Other Drivers for Change. The proposals set out in this Initial Agreement respond to several national and local strategies and a summary of these is attached at Appendix SC13. The Health and Social Care Delivery Plan published in December 2016 by the Cabinet Secretary for Health and Sport, brought into sharp focus the urgent need to address the rising demands and challenges facing the NHS in Scotland. Audit Scotland also prepared a Report ‘‘NHS in Scotland 2017” (October 2017) which further described how the NHS is under pressure with the need for change and longer- term planning, particularly regarding workforce. The Xxxxxx report (February 2021) and recent announcement of the National Care Service will shape our proposals going forward. NHS Highland’s Quality and Sustainability Plan published in May 2017 reflected our local context around the challenges to sustain and transform services. This included reference to the need to redesign services in Caithness. It also set out several goals and principles that underpin the proposed redesign and transformation of services. Sustainability goals include: • Providing services and facilities which meet 21st Century health and social care needs; • Providing high quality, integrated and cost-effective services; • Reducing waste and inefficiency across services; and • Ensuring that services are sustainable. Principles include: • Support for people to stay at home for longer; • Supporting people and communities to be more independent and resilient; • Increased choice for end-of-life care; • Greater embedding of realistic medicine principles; • Greater integration, co-location, and co-ordination of care; • Greater Regional collaboration and solutions; • Greater use of technology; • Reduction in the length of time people spend in institutional care; • Reduction in unnecessary attendances and appointments; and • Reduction in waste, harm, and unwarranted variation. The changes flowing from implementing our strategic vision and plan therefore require us to remodel our care pathways, workforce and our assets. It was highlighted that, over time, this would bring about a planned reduction in the number of staff working in traditional hospital settings. Services would instead be provided by co-located teams from fewer sites, in modern, strategically placed buildings. Such a transition would support more people to be looked after at home or in a homely setting. The new model will ensure service sustainability and will deliver services capable of meetin...
Other Drivers for Change. As described in 2.1.1 Existing service/activity provision, the following emphasise the drives for change. Barriers to access Due to commissioning arrangements, English units necessarily prioritise local patients and may not be able to admit young people from Scotland. Delays Due to geographical distance and time commitments, English services cannot readily arrange assessment visits to young people in Scotland. Typically, it would take around a month from date of referral to a decision about suitability for admission to a service in England. Then a lengthy legal process begins: Legal processes Since Scotland and England are separate jurisdictions with different mental health legislation, special regulations must be followed before any patient is moved across the border in either direction. Application must be made to the Scottish Ministers for a transfer warrant, with fixed time frames and appeal processes. Due to the particular vulnerabilities of children, clear processes must be followed before a warrant is granted, including gaining informed consent of the patient. In addition, remand prisoners cannot be moved across the border until their case is concluded. Once a patient is admitted to an English hospital, they become subject to English mental health legislation. Similar processes must be followed before a detained patient can return to Scotland. These necessary procedures and safeguards result in significant delays. Typically, several weeks or months pass between acceptance of a patient for admission and their actual transfer to an English hospital. Such delays mean that a child patient must wait in an inappropriate setting (adult xxxx, community, custody) without suitable treatment. Separation from families Efforts are made to ensure that young people transferred to English services are supported to receive visits from families and otherwise stay in touch with people who matter to them. However, such contact is inevitably limited by geographical distance, and restrictions of access to mobile phones, internet and contact with younger siblings in secure settings. Disconnection from services Referring clinicians are expected to maintain contact with patients and contribute to their care planning. In practice, this would involve attendance at 3/6 monthly reviews and mental health tribunals’ and/or other statutory hearings. Social workers and other professionals achieve similar levels of contact. However, this involves time out of local services and diffi...
