The Sir Lewis Ritchie Report
So what is the Sir Lewis Ritchie Report... and what does it mean for us here on North Skye & Raasay??
Sir Lewis Ritchie has carried out an independent review of the sustainability of Out of Hours services in Skye, Lochalsh and South West Ross, particularly in North Skye, Raasay and Glenelg.
The Report from this review sets out recommendations for improvement of these, and related, services. NHS Highland have accepted the findings of the report, and an implementation project in now in hand.
Date of next Sir Lewis Ritchie Steering Group meeting : 22nd November '22
Transport & Access
Neil Campbell & Caroline Gould
Centre of Excellence
NHS Highland – A Vision for North Skye in 2021 and Beyond
Louise Bussell , Chief Officer , NHS Highland
'I joined NHS in July last year and took on the role of Interim Chief Officer for North Highland in November. Since then I have been getting to know the challenges and, most importantly, the opportunities for the future. One of the greatest opportunities that I have seen already is the passion and commitment of our communities to work with us and our partner organisations to make health and social care services the best they possibly can be.
I welcome this chance to set out NHS Highland’s vision for North Skye (and indeed the whole of Highland). The ambition is for people to receive care in the right place, at the right time and from the right services. This will include ensuring people can be at home, wherever possible and appropriate, with a focus on the Home First approach. This will involve making best use of equipment, adaptions, technology and Care at Home services while recognising the absolute need for high quality in-patient, care home and out-patient facilities including urgent care provision and a network of other support services. In both the development and provision of services in collaboration with the community, we will continue to work in partnership with all other organisations including the Council, Third Sector organisations, housing providers, the Scottish Ambulance Service, Highlands and Islands Enterprise and the Scottish Government.
In North Skye, we have been active participants in the Sir Lewis Ritchie Implementation Steering Group and would like to place on record our appreciation of the positive contribution and commitment of Maggie Cunningham in her role as Independent Facilitator and chair of the Steering Group. We wish her well for the future as she steps down from that role.
At last week’s meeting, the Group heard that the Board continues to be involved in the Options Appraisal and recognises the need for the communities’ views to be front and centre in this key piece of forward planning in line with the Sir Lewis Ritchie recommendations. It is essential we keep this in focus as we plan ahead. Norman Sutherland, the Independent Clinical Advisor, reported progress to the Steering Group following three multi-stakeholder workshops and a large number of smaller meetings, all conducted using the Zoom VC platform. He and we recognise that there is understandable anxiety about such a fundamental part of planning for the future and that getting this right is clearly essential. To this end, as we move out of restrictions and some travel is allowed, Norman and the project architect visited Skye to get more of a feel for the locations and facilities and I did the same last week. For me, it was great to see our services in action and to meet with staff who were truly motivated and positive about the care they provide. Norman reported at the Steering Group the need for two further meetings to be assured that the options under consideration are the right ones for North Skye. I am happy to support this extension to the programme as we need to do this properly for all concerned.
Last week’s Steering Group meeting was due to be the last one. However, being mindful of the ongoing Options Appraisal work, I have agreed to chair a further meeting at the completion of that process. We then plan to establish a new forum to continue the work needed to ensure ongoing quality improvement is achieved for the whole of Skye. I welcome the opportunity to take a role in leading developments as I recognise it is essential that as an accountable organisation we work closely with the community and partners and move forward together.'
Updates and Community Health & Wellness newsletters
Last updated April '21
Urgent Care in Portree
Urgent care in Portree has been impacted like everything else. There has been a knock-on effect of course, mainly due to the covid assesment centre for Skye & Lochalsh being based in Portree Hospital. This has been manned by the ANP team. However they have continued to do their very best to manage urgent care throughought the last year of lockdown despite restrictions. We continue to be involved in the Options Appraisal which will shape the future of Urgent Care and other services in North Skye
Sir Lewis Ritchie’s last review of progress was in October 2020 and following this he wrote “The spirit of pulling together and co-production were both evident and compelling”. Since then we’ve been developing a new Community Forum that will aid communication between existing groups concerned with health and care in north Skye and Raasay. This Forum will be inclusive and is being formed to help people raise questions and concerns about health and care provision so we can all work together to address these. It will link in with a new Partnership group that will build on what has been achieved so far. The Partnership will oversee coproduction between community members and the organisations already working together: NHS Highland, Scottish Ambulance Service, NHS24, Lochalsh & Skye Housing Association, Lucky2Bhere, and community trusts and community councils involved in providing the support that has become so important during Covid. The way forward is for communities like ours to be much more involved in how our public services are delivered. ore information about how to become involved will be made available and we encourage as many as possible to do so. More information about how to become involved will be made available and we encourage as many as possible to do so. You can find out more about these groups at ……… Covid has made it more difficult for all of us to know what’s going on but its also been a time when we’ve discovered how to communicate using zoom and other tools. The power of working together between communities and services has also been shown and we aim to build on that as life hopefully returns to more normality soon.
Community Beds in Portree
Whilst COVID restrictions are being released for the country as a whole the NHS has just been advised by Scottish Government that the NHS is remaining on an emergency footing until at least the 30th June 2021. What this means for us in Portree hospital is that we need to maintain the Covid Assessment Centre(s) (CAC's) and this will continue to operate alongside our Urgent Care Centre. The reopening of beds with Portree hospital will be subject to guidance from the Scottish Government around standing down CAC's and remobilising services. Depending on the guidance we may need to look at how the hospital operates, for example in relation to entry and exit routes or how we limit contact between visitors during visits. All this may have an effect on when or how many beds can be reopened. At this time 7 beds are open and in use at Portree hospital.
Our residents are often reluctant to go off Raasay at this time, so we are so relieved that our nurses were in place before Covid threw everything into chaos. They are doing a great job and their presence makes a massive difference to everyone caring for relatives or neighbours on the island. We can't praise highly enough all those involved in the recent medical emergency evacuations from Raasay. It's a truly amazing service. Thanks again too for the continuing work of Skye Community Response in delivering prescriptions to the ferry every week for those who have difficulties in getting them any other way. The updated leaflet from SCR has now arrived on the island and will be delivered to each household soon.
Near Me was initially introduced in NHS Highland just over 3 years ago with the aim of reducing the number of patients having to travel long distances to attend an appointment. In February 2020 there were around 80 mainly outpatient waiting areas set up and offering video appointments to their patients.
COVID changed everything and Near Me was very quickly scaled up not only for outpatient departments but for GP practices, community nursing and many more groups of clinicians. There are now over 400 waiting areas. Near Me is now an integral part of normal day to day patient care. Patients, where appropriate, don’t have to travel, take extended time off work or find someone to cover their caring responsibilities and is just as valuable for those living close to a Hospital as those living some distance away. The majority of Near Me appointments take place in the people’s homes but with support from rooms set up’s at Community Hospitals, some GP practices and community groups.
It’s easy to use: when you receive confirmation of your clinic,just visit the NHS Highland Near Me website https://www.nhshighland.scot.nhs.uk/NHSNearMe
There’s no app to download – you just need a suitable device (smart phone, tablet or laptop with speaker and camera) and a reliable internet connection. Why not try a test call at https://nearme.scot dialogue between NHS24 and our communities could only be a positive thing. NHS24 is here to stay, so we must try to understand how they operate and why procedures are set up as they are. The PPF gives us the opportunity to explain the effect of these procedures on remote and island communities and highlight what works well for us and what does not. Further update early Jan - Andrina Robb , Near Me Project Manager
“We are delighted to be working in partnership with the Near Me Community Initiative in Skye & Lochalsh to support people to access Near Me Appointments in their own homes or local area. Staffin is the first area to test out this support, with Raasay coming on board soon. Next steps will be to offer encouragement and support to other interested communities in Skye & Lochalsh and the rest of Highland thereafter.” - Mairi MacIvor, Health Enabled Care NHS Highland
Transport & Access
The group continues to met regularly with Derek Halden's report which has now been approved for action. The group is looking at how to action the report and have identified a considerable amount work in bringing it all together. A report has been produced and will be discussed further at the next Steering Group meeting. To this end they are looking at funding for a project worker to action some of the recommendations of the report.
Centre of Excellence
The vision for the Centre for Excellence is for it to support improved and effective health and care service delivery by maximising and establishing excellence in community engaged, multidisciplinary and multiagency models of health and care, practice, education, training and digital innovation. This will support service sustainability, resilience, improved recruitment and retention of skilled staff and the sharing of models of excellence for the continuous improvement of the health and wellbeing of people in remote, rural and island communities throughout Scotland. The CoE will raise the profile of remote and rural practice as a career choice and place the spotlight on Scotland for excellence in developing and delivering effective and innovative multi-agency models of remote, rural and Island health and care from a national and international perspective. More information on the Centre of Excellence is available at: https://learn.nes.nhs.scot/27194/rrheal-covid-19-support/scottish-centre-of-excellence
As a result of the Covid 19 pandemic work had to be put on hold for part of 2020 but was restarted in October last year. The CoE Working Group are currently applying for funding to support the next stage of developing the CoE and working to identify accommodation for the CoE main hub on Skye.
The CoE Working Group recently submitted a funding bid in partnership with colleagues in NHS England to The Health Foundation, which is an independent charity committed to bringing about better health and health care for people in the UK. Their aim is to have a healthier population, supported by high quality health care that can be equitably accessed. RRHEAL are currently waiting on the results of their proposal submission. More information on the health foundation can be accessed at: http://www.health.org.uk/
The group has established four interdependent practical working groups: Training and Education, Retention and Recruitment, Digital Innovation and Social Accountability. Each of the subgroups has a lead person, specific objectives and deliverables. The aim of the subgroups is to enable key expert partners to collaborate at a practical level to produce and progress programmes of work in accordance with the CoE purposes and functions,
In his report of 2018 Sir Lewis Ritchie recommended the following regarding Digital Innovation: We recommend that:
a) Ongoing collaboration with the Digital Health & Care Institute should continue to explore and evaluate emerging digital technology to enable remote monitoring and video consultations from people’s homes.
b) A review of video-conferencing facilities at all relevant care sites should be undertaken to provide reliable 24/7 professional-to-professional communications On his (virtual) assessment of progress to date on the implementation of his report in October 2020 Sir Lewis emphasised the importance of embracing new digital technological developments in health and social care in the light of the pandemic. The main initiative to come from the Digital Innovation group is the creation of a Skye lab.
Skye Lab has two components: a digital living lab, inspired by the Living Lab concept (A ‘Living Lab’ is a user-centred, open-innovation ecosystem integrating concurrent research and innovation processes within a public-private-people partnership. (ref Living lab - Wikipedia)); the other component being a physical training site. The Skye Lab concept has several potential layers: a base for training health and social care professionals, and community members; demonstrating digital services, possibly online, that can assist independent living; research into remote/rural application of innovations developed in urban settings; academic research (eg postgraduate students) into digital innovations for remote rural communities. This proposal involves working in partnership with Portree-based company Sitekit Ltd, an SME focussed on digital innovation that works at a national level with NHS England and NHS Scotland on digital transformation projects. Sitekit has offered the use of premises to host the facility pro-bono for the initial 6m proof of concept period. There has already been a considerable appetite from a range of clinicians for using the premises for training purposes and it is hoped that the first training sessions will take place in early March. A sub-group of the DI group has been set up to take forward the Skye Lab concept and to provide governance and this group is in the process of developing a memorandum of agreement, a business plan and applying for CIC status.
Community members are engaging with NHS Highland and a number of other NHS and public agencies in an Options Appraisal about community hospital and care bed provision in north Skye. These sessions started in February 2020 but had to be put on hold due to the pandemic. The discussions re-started in December, 3 hour virtual sessions using zoom because its still not possible to have actual meetings. A long list of options has been drawn up and the process to cut this down to a short list started at the 4th session in February this year. Community members involved have some concerns about the short list and are raising these with the independent facilitator and NHS Highland. There is a group for wider community engagement for information about the options appraisal and if you would like more information or to give your views...... Catriona Macdonald
Further verbal update from Norman Sutherland, Independent Facilitator given 6th April '21
The North Skye Option Appraisal process has to date included three multi-stakeholder workshops and a large number of smaller meetings, all conducted using the Zoom VC platform. The process is the most involved and complicated Options Appraisal currently being progressed across NHSScotland virtually in reflection of the on-going COVID situation.
Following the third meeting of the option appraisal group, a number of concerns were highlighted by community representatives both directly and via the OA Oversight group.
There is a sense that the purchase of Home Farm has fundamentally changed the OA process
…and that its inclusion within the options is not welcome/popular from a community perspective…
…also that current options mix short and long-term possibilities but lack a real long-term vision or sufficient aspiration
Overall, that as a result of this, we are not ready to score options.
In addition, the suggestion that we are not ready to evaluate options has also been raised by NHSH staff but for different reasons.
It is extremely important for me as an independent facilitator to acknowledge all of these concerns – and also recognise that they must be addressed to the satisfaction of all participants before we can successfully proceed.
Higher Ground Health have therefore developed a proposal that attempts to address these concerns and have asked for a meeting of the option appraisal oversight group to discuss this in the first instance before any further action is taken.
There are two key elements to this proposal:
The agreement of a long-term vision of the future health & social care model by all parties
The evaluation of shorter term options in the form of co-ordinated programmes of change/investment that present these in terms of pathways to this vision – rather than time limited options in their own right
It is important to recognise that none of the work carried out to date will go to waste. Option appraisal is a complicated process – and this is an especially complicated discussion. In so far as we are making decisions that are likely to affect investment and disinvestment decisions for decades to come it is more important, we believe, that we do it right rather than that we do it fast.