Primary Care Emergency Service – Contingency Measures Update To Board

Three weeks into contingency measures to protect patient safety during the hours of midnight and 8.00am, the numbers of people presenting overnight at the Victoria Hospital Primary Care Emergency Service (PCES) have remained at their usual levels, with around 11 each night between midnight and 8am.

This was the message to Members of the Fife Health and Social Care Partnership Board today (26 April) at its regular meeting. It comes as the Partnership continues to set out the challenges being faced including the growing difficulties in ensuring clinical (medical and nursing) cover in GP Out of Hours Services.

It was explained that there are 150 GPs with PCES contracts, however only 68 provide regular sessions.  This means that GP cover for the PCES service has to be negotiated and arranged on a day to day basis.  At the beginning of April, out of 84 overnight sessions (in a 4 week period) 43 were permanently vacant.

Michael Kellet, Director, Fife Health and Social Care Partnership stated:  “Patient safety comes first.  The Primary Care Emergency Service has had staffing challenges for some time.  Before the end of March through careful planning and strenuous efforts of staff we managed to sustain the existing service which involved 3 centres being open for PCES appointments overnight between 12 midnight and 8am.   One figure is telling. At the end of March, looking into April only 4 of the 28 overnights were fully staffed with GPs.  The clinical advice was clear that in the face of those challenges seeking to maintain 3 overnight centres wasn’t sustainable and would compromise patient safety.

We therefore took action.  We discussed with colleagues in NHS Fife and then made the decision that we should put in place the contingency measures from Monday 9 April.

The Partnership’s Clinical and Care Governance Committee were informed of the need to move to contingency on 4th April 2018 and on hearing of the challenges the service faced, the committee supported the plan.  Clinical and Care Governance having supported the decision we then set about communicating the decision to staff, to the Board, to local and national elected members and to the public.  Ideally, of course, it would have been useful to have given more notice to everyone of the new arrangement but we were in an emergency situation and had to act accordingly.”

Since the contingency arrangements began on 9th April 2018 the demand for the PCES in the overnight period has been as expected with the number of people presenting remaining consistent with normal service delivery – around 11 treatment centre appointments and 5 to 8 home visits across Fife on average.

An arrangement has been made with NHS Tayside to support treatment center attendance in Dundee for patients living in North East Fife – to date this has not been utilised.

Meanwhile, PCES continues to run normally between 18:00 and midnight weeknights and from 08:00 to midnight over weekends and public holidays, with the service available at:

  • Queen Margaret Hospital, Dunfermline
  • Victoria Hospital Kirkcaldy
  • Glenrothes Hospital
  • St Andrews Community Hospital

Addressing the Board, Seonaid McCallum, Associate Medical Director with the Partnership stated:

“We have a duty of care to provide safe care for the whole of Fife.   We also needed to rapidly support our GPs with an experienced multi-disciplinary team including Urgent Care Practitioners and specialist paramedics. It would have been unacceptable and clinically unsafe to have adequate cover in some areas of Fife and not others. The only clinically safe option was to ensure we entered into a contingency which allowed flexible working with medical staff across fife so that we could respond to clinical need.   Moving to contingency measures has ensured we can still see patients at a treatment centre but also respond flexibly to see people at home across Fife in a fair and equitable manner.”

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Fife hospital tests new model of housing help for homeless patients 

Homeless people attending A&E at a Fife hospital are to be given specialist housing advice as part of a ground-breaking service delivered by charity Shelter Scotland and Fife Health and Social Care Partnership (HSCP).

Victoria Hospital, Kirkcaldy

It’s hoped the new service can improve the lives of patients with multiple and complex needs and save vital NHS resources by getting the right advice to people in hospitals who might otherwise not seek out help with housing problems.

Two specialist advisers will be based at the Victoria Hospital in Kirkcaldy during the two-year trial which has its formal launch today (23 April 2018).

Alison Watson, Deputy Director for Shelter Scotland, said:  

“People experiencing homelessness are more likely to suffer from ill-health and the lack of stable, suitable accommodation is a big factor in this. A good home is fundamental to our health and well-being.

“This project aims to demonstrate how improved links between healthcare and housing can deliver better health for patients and be more cost effective for the NHS by cutting the number of repeat visits.”

The project is backed by £173,000 of funding with the majority being supplied by Shelter Scotland with contributions from Fife HSCP and Fife Council.

Homeless people are 3.8 times more likely to attend A&E and 2.2 times more likely to be admitted to hospital than people who are settled in a home of their own.

During the project health staff will refer patients who are homeless or at immediate risk of losing their home to Shelter Scotland advisers in the hospital who will work with them to resolve housing issues. Among the expected benefits are a reduction in delayed discharge cases.

In the first six weeks the service has seen 19 people benefit, with the majority of patients only having to wait 24 hours before they leave hospital rather than the average six weeks.

Michael Kellet, Director of Fife Health and Social Care Partnership, said:  “We are delighted to be working with Shelter Scotland to bring this vital initiative to Fife. The early signs are positive.

“People who are homeless or at risk of homelessness often have varied and complex needs.  By partnering with Shelter Scotland, we are working together to support people into safe and appropriate accommodation earlier.

“By working as one team our aim is to help prevent re-admissions, and attendances at the Emergency Department by supporting the wellbeing of some of the most vulnerable in our community. I look forward to watching the programme progress over the next 12 months.”

Tricia Marwick, Chair, NHS Fife, said:

“I am pleased to officially mark the launch of an initiative which sees Fife take partnership and new ways of working to the next level.

“We cannot underestimate the value this will bring to people who potentially could be facing an uncertain or unstable future when leaving hospital.  Frontline staff will benefit too as they are reassured that the person leaving the hospital door will go into a more secure and stable environment which they can hopefully call home.”

Those who receive help from the Intervention Service will be asked for their feedback to help health and housing services work more effectively together in the future.

Healthcare Improvement Scotland will provide improvement advice and support to help in the planning of the project and in evaluation of the service.

Dianne Foster, Associate Improvement Advisor, Healthcare Improvement Scotland, said: 

“We are delighted to be invited by Shelter Scotland, NHS Fife and Fife Health and Social Care Partnership to support this innovative project.

“Being able to demonstrate the impact and outcome of new ways of working is not easy and we are pleased to be working in partnership with Shelter Scotland, providing support to the local team to build their knowledge and skills around improvement and to consider how best to evaluate this new service.”

Appointment of NHS Fife Non-Executive Board Member

NHS Fife is looking for a new Non-Executive member to join its Board.

Non-Executive members play an important role in shaping healthcare, guiding the strategies which address health priorities, the needs of the local population, and the delivery of services.

The NHS Fife Board, as a board of governance, has responsibility for a wide range of issues such as strategic planning, resource allocation and health improvement.

Chair of NHS Fife, Tricia Marwick, said: “I am keen to build on the existing strong and focused team of Non-Executives on the NHS Fife Board with an individual who can contribute from a broadly-based background.

“While everyone has some knowledge of the NHS, many people will have specialist skills or talents or knowledge of the local community which could make a valuable contribution to the overall aims of the Board.

“I am particularly keen to hear from individuals who have an understanding of the issues that can impact on the health and social care experience of young people.

“You do not need to be a health expert or have experience of senior management or service on other Boards to apply, and if appointed you will receive support to develop your skills and to learn any new skills you may require.”

Anyone with the essential knowledge, personal qualities and skills to make a contribution to the Board and who is interested in a role which is challenging, rewarding and has a lasting impact on the delivery of healthcare to the people served by NHS Fife, is encouraged to apply.

The Non-Executive member will be recruited for a period of four years. Time commitments vary week-to-week, but on average the role will take up around eight hours per week and will include activities such as Board meetings, committee meetings, background reading and attending stakeholder events.

For further details and an application pack visit the Public Appointments website www.appointed-for-scotland.org or call (freephone) 0300 244 1898.

If you experience difficulties accessing the website, please contact the Public Appointments Team on (freephone) 0300 244 1898, email PA_Applications_Mailbox@gov.scot or write to the Public Appointments Team, Scottish Government, Area 3F North, Victoria Quay, Edinburgh, EH6 6QQ.

Completed applications should be returned on or before Friday, 4th May, 2018.

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Challenges and opportunities

Some difficult decisions as well as opportunities to celebrate have been faced by the Partnership.  The on-going challenge of clinical cover has meant we had to enact contingency measures in our Primary Care Emergency Services overnight. A tough decision to reach but one that ensures patient safety which is our first priority.  We thank the public for their patience and understanding.

Across the Partnership there is much to acknowledge including the three Fife nurses who have been selected to become Queen’s nurses, our award winning Care At Home Team and most recently the announcement of a £10m care village in Methil.

Ahead of the new Carer’s Act going live on 1 April, we conducted a consultation to develop a Carer’s Strategy for Fife. Over 250 unpaid carers took part. Check out our Guest Blog by Scott Fissenden, Change Manager and Carer’s Strategy lead.

What Matter’s To You Day takes place on 6 June and staff and users of services are being asked to share their stories on how we can encourage ever more meaningful conversations between people who provide health and the people, families and carers who receive services. This will help to continually improve our service and the people’s experience of care.

We are also supporting Save a Life for Scotland’s ‘I would press 500 times..’ campaign which is asking everyone in Scotland to get ready to do cardiopulmonary resuscitation (CPR).

 

Michael

Director

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£10m care village will help young and young at heart flourish

The construction of a new Care Village in Methil will see the delivery of an innovative and creative solution which turns traditional thinking on its head.

In a first for the Kingdom, Fife Health and Social Care Partnership (FHSCP), alongside Fife Council’s Housing and Education and Children’s Services are taking an intergenerational approach to build:

  • a new 36 bed residential care home,
  • specific needs housing, and;
  • a new Early Years Centre

all on the site of the former Kirkland High School site on Methilhaven Road.  Funding from Scottish Government, Housing Revenue and Fife Council’s Capital Programme will see a total of just over £10million being invested and was approved by Fife Council’s Policy & Coordination Committee today (12 April 18).

The new care home and the Early Years Centre will be joined together through a shared space which will contain a café, multi-functional space for activities as well as meeting and conference rooms.  The care village will also include a mix of housing designed to meet a range of support needs.

Methil Care Village Artist Impression

 

 

 

 

 

 

 

 

 

 

 

The concept of inter-generational care began in 1976 when a nursery school and a care home were combined in Tokyo. Since then, there have been successful schemes across Europe, Australia and the US.  In the UK it is early days but Fife is proactively working towards care that helps both the young and the young at heart to flourish.

Cllr David Alexander, Fife Council Co-Leader said: “This is a really exciting project. It will provide some essentials – a much needed care home replacement, a contribution to our target of 3,500 more affordable homes and increased nursery capacity to meet the Scottish Government’s commitment to 1,140 hours of early learning and childcare entitlement. But it could be much more than these component parts. What we’re aiming for is a brand new, inter-generational community facility. Bringing children and adults together in activities is beneficial for the people directly involved, and is also proven to build more cohesive communities.”

Co-Leader Cllr David Ross added: “I’m delighted we’ve approved these outline plans. This kind of multi-purpose facility at the heart of communities is exactly what we’ve described in our Plan for Fife. This building will integrate a range of services provided by the Council and the Health & Social Care Partnership and has the potential to involve many community groups. Designing local services around people in this way will help us create thriving places and support successful and confident Fifers.  The nursery element is dependent on funding coming from the Scottish Government’s 1,140 hours expansion programme, which we expect confirmation of in May. However, we’re hopeful that this new care village could be open by summer 2020.”

Cllr David Graham, Health and Social Care spokesperson for Fife Council welcomed the announcement: “I am delighted that not only will Methil have a new care village but it will be part of a movement to nurture and develop contact between young and older people.  In today’s world, this has never been more important.  I am pleased to see services working in partnership to not only deliver high quality care but to also help build and strengthen communities by taking such an innovative approach.”

David Heaney

David Heaney

Leading the programme of work for Fife Health and Social Care Partnership, David Heaney, Divisional General Manager (East) gives more information on the inter-generational approach:   “We see the approach we are taking in Methil as having benefits across generations as the service users share and learn from each other’s perspectives.

We have always encouraged younger and older generations to visit and mix, whether this is through accommodating visits to our day centres or care homes from nursery and primary school pupils.

 

Our vision for the Methil care village is to see people live, play and connect as part of one shared community.  The approach also extends to the gardens where there will be outside space which will provide opportunities for shared learning and social activities in a safe environment.”

John Mills, Head of Housing Services, Fife Council states the commitment to increasing housing opportunities for older people and for people with specific needs to remain in their community:

“The Methil Care Village is a vital commitment in the Council’s Affordable Housing Programme to build extra care bungalows and specific needs housing for people in the Levenmouth area.  Built to a very high standard, these individual homes will enable tenants to remain in the community with the ability to use support and care services as part of the Care Village.”

Clark Graham, Education Officer, Fife Council welcomed this new approach to early learning and childcare:

“Whilst ensuring we provide sufficient capacity for those children in the Methil area to access their entitled funded time in nursery, this is an exciting, innovative opportunity to support a planned approach to intergenerational work.  The benefits which will be provided by our youngest children playing and learning alongside the care home service users and residents can only strengthen the links and relationships within the community both now and in the future.”

Three Fifers selected to become Queen’s nurses

Three Fife nurses have been selected to take part in a special professional development programme that will earn them the right to use the coveted Queen’s Nurse title.

The Queen’s Nursing Institute Scotland (QNIS) was established by Queen Victoria in 1889 in honour of her Golden Jubilee. Historically, the Queen’s Nurse title was awarded to nurses who completed training that equipped them to work in the community. They provided healthcare and health promotion to people in their own homes, and were well respected in the communities in which they practised.

Pauline Buchanan, Community Dermatology Nurse Practitioner based in Dunfermline; Lyndsey Forsyth, ADHD Nurse Specialist based in Kirkcaldy; and Gerrard Hastie, Community Psychiatric Nurse based in Leven, make up three of the 21 community-based nurses from across the country selected by the QNIS to join this year’s Queen’s Nurses Development Programme.

This is the first time that Fife will have three nurses inducted into the programme in a single year.

All candidates were nominated having demonstrated their commitment to high quality, compassionate care. They then completed a written application and were chosen to go forward for the programme after attending a selection event where they impressed a panel of nursing leaders.

The new Queen’s Nurses will take part in a nine-month programme, developing and honing their existing skills and capabilities, culminating in an Awards Ceremony in December.

(L to R) Sally O’Brien (Lead Nurse), Gerrard Hastie (Community Psychiatric Nurse), Ken Quinn (Head of Nursing – FH&SCP), Lyndsey Forsyth (ADHD Nurse Specialist), and Jackie Young (Service Manager – Community Child Health Services)

Once they have completed the QNIS development programme, the modern Queen’s Nurses will support new models of care to promote health improvement and local delivery of services.

On their selection to the QNIS development programme, NHS Fife Director of Nursing, Helen Wright, said:

“I am delighted to see three Fife nurses inducted into this year’s QNIS Development Programme.

“Our inductees have each been selected because they have demonstrated a real passion and commitment to continually improve the care and treatment offered to patients in Fife.  With an ever increasing amount of care now able to be delivered safely in our communities, their participation in the programme is likely to positively influence the nursing care offered to patients across Fife in the years and decades to come.”

Ken Quinn (Head of Nursing – FH&SCP) and Pauline Buchanan (Community Dermatology Nurse Practitioner).

Reflecting on her induction to the QNIS development programme, Pauline Buchanan said:

“I am delighted and honored to have been selected for the Queen’s Nurse Programme.  It is a very exciting opportunity to make change happen in creating new ways of working.  Hopefully it will also provide the best possible care in the community for persons living with long term skin conditions.”

Upon her selection, Lyndsey Forsyth said:

“It is a real privilege to have been selected for the Queens Nurse Programme.

“The experience so far has been inspirational and I am excited about the journey ahead. I am especially looking forward to the opportunity to cascade my learning from the program into our service for the benefit not only of colleges but our patients and their families”

 

Lastly, Gerrard Hastie said:  “Undertaking this development programme is a great privilege and I feel genuinely humbled to be doing this.  The QNIS programme is an opportunity to build on my skills as a community nurse and ultimately this will benefit the people in my care.”

About QNIS:

QNIS was established in 1889 thanks to a donation from Queen Victoria on the occasion of her Golden Jubilee

  • QNIS originally trained nurses for community district work, with the last award made in January 1969. Since then, QNIS has become a charity, promoting excellence in community nursing to improve the health and wellbeing of the people of Scotland.
  • QNIS is based in the same building that training took place in, going all the way back to 1890.
  • To learn more about Queen’s Nurses in Scotland, visit their website.

 

And I will press 500 times….

Every year over 3,000 people around Scotland are treated by the Ambulance Service after having a cardiac arrest. Unfortunately, only around 1 in 20 people will survive. An important contributor to this is the delay in the casualty receiving cardiopulmonary resuscitation (CPR).

For every 60-seconds that passes after cardiac arrest before CPR is performed, the chance of survival falls by 10%.

Starting CPR can save lives. It at least doubles the chances of survival.

Save a Life for Scotland is asking everyone in Scotland to get ready to do CPR.

Save a Life for Scotland is a movement. A collaboration of partners committed to getting Scotland CPR ready in order to save hundreds of lives across our country each year.

Shona Robison, Cabinet Secretary for Health & Sport

“Any CPR is better than no CPR – it saves lives and this film is a great way to learn those lifesaving skills. The latest statistics show around half of adults in Scotland are confident giving CPR and to date more than 200,000 people across the country have learned CPR since 2015. This is testament to the work put in by SALFS partners, who have brought these lifesaving skills to people across the country.”

Lisa MacInnes, Director of the Save a Life for Scotland campaign

“We hope that 500 miles will become the CPR anthem for a generation in Scotland. This familiar tune will remind us that CPR is the right thing to do and the beat helps us remember the right rhythm for chest compressions. Someone who is having a cardiac arrest needs help, you cannot make the situation worse for them. You can be the one to help buy them time until the ambulance arrives and save a life.”

Save a Life for Scotland Partners:

British Heart Foundation British Red Cross
Joint Forces Command Lucky 2 Be Here
Resuscitation Research Group Royal Life Saving Society
Scottish Government Scottish Fire & Rescue Service
St John Scotland Scottish Ambulance Service
Police Scotland Chest Heart & Stroke Scotland
East Neuk First Responders

Overnight Primary Care Emergency Services in Fife – Contingency measures

Fife Health and Social Care Partnership are introducing contingency measures overnight in the Primary Care Emergency Services (PCES) in response to nursing and medical staffing difficulties.

Patient safety is our primary concern and measures have been put in place to ensure services are being provided with safe levels of nursing and medical staffing.

PCES (commonly called Out-of-Hours services) provides urgent care to the people of Fife when GP practices are closed. Contact with the service is via NHS24 (freephone 111), with urgent care provided by a team of healthcare professionals in centres across Fife.

From Monday, 9 April, 2018, all PCES centres will continue to operate as normal from 6.00pm to midnight (Monday to Friday) and 8.00am to midnight (weekends & public holidays).  However, overnight, from midnight to 8am, no PCES services will be delivered at:

  • Queen Margaret Community Hospital, Dunfermline
  • Glenrothes Community Hospital, Glenrothes
  • St Andrews Community Hospital

Overnight PCES services will be available at Victoria Hospital, Kirkcaldy.   This contingency measure will be in place for a three month period.

There will be no changes to the operation of the Minor Injuries Unit at Queen Margaret Hospital, which will continue as normal.

Fife Health & Social Care Partnership continues to make every effort to resolve clinical staffing difficulties as quickly as possible.

Dr Alan McGovern, Clinical Director (West Division), Fife Health and Social Care Partnership stated:

Dr Alan McGovern, Clinical Director

“The safety of every single patient is in Fife is our first priority.  As with most areas in Scotland, difficulty in recruiting GPs and Primary Care medical staff for out of hours work has put enormous pressure on delivering the service.

“In Fife, the out of hours service has only been able to maintain cover through daily monitoring and enormous efforts by all staff.   Unfortunately we are now in a position where we are unable to cover all the overnight shifts, meaning we have had to move to contingency measures to ensure patient safety.  Between midnight and 8.00am, around 11 people attend Queen Margaret Hospital, Glenrothes Hospital and St Andrews centres in any one night. They will now go to the centre at the Victoria Hospital, Kirkcaldy.   Home visits, for those who require them, will not be affected. These contingency measures will be reviewed in three months.”

The longer term plans for Fife’s Out of Hours services

The current Out of Hours services (PCES) service in Fife is experiencing:

  • Reducing numbers of GPs and Nurses available to work evenings, holidays and weekends.
  • Clinical and professional skills being spread across 4 centres, and;
  • An inability to ensure a sustainable and safe level of response for the public if the model continues in its current shape

To address these issues, clinical staff and partners across Fife are working to develop a longer term solution for urgent care services alongside other proposals for more joined up care in Fife and hope to consult on those plans later this year.

Michael Kellet, Director, Fife Health and Social Care Partnership said:

“We’ve had to take immediate action in relation to Primary Care Emergency Services in Fife to ensure we can continue to deliver a clinically safe and sustainable service over the next few months.  As we do so we will continue to develop our plans for the longer term measure for urgent care.  We will consult the public on those longer term plans before any permanent decisions are made.”

Please click here for Frequently Asked Questions.

 

 

Duty of Candour

From the beginning of April it will be a legal requirement for health, care and social work providers to inform people (and their families) when they have been harmed physically or psychologically as a result of the care or treatment they have received.

Organisations will also be required to review each incident and consider support available to those affected.

You can find out more on these pages about the Duty of Candour provisions along with useful links to other information and support, including LearnPro modules.

The duty of candour provisions in Part 2 of the Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016 were given Royal Assent on April 6, 2016 and regulations setting out the procedure have been published. They come into force on 1 April 2018.

What is the duty?
A legal requirement for health and social care organisations to inform people (and their families) when they have been harmed (either physically or psychologically) as a result of the care or treatment they have received.

To whom does the duty apply
All health and social care providers, including Health Boards.

When does it apply?
If an unintended or unexpected incident occurred in the provision of a health service, a care service or a social work service to the person, and in the reasonable opinion of a registered health professional that:

  • that the incident appears to have resulted in or could result in one of the specific outcomes listed in the act
  • that the outcome relates directly to the incident rather than to the natural course of the person’s illness or underlying condition.

What outcomes trigger the duty?

  • the death of the person,
  • a permanent lessening of bodily, sensory, motor, physiologic or intellectual functions (including removal of the wrong limb or organ or brain damage) (“severe harm”),
  • harm which is not severe harm but which results in: (i) an increase in the person’s treatment, (ii) changes to the structure of the person’s body, (iii) the shortening of the life expectancy of the person,
  • an impairment of the sensory, motor or intellectual functions of the person which has lasted, or is likely to last, for a continuous period of at least 28 days,
  • the person experiencing pain or psychological harm which has been, or is likely to be, experienced by the person for a continuous period of at least 28 days,
  • the person requiring treatment by a registered health professional in order to prevent one or more of the outcomes mentioned above.

What must be done?

In respect of an incident, the responsible person (i.e. the Health Board) must give the relevant person*

  • an account of the incident insofar as the responsible person is aware of the facts at that date
  • an explanation of the actions that the responsible person will take as part of the duty of candour procedure; and
  • where the procedure start date is later than one month after the date on which the incident occurred, an explanation of the reason for this.

The responsible person must:

  • offer a written apology to the relevant person,
  • invite the relevant person to attend a meeting, and set out the information to be provided to the relevant person during and after such a meeting,
  • carry out a review of the circumstances which it considers led, or contributed, to the incident,
  • provide training and support to relevant employees,
  • keep a written record for each incident

 

* Relevant person means either the person who has received the health service or, where that person has died or lacks capacity, a person acting on their behalf.

 

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The Carers Act is now live

The Carers Act went live on 1 April 2018.

During January and February Fife’s Health & Social Care Partnership was consulting with carers before the introduction of the new Carer Act.  The Act came into life from 1st April 2018 and introduces a range of new duties designed to support carers’ health and wellbeing and help make caring more sustainable.

Check out our Guest Blog where Scott Fissenden, Change Manager who is leading the Carers Act work talks about how Fife has been preparing and what happens now.