Annandale and Eskdale Local Health Partnership Service Review

1
Annandale and Eskdale Local Health Partnership
Service Review

• Reasons For Change
• Models of Care
• Review of Possible Options

2
Annandale and Eskdale Local Health Partnership
Service Review

• Reasons For Change
• Models of Care
• Review of Possible Options

3
Reasons for Change

• Demographics
• Policy
• Workforce
• Finance / Resources
• DGRI
• Technology

4
Strategy shifting the balance of care

• Hospital ? Community
• Central ? Local
• Specialist ? Generalist
• Care ? Enablement
• Illness ? Wellbeing
• Status quo ? Sustainability

5
Workforce

• Age profile - retirement and recruitment
• Are the right staff in the right place doing the
  right job? - skill-mix and training

6
Finance

• Use under utilised resource - community beds, or
• Generate reinvestment opportunities - new, more
  relevant services
• A key decision

7
Technology

• Constant change
• Diagnositics x-ray etc more portable
• Telehealth specialist opinion from anywhere
• E-care - better, more complete patient
  information available anywhere as needed

8
Annandale and Eskdale Local Health Partnership
Service Review

• Reasons for change
• Models of care
• Review of possible options

9
How we could provide hospital care (Inpatient)

• Existing four local community hospitals
• Health beds in local care homes
• Single local community hospital
• Combination of single hospital and care homes
• No local beds (post-acute rehab in Dumfries)

10
How we could provide clinic based care (Out
patient)

• Expand range of AHP services eg physio, podiatry
• Develop more nurse led care eg pre-op assessment,
  transfusions, etc
• Develop services provided by community
  practitioners with a special interest
• Bring services out from DGRI

11
How we could provide day services

• Continue to develop rehabilitation for strokes
  etc. in day hospitals
• Develop dementia day care
• Partnership with social services/voluntary sector

12
How we could provide community based treatment
and care

• Integrated community teams
• Support for rehabilitation and independent living
• Improve management of long term conditions -
  more self-care/patient education
• Develop key worker roles
• Shared care between specialist and local services

13
Annandale and Eskdale Local Health Partnership
Service Review

• Reasons for change
• Models of care
• Review of possible options

14
Options

• For community hospitals
• For community teams
• For other services
• Do nothing
• Incremental change
• Radical change

15
Do nothing

• Hospitals remain as they are
• Community teams can improve processes and team
  working, but no increase in capacity
• Other services no opportunity to develop other
  priority services

16
Pros and Cons - do nothing

• Pros
• No organisational turbulence
• No short term effect on staff
• No short term effect on patients
• No local controversy

• Cons
• No future planning
• No effect on immediate service pressures
• Ignores lack of sustainability of existing
  services
• Large resource for small number of people

17
Incremental change

• Hospitals minimal change for Thomas Hope and
  Moffat change for Lochmaben and Annan (incl
  Treastaigh) (see following slides)
• Team can improve working practices with minimal
  increase in capacity (Hospital and Community
  teams working more closely)
• Other services no opportunity to develop other
  priority services

18
Incremental change (contd)

• Annan, Lochmaben and Treastaigh (Elderly mentally
  ill (EMI) issue)
• EMI remains at Treastaigh Lochmaben as
  rehab/palliative care unit Annan rehab/
  palliative care/clinic unit rationalise beds
  across Annan/Lochmaben develop community
  capacity
• EMI remains at Lochmaben Treastaigh closes for
  EMI and becomes Annan Hospital, existing hospital
  becomes Annan Clinic, or vice versa

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Pros and Cons (incremental change)

• Pros
• Minimise disruption
• Can resolve the EMI issue
• Can resolve the Annan Clinic issue
• Can do some of this now

• Cons
• Less sustainable future option
• Less flexibility to respond to needs

20
Radical change

• Hospitals either single hospital or no local
  hospital (develop Dumfries services)
• Teams opportunity to develop capacity
  significantly, and change to a more integrated
  model
• Other services opportunity for significant
  development of other priority services

21
Radical change (contd)

• Hospitals remaining community hospitals
  redeveloped as community health resource centres
  (CHRC)
• Teams develop four integrated teams round CHRCs
  to support rehabilitation, LTC and in-reach to
  care homes
• Other Services dietetics, podiatry, nursing
  services, council services (via resource
  transfer), prioritise developments

22
Pros and Cons (radical model)

• Pros
• Opportunity to develop a sustainable future model
  of care
• Development of a range of other services
• More integrated approach possible with both
  social services and secondary care

• Cons
• Lose benefits of very local inpatient care
• Transport - access for relative visiting more
  difficult
• Major organisational change for staff

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What happens next ?

• Will be an option appraisal process
• There are more pros and cons to be identified
• Local opinion will be taken account of
• As will facts, figures and opinion of clinical
  and management staff
• NHS Board paper