account of the criteria that will be used to assess the options, these are:

• Patient safety and risk of providing that service • Quality of service • Good access to the service • Best use of staff in terms of skills and numbers • Would offer value for money


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Option 6 Change the availability (limit the time of operati on) of

the Out of hours X-Ray service

Option 9 Provide an on duty Out of hours X-Ray service in Campbeltown,

Mid Argyll, Bute, Cowal and Oban hospitals

Please say why the options you ranked 1, 2 & 3 (you r top 3) would best meet the needs of local people? Option Number ...… Option Number ...… Option Number ...…

We would also like your views on options you do not like, and why .

Do you have any concerns or comments that you would like to make regarding the future of out of hours X-Ray services in Argyll and Bute CHP?

Please indicate if your interest is as (tick one bo x):

A service user A clinician referring to the service A member of the public Scottish Ambulance Service NHS Highland staff NHS GG&C (Clinician/EMRS)

Other (please state) ……………………………………

Please e-mail to or post to: Caroline Cecil Planning & Public Involvement Manage r

FREEPOST RRYT-TKEE-RHBZ NHS Highland (Argyll and Bute CHP) Blarbuie Road, L OCHGILPHEAD, Argyll, PA31 8LD

Feedback forms returned by post must arrive

no later than Monday 22 nd April 2013

MANY THANKS INDEED FOR TAKING THE TIME TO COMPLETE THIS FORM


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9- Glossary Acute - Used to describe a disorder or symptom that comes on suddenly and needs urgent treatment. It is not necessarily severe and is often of short duration. Acute is also used to describe hospitals where treatment for such conditions is available.

Argyll and Bute Community Health Partnership (CHP) - provides a range of primary, community and mental health services across Argyll and Bute. It delivers these services from a network of facilities including a rural general hospital, community hospitals, day hospitals, health centres, medical centres, and mental health facilities. It also contracts with other Health Boards for specialist services e.g. Orthopaedics

Casualty Department - is a medical treatment facility specialising in the acute care of patients who present without prior appointment. The department provides initial treatment for a broad spectrum of illnesses and injuries, some of which may be life-threatening and require immediate attention. It operates 24 hours a day

Chronic illness - a disease that is long-lasting and reoccurring e.g. asthma, diabetes. The opposite of acute

Community Health Partnerships (CHPs) - are organisations which have been set up by Health Boards across Scotland to manage a wide range of community-based health services.

Community Hospital - is a locally based centre which provides a bridge between home and specialist hospital care and provides planned care, unplanned care and diagnostic services

Consultant - is the title of a senior doctor who has completed a specialist training and been placed on the specialist register in their chosen speciality. Consultants accept ultimate responsibility for the care of all the patients referred to them. A consultant typically leads a team of doctors training to work in the consultant's speciality.

Continuity of Care - Users experience services arranged or provided by different agencies without encountering difficulties arising from organisational or professional boundaries

Elective care - is pre-arranged, non-emergency care

General Medical Services – medical services provided in primary care. It also refers to the national contract introduced across the UK for General Practitioners (GPs) to operate in the NHS.

Health Board (HB) - The Organisation which plans and provides health and healthcare services for the people of the region acting on behalf of the Scottish Government locally

Independent Sector Organisations which provide health and social care on a private not for profit or voluntary basis.

The Ionising Radiation (Medical Exposure) Regulatio ns (IRMER) - The Regulations impose duties on those responsible for administering ionising radiation to protect persons undergoing medical exposure whether as part of their own medical diagnosis or treatment or as part of occupational health surveillance, health screening, voluntary participation in research or medico-legal procedures.


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Locum doctor - is a doctor who works in the place of the regular doctor when that doctor is absent, or when a hospital/practice is short-staffed. Often provided by an agency.

Minor Injuries Unit (MIU) - is a hospital department staffed by emergency nurse practitioners (ENPs) working autonomously who look after minor injuries such as lacerations and fractures, and have access to X-ray facilities. No appointment is needed.

NHS 24—National Health Service 24 - Confidential 24 hour telephone health service, which coordinates out of hours care and provides advice, support and information

Patient Focus - This term is often used interchangeably with 'patient centred' or 'people centred' which means that services or care delivered should be responsive to the individual's unique preferences, values and needs, identified and agreed in partnership with the patient.

Nurse Practitioner (NP) - an Advanced Practice Registered Nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice for example Emergency Care

OOH – Out of Hours – services that are provided outside normal working hours and at weekends and bank holidays

Palliative Care - work designed to improve the quality of life of patients who have a life threatening illness.

Primary Care - Primary care is health care at the first point of contact (your GP, Dentist, pharmacy, optician) with the Health Service, addressing physical, social and psychological problems, but also providing continuity of care if you have had specialist treatment.

Primary Care Emergency Centres (PCEC) - are well equipped clinics where doctors and/or nurses will be able to give you the treatment you need. They are not Accident and Emergency Units and are not walk-in facilities. Patients will only be seen when directed there by NHS24

Radiographer - Diagnostic Radiographer - graduate professional registered with the UK Health and Care Professions Council. Responsible for the justification /authorisation and acquisition of clinical images involving radiographic technique and patient positioning to achieve an optimal diagnostic image, taking full responsibility for minimising exposure to patients in accordance with ionising radiation regulations e.g. IR(ME)R 2000. The radiographer clinically evaluates the quality of images and provides clinical information to referrers through initial image interpretation and/or in the provision of a written report. Takes the lead responsibility for the management and care of patients undergoing the whole range of imaging examinations, e.g., x-ray, ultrasound, magnetic resonance imaging (MRI), computed tomography (CT).”

Radiologist - A medical doctor specially trained in radiology (X ray, CT, MRI) interpretation and its use in the diagnosis of diseases and injuries

Rehabilitation - is a treatment or treatments designed to facilitate the process of recovery from injury, illness, or disease to as normal a condition as possible.


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Rural Medical Practitioner - A term used to describe a Doctor employed by the Health Board to provide medical services in a hospital. This doctor is GP trained and also may have or be undergoing additional training to provide hospital casualty and inpatient services. Referred to as CHP employed Doctors in this report.

Salaried Medical staff - A GP or Doctor who is employed by a GP practice or by the NHS Board on a salaried basis

Scottish Ambulance Service (SAS) The emergency service used to transport people to hospital

Scottish Health Council SHC — National organisation with local offices to oversee public involvement in healthcare. SHC became part of Healthcare Improvement Scotland formed in 2011.

Secondary care - The second stage of treatment when you are ill and usually provided by a hospital. See also primary care and tertiary care.

Service Level Agreement - SLA: a contract between NHS Boards

Stakeholders - People with a shared interest in services, either as a provider or user or partner in delivering services e.g. the council or voluntary sector

Step-down care - intermediate between that of an intensive care unit and a normally-staffed ward.

Tertiary care - The third and highly specialised stage of treatment, usually provided in a specialist hospital centre. See also primary care and secondary care.

Argyll and Bute CHP - NHS Highland

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