VOLUME 2 FACT FILE ***TO INFORM VOLUME 1, THE ACTUAL PLAN*** Last Updated: 15.06.11 Page 1 of 12
Contents 1. Demography of NHS Highland...4 2. Epidemiology of NHS Highland...5 3. Provision of Health and Social care for Patients in nhs highland.6 4. NHS Highland Strategic Objectives...7 5. Other Agencies Objectives...8 6. National Policy Drivers...8 7. Local Policy Drivers. 8 8. Workforce...9 9. Performance Management...11 10. Stakeholder Involvement...11 11. Members of Neurology Services Improvement Network...11 Page 2 of 12
This document can be printed off and read. However if read online there are several hyperlinks that enable the reader to jump from areas of the document to other references. For example if actions refer to policy or where performance information is available within narrative sections. (Contents) Page 3 of 12
1. D E M O G R A P H Y O F N H S H I G H L A N D 1.1. Geography of NHS Highland. 1.1.1. NHS Highland comprises the largest and most sparsely populated part of the UK, with a mountainous terrain, rugged coastline and some populated islands. The area covers 33,028km², around 41% of Scotland. 1.1.2. Inverness is the largest population centre and only city within Highland, with further regional towns acting as the hub within different areas of the Highland region. Population density ranges from 24.8 people per km 2 in Inverness to 2.2 people per km 2 in Sutherland. 1.1.3. Over 75% of the NHS Highland population lives in a remote or rural location, including 35 inhabited islands. 1.2. Demography of NHS Highland 1.2.1. The population of NHS Highland is 322,350 1. The population of NHS Highland has increased over the last 10 years and is predicted to increase by a further 10% over the next 20 years. The numbers of people aged over 75 years will more than double in the same time. 1.2.2. The main influence on population growth in recent years for Scotland as a whole has been inward migration, rather than an increase in births or reduction in deaths, but population movements across Europe have made it increasingly difficult to provide accurate estimates and projections of future growth. The recent pattern of population growth dependent on net migration gain has not been evident across all NHS Highland and while the Highland population has increased by over 5% the population of Argyll & Bute has fallen by 1.7% over the last 10 years. 1.2.3. Life expectancy has increased steadily in both the male and female populations in Highland. For those living in rural areas of Scotland, whether those areas are accessible or remote, life expectancy is longer on average than in urban areas. 1.3. Socioeconomics of NHS Highland 1.3.1. Social changes include a move towards more single occupancy households, and fewer multi-generational households. If this trend continues, the number of single person households in the NHS Highland area is expected to increase from 48,920 in 2008, to 74,900 in 2033. Of these, 37,360 are expected to be people aged 65 years or older living alone. 1 QOF Practice Population Figures, 1 st January 2011. Page 4 of 12
1.3.2. According to the 2001 census, only around 0.5% of the population in NHS Highland are from an ethnic minority background; estimates of this proportion are likely to increase following the 2011 census. No single ethnic minority group is predominant in the area and ethnic minorities are widely distributed geographically. Inward migration from Europe, largely Eastern Europe, has accounted for substantial changes in the ethnic minority population in recent years. 2. E P I D E M I O L O G Y O F N H S H I G H L A N D 2.1. Premature deaths from circulatory disease and cancer continue to decrease, while alcohol-related deaths are still increasing. Life expectancy and healthy life expectancy continue to increase, but the gap between the two is not reducing; while people are living longer and staying healthy for longer, many older people are still tending to spend the last years of their life with one or more chronic long-term health problems. Socio-economic inequalities in health are also not reducing, despite the overall reduction in death rates. 2.2. On average there are just under 3,500 deaths in NHS Highland each year, and 80% of these deaths occur in people aged 65 years or over. The commonest causes of death are circulatory disease, including heart disease and stroke (34%), cancers (28%), respiratory disease (11%) and dementia (6%). 2.3. External causes, such as accidents, violence and suicide, account for a higher proportion of deaths in younger people, while in older people circulatory disease, cancer and respiratory disease predominate. 2.4. Prevalence rates for Neurology conditions within NHS Highland are difficult to confirm. Prevalence rates for epilepsy as indicated by the Quality & Outcomes Framework (QOF) data indicate that NHS Highland is just slightly lower (0.71) than the Scottish average prevalence rate (0.73) for this condition. 2.5. Other neurological conditions are not indicated through QOF however information on new outpatient appointments indicate that the following number of new neurology outpatient referrals have been seen in the previous 3 years: Northern NHS Highland Patients A&B Patients (seen by NHSGG&C) 2008: 1,215 patients 2008/09: 452 patients 2009: 1,293 patients 2009/10: 529 patients 2010: 1,934 patients 2010/11: 591 patients 2.6 The above new neurology outpatient referrals for both Northern Highland and Argyll & Bute indicate a significant increase in the number of outpatient referrals over the past 3 years. 2.7 Further investigation is warranted to understand the reason for this increase and to ascertain whether this is part of a national trend or localised to NHS Highland. The outcome of this investigation will help to inform the capacity and demand work that is required to formulate a robust 3 year plan for neurological services. Page 5 of 12
3. P R O V I S I O N O F H E A L T H A N D S O C I A L C A R E F O R P A T I E N T S I N N H S H I G H L A N D Primary care services 3.1. Primary Care services within NHS Highland are managed through 4 Community Health Partnerships (CHPs). There are 101 GP Practices operating within NHS Highland with the following breakdown between CHPs: CHP Number of GP Practices Total Number of GPs (Headcount) Total CHP Population North Highland CHP 17 43 39,927 Mid Highland CHP 33 125 96,602 South East Highland CHP 17 100 96,932 Argyll & Bute CHP 34 98 89,190 Total NHS Highland 101 366 322,651 3.2. In addition, primary care services consists of NHS employed Community Nursing and AHP staff who are directly managed by the CHPs. 3.3. There are 77 Community Pharmacies across NHS Highland covering each locality. 3.4. Community Hospitals are also available within each locality offering a range of day and inpatient services as well as outpatient clinics. Acute Care Services 3.5. NHS Highland has one district general hospital in Inverness as well as three rural general hospitals in Wick, Fort William and Oban. 3.6. The rural general hospitals offer a range of general medical and surgical services as well as diagnostic and outpatient departments. All rural general hospitals have an Accident and Emergency department. 3.7. Raigmore Hospital in Inverness offers more specialist inpatient, day and outpatient services as well as diagnostic treatments. 3.8. General medical beds are used to accommodate neurology inpatients within NHS Highland with patients being supported and managed by the Consultant Neurologists. Neurology clinics are undertaken at Raigmore Hospital in Inverness. In addition, outreach outpatient clinics using videoconferencing are established in Wick, Skye and Fort William for some neurological conditions. Clinical Nurse Specialists also hold peripheral clinics for certain conditions across Northern NHS Highland. Services provided by Other Localities to NHS Highland to patients 3.9. Patients with Motor Neurone Disease are managed by NHS Highland Consultant Neurologists with support from a Clinical Specialist based in and employed by NHS Grampian. Page 6 of 12
3.10. The main referral route for all neurology patients in Argyll & Bute CHP is to the Southern General Hospital in Glasgow and a Service Level Agreement is in place between Argyll & Bute CHP and Greater Glasgow & Clyde Health Board to oversee this. Argyll & Bute CHP patients are also seen in neurology outpatient clinics at other NHS Greater Glasgow & Clyde Hospitals including Inverclyde Royal Hospital, Royal Alexandra Hospital and the Vale of Leven General Hospital. Service provided by Community Planning Partners 3.11. NHS Highland has strong community care partnerships with its 2 Local Authority Partners The Highland Council and Argyll & Bute Council. Both Local Authority partners provide social care services for people living within their area. 3.12. Services include social work and occupational therapy services to support people to remain in their own home. In addition the Councils provide support and respite for unpaid carers. Services provided by the Voluntary/ Private and Community Providers 3.13. NHS Highland has service level agreements with a number of different voluntary organisations that support the health board in providing health care within a community setting. 3.14. An example of this joint working is funding from the MS Society to fund for a 3 year period a physiotherapist post specialising in MS rehabilitation. 4. N H S H I G H L A N D S T R A T E G I C O B J E C T I V E S 4.1. NHS Highland set out its strategic framework and vision in a paper to the NHS Highland Board meeting in October 2010. In this framework, the vision for NHS Highland over the next five years is to provide quality care at all times; to support people and communities to maximize their own health; to develop precision driven services so that when people need our care they experience timely, focused, effective services that minimises the duration and frequency of contact; and to ensure that every health pound spent delivers maximum health gain. 4.2. Underpinning this broad vision are the following 7 characteristics of service delivery which the Health Board will work towards achieving over the next five years: 1. Promoting good health, self care and independence 2. high quality, integrated, equitable, needs and evidence based, and cost effective 3. increasingly community based with hospital beds preserved for the most acutely ill and those with specialist needs 4. integrated with, and complementary to, local authority, voluntary and independent sector care 5. run by healthy, flexible, well motivated and well trained staff working to their maximum potential and capability Page 7 of 12
6. using modern, flexible, efficient, green assets to maximum effects 7. with zero wastage and inefficiency across all services and no unnecessary overheads. 4.3. It is recognised that the above broad vision and characteristics of service delivery require translation into specific service strategies to support application and implementation. Care pathways will be developed for major programmes of care characterised by those disease areas that constitute the most significant demand for health care. These in turn will be further supported by more generic pathways in respect of: Self care Anticipatory care Unscheduled care Planned care 5. O T H E R A G E N C I E S O B J E C T I V E S 5.1. Both Local Authorities have clear objectives agreed to meet the requirements and challenges of their authority areas. Both Local Authorities work closely with their Community Partners to deliver on the single outcome agreements. In particular, both Local Authorities are working closely with NHS Highland to achieve the following shared single outcome agreements: We live longer, healthier lives We have strong, resilient and supportive communities where people take responsibility for their own actions and how they affect others Our public services are high quality, continually improving, efficient and responsive to local people s needs. 5.2 An agreement has been reached recently between NHS Highland and The Highland Council to integrate its health and social care services, with adult services being managed by NHS Highland and Children s Services by The Highland Council. Full integration of these health and social care services is planned for April 2012. 5.3 Similar discussions are currently ongoing within the NHS Highland and Argyll & Bute Council Partnership. 6. N A T I O N A L P O L I C Y D R I V E R S Key policy Drivers are: Sally will complete this for you all 7. L O C A L P O L I C Y D R I V E R S 7.1. NHS Highland 7.1.1. NHS Highland s strategic framework and vision is underpinned by the following key policy drivers: Page 8 of 12
NHS Scotland Healthcare Quality Strategy: NHS Highland is fully committed to ensuring that all aspects of NHS business adhere to the 3 quality ambitions of patient centred, safe and effective care. HEAT Targets: NHS Highland s local delivery plan sets out how it plans to achieve the agreed HEAT targets. Those HEAT targets for 2011-12 that bear particular relevance to neurological services include: 8. W O R K F O R C E 18 weeks referral to treatment targets Reduction in emergency bed days for over 75 s Reduction in A&E attendances 8.1.1. The current number of staff employed by NHS Highland stands at 8,814 staff, giving a total whole time equivalent (WTE) total of 6,956.47. This total workforce is broken down as follows by Operational Unit and by Job Family: 8.1.2. Operational Unit Operational Unit Headcount WTE North Highland CHP 811 570.33 Mid Highland CHP 1,201 852.74 South East Highland CHP 1,475 1209.24 Argyll & Bute CHP 1,663 1304.74 Raigmore Hospital (Acute) 2,812 2249.11 Corporate Services 516 454.47 Operational Support Services 336 315.85 Total 8,814 6956.47 8.1.3. Job Family Operational Unit Headcount % of Workforce Nursing/Midwifery (Registered) 2,954 33.51% Nursing/Midwifery (Unregistered) 1,000 11.35% Allied Health Professionals 673 7.64% Medical & Dental 498 5.64% Medical & Dental Support 276 3.13% Administrative Services 1,648 18.70% Support Services 1,152 13.07% Senior Management 69 0.78% Healthcare Sciences 283 3.21% Other Therapeutic 204 2.32% Personal & Social Care 57 0.65% Total 8,814 100% Page 9 of 12
8.1.4 Workforce figures for Neurology Services covering Northern NHS Highland are as follows: Consultant Neurologists: 1.6 wte Consultant Neurophysiologist: 1.0 wte MS Clinical Nurse Specialists: 2.0 wte Adult Epilepsy Clinical Nurse Specialist: 1.0 wte Parkinson s Clinical Nurse Specialist: 1.0 wte MS Physiotherapist 0.8 wte Neurophysiology Technicians: 1.25 wte In addition, staff in the following areas have a specialist interest in neurological conditions: Clinical Psychologists Care of the Elderly Physicians (for Parkinson s Disease) Rehabilitation Consultants 8.1.5 In Argyll & Bute CHP specialist neurology support is provided by NHS Greater Glasgow and Clyde employed staff. There is also a Consultant Care of the Elderly Physician based in Oban in A&B CHP who has a specialist interest in Parkinson s Disease and provides support for A&B PD patients locally. 8.2. Workforce Drivers 8.2.1. Drivers which will influence the shape, size and skill mix of the workforce are based largely on the demography, access / provision for training and education, with political recommendations, employment law, financial climate, and clinical quality outcome measures and professional groups guidance. 8.2.2. Within NHS Highland the key workforce drivers which influence the size and skill mix of the workforce include: 8.2.3. Shifting the Balance of Care: In line with Scottish Government policy, NHS Highland is redesigning services to maximise the provision of services as close to home as possible. 8.2.4. Geography/Skill Mix: Due to the unique geography of NHS Highland, many areas of the region are sparsely populated. This often presents a challenge in terms of providing equity of access to all areas as it can be difficult to recruit and retain staff in certain areas. In order to overcome this therefore there requires a flexibility to adapt local service provision to the skill mix of the staff available in that area. Other solutions such as videoconferencing and telemedicine also help to ensure equity of access and support for staff working in remote and rural areas. Page 10 of 12
9. P E R F O R M A N C E M A N A G E M E N T 9.1.1. Performance management of NHS Highland s compliance against the neurological standards will be overseen and managed by the NHS Highland Neurology Services Steering Group. 9.1.2. Regular reports on progress will be submitted to NHS Highland s Clinical Governance committee for noting and action as required. 9.1.3. Performance against the standards will also be monitored and managed through NHS Highland s performance against HEAT targets and the NHS Scotland Healthcare Quality Strategy Outcomes and measures, as described in section 7.1. 1 0. S T A K E H O L D E R I N V O L V E M E N T 10.1. Stakeholders have been, and continue to be, involved in the neurology improvement work in a number of ways. Section 11 below provides details of members of the Neurological Improvement Network. All members of the network have a responsibility to ensure engagement and awareness of the neurology work with their colleagues and other contacts. 10.2. In addition, there have been 2 large stakeholder events which have taken place within NHS Highland to engage and consult with a wide range of neurology stakeholders. The first was undertaken in Inverness in 2008 as part of the Neurology Services Review. This involved a wide range of patients, carers and staff with a view to identifying what worked well and where the gaps were in service provision. 10.3. A further event was held in May 2011 in Argyll & Bute CHP to engage with key stakeholders regarding neurology service provision, with a particular focus on Argyll & Bute CHP. Participation at the event came from staff, patients, carers and members of voluntary organisations. The event also included representation from NHS Greater Glasgow and Clyde as much of the secondary care neurology services for Argyll & Bute patients is provided by this Health Board. 1 1. M E M B E R S O F N E U R O L O G I C A L S E R V I C E S I M P R O V E M E N T N E T W O R K 11.1. The following are members of the Neurological Services Improvement Network in NHS Highland: Name Heidi May Dr Bethany Jones Alexa MacAuslan Richard Bennie Designation Board Nurse Director (Exec Lead and Chair) Consultant Neurologist (Clinical Lead) LTC Programme Manager/Network Manager Service Manager for Emergency Dept, OOH, Neurology, Stroke and Rehabilitation. Page 11 of 12
Dr Louise Blackmore Iris Clark Gordon Bogan Dr Jim Law Donald Mackintosh Paula McCormack Dougal Sim Anne Stewart Lindsay Parks Sharon Sutherland Jackie Milburn Margaret Moss Andrew Johnston June Blake Maggie Clark Dr Barbara Chandler Lorraine Coe Mirian Morrison Dr Kate Taylor Carena MacIvor Diane Wilsdon Pat Tyrrell Paula MacGillivray Alexander Renfrew Consultant Clinical Neuropsychologist PHOS Speech and Language Therapy Huntington s Specialist Nurse Consultant Clinical Psychologist Sapphire Epilepsy Nurse Specialist Director of Education, Highland Hospice PHOS Physiotherapy MS Nurse Specialist MS Nurse Parkinson s Nurse Specialist Pain Management Representative AHP Lead / Mid CHP Representative MS Society Representative Epilepsy Nurse Specialist / SE CHP Rep LTC Programme Manager / Argyll & Bute Rep Consultant Rehabilitation Medicine Clinical Nurse Manager / North CHP Rep Clinical Governance Manager Consultant Neurologist Lead Nurse / North CHP Rep Area Development Officer, Parkinson s UK Lead Nurse / Argyll & Bute CHP Rep Area Development Officer, MS Society Patient/Carer Representative Page 12 of 12