Kithstone Consulting Final Report Islay Action Plan for the … · 2014-03-07 ·...

[email protected] Kithstone Consulting Islay Final Report Nov 2013

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Kithstone Consulting

Final Report

Islay

Action Plan for the Development of Clinical and Care Services

November 2013

Professor Gordon Peterkin

Dr Helen Tucker

Iain Hunter


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1. Introduction

This, the final report from Kithstone Consulting is designed to bring together the short,

medium and long term actions distilled from our work on Islay. We set out at the beginning

that this was not to be ”Just Another Review,” but that we would develop our process as a

form of action research with specific outcomes and end points in mind.

2. Kithstone Contribution to Date

We have been commissioned to carry out a review of clinical services and recommend a way

forward to achieve a sustainable, quality service for the longer term. We have presented

three reports to date and this is our concluding report, which is a synthesis of our findings

and recommendations.

Our initial report provided a policy context for the commission. Following visits and

interviews, we provided an interim report in which we identified good practice and areas

requiring further attention. We then facilitated a workshop designed to enable those

involved in the service to identify features of a future vision for the service. We prepared a

third report based on the workshop, which included an action plan. The action plan

incorporated suggestions from the workshop, proposals from Kithstone consultants, and

actions already identified and in progress from the Islay Review Steering group. This

comprehensive action plan was categorized into 10 headings for 42 tasks. The tasks within

the action plan included those that required attention within the short, medium and longer

term. The Vision report from the workshop was intended to be a resource document that

tried to capture the many ideas and suggestions from participants, as well as the many


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actions considered to be critical to improving the service. There was a strong consensus for

the need for transformational change, and a shared vision of a more integrated service.

Integration was described in terms of extending team working across disciplines and

agencies, as well as physical integration of buildings and facilities for health and social care

co-located in one place.

In this final report, we want to look at the spectrum of actions, many of which are

interdependent, and map out a way forward for the Island. The actions undertaken at the

beginning of this journey will lead to the development of subsequent, sequential steps. Key

to the whole process is a better understanding of the pressures and commitments that are

faced by clinicians and management in their various groupings and how developing aligned

values and integration will improve performance throughout. A significant investment has

been made in supporting the Islay practices and much more clinical value can be produced

by the development of joint working, reducing transfers to Glasgow and looking objectively

at what happens currently and re- allocating resource in ways which benefit patient care and

improve clinician effectiveness and morale.

We have purposely painted a broad-brush picture in this plan as the definitive steps

will be mapped out by the Islay Implementation group who will have to adapt to changing

circumstances, be flexible and innovative in their movement towards the new model of

working. It’s important that they are not tied to unrealistic specifics at the beginning of their

work


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3. Action Plan for Islay

Islay Execu ve Group

Islay Integrated Care Manager

Islay GP Prac ce

Management Finance Service

Development Infrastructure IT

Governance Arrangements

� Islay Executive Group

The creation of an on- Island Executive group with strong links to the CHP through a

nominated member of the CHP Core Management team. This group will undertake to

develop the plan around the areas outlined in the list of 42 actions from the workshop. This

group needs representation from the Clinical groups on Islay, CHP and local Authority


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support and involvement of the population, in particular around infrastructure development,

and patient communication and involvement.

� A single Islay GP Practice with Clinical Lead

The amalgamation of the three practices into one. In order to achieve economies of scale,

give the existing GPs control over their environment and move towards a more creative

model with control over purchasing secondary clinical services and, for example IT systems

among other areas. The development of education, premises, recruitment and logistics will

not happen readily without this essential step.

� Islay Integrated Care Manager

The appointment of a joint manager for Health and social care with overall responsibility for

Islay management. This is ongoing and is an essential component. The individual appointed

will require a positive nature and will need support from both the Island team and the CHP.

No decisions altering services on Islay should take place without discussion with the post

holder who will have a key role in communication. This will be an innovative appointment

and the individual concerned should be well supported with possibly a mentoring

component built in to their appointment and regular review.

Areas of Work

Islay Executive Group, including the Islay Integrated Care Manager and the Islay GP clinical

lead would be attending to five key areas of work. We would suggest that the executive

group should have a three-year programme put in place with annual review by an external

agent. Plans need to be flexible and performance measurements put in place agreed by the

Executive group representatives.


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� Management

Management, leadership, team building and communication all, to our mind, come under

the second heading which is about the development of a single practice, education around

new ways of working and learning from others who are sharing the same sorts of problems.

The visit to Arran was an example of a shared learning experience and practical information

around contracting and workforce regulation comes into this category.

� Finance

Finance and Contracts require someone with an accounting background to unpick data and

explain to others less used to such matters. Campbell Mair’s involvement is a useful start in

this process but possibly there will be a local individual with translational skills

� Service Development

Service development, new ways of working, integration of teams, education and clinical

quality together with developing established links with secondary care in Glasgow are very

much what the existing clinical lead has been about and should continue to receive input

with more general discussion. Good ideas can come from unusual sources.

� Infrastructure

Examining the existing building resources and working out how to best use the estate in the

short term across all agencies but developing ideas for the establishment of a central hub

including, health, social care and anything that can be added to the mix to make such a

project viable. The engagement of wider industry on the Island and notable individuals with

influence should be part of this- probably a long-term project but opportunities can be

created and grasped.


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� IT

IT is a huge and significant component for future development with the potential to link

Health and Social Care and provide better linkages to secondary care in other areas but

particularly Glasgow. The Department led by James Brass has done good work within the

limits of their resource and the anomalous situation where IT is an NHS Highland function

but clinical activity is fairly exclusively between Islay and Glasgow or Paisley. The clinical

systems are not appropriately linked to Glasgow and the NHS Highland IT developments are

a drag on clinical activity and potentially may pose clinical risk. This conundrum should be

examined at an NHS Scotland and Board level.


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4. Conclusion

It has been a pleasure working with the staff, patients, community and associated

individuals and agencies concerned with the health and wellbeing of the population of Islay.

We have been impressed by the commitment and passion of those concerned, and by the

many ideas that were shared about how to make improvements for the benefit of patients

and the overall service. Implementing the action plan and managing the change will require

a clear vision and strong leadership and it is essential that this is vested within the island

itself, with support from the CHP. The GPs have shown a particular commitment to

maintaining and sustaining the service under considerable pressure, whilst at the same time

preparing for major change. Their contributions in terms of discussions on options informed

by their audits and case studies have been invaluable.

The review has shown a considerable commitment by the CHP to find ways of addressing

the current issues, and to put in place a sustainable, appropriate and high quality service for

all. We trust that our independent role in supporting the deliberations and being a “critical

friend” has helped to create a clear vision for an integrated service for the future.

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