The steps required to assure the Scottish Government of progress towards sustaining appropriate emergency and urgent response are summarised below:-

Transcription

1 land NHS Board 1 August, 21 Item.6 UPDATE ON STRATEGIC OPTIONS FRAMEWORK FOR EMERGENCY AND URGENT RESPONSE IN REMOTE AND RURAL COMMUNITIES AND MEMORANDUM OF UNDERSTANDING WITH SCOTTISH AMBULANCE SERVICE Update Report by Milne Weir, General Manager, North Division, Scottish Ambulance Service, and Gill McVicar, General Manager, Mid land CHP on behalf Pauline Howie, Chief Executive, SAS and Roger Gibbins, Chief Executive, NHS land The Board is asked to: Note progress being made in addressing the priority areas that were identified in the June Board Paper. Agree draft delivery programme and recommended timeframe. 1 Background and Summary CEL 21 (21) was issued as a Health Department Chief Executive letter in June 21. It sets out the framework through which the Scottish Ambulance Service and NHS territorial Boards can ensure that there are robust and responsive systems in place within remote and rural communities to respond in emergency or urgent situations. The steps required to assure the Scottish Government of progress towards sustaining appropriate emergency and urgent response are summarised below:- SAS assumes lead role to implement the framework in collaboration with Board and CHPs Mapping of current emergency and urgent service provision to identify gaps SAS in collaboration with Partners, engage local communities to develop options Detailed implementation plans including timescales for delivery by October 21 Existing performance management arrangements to be used to monitor progress on achieving standards New models to be evaluated after 6 months Good Practice event to be held in autumn 21 NHS land Board received a paper in June 21 which noted the updated position on mapping, modelling and gap analysis against the Strategic Options Framework. Since this paper was presented, there have been challenges presented by a reduction in the numbers of doctors available to work in the out of hours service, despite considerable efforts to recruit to vacant shifts and contingency measures including the use of unscheduled care practitioners with remote doctor support, have had to be employed. This has served to underline the importance of building a safe and sustainable multi professional model as quickly as possible. This paper will describe the progress being made in addressing the priority areas that were identified in the June Board paper. It also sets out a draft delivery programme and recommended timeframe for the next 12 months. Appendix 1 contains the draft implementation plan.

2 2 Mapping, Modelling and Gap Analysis NHS land and the North and West Divisions of the SAS are in the process of updating the mapping, modelling and simulation exercises. A summary of the work that has been undertaken to date is included in this paper. It is recognised that further work is required to complete the gap analysis. This work is ongoing and once complete will provide an accurate assessment of current performance against emergency and urgent response standards as set out in the Strategic Options Framework. It will also help to inform what areas require further attention, the types of solutions that may be required and the timelines for taking these forward through detailed implementation plans. A joint workshop is planned for September and the gap analysis will be completed and presented to the Board in October. Appendix 2 includes an updated map of Scottish Ambulance Service and NHS land emergency response resources with a drive footprint of 3 minutes. This provides a useful overview of existing resources but further analysis is required. The SAS in collaboration with NHS land and other partners is committed to engaging with communities to fully understand local issues and explore opportunities for multiagency and multidisciplinary working. There will be no significant new investment available to implement the strategic options framework; however, there are opportunities for partners and local communities to jointly explore how existing resources can be used to deliver safe, sustainable and affordable models of care in the future. Appendix 3 provides some data which will assist SAS and CHP managers to carry out an in depth gap analysis of emergency response resources against the performance criteria set out in the Strategic Options Framework. It is recognised that further work is required on this data and it excludes localities which will need to be included in the gap analysis work. The planning assumptions from this data are that each community shown in the table has a resident population of under 3, the data identifies the RRIG classification of the community, its nearest community with a population of >1, and the 3 minute drive time compliance from the nearest SAS location. The final gap analysis will also show performance against the 3 minute standard for all the actual call outs for a two year period to ensure that all relevant information is considered as part of the risk assessment and prioritisation process. As described in Section 6 which relates to Skye and Lochalsh, similar early approaches have been made with communities to start the engagement process regarding the possibility of developing multi-disciplinary working, and introducing patient centred benefits such as anticipatory care and reduction in avoidable admission to hospital. Once the final data has been analysed using the simul8 modelling tool, a series of community engagement events will follow, in the meantime, the SAS have developed a community engagement toolkit to support its managers in delivering engagement to agreed national standards. 3 Update on First Responder Schemes A First Responder is a member of the public who volunteers to help their community by responding to medical emergencies whilst the ambulance is on its way. All volunteers receive specialist training and equipment so that they can provide an early intervention before the arrival of the professional ambulance crew. Anyone who wishes to help their community can volunteer and no previous medical experience is necessary, although they will need a caring attitude and the ability deal with potentially distressing situations. First Responders are trained in the use of automatic external defibrillators, oxygen therapy and a wide range of emergency skills, including how to assist in life threatening situations such as heart or asthma attack. 2

3 First Responders Schemes are in addition to the statutory ambulance provision, and support patients by responding to assist until the ambulance crew arrives. Table 1 outlined below shows Scottish Ambulance Service First Responder locations in NHS land Board area. Table 1 : SAS First Responder Locations in NHS land Board Area Location Number Of Volunteers Registered Status Description With IHCD Achiltibue 14 Active SAS / land Health Board / Beauly * Active SAS / Cannich 12 Active SAS / Cromarty 8 Active SAS / Dounreay Active Trained to Ambulance Technician Grade Fort Augustus 8 Active SAS / Fort William 9 Active SAS / Helmsdale 11 Active SAS / Airport * Pending SAS Kinbrace 9 Active SAS / Kirkhill * Active SAS / Kyle of Lochalsh 3 Active SAS / British Red Cross Kilchoan tbc Pending SAS/ Lybster & Dunbeath * Pending SAS / Muir of Ord * Active SAS / Newtonmore Active SAS / Rosehall 14 Active Spean / Roy Bridge 8 Active SAS / Thurso 11 Active SAS / Torridon 1 Active SAS / Dalmally 8 Active SAS Isle of Luing 12 Active Strathclyde Police - Dunoon 12 Active SAS / Strathclyde Police Strathclyde Police - Rothesay 8 Active SAS / Strathclyde Police 4 Paramedics and Unscheduled Care Practitioners The Paramedic role is operating in a number of Health Board areas and is staffed by State Registered Paramedics with additional training and education in minor injury/ minor illness assessment and treatment skills. This service model supports the delivery of emergency ambulance services and has shown a high level of efficacy and patient benefit when integrated with Health Board unscheduled care services. A Paramedic Pilot Project will commence in for a period of six months from September 21. The community paramedic will standby at the A&E and Out of Hours Department at Raigmore Hospital and respond to appropriate calls from this location. A detailed evaluation will be undertaken looking at the number and types of calls that were responded to, how many patients did not require to travel to an A&E Department and were either treated at home or treated and referred along a more appropriate care pathway and the number of patients that were conveyed to hospital. 3

4 The use of unscheduled care practitioners will be considered in certain areas to provide both an emergency response and a primary care resource working in partnership with GP practices and other healthcare professionals to provide integrated health provision where required. The use of unscheduled care practitioners is a longer term solution that would require investment for training and for dedicated posts; however the benefits of using these autonomous practitioners linked by telemetry to the main treatment centres would be immense. Practitioners could be introduced within months, which would be dependant on either recruiting trained practitioners or having to train existing paramedics up to this level. Strontian and the Ardnamurchan Area There are two Paramedic Posts and three Ambulance Technician Posts based at Strontian in the Ardnamurchan area. There are currently two vacant Ambulance Technician posts. The Scottish Ambulance Service is making every effort to recruit to these posts and is actively working with local communities, GPs and elected members to attract suitable candidates into the Ardnamurchan area. The recruitment process for the two vacant Ambulance Technician Posts will be completed by the middle of August 21. Strontian Ambulance Station is fully covered with double staffed A/E vehicles 24 hrs per day. Plans are being reviewed to maintain cover until the vacant ambulance technician posts are filled. Paramedics in the Ardnamurchan area will be encouraged to undertake extended skills training with a view to working at a Paramedic level in the future. The Scottish Ambulance Service is working in partnership with NHS land to look at opportunities for introducing the community paramedic and unscheduled care practitioner roles as part of an integrated healthcare team in the Ardnamurchan area. Training commences in Kilchoan on 2 th August 21 for the first First Responder Team in the Ardnamurchan area. Plans for other first responder schemes and locations will be reviewed in partnership with local communities. 6 Skye and Lochalsh Following on from the Skye and Lochalsh Services Workshop held in February this year, meetings between NHS land, the Scottish Ambulance Service, partners and local communities will take place during August and September 21 to review gaps in existing emergency and urgent service provision, and opportunities to capitalise on the available resources and skills on Skye. There is great potential to develop integrated models of care, with the development of Enhanced Nurse Practitioners and Enhanced Skills Paramedics providing services such as anticipatory care in the home. The outcome of these meetings will be an implementation plan with clearly defined activities, timelines and funding streams where these are required. Wester Ross Previous joint planning between NHS land, the Scottish Ambulance Service, partners and local communities has produced the current service model in Wester Ross. The opportunity now exists to review the existing service model, and to plan for the future. To start this process, in Wester Ross meetings will take place during August and September 21 to identify the joint resource and skills available in the area, and to start to design safe and sustainable service delivery models which makes best use of emerging developments in pre hospital care. 4

5 8 Glenelg Linked to the work of the Skye and Lochalsh Services Workshop, meetings between NHS land, the Scottish Ambulance Service, partners and local communities are being planned to start looking at the needs of this community, in particular, around the community resilience needs such as a possible First Responder Service to supplement the current medical and emergency response provision in the Glenelg area. 9 Badenoch and Strathspey There have been meetings between NHS land and the SAS to review the provision of health care in Badenoch & Strathspey. The next CHP locality meeting to discuss service provision and development with partners is scheduled to take place on the 22 nd. September in Kingussie. The SAS currently have a team of 1 Volunteer First Responders operating out of Newtonmore. The Board will be aware of the service redesign trial undertaken by the SAS in the Badenoch and Strathspey area in late 28 into early 29, and may wish to refer to the lessons learned from the trial, in particular, the need for effective public engagement. 1 North West Sutherland The Scottish Ambulance Service will hold interviews during the week commencing 26 th July 21 to identify a Paramedic who will be dedicated to the anticipatory care pilot scheme for a period of six months. It is anticipated that training and mentoring will commence soon after appointment. The anticipatory care pilot scheme will operate in the Lairg and Bonar Bridge areas of North West Sutherland, and will see a Paramedic become part of an integrated care team which will delivers H8 testing to patients in their homes along with more general health and wellbeing advice being offered. The H8 target relates to the prevention of coronary heart disease in the age range 4 to 64. Patients will have a set tests carried out at home, the results of which will be monitored as part of the CHD prevention programme. 11 Oban particularly inner islands The SAS has been working along side the Argyll & Bute CHP to deliver a response to the island communities within the Oban catchment area. An innovative initiative with Strathclyde Fire Service in Argyll and Bute will allow the isles of Lismore, Gigha, Colonsay, Coll, Luing, and Jura to have an ambulance vehicle available to the air ambulance when it attends an emergency on that island. Each island has its own specific challenges with varying levels of response from the Argyll and Bute CHP and SAS first responder scheme. If a life threatening call is made to one of these islands and requires an ambulance crew to attend, the air ambulance will be dispatched and the fire service will lay out landing lights if in the hours of darkness where, on arrival, the air ambulance crew will be met by the fire service on that island. The air ambulance crew will drive the ambulance to the patients location and treat, and then transport the patient to the air ambulance and onward to hospital. The role out of training to Strathclyde Fire Service is commencing in the month of August and implementation to each island can start once this training is complete. With the withdrawal of out hours ferry services to some island locations this initiative is the most appropriate way to deliver patient care to these island communities. Each island will have its own particular system of delivering this initiative with some islands still using other agencies to help coordinate this response. Other islands such as Iona, Kerrerar and Easedale within this area are also being reviewed in partnership with the Argyll & Bute CHP.

6 Oban ambulance station has commenced a reduction in their on call which has increased there availability of live cover over the weekends where demand is at its highest. This is proving to be an increased level of service to the public. 12 Campbeltown Recent meetings between the Argyll CHP and the Scottish Ambulance Service have reviewed gaps in existing emergency and urgent service provision, to develop a range of options for the future and to agree an implementation plan with clearly defined activities, timelines and funding streams where these are required. Long distance transfers of up to seven hours round trip from Campbeltown have been an issue with compensatory rest affecting the ambulance cover in the area. A reduction in their on call working has seen an improvement of the live ambulance cover in the area. 13 Dunoon/Cowal Recent meetings between the Argyll CHP and the Scottish Ambulance Service have reviewed gaps in existing emergency and urgent service provision, to develop a range of options for the future and to agree an implementation plan with clearly defined activities, timelines and funding streams where these are required. Recently a business case was approved by the Argyll CHP to provide an IHT transfer vehicle and crew to transfer patients from the Dunoon area to the GG&C catchments areas. 14 Islay Recent meetings between the Argyll CHP and the Scottish Ambulance Service have, again, reviewed gaps in existing emergency and urgent service provision, to develop a range of options for the future and to agree an implementation plan with clearly defined activities, timelines and funding streams where these are required 1 Lochgilphead The Scottish Ambulance Service is working in partnership with the Argyll CHP to look at opportunities for introducing the community paramedic and unscheduled care practitioner roles as part of an integrated healthcare team in the Lochgilphead area. A more in depth meeting with the hospital staff and management teams is set for mid August. 16 Draft delivery programme and recommended timeframe Appendix 1 sets out the draft implementation plan that will be refined and developed as a result of further discussion and the risk assessment exercise described below. Further work is required and this will be managed through additional resources. 1 Risk Assessment A risk assessment will be taken forward in partnership with local communities to quantify the level of risk against the performance measures outlined in the strategic options framework and local intelligence. One size does not fit all and there will be a requirement to look at different models of care to meet local needs particularly in remote and rural communities. There are opportunities to extend multidisciplinary working by harnessing the skills and expertise of clinical staff working in local communities. This will be supported through profession to profession support, common triage tools, telemedicine and locally available diagnostic tests and investigations. The availability and utilisation of existing resources will need to be reviewed to ensure we have the right skills and workforce in the right place to provide safe and sustainable services in the future. 6

7 18 Next Steps Work on the gap analysis will continue jointly through a small project team. The risk assessment and prioritisation will follow and in parallel some community meetings will be held to ensure that communities already identified as being in the priority list due to challenges in delivering the service or other ongoing change initiatives, have the opportunity to be involved in the process. A full implementation plan addressing the priority areas will be presented to the Board in October 21. NHS land Board is asked to note progress to date and to agree the programme and timescale for the next steps. 19 Impact Assessment The final plan and any resulting areas of activity will be impact assessed. Milne Weir General Manager North Division Scottish Ambulance Service Gill McVicar General Manager Mid land CHP 3 August 21 Encs: Appendix 1 3 Draft Implementation Plan Appendix 2 3 Minute Drive Time Map All Emergency Response Resources Appendix 3 Emergency response resources against the performance criteria

8 NHS Board: NHS land Remote and Rural Implementation Group Appendix 1 Strategic Options Framework DRAFT Implementation Plan The following implementation plan describes the agreed short term implementation plan for the SAS and NHS land for emergency and urgent response in order to meet the standards described within the Strategic Options Framework for Emergency and Urgent Response in remote and rural communities. CHP/Locality Area Mid land Skye and Lochalsh Who will have responsibility How will the responsibility be discharged Process of staff Engagement SAS and NHSH Project Team Meeting with SAS, GPs, RPs and UCPs in advance of public engagement meeting Process of Public Engagement Meeting with Reference Group sub group to be held in August/September Agreed timescales, including key milestones Aug/Sept Priority Mid land Wester Ross Mid land Strontian and Ardnamurchan SAS and NHSH Project Team Meeting with SAS, GPs, RPs and UCPs in advance of public engagement meeting SAS and NHSH Project Team Ongoing meetings between SAS and Mid H CHP staff Meeting with Reference Group sub group to be held in August/September Council, Local Members already engaged, wider engagement planned Aug/Sept Aug/Sept Medium South East land Badenoch and Strathspey SAS and NHSH Project Team Exploratory meeting is planned between CHP management team and SAS to scope possible joint working opportunities tbc 1 st Meeting to be held in September 21 Medium South East land SAS Provision of Paramedic with agreed additional patient care and history taking skills Ongoing meetings between NHS land and SAS Briefing of PFPI Members on Both NHS Boards Secondment Advertised W/comm. 8

9 North North West Sutherland SAS An SAS Paramedic will be dedicated to the pilot scheme for a period of six months. The pilot scheme will operate in the Lairg and Bonar Bridge areas of North West Sutherland. An evaluation report will be produced on completion of the pilot scheme. Ongoing meetings between NHS land and SAS Briefing of PFPI Members on Both NHS Boards Interviews to be held W/comm. 26 th July 21. Argyll and Bute Oban and inner isles Argyll and Bute Campbelltown Argyll and Bute Dunoon and Cowal Argyll and Bute Islay Argyll and Bute Lochgilphead SAS and NHSH SAS and NHSH SAS and NHSH Provision of an ambulance to inner islands which will be available for aircrew attending the island. Local Fire Service personnel will manage the use of landing lights at night. Business case has been approved by the Argyll CHP to provide an Inter Hospital Transfer Vehicle & crew for the Dunoon catchment area. Ongoing meetings between CHP and SAS to identify gaps in service provision Ongoing meetings between CHP and SAS to identify gaps in service provision SAS and NHSH Ongoing meetings between CHP and SAS to identify gaps in service provision SAS and NHSH Proposal being drawn up for the introduction of Paramedic / Unscheduled Care Practitioner Integrated Healthcare Model in the Lochgilphead area. Meetings between Argyll CHP and SAS have taken place re use of Paramedics / UCP s. Training for Fire Personnel ongoing Sept Sept Sept In depth meeting planned for Mid august 21 Medium NHS Board Lead: Milne Weir SAS and Gill McVicar_NHS land Phone Number: Designation: 9

10 Appendix 2 Scottish Ambulance Service and NHS land emergency response resources with a drive footprint of 3 minutes 1

11 Appendix 3 Emergency response resources against the performance criteria Locality Cromarty Milton & Kildary Kilcreggan Strathpeffer Rosneath Auldearn Rosemarkie Evanton Drumnadrochit Fortrose Beauly Avoch Ardersier Conon Bridge Garelochhead Muir of Ord Kirkhill Shandon Balloch Smithton Cardross Rhu North Kessock Isle of Bute RRIG Classification Isle of Islay Isle of Mull Tobermory community Bowmore community Port Ellen community Isle of Tiree Isle of Coll Isle of Jura Isle of Luing Isle of Lismore Isle of Iona Isle of Colonsay Isle of Gigha Isle of Easdale Isle of Kerrera Isle of Ulva Isle of Erraid Isle of Lunga Isle of Danna Isle of Gometra 28 Midyear Population Estimate , ,11 1, 1,38 1,2 1,3 1,2 2,8 1,1 2,19 9 2,2 1,43 2,23 2,1 1, Nearest Pop >1, Drivetime (mins) Elgin /Dumbarton Dingwall Alness Dingwall Nairn Alness Dingwall Dingwall Dingwall Rothesay <8mins 3441 Bowmore <8mins 312 Tobermory <8mins Tobermory Bowmore Bowmore Contractor & GP 1 21 Initiative pending 212 GP & Volunteers First responder / Initiative pending Initiative pending 12 Tobermory 123 Initiative pending 11 Initiative pending 8 Oban 42 Oban 16 Tobermory 8 11 Nearest SAS Drivetime ambulance resource (mins) Oban 9 34

12 Isle of Oronsay Isle of Inchtavannach Isle of Davaar Isle of Innischonan Isle of Sanda Locality Isle of Shuna Portree Port Bannatyne Isle of Seil Golspie Newtonmore Dornoch Kingussie Innellan Inveraray Balintore Nethy Bridge Fort Augustus Grantown-onSpey Sandbank Aviemore Castletown Halkirk Mallaig Broadford Kyle of Lochalsh Tarbert Kinlochleven Dunbeg Ballachulish Ardrishaig Lochgilphead Brora Ullapool RRIG Classification Nearest Pop >1, Drivetime (mins) community community 28 Midyear Population Estimate 1 2,1 1,33 6 1,38 1,6 1,21 1,34 1, , ,3 Largs (ferry) Alexandria Gourock (ferry) 1,11 2, , ,31 2,3 1,18 1,38 Gourock (ferry) /Alexandria /Alexandria 12 Nearest SAS ambulance resource Drivetime (mins) Portree Rothesay Oban Golspie Kingussie Tain Kingussie Dunoon Inverary Tain Grantown-on Spey Fort Augustus Grantown-on Spey Dunoon Aviemore Thurso Thurso Mallaig Broadford Kyle of Lochalsh Tarbert Glencoe Oban Glencoe Lochgilphead Lochgilphead Brora Ullapool