Information Session 2

Fingal Centre, Portree High School, Monday 24th Feb, 2020

What Happened?

The panel consisted of David Park, Tracy Ligema, Dr Hannah MacLeod, Dr Al Innes, Pat Matheson, Community Nurse, Mairi MacDonald Community Rep, Fay Thomson Community Rep. There were also representatives from other agencies in the audience.


The schedule for Monday night is

•             Introductions (Norman) 5 mins

•             Background (David Park and Tracy Ligema) 10 mins

•             Summary of last week's presentations/questions  (Dr Hannah MacLeod) 10 mins

•             Emergency work and Out of Hours (Dr Al Innes) 10/15 mins

•             Presentation from Community Rep, Fay Thomson

•             Panel discussion 1hr 20 mins

The Presentations

Here are all of the presentations from Session 2

Questions and Answers

Q & A Session 2  - Portree High School 24 Feb 2020

Summary of question &  answer session
Norman Sutherland  to Tracy Ligema - 
Are 12 beds what we need?

Tracy Ligema Certainly opening the beds in Portree Hospital is the right thing to do as per Sir Lewis Ritchie. The figures represent a number that is not constant, and the quantity of beds is not always what’s needed.
Looking at the big picture we need to see beds in the wider context with community services and what that looks like in the future, e.g. with Care @ Home

Member of the audience How can we deal with the problems with modern technology? E.g. house call systems and the logistics of travel

Tracy Ligema NHS Highland does really well with managing help calls, telecare, and Near Me video conferencing facility.

Pat Matheson With regard to telecare there are a lot of other pieces of equipment that can go into a person’s house to keep them safe at home. Medical Physics in Inverness maintain and repair equipment.
Ruairidh MacKinnon Skye & Lochalsh Housing Association also supports community equipment and technology devices in Skye. Telecare has annual maintenance and rapid response provision which is a Highland wide
service. The housing association will go out, assess and fix equipment or arrange for a replacement while sending the other piece for repair. S&LHA confirmed they could cope with more.

Norman Sutherland to the panel What is the panels view for community beds?

Tracy Ligema Nobody knows at this stage if 12 beds is the right number, this may change.

David Park We need to consider what type of beds we need. The waiting list for care home placement is small, and the way we care for people changes over time. Capacity is not linear. When planning, we need to plan in flexibility to meet the needs of an individual and not be restricted by beds or people, e.g. a respite bed for someone who
may not need a hospital bed, so a step up or step down bed is important for rehab.
We need to provide supported care in the right place. We will look at demand over time to plan capacity.
Norman Sutherland Mairi, you said last week we need to be flexible Mairi MacDonald You have to have different types of beds, have flexibility and staff accommodation. Don’t restrict people to working in one place.
Dr Hannah MacLeod The numbers presented in the table is an arbitrary number and we don’t decide on the numbers presented as this doesn’t include emergency need. People may remain in MacKinnon Memorial Hospital because there
is nowhere else for them to go for ongoing care.

Norman Sutherland We need better quality data including the variation.
Dr Hannah MacLeod The need is going up.
Martin Lesley Are we getting away from the fact that Portree is the capital of Skye; we have a school and need proper facilities. Does the panel think we have them?

Tracy Ligema The future model will be based on factual need.
Norman Sutherland Do we need a model that doesn’t include beds?
David Park No. Services have changed over time, we are doing more activity 
but in a different way.

Dr Al Innes Things wax and wane, and bed capacity fluctuates. It is rare to send
anyone away from Skye due to lack of beds. We keep care as local as possible.
The need for people is different, younger adults don’t always need a stay in bed.

Norman Sutherland The audience were asked to think about the fact that the decision about the new hospital in Broadford is made so we don’t need to worry about that. Sometimes it is unhealthy to divide capacity into
too many different bed categories. Keep the point made about

Catriona MacDonald Is there a need for medically supervised beds, I feel there is.
David Park Things have improved, 24/7 urgent care, 6 beds open the others opening in full by the end of March. This give the community the opportunity to assess what community bed care is needed. Loss of 45 beds in the community and need to consider the private enterprises in the community.

Myra MacLeod What about people in care homes, what happens if the care home

closes, where do people go?

David Park NHS Highland has a responsibility for people in a Care Home and supporting stability in care homes is very important to NHS Highland.

Myra MacLeod I’ve heard there is a queue of people waiting to be assessed as a social worker had left and was not replaced.

Kate Earnshaw People are prioritised for care and NHS Highland does not have vacancies in the social work team to assess.

Anne Gillies Are there people from Skye in a Care Home away from Skye?
Tracy Ligema Yes, there is one person who would like to come back to Skye.
Norman Sutherland We need to factor in things which we don’t do, what are those 

Dr Hannah MacLeod New GP run beds, enough nursing and residential beds, more home
care hours and an increase in the number of care at home people. More sheltered housing perhaps, or the Care Village idea.

Norman Sutherland Is the Care Village an option?
David Park People’s care goes beyond services. The term Care Village provides  
elements from different organisations, or NHS Highland looking after our community. Social isolation is a real issue; the whole point of a care village is to wrap services around people. Need to organise
ourselves with all our assets in common.

Mairi MacDonald There is no common staff bank, is there a way around that?
Norman Sutherland Coming together brings more benefits. We should not be 
competing against each other and there are things we can do about this.

Caroline Gould What does NHS Highland do for carers if there is no Anticipatory Care Plan and things go wrong?

Ross MacKenzie There is a policy that NHS Highland follows. The community are
aware of people who are only a step away from needing more support. A Needs Assessment is carried out to address issues.
Caroline Gould Do you consider a Care Home a suitable place for an 18 year old?

Ross MacKenzie No, there are other options. This can be factored in when doing the Options Appraisal work.

Caroline Gould Do you have anticipatory care plans for people?
Dr Hannah MacLeod Yes, we do, and we try to have extra information for Out of Hours
or emergency care available electronically. We can have all the
plans, but have to work with what we’ve got.

Dr Al Innes It is not always possible, we need to flex and react to situations. To have an anticipatory plan for all patients is a huge piece of work. When looking for emergency respite, there is not always capacity, the stop gap is MacKinnon Memorial Hospital.

Norman Sutherland to Caroline Gould Are you willing to compromise to deliver flexibility?
Caroline Gould Yes, need to be flexible but needs to be inclusive for all.
Catriona Leslie Loneliness can be a problem for patients in the single rooms; can 
we have flexibility around single rooms?

David Park The Scottish Government tells us new builds have to be 100% single
occupancy rooms. There may be potential to have a hybrid model, but we can’t call it a hospital because of the connotations.
Mairi MacDonald Initially the community called it a hospital because people who

work there may think they are out of a job.

David Park No one should feel their job is threatened by what is being

discussed this evening.

Ruairidh MacKinnon LSHA are looking at supported housing/healthy homes and

discussing options with partners in Skye. Housing would be part of the care village

Pat Matheson Everything we are talking about here seems to be centered around
Portree. There are other remote communities in North Skye to consider.

Norman Sutherland Are we having a Portree centered conversation?
Ruairidh MacKinnon This model can be within any community. This is about keeping 
people at home in their own community.

Norman Sutherland Does that spread people too thinly? Do we accept that the options
we are discussing can be delivered across North Skye, and what is the impact on staff?

Dr Hannah MacLeod There are significant travel times, and there needs to be sufficient
numbers to support facilities. The closed care home beds have come from outlying communities, we need to do more to support people to stay at home. In terms of staff the logistics are different.

Norman Sutherland As we develop options we will look at elements out with Portree.
Anne Gillies Should we consider more day care places?
Dr Hannah MacLeod Yes, day care is a lifeline. This is quite different to a day hospital
which is a single place people can access all services such as
physiotherapy or occupational health.

Norman Sutherland to Fay Thomson Is day care part of the answer, and does NHS Highland have to
provide day care?

Fay Thomson Yes and yes, the community feel it is. This keeps people healthy and active. There are no nursing homes in south Skye. There are several “Men’s Sheds” in Skye which have been very

Pat Matheson A lot of people in outlying areas get taken in to Portree by bus to access services. Transport needs to be provided.

Norman Sutherland We have to understand services that make sense to deliver for a small numbers. The challenge is sustainability. Is there a community component here to add value?

Stuart MacPherson There are several well respected 3rd sector organisations in Skye.

Will their services be supported by extra funding?

David Park NHS Highland has conversations with the 3 rd sector, and their stability is important. If one is funded it then excludes others and becomes complicated.

Norman Sutherland The options appraisal will give an opportunity to understand 3rd
sector needs and therefore commissioning on what is needed.
Dr Hannah MacLeod The 3rd sectors support a lot of work in Skye and are vital to
delivery of care. GPs couldn’t do their job without them.