Ritchie Implementation Steering Group meeting - Portree, Thursday 15 November 2018

The total number of inpatient beds available in Portree Hospital is now six with a proposal that another six will be open by by May 2019, according to information from NHS Highland at the Ritchie Implementation Steering Group meeting in Portree on Thursday 15 November 2018. Hugo Van Woerden; Director of Public Health at NHS Highland, reassured the meeting that these beds would remain open in Portree until a resilient alternative was available.


David Park; NHS Highland’s Chief Officer for North Highland, said: "Support for the business plan for the redesign of healthcare, and the proposal for building the new hospital in Broadford would be welcomed from the local community. The recommendations from the Sir Lewis Ritchie report are in addition to the business case and will be implemented while developing a longer term vision for North Skye."


There was some concern expressed at the meeting, that the recruitment process for staffing the additional beds was taking longer than originally anticipated. After the meeting, Ross MacKenzie; Area Manager West at NHSH, confirmed that the adverts for additional staff for Portree would be out by Friday 23 November 2018.


The first meeting of the new Raasay Community/NHS Highland Liaison Group faciliated by Dr Miles Mack, was held on Raasay on Wednesday 7 November 2018. The difficulty in establishing an adequate model of care that was acceptable, to the community was recognised. The meeting was a chance to acknowledge and recognise the difficulties that had arisen in trying to establish a new model of care for the Island of Raasay since 2015. There was agreement about actions that can be progressed now. In particular, it was agreed to seek prioritisation of the 'NHS Near Me' project (see below) to link the Raasay community better with the GP practice in Portree, the Rural Practitioners in Broadford Hospital and Outpatient clinics in Raigmore Hospital. At the next local meeting the group will look again at the wider health needs of the island with a view to agreeing an equitable, safe and sustainable model for the future.


Dr Miles Mack is also facilitating meetings with the communities to discuss health care provision in Glenelg and Arnisadale. At the most recent meeting, NHS Highland representatives offered an additional two nights of resident Advanced Nurse Practitioner cover. Whilst this was welcomed as an improvement by the community, it failed to acknowledge the community's concern with lack of a continuing presence - this new provision reduces the average from no cover for 86hr/week to 59hr/week.


Clarification has been received that Broadford is being strengthened by the addition of an ANP on all weekend shifts. The posts to support this are recruited into and are in training. These Advanced Nurse Practitioners would be available to visit Glenelg as required. Broadford also has a Rural Practitioner on duty as well as a second Rural Practitioner on-call. If required, the Rural Practitioner on duty could visit Glenelg and call in the second Rural Practitioner.


The community are happy with this additional support as long as NHS Highland addresses the underlying core service and that this work would not be undertaken instead of addressing the underlying core services that are their main concern.


The meeting also heard that NHS 24 intends to establish a base on Skye next year by working in partnership,with NHS Highland. Billy Togneri; Clinical Services Manager and Stephanie Phillips; Head of Service Delivery, told the meeting that NHS 24 and NHS Highland would work in partnership to deliver a sustainable delivery model for out of hours urgent care. It is proposed that Advanced Nurse Practitioners will support the base and piloting for this will start early in the New Year.


It is estimated that the Scottish Ambulance Service’s Rapid Response Vehicle being proposed for North Skye will require an additional six Paramedic Practioners. Training for these roles could take up to 18 months but it is hoped that the vehicle could be used by both Paramedics and Advanced Nurse Practitioners. This could reduce the timescale for having the vehicle in place and ensure the enhancement of urgent care. However, this requires further discussion regarding roles and competencies of both sets of professionals and funding.


The meeting also heard that a demonstration of 'NHS Near Me' had been held in Portree on 8 November 2018. This new service aims to reduce the need to travel for outpatient appointments. Part of the service has been developed in Caithness and NHS Highland are now keen to co-design the next phase of the service with people in Skye. This first meeting was to raise awareness of the service and it is hoped that a group of people locally will work with NHS Highland on the detail of the next stage.


Councillor Ronald MacDonald told the meeting that North Skye was at a greater disadvantage than other remote areas. Although the metrics used to calculate funding for the health service; known as the National Register of Access Consultants (NRAC), shows that North Skye is an area of extreme rurality, it does not qualify for funding because it is part of NHS Highland. Councillor MacDonald said: "We are funded in the same way as Badenoch and Strathspey, although they are not an area of extreme rurality. Skye does not appear to receive the same level of funding provided to island boards, including the Western Isles, Orkney and Shetland, because it is part of a larger board, NHS Highland.


"I believe that addressing the funding deficit is crucial to implementing Ritchie in full and why NHS Highland have been dragging their feet so much in providing community beds on the island. Lewis and Harris are allocated five beds per thousand whereas we are having imposed a 1.6 beds per thousand ratio."


After the meeting, Catriona MacDonald, Chair of the Ritchie Implementation Steering Group, said: "Community representatives are engaging positively with NHS Highland & partner agencies and are pleased that working groups have reached agreement on the priority recommendations regarding 24/7 Urgent Care and re-opening of twelve inpatient beds in Portree. However it is crucial that these plans become reality before the community will have confidence in NHS Highland’s intentions. It is crucially important for our community to improve local access to the healthcare we need."


Sir Lewis Ritchie is due back in Skye on 4 December 2018 to review progress of his recommendations.

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