Our Current Service Provision
Across the Western lsles, our health and social care teams work hard every single day of the year to provide high quality and person-centred care
Over the last few years, we have sought to develop our services and respond to the challenges of growing demand and tighter resources. We are seeking to apply the stepped model of care, as highlighted in the graphic on page 12. This promotes tailored interventions, according to complexity of need.
Older People’s Care
The delivery of care and support to older people relies on a network of linked professionals across the NHS, Comhairle, third and independent sectors, who provide medical, nursing, and therapeutic interventions, day care, home care and residential care.
The majority of older people with assessed care needs are supported at home by our combined services. This involves care and support for people in their own home to help them with personal and other essential tasks. It is a key service in supporting older people to remain at home.
Care at Home Services
The Comhairle is the largest provider of care at home services in the Western Isles. The level of care at home provision had been declining steadily in Scotland over the last 10 years. However, the rate of care at home provided by the Comhairle had remained consistently higher than the national average. In 2013-2014, the rate of care at home provided by Western Isles Comhairle was 70 per 1,000 older people compared with 53 per 1,000 older people for Scotland.
Following the introduction of the Self Direct Support legislation, individuals have the opportunity have more choice in how they wish to have their support services arranged. The four options range from the individual accessing the budget to have full control and management of the services they receive through to the local authority managing and delivering the service.
We face significant challenges in meeting the assessed need and demand for care at home services. A number of older people are waiting for a care at home package. This is a problem across the islands, but is most acute in Stornoway and Broadbay. There are also challenges in some of the most remote and rural areas, where care at home staff have to travel very large distances to visit older people. In light of these challenges, we are carrying out a significant redesign exercise in respect of our care at home services.
NHS Community Nursing
There are 85 WTE community nurses, 24 within specialist roles and 61 within geographical teams. Five Community nursing teams exist within NHS WI; they are geographically based and aligned with GP practices. The Community Nursing service is primarily aimed at patients who are housebound and it is recognised that patients should not be disadvantaged by their remote and rural location. However, strict referral criteria have been developed to encourage self-management and ownership of health needs. From the 2015 community nursing consultation, it was apparent that the care of older adults should be the focus of district nursing services. The increasing number of older people with multiple co-morbidities, long term conditions, polypharmacy and complex social care needs emphasised the importance of community nurses’ case management and specialised clinical skills. Discussions highlighted the need for community nurses to proactively manage care by promoting health, anticipating health needs, enabling and supporting self-care and providing support and supervision to the well elderly.
Community Psychiatric Nursing (CPNs) service
There are 7 WTE CPNs who provide a generic mental health service to the people of the Western Isles. One CPN has a part-time dementia liaison remit for Lewis and Harris, and dementia care in the Uists and Barra is subsumed into the generic CPN profile. There are also two Learning Disability Nurses providing specialist care to people with learning disabilities across the islands.
Psychiatry and Psychology
The Western Isles has two consultant psychiatrists who provide hospital based care together with outreach to care facilities and people living in their own homes.
A new Psychology Service has recently been developed in the Western Isles, with two 0.5 WTE consultant psychologists, one specialising in older age psychology.
Hospital Dementia In-Patient services
Clisham ward currently has 10 beds for people with dementia. People who present with behaviour that is perceived as challenging can be admitted to Clisham ward for assessment. Most of the current patients in Clisham are awaiting alternative forms of care and no longer need to be in hospital.
Allied Health Professionals (AHPs):
AHPs provide a range of services that help older people with dementia to continue to live independently and safely at home.
These services focus on self management, prevention, rehabilitation and re-ablement. An AHP can assist with falls prevention, swallowing assessments, nutritional support, pulmonary and cardiac rehabilitation, provision of aids and adaptations, pain management and fatigue management.
People living with dementia can access any of the AHP services and expect the same level of assessment and support regardless of which part of the service they access.
AHPs have a role in supporting both formal and informal /family carers by giving them the knowledge and skills required to meet the needs of the person living with dementia. This takes the form of delivering training both formally and informally and will include topics such as eating and drinking support, communication support, foot-care training and keeping people active.
End of Life Care
The proportion of older people in the Western Isles who spend the last 6 months of their life at home or in a community setting is increasing. By 2012-2013, this was higher than the proportion for Scotland as a whole. We have systems to support palliative care, with community and unscheduled care nurses and the community equipment store making a strong contribution. This approach helps to avoid calls to NHS 24 or presentation at hospital, and helps to minimise stress for the older people and families concerned.
The use of technology to support personal independence is also improving. Over 800 people in the Western Isles have a community alarm or other telecare service; usage is higher per capita than the national average. We are committed to expanding the number of community alarms by 15% each year until we reach the point where everyone over the age of 75 years, assessed as benefitting from having an alarm, has one. We recognise, however, that our success will depend on informal support from unpaid carers.
There are seven residential care homes and one nursing home in the Western Isles, providing a total of 209 places for older adults incorporating respite beds: three in Stornoway, two in Harris, two in the Uists and one in Barra. One nursing home and one care home operate independently of the local authority. The care homes range from older establishments - Dun Berisay in Stornoway was built in the 1960s - to the very new - Harris House has 16 beds and was opened in 2014. Capital investment is being sought to a new health and social care hub in Barra, and the replacement of the two ageing care homes in Stornoway. It is envisaged that extra-care housing will form part of the new service once it is built. This will provide older people with individual tenancies, while retaining the high-level care input of traditional residential care.
In respect of the care and support we offer to people with a dementia diagnosis, we recognise that we have more to do. We are keen to ensure early diagnosis with post diagnostic support and will liaise with Alzheimer Scotland, service users and carers on how to improve our overall service offer.
Day Care and Respite Services
Alzheimer Scotland (Western Isles) provides advice and support for people with a diagnosis of Dementia and their carers/families. This includes individualised support services and peer support groups in Lewis and Harris to promote independence and well-being. Solas Day centre in Stornoway is open 6 days a week and has a part time Dementia Advisor. The Dementia Resource Centre serves the whole of the Western Isles as a hub to provide advice and information with added opportunities for support by phone, email and Skype.
In the Uists, Tagsa Uist provide some individual support at home and there are plans to expand to provide more dementia specific services if additional funding can be sourced..
The Barra Day Centre supported by the Comhairle includes a community learning centre and garden and provides generic support including to the older person, and Cobhair Bharraigh provides a range of services including care and support to people with dementia.
Respite services are provided through the provision of care delivered within the home, residential care respite services and the allocation of a personal budget to enable the individual to commission their own arrangements within their own, through specialist providers or in the form of a short break.
Support for Carers
Most carers tell us they feel supported with their own healthcare needs and this has enabled them to continue in their caring role.
The third sector has an active and hugely important role in providing support to carers. Nonetheless, the support we provide to unpaid carers will be even more important into the future.
We continue to face challenges in identifying unpaid carers and in trying to ensure that they received the right help and support to enable them to continue in their caring role.
Western Isles Community Care Forum
The Western Isles Community Care Forum maintains a register of people who are carers and this is kept up to date by liaising with GPs and the local community to encourage carers to register. They administer projects that support carers in various ways.
The Stepped Model of Care
As we move to redesign both our mental health services and wider services which support people with dementia, we will use a stepped model of care to frame our service offer (opposite).
A stepped model of care illustrates that for most people, generic services (Tier 0 and 1) will be appropriate to support their health and well-being. However, as a person’s needs change and become more complex, more specialist input may be required (Tier 2 locally, Tier 3 from mainland providers).
More detail about how our services will change and develop is described later in this strategy document.