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.
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 care, nursing care, therapeutic care, day care, home care and residential care.
There are seven care homes in the Western Isles: three in Stornoway, two in Harris, two in the Uists and one in Barra.The care homes themselves range from the old - Dun Berisay in Stornoway was built in the 1960s - to the very new - Harris House has 16 beds and was opened in 2014.Further capital investment has been earmarked to support new extra-care housing in Barra to replace the St Brendan’s Care Home. This will provide older people with individual tenancies, while retaining the high-level care input of traditional residential care. We continue to face significant pressures on care home bed availability in Lewis and Harris.
Our balance of care remains positive, with the majority of older people with assessed care needs being supported at home by our home care service. 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.
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 level of care at home provided by the Comhairle had remained consistently higher than the national average. In 2013-2014, the level 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.
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 some of the most remote and rural areas and is exacerbated by care at home staff having 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.
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 procedures to support palliative care, with community 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.
We are also improving our use of technology to support personal independence. Over 800 people in the Western Isles have a community alarm or other telecare service, which is higher per capita usage 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.
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 revive our post diagnostic support and will liaise with Alzheimer Scotland, service users and carers on how to improve our overall service offer. We want to build a comprehensive strategy to support people with dementia.
The Partnership has inter-agency procedures for adult support and protection, which are designed to ensure consistent intervention and practice. However, we know that we can also strengthen our protection work in respect of our use of case conferences, data collection and use, and service planning.
Support for People with Long-term Conditions
Across the Partnership, we have a well-developed network of condition-specific services which help people with chronic illnesses to achieve good personal outcomes and self-manage their conditions. This includes:
- The nurse-led heart failure service which provides education to enable patients and carers to self-monitor and self-manage their condition. The service had also begun work with GPs to provide intravenous diuretics in the community to reduce the number of patients admitted to hospital with heart failure.
- The cardiovascular disease prevention and rehabilitation service, Hebrides Healthy Hearts, offers a menu-based rehabilitation programme. This is provided to patients with acute coronary syndrome or angina, or following cardiac surgery, heart transplant or device implantation, as well as supporting individuals who were at high risk of developing cardiovascular disease. The core team consists of a cardiac rehabilitation nurse, dietician, physiotherapist and Comhairle exercise specialists, with referral to other specialists for specific input.
- We have recently appointed a Multiple Sclerosis and a Parkinson’s disease specialist nurse. This is a positive development which will allow for the provision of consistent and coordinated care, and for people to be given information and support to manage their own conditions. We will consider whether there are gaps in other areas of specialist provision.
- The AHP services support people with long term conditions and have specialist skills and knowledge relating to conditions such as Multiple Sclerosis, Motor-Neuron Disease, Parkinson’s and Diabetes
recognise that there is opportunity to improve how we support people with
long-term conditions. For example, we have not widely used Anticipatory Care
Plans. These seek to anticipate significant changes in a patient’s condition
and describe actions which can be applied to support those living with a
long-term condition to plan for an expected change in health or social circumstance.
They also incorporate health improvement and staying well.
Support for Adults with Disabilities
We provide and support a range of formal and informal support services for adults throughout the Western Isles. These services are targeted towards a broad spectrum of the population in both directly supporting people who receive care but also in some cases to support those who are carers themselves.
The type of support arrangements that we offer are generally for adults with complex needs who need support structures or financial assistance to be arranged to achieve specific personalised goals.
We continue to develop self-directed support arrangements, which give people choice and control over how they use support to meet personal outcomes. Since April 2014, councils have a statutory duty to offer the four self-directed options to people who need social work services. Although we have increased the number of people who are supported via a direct payment (where people are given money to employ a carer or meet their own needs), we have yet to develop a comprehensive framework for the delivery of self-directed support.
Although our partnership is not responsible for specialist children’s services like children’s social work, specialist children’s mental health teams, or paediatric care, we are responsible for very important universal services for children: health visiting and school nursing and traditional family health services such as GPs, pharmacists and dentists.
We have a duty to ensure that we implement the policies and legal frameworks that are relevant to the children within our localities and we have an important role in continuing to work within a wider partnership environment with education, and other key children’s services.We are contributing to a picture where more children and young people are being helped to meet their developmental milestones, achieve their potential and move into sustained and positive destinations.
Comhairle nan Eilean Siar undertook a whole stock transfer in 2006, when the Hebridean Housing Partnership (HHP) was set up to receive the local authority housing stock. Trust Housing Association provides specialist Sheltered Housing for elderly and vulnerable individuals. The private rented sector consists mainly of single property landlords and has no organised identity
Tighean Innse Gall (TIG) provides a general care and repair service and its ancillary projects deliver adaptations and other preventative services which assist people to live independently in the community.
The Western Isles has very small numbers of homeless persons in comparison to other partnership areas, with 42 applicants for the second quarter in 2015. However, this is still significant in proportion to the limited range of housing options available to resolve homelessness.
There are three hospitals within the Western Isles. The Western Isles Hospital in Stornoway is a rural General Hospital. The IJB will have responsibility for the resource which funds general medicine, geriatric medicine, psychiatry, rehabilitation medicine. That amounts to a significant proportion of the 93 staffed beds.
The Uist and Barra Hospital is a community hospital in Benbecula, serving the communities of North and South Uist, Benbecula and Eriskay. It provides emergency, general medicine and nursing care.
St Brendan’s Hospital on Barra is a 5 bed hospital in Castlebay and it too provides emergency, general medicine and nursing care.Plans are underway to redevelop St Brendan’s into a health and social care hub. The resources for the day-to-day running of the hospitals in the southern isles will be delegated to the Integration Joint Board.
For the majority of people their main contact with the NHS is via their GP, and the ability to access this service is an important aspect of ensuring the health and wellbeing of the population.
The Western Isles in common with other rural areas has comparatively low GP Practice list sizes.This means that patients in Western Isles are relatively well served in terms of the number of GPs per patient population. This is supported by our annual patient GP survey which indicates, based on the 2014 survey, that 96% of respondents were satisfied with ability to access GP within 48 hours.
The level of GP provision in the Western Isles has remained fairly constant over recent years although this perhaps masks quite significant challenges we have faced in sustaining the GP workforce. The organisation of General Practices has also changed, with the amalgamation of some practices in rural Lewis becoming part of the Langabhat Practice. We now have nine practices in total, although half of these are short-staffed.
Within primary care, we have implemented a range of tools and resources from the Scottish Patient Safety Programme. For example, our dietetic service was working with district nurses to support self-management nutrition tools for patients within the community. Screening for the risk of malnutrition enables early and effective interventions.We are also undertaking work to reduce polypharmacy by reviewing medication with patients over the phone or by video-conferencing.
While there have been some challenges from patients in accepting this approach, our evaluation of the project found that it reduces the amount of medications prescribed.
Dentistry is provided by our community dental service, which has coverage across the islands. It is anticipated that an independent dental service will be developed in Stornoway during 2016/17.
Dispensing services are often delivered by GP practices, although there are three independent pharmacies in the Stornoway and Broadbay locality.
We have two independent opticians operating from the Stornoway area, with two opticians visiting the islands on a variable basis.
Over the last few years, we have sought to develop systems that prevent unnecessary hospital admission. We have worked hard to develop an effective out of hours system, with the community unscheduled care nurses working with GPs to reduce overnight admission to hospital. Our unscheduled care rates are lower than average for Scotland across A&E, hospital admissions and NHS24 services, with only ambulance service activity being broadly comparable.
However, the level of multiple attendances at hospital by patients is significant: almost a half of all hospital attendances in the Western Isles are repeat visits.
Furthermore, the level of emergency hospital activity for older people is the highest in Scotland when measured in terms of the hospital bed days older people utilise.
Indeed, arguably our greatest failing as a partnership has been in the length of time that older people wait in hospital despite being ready for discharge. We consistently have more than 30 of the 96 beds in the Western Isles Hospital occupied by people who do not need to be there. We are the worst performing partnership in Scotland on this measure and we need to improve our record. Hospitals are not the most appropriate setting for long-term patient care. We have been working hard to turn this around – but now need to become more radical in shifting resources from supporting people to stay in hospital to supporting people to live in the community. That will involve reducing the number of hospital beds.