Welcome and Introduction Rani Dhir MBE Chair West Dunbartonshire Community Health Partnership.
112
-
Upload
claribel-wilson -
Category
Documents
-
view
245 -
download
3
Transcript of Welcome and Introduction Rani Dhir MBE Chair West Dunbartonshire Community Health Partnership.
Welcome and Introduction
Rani Dhir MBE
Chair
West Dunbartonshire Community Health Partnership
Purpose of Event and Wider Context
Tom Divers
Chief Executive
NHS Greater Glasgow and Clyde
Health Needs Assessment Dr Linda de Caestecker, Director of Public Health
Key Results
• The population
• Life expectancy and causes of death
• Health behaviours
• Chronic diseases
• Cancer
• Child health
• Mental health
• Service utilisation
• Conclusions
West Dunbartonshire population projection 1996 – 2015, all ages
88,059
91,321
95,320
80
82
84
86
88
90
92
94
96
98
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Th
ou
sa
nd
s
Projected percentage change (2004-based)Council area
2004 - 2024
-30
-25
-20
-15
-10
-5
0
5
10
15
20
25
Abe
rde
en
City
Dun
de
e C
ity
Eile
an
Sia
r
Inve
rcly
de
She
tlan
d Is
lan
ds
Eas
tD
unb
art
onsh
ire
Wes
tD
unb
art
onsh
ire
Ren
fre
wsh
ire
Nor
th A
yrsh
ire
Gla
sgo
w C
ity
Ang
us
Eas
t A
yrsh
ire
Sou
th A
yrsh
ire
Mid
loth
ian
Dum
frie
s &
Gal
low
ay
Ork
ne
y Is
lan
ds
Cla
ckm
ann
an
shir
e
Nor
th L
ana
rksh
ire
SC
OT
LAN
D
Eas
t R
enf
rew
shir
e
Hig
hla
nd
Mo
ray
Arg
yll &
Bu
te
Sou
th L
ana
rksh
ire
Stir
ling
Per
th &
Kin
ross
Fa
lkir
k
Abe
rde
ens
hir
e
Fife
Edi
nb
urg
h,
City
of
Eas
t L
oth
ian
Sco
ttis
h B
ord
ers
Wes
t L
oth
ian
Per
ce
nta
ge
ch
an
ge
Age structure of council areas, 2005 GRO mid-year
(% of population under 16, 16-44, 45-64 and 65+ years)
18.2 17 18.4
39.6 46.5 39.6
25.8 21.7 25.9
16.4 14.8 16
0%
20%
40%
60%
80%
100%
SCOTLAND Glasgow City WestDunbartonshire
0-15yrs 16-44yrs 45-64yrs 65+yrs
West Dunbartonshire population projection 1996 – 2015, by age group
139311554918926
32475
3714940287
256322415821345
143921291913507
1629154612550
50
100
150
200
250
300
350
400
450
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Hu
nd
red
s
0-14 15-44 45-64 65-84 85+
2004 Based Household & Population Projections: West Dunbartonshire
(Source: GROS)
0
10
20
30
40
50
60
70
80
90
100
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024
Th
ou
sa
nd
s
Households Population
Increase 2004 to 2024 (n=2,280)
Decrease 2004 to 2024(n=7,969)
Demography
• 91,300 population
• 7.67% of NHS Greater Glasgow and Clyde
• Decrease of 4.7% from 95,870 in 1995
• Further 8% predicted decrease by 2024
• Small predicted increase in 65+ yrs of 1,556
• 6% increase in number of households
Scottish Index of Multiple Deprivation
• Whole of Scotland divided into 6505 areas – “datazones” of about 769 people
• Multiple deprivation measured by 7 characteristics: current income, employment, health, education, geographic access to services, housing and crime
Percentage of West Dunbartonshire, Glasgow City and NHS Greater Glasgow & Clyde residents living in 5% and
20% most deprived areas of Scotland
0
10
20
30
40
50
60
5% Most deprived data zones 20% Most deprived data zones
Glasgow City West Dunbartonshire NHS Greater Glasgow & Clyde
SIMD 2006Datazones in the worst
15% in Scotland
74.0
77.7
74.7
76.8
69.9
68.2
71.0
69.5
74.2
71.5
66
68
70
72
74
76
78
1991-1993 1992-1994 1993-1995 1994-1996 1995-1997 1996-1998 1997-1999 1998-2000 1999-2001 2000-2002 2001-2003 2002-2004 2003-2005
Yea
rs
East Dunbartonshire East Renfrew shire Glasgow City West Dunbartonshire Scotland
Male life expectancy at birth (years) : West of Scotland Council Areas vs Scotland
1991-1993 to 2003-2005Source: Office for National Statistics
81.2
78.8
79.3
81.0
76.7
75.0
77.1
77.5
79.2
77.2
74
75
76
77
78
79
80
81
82
1991-1993 1992-1994 1993-1995 1994-1996 1995-1997 1996-1998 1997-1999 1998-2000 1999-2001 2000-2002 2001-2003 2002-2004 2003-2005
Yea
rs
East Dunbartonshire East Renfrewshire Glasgow City West Dunbartonshire Scotland
Female life expectancy at birth (years); West of Scotland Council Areas vs Scotland;
1991-1993 to 2003-2005Source: Office for National Statistics
All-cause deaths by council area: directly age/sex standardised rates per 100,000 population, 2005 - GROS
0
100
200
300
400
500
600
700
800
900
1000
1100
Council area of residence
Scotland
Comparative SMR 2003-2005
0
50
100
150
200
250
All Cau
ses
Cance
rCHD M
I
Stroke
Respir
ator
y
Digest
ive
Alcoho
lic liv
er
Suicid
e
Homici
de
Cause of death
SM
R (
Sc
otl
an
d =
10
0)
NHSGGC SMR WD SMR
0
10
20
30
40
50
60
70
80
90
100
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005
Year
Rat
e p
er 1
00,0
00 p
er y
ear
Min Max Mean Scotland Greater Glasgow West Dunbartonshire
Liver cirrhosis age standardised mortality rates among men aged 15-74 years in Scotland, NHS Greater Glasgow and West Dunbartonshire in the context of
maximum, minimum and mean rates for 16 Western European countries.
Perinatal Deaths : West Dunbartonshire
0.02.04.06.08.0
10.012.014.0
2004 2005 2006
Year
Rat
e pe
r 1,0
00 b
irths
West Dunbartonshire Scotland
West Dunbartonshire Health & Wellbeing
Perception of Health & Illness
• 69% positive perception
• Less positive than Greater Glasgow (80%)
Dental Health5% of 45-54 year olds with no natural teeth by the year
2010 (Source: Towards a Healthier Scotland)
• 9% with no natural teeth
• Compared to 6.6% in Greater Glasgow.
Health Behaviours - Smoking
• 40% current smokers
• Over half of smokers are heavily addicted
• 20% of 15 year olds are regular smokers
Health Behaviours - Alcohol
• Health and Wellbeing Survey: 34% of men exceed the weekly alcohol limit. (25% in Greater Glasgow, 27% in Scotland)
• 18% of women exceed the weekly alcohol limit. (11% in Greater Glasgow,14% in Scotland).
Health Behaviours – Binge Drinking
• More men (48%) than women (28%) reported binge drinking (Greater Glasgow 39% and 19%)
Health Behaviours – Physical Activity
• 47% of respondents had a minimum of
30 minutes of physical activity on 5 or more
days of the week or 20 minutes of strenuous
activity on 3 or more days of the week (58% in
Greater Glasgow).
Diet, exercise and obesity
• Only 23% are eating 5 fruit and vegetables per day
• Average number of portions 3 per day
• 16% with a BMI over 30.
Overall
• Poorer health and wellbeing than the rest of Greater Glasgow
• 106/112 indicators same as or worse than Greater Glasgow (mainly worse)
• Greater Glasgow is not great!
Problem drug use
• 1,185 people with problem drug use in West Dunbartonshire (2.2%)
• 551 drug injectors in West Dunbartonshire (1.0%)
• Glasgow City 3.3% and 1.32%
• Scotland 1.84% and 0.67%
• Over 20% of 15 year olds responded they had used drugs in the last month
Chronic Diseases
Diabetes • Type 1 diabetes is due to inadequate insulin and is thought to be
infectious in origin and influenced by genetics.
• Type 2 diabetes is associated with a resistance to insulin related to excess intake of alcohol, sugar and calories, too little exercise and overweight/obesity.
• There is significant under-diagnosis of Type 2 diabetes.
• Diabetes prevalence rising in Scotland, Greater Glasgow and WDCHP
• Assumed to be related to the rise in alcohol consumption, and overweight/obesity
• WDCHP residents suffer from diabetes more often than their Greater Glasgow and Scottish counterparts according to primary care information (3.6%)
Diabetes
Chronic Obstructive Pulmonary Disease (COPD)
• COPD is the fourth commonest killer in Scotland (5% of deaths).
• 80-90% of COPD is caused by smoking.
• Recent study: as many as 13% of Britons over 35 years of age have (salivary or x-ray) evidence of COPD and most of these have never been given a diagnosis.
• Recent study suggested that 25% of smokers will develop COPD.
• Primary Care information shows that WDCHP has a 17% higher prevalence of COPD (2.1%) than does Scotland (1.8%), in keeping with the higher
prevalence of smoking.
Chronic Lower Respiratory Diseases, age standardised mortality rates Males, all ages Scotland, NHS Greater Glasgow, Glasgow City
and West Dunbartonshire Council area Directly standardised to Western European population
0
10
20
30
40
50
60
70
80
90
100
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005Year
Ra
te p
er
10
0,0
00
po
pu
lati
on
pe
r y
ea
r
Scotland Greater Glasgow Glasgow City West Dunbartonshire
Chronic lower respiratory diseases, age standardised mortality rates Females, all ages Scotland, NHS Greater Glasgow, Glasgow
City and West Dunbartonshire Council areaDirectly standardised to Western European population
0
10
20
30
40
50
60
70
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005Year
rate
per
100
,000
po
pu
lati
on
per
yea
r
Scotland Greater Glasgow Glasgow City West Dunbartonshire
Hospital discharges with chronic lower respiratory diseases (in first or second diag position) Age standardised mortality rates, males NHS
Greater Glasgow, Glasgow City and West Dunbartonshire area Directly
standardised to Western European population
0
100
200
300
400
500
600
700
800
900
1997 1998 1999 2000 2001 2002 2003 2004 2005Year
Rat
e p
er 1
00,0
00 p
op
ula
tio
n p
er y
ear
Greater Glasgow Glasgow City West Dunbartonshire
Hospital discharges with chronic lower respiratory diseases (in first or second diag position) Age standardised mortality rates, females NHS
Greater Glasgow, Glasgow City and West Dunbartonshire area Directly standardised to Western European population
0
100
200
300
400
500
600
700
800
900
1997 1998 1999 2000 2001 2002 2003 2004 2005Year
Rat
e p
er 1
00,0
00 p
op
ula
tio
n p
er y
ear
Greater Glasgow Glasgow City West Dunbartonshire
300
400
500
600
700
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
rate
s p
er
10
0,0
00
Males (Scotland) Males (Greater Glasgow) Males (WDC) Males (GCC)
Age-standardised incidence of CHD rates per 100,000 for males - Scotland, Greater Glasgow,
West Dunbartonshire and Glasgow City. 1996-2005
200
250
300
350
400
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
rate
per
100,0
00
Females Scotland Females Greater Glasgow Females WDC Females (GCC)
Age-standardised incidence of CHD rates per 100,000 for females - Scotland, Greater Glasgow,
West Dunbartonshire and Glasgow City. 1996-2005
200
225
250
275
300
325
350
375
400
425
450
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
rate
per
100
,000
Males (Scotland) Males (Greater Glasgow) Males (WDC) Males (GCC)
Age-standardised Acute MI incidence rates per 100,000 for males - Scotland, Greater Glasgow,West Dunbartonshire and Glasgow City. 1996-2005
50
75
100
125
150
175
200
225
250
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
rate
per
100
,000
Females (Scotland) Females (Greater Glasgow) Females (GCC) Females (WDC)
Age-standardised Acute MI incidence rates per 100,000 for females – Scotland, Greater Glasgow,West Dunbartonshire and Glasgow City. 1996-2005
Age-standardised Cerebrovascular Disease incidence rates per 100,000 for males - Scotland, Greater Glasgow, West Dunbartonshire and Glasgow
City. 1996-2005
0
50
100
150
200
250
300
350
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
rate
per
100
,000
Males (Scotland) Males (Greater Glasgow) Males (GCC) Males (WDC)
Age-standardised Cerebrovascular Disease incidence rates per 100,000 for females - Scotland, Greater Glasgow, West Dunbartonshire and
Glasgow City. 1996-2005
0
50
100
150
200
250
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
rate
per
100
,000
Females Scotland Females Greater Glasgow Females (GCC) Females WDC
n=7003
n=894
n=136n=1241
Summary of CHD and CVD epidemiology• Most regions show clear decline for all indices.
• In 2005, for the first time, there were more new cases of acute MI and CHD in WD females than WD males.
• From 2002, the rate of new cases of acute MI has been increasing for WD females.
• CHD incidence rate in WD females in 2005 returned to that for 1996.
Prevalence of chronic conditions from primary care information
• COPD - 2.1% - lower than GG• Stroke - 2.2% - higher than GG• CHD - 4.9% - higher than GG• Hypertension - 13.5% - higher than GG
Cancer
10 most common cancers in men and women, 1998-2002
0.0
20.0
40.0
60.0
80.0
100.0
120.0
140.0
Lun
g
Pro
sta
te
Co
lore
cta
l
He
ad
an
d
Ne
ck
Oe
sop
ha
gu
s
Sto
ma
ch
Bla
dd
er
Leu
kae
mia
s
No
n-
Ho
dg
kin'
sSk
in
me
lan
om
a
Bre
ast
Lun
g
Co
lore
cta
l
Ova
ry
Co
rpu
s u
teri
Skin
me
lan
om
aN
on
-
Ho
dg
kin'
sH
ea
d a
nd
Ne
ck
Sto
ma
ch
Oe
sop
ha
gu
s
Male Female
cancer site, sex
age-s
tand
ard
ised a
vera
ge
West Dun.
All Scotland
Cancer NeedsPrevention is better than cure• Reducing cigarette smoking• Reducing alcohol use• Reducing obesity• Increasing physical activity• Increasing fruit and vegetable intake• Participation in cervical, breast, and colorectal cancer
screening programmes
Child Health
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
2001 2002 2003 2004 2005
% o
f L
ive
Sin
gle
Bir
ths
West Dunbartonshire Scotland
Proportion of low birth babies (<2500g)
% of Mothers Smoking During Pregnancy*
19
21
23
25
27
29
31
2004 2005
Year
Per
cent
age
Scotland GG&Clyde Glasgow City West Dunbartonshire
*Provisional data
0
10
20
30
40
50
60
2002 2003 2004 2005
Year of Birth
% B
reas
t F
ed
East Glasgow West Dunbartonshire GG&Clyde Scotland East Dunbartonshire
% of Babies Breast-Feeding at 6 weeks* 2002-2005
Immunisation rates in the
West Dunbartonshire CHP Evaluation Quarter:
01/04/06 - 30/06/06
West Dunbartonshire
CHP ScotlandDiptheria 97.7 97.7Tetanus 97.7 97.7
Pertussis 97.7 97.7Polio 98.1 97.7Hib 98.1 97.5
MMR 92.6 91.9Men C 98.4 97.5
Number in Cohort 258 13427
% of children who have completed
primary course at 24 months
Mental Health
Positive Perception of Mental Health
• 75% of the total sample reported a positive perception of mental health
• Less positive than Greater Glasgow (84%)
Prevalence of mental illness from primary care information
• 0.6% of population
• Lower than GG
• Same as Scotland
0
5
10
15
20
25
30
35
40
1980-84 1985-89 1990-94 1995-99 2000-04 2005
year
cru
de
mo
rtal
ity
rate
per
10
5
Male West Dunbartonshire City of Glasgow Scotland
Female City of Glasgow Scotland West Dunbartonshire
Suicide in males and females, 1980-2005. West Dunbartonshire, Glasgow City and Scotland
Service Utilisation
Use of Health Services
• % of respondents who thought it was difficult to access health services– 20% GP appointment– 10% Hospital appointment– 4% Dental appointment– Compared to Greater Glasgow more
dissatisfaction (exception dental health)
148
231
74
2749
423
2121
4
98
1399
2078
231
936
68
958
1362
West Dunbartonshire residents elective activity to GGC hospitals (selected specialties 2005/2006)
General Medicine
General Surgery
Orthopaedics
GJH
GGH
GRISGH
VOL
RAH
West Dunbartonshire residents emergency activity to GGC hospitals (selected specialties 2005/2006)
2895
127
6240
2827
49
819
5919
1121
60
449
822
341
General Medicine
General Surgery
Orthopaedics
GJH
GGH
GRISGH
VOL
RAH
0
500
1000
1500
2000
2500
3000
3500
4000
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Year of admission
Rat
e pe
r 100
,000
65-69 70-74 75-79 80-84 85+
n=33
n=40
n=48
n=57
n=58
West Dun CHP: Rate per 100,000 population of patients with 3 or more emergency admissions within 1 year by age group, years ending 31 March 1995-2006 (aged 65+) (n=236 in 2006)
Key Messages• Smoking, drinking and drug misuse are major public health problems• Smoking in pregnancy and low breastfeeding rates have major
implications for future health• Need to improve access to smoking cessation and problem drinking
services• Oral health, obesity and physical activity must be addressed• More health improvement work needs to be directed at women
in WD to manage relative increase in cases of CHD (including acute MI).
• CHD, stroke, COPD, hypertension and diabetes are all more common in WD than Scottish counterparts.
• Priority is to manage chronic diseases in primary care
Health Needs and Health Services: OverviewMeeting Health Needs – Role of West Dunbartonshire Community Health Partnership
Keith Redpath
Director
West Dunbartonshire Community Health Partnership
Content
• CHP perspective on analysis
• Role of CHP
• Developing a local response
Key Messages from Needs Assessment• West Dunbartonshire overall not significantly different form the rest of
Greater Glasgow and Clyde
• But 2nd highest death rate in Scotland
• We also compare poorly across a range of issues e.g.– Too many people smoke– Too many people drink too much– Too few people are active enough– Too many people abuse drugs– Too many people with poor dental health– Too many vulnerable people are repeatedly re-admitted to hospital
• However, all of these issues are conducive to being addressed at local level
“90% of patient interaction with the NHS starts and ends in Primary Care”
Source: ‘Delivering for Health’, Scottish Executive, November 2005, P. 15.
“No-one has challenged the case for extending and enhancing local health care services to build healthier communities…
“Hospitals should be our last resort for most health care needs, not our first port of call.”
Source: ‘Delivering for Health’, P. 12.
The 90% referred to is in some way the responsibility of the CHP
As a direct provider of:• Community nursing services• Community-based AHP services such as physiotherapy and
podiatry• Community mental health services• Addiction services
The 90% referred to is in some way the responsibility of the CHP
Holding the contractor budgets for:• General Practice• Dentists• Optometrists• Community Pharmacy
The 90% referred to is in some way the responsibility of the CHP
As a partner with other related service-providers e.g.:• West Dunbartonshire Council• Voluntary sector• Other providers• Carers
Broader Role for the CHP
Scheme of establishment states that the CHP will be charged with (amongst others):
• Real action on health improvement
• Focusing on the health of the whole population – not just on services
• Improving the health of our population and closing the inequalities gap
Broader Role for the CHP• Leading ‘health improvement’ activity across all partners
• Leading Health contribution to the economic and physical regeneration of the area
• Ensuring action targeted on the broader determinants of ill-health, such as unemployment/poor housing/community safety
Developing the local response to the needs analysis
Using the CHP Development Plan• Ensuring that priorities for action are identified
• Matching expectations to the available resources
• Continuing the debate on the outcomes
Chronic Disease and Long-Term Conditions Management
• Achieving equity across the whole of the area
• Renewed focus on the management of long-term conditions with performance and delivery monitored nationally
Using the Community Planning Processes
• Agreeing specific targets and contributions across the partners
• Engaging with the wider community on the issues
Action on Lifestyle Changes e.g.
• Action to tackle levels of smoking
• Action to tackle alcohol abuse
• Action to tackle drug abuse
• Recent announcement of West Dunbartonshire being added to ‘2010’ prevention programme
Repeated Hospital Admissions
• Workshop session later to discuss details
• Examine practice locally
• Approaches of local community services, NHS and social care
• Is it levels of ill-health or lack of access to services to avoid admission?
Conclusions
• Highlights areas for priority attention
• Sets an agenda for the CHP to lead
• Supports the need to continue to deliver programmes of care through extended primary care teams and care models
• Emphasises the continuing importance of using the information we have to improve the health status of the people of the area
Reporting Back on Local Health Service ReviewsReview of Maternity Services
Deb Den Herder
Director
Clyde Acute Services
NHS Greater Glasgow and Clyde
Context for Review
• Review of assumptions made in former NHS Argyll and Clyde strategy
• Greater Glasgow Maternity Strategy
Current Configuration of Service in Clyde (est. 2003)
• One consultant-led unit based at Royal Alexandra Hospital
• Three Community Midwifery Units, located at Inverclyde Royal Hospital, Royal Alexandra Hospital and Vale of Leven Hospital
Role of the Community Midwifery Units
Community Midwifery Units were intended to provide allservices to women with low and high risk pregnancies
except:
• Inpatient antenatal care
• High risk labour care
• Neonatal special care
Services Provided in CMU
• Midwife-led antenatal care
• Consultant-led antenatal care via outreach clinics
• Day care service (Monday – Friday)
• Early pregnancy service (Monday – Friday)
• Ultrasound service (Monday – Friday)
• SNIPS in liaison with Consultant-led unit (Monday – Friday)
• Smoking cessation service
• Parent education classes including aqua-natal
• Community midwifery care including home booking and home delivery and postnatal care
• Alternative therapies e.g. aromatherapy
• Midwife-managed birthing suite 24/7
CMU Birth – Assumptions of the NHS A & C Review• The proportion of women suitable and choosing to deliver in a
CMU would be 25%
• During labour 10 – 15% would be transferred
• Numbers based on best evidence (Scotland)
• Anticipated increase in numbers over time as increase in confidence in the model grew
Births at the Vale of Leven CMU Compared to Predictions
• Predicted births: 179 - 210
• Actual births:– 2004 – 61 births
– 2005 – 64 births
– 2006 – 74 births
West Dunbartonshire Residents: Place of Delivery
2004 2005
Glasgow 742 685
Clyde
(VoL)
228
(31)
287
(34)
Total 970 972
Former Greater Glasgow Maternity Services Review – Key Principles
• Developed in 1999, supported by the Professor Reid report of October 2003
• Reduces maternity units from three to two with closure of Queen Mothers Hospital
• Co-locates Maternity/Adult and Maternity/Paediatric Services
• Southern General is to be new hospital site
• Review now extended to include Clyde
Clyde CMU Review Process
• Review established December 2006
• Community engagement events January 2007 (two), February and March 2007
• Stakeholder participation on review
• Consultation on proposals to commence June 2007
Reporting Back on Local Health Service ReviewsReview of Mental Health Services
David McCrae
Head of Mental Health and Partnerships
NHS Greater Glasgow and Clyde
West Dunbartonshire Mental Health Strategy Group• West Dunbartonshire/Argyll & Bute CHP
• West Dunbartonshire/Argyll and Bute Council
• Local mental health forums
• Carer organisations
• Service user organisations
• Advocacy services
• Voluntary organisations
Range of NHS Mental Health Services
• Primary Care Mental Health Services
• Psychotherapy
• Integrated Community Mental Health Team
• Assertive outreach
• Early intervention for psychosis
• Crisis Resolution Team including out of hours
• Rehabilitation
• Admission Unit
• IPCU
Clydebank – Lomond Comparison
Clydebank
• Primary Care Mental Health Team
• Psychotherapy
• Integrated Community Mental Health Team
• Intermediate Service
• Early intervention for psychosis
• Out of hours service
• Rehabilitation (Gartnavel Royal)
• Admission Unit (Gartnavel Royal)
• IPCU (Gartnavel Royal)
Lomond
• Community Mental Health Team (split sites – non-integrated)
• Rehabilitation (Lochgilphead)
• Admission Unit (Vale of Leven)
• IPCU (Lochgilphead)
Work in Progress for 2007
Clydebank
• Assertive Outreach• Crisis Resolution (CHP-wide)
Lomond
• Psychiatry recruitment
• Psychology recruitment
• Integrated CMHT
• Assertive Outreach
• Crisis Resolution (CHP-wide)
• IPCU pathway changing from Lochgilphead to Gartnavel Royal
Next Steps
• Progress discussion regarding funding required to access Psychotherapy for all of CHP
• Complete recruitment of Consultant Psychiatrists which will enable EMI service to move from dementia-only service to older adult model
• Lomond Mental Health Services will be part of the ongoing review of Mental Health Services across all of Clyde
• Community Engagement events across al of Clyde for MH to inform strategy
• West Dunbartonshire Mental Health event: 20th March 2007, 2.00 – 4.00 PM at Abbotsford Hotel, Dumbarton
• Consultation on Clyde MH Strategy – Summer 2007
Reporting Back on Local Health Service ReviewsVale of Leven Hospital Unscheduled Care
Helen Byrne
Director of Acute Services Planning
NHS Greater Glasgow and Clyde
Vale of Leven Hospital: Overview of Activity
• 54 beds unscheduled care
• 64 beds rehabilitation
• 21 beds elective care
• 7 beds community midwifery unit
• MAU = approximately 5,500 patients
• MIU = approximately 8,000 patients
• Outpatients = approximately 50,000 patients
Vale of Leven Hospital: Overview of Activity (continued)• A & E, Surgery and Trauma and Orthopaedic-receiving at RAH
• Currently flows to RAH – approximately 5,000 A & E attendances and 3,700 unscheduled admissions
• 1,700 planned admissions
• Current flows to West Glasgow – 2,700 patients including tertiary services
Starting: Lomond Integrated Care Model
• New approach across Primary and Secondary Care
• New skills and methods to assess patients
• Bypass of very acutely ill
• Rapid referral and retrieval
• Our of hours:– GPs– Nurse Practitioners
• Post-acute transfer back to Vale of Leven
Lomond Integrated Care: Progress since April 2006
• Greater Glasgow and Clyde developed proposals to fully implement pilot
• Open clinical meeting
• Safety issues raised
• Further discussions:– Vale consultants– Wider group of consultants
• Consensus: not a safe system of work
Anaesthetics Workstream
• Group established to review Anaesthetic position
• Membership includes:– Anaesthetists from Clyde
– Anaesthetists from Greater Glasgow
– Physicians from Clyde and Greater Glasgow
– CHP/GP involvement
Key Areas of Work - Anaesthetics
• Review of the current rotas for Greater Glasgow and Clyde anaesthetic provision to consider the options to allow cover on the VOL site
• Identify the number of patients who have required anaesthetic support on site at the VOL, or who have been transferred off-site, including details of reasons for involvement and time of intervention
• Seek new models of working across the United Kingdom that could be transferable
Unscheduled Medical Admissions Workstream
• Established in October 2006
• Membership includes:– Physicians from the Vale/RAH
– Physicians from Greater Glasgow
– West Dunbartonshire and Highland GPs
– Operational management and Acute Planning input
Future Options for Unscheduled Medical Admissions
• Anaesthetics: currently subject to review
• If anaesthetics not sustainable then four options:– Option 1 – All medical patients access services at the Western
Infirmary in Glasgow– Option 2 – All medical patients access services at the Royal
Alexandra Hospital in Paisley– Option 3 – Split the geographic catchment so that some medical
patients attend the Western and some the RAH– Option 4 – Patient and GP choice
Rehabilitation Workstream
• Established in October 2006
• Membership includes:– Physicians from the Vale/RAH
– Associate Medical Director and Lead Director of Rehabilitation (GGC)
– GP/CHP input
– Operational management and Acute Planning input
Future Options for Rehabilitation
• Option 1 – Status quo; No service change other than as part of ongoing joint-planning
• Option 2 – Patients transfer at an early stage in the admissions: circa one week
• Option 3 – Patients transfer at a later stage in their admission: circa two weeks
• Option 4 – Patients transfer near the end of their admission
Progress since October 2006
• Anaesthetics – engagement meeting held on 21 November 2006
• Unscheduled medical admissions – engagement meeting held on 19 December 2006
• Rehabilitation – engagement meeting held on 23 January 2007
Next Steps
• Continue detailed work to take forward the three streams of work
• Further engagement in May 2007
Question and Answer Session
Chaired by Rani Dhir MBE
Move to Workshop Groups
A – The Factors Driving Change in Acute Hospitals Auditorium
B – Emergency Admissions Training Room 1
C – Maternity Services Auditorium Foyer
D – Mental Healthcare Waverley Rooms 1 & 2
E – Transport and Access to Healthcare Training Room 2
F – Local Services provided through West Dunbartonshire CHP
Cameronia Room 1
G – Improving the Health of Local People Cameronia Room 2
