Reviewing our services
In 2016, we undertook a review of people’s experiences of Arran services to understand how people experienced the care we provide.
Ten individuals with complex care needs shared their care journeys and we reviewed what had happened over a 12-month period. This revealed a number of things and influenced next steps, as we started to develop plans for integrating our health and our social care services:
- We realised many of our services were uncoordinated
- We realised some people had lots of visits on the same day and some people had long gaps in between visits
- We realised we had gaps in some of our services and that we provided services from a large number of sites and buildings of differing standards (some are old buildings and some are purpose-built new ones.)
Demographics – current and future
On Arran we have an ageing population and this is higher than the rest of Scotland.
The data predicts that 10 years from now, in 2029, over 50% of our island population will be over 80 years of age. We also know we will have fewer young people on the island. This means we need to change the way we provide our services. We need to join them up so we can sustain our services on-island services. See attachment 1 [EM: can you provide this?].
Current services on Arran
When we map our services, we realise many of our services are provided by different sectors (see attachment 2 [EM: can you provide this?]).
Mapping our services has also shown:
- Services are often managed by different managers with separate budgets
- Some teams have difficulty recruiting and retaining staff
- We have multiple contact points
- Teams are geographically separate from each other
- Most roles are very clearly defined and therefore very little crossover.
We realised our services are fragmented. In spite of this we still do manage to provide many examples of excellent care and we want to build on and continue to sustain this into the future.
What do we want to do?
Single team – We would like to create a single team so all health and social care staff on Arran work together and are managed within one structure on Arran, with one all-island budget.
Model of care – Caring for people with complex needs is a significant part of what we do on Arran due to the nature of our elderly population. We are currently trialling a new role, health and care support worker, to combine both personal care and medical care into one role. We think this will be a better way of coordinating care and ensuring people can continue to stay at home for as long as possible.
We also want to centralise our unscheduled care service at the hospital. This will enable all urgent needs to be provided from one location. To do this we:
- Have increased the capacity of Accident and Emergency Department at Arran War Memorial Hospital
- Have introduced a dedicated ambulance transfer service
- Will be installing a new X-ray machine.
We have also trained advanced nurse practitioners (ANPs) to care for people with urgent needs; people can be treated by ANPs in their GP practice or in the hospital.
Single point of contact – We want people to be able to call one number for all their health and social care needs. We are currently scoping a new system called Netcall, this will enable us to introduce one single number for health and social care services on Arran. We hope this will improve your experience and make it easier for you to access services, for example, GP appointments, query about social care or related to Montrose House.
Integrated hub – We want to re-provide the hospital, Lamlash Practice and Brodick Practice into one new building along with residential care, social services and community nursing. We believe this will enable us to coordinate care more effectively and give us greater flexibility over 24 hours and 7 days.
To have one new building we must follow four key stages within the Scottish Capital Investment Manual. We are currently at Stage Two and we need Scottish Government to endorse our plans for an integrated hub. We have identified the preferred way forward, having the services (outlined above) together in one building.
We don’t yet have a site where this would be, however have included Montrose House site as one possible location. If our plans are endorsed we will then need to move to a formal consultation phase with the Arran community. This will include an option appraisal regarding the site for the building. It could take as long as two years to get all the necessary stages completed and approved.
Engagement – We will continue to run engagement events and meet different on-island groups to ensure we maximise people’s input and feedback on our plans.
The services we are planning are for everyone on Arran and we really need your support and views on plans as they develop.
HSCP INTEGRATION ON ARRAN – APRIL 2018
- The Arran population of 5000 is much older than Scottish or Ayrshire averages. 30.5% are aged over 65 and this has risen from 23% in 2001. Some of this rise is driven by movement to the island later in life and 30% of over 65s have moved to Arran in the last 10 years. Population Projections for the coming decade predict an increase of 50% in over 80s and 25% over 75s (A&A Public Heath report). There is high life expectancy – for males this is nearly 4 years higher than the North Ayrshire average and 2 years above Scottish averages.
- In line with the older population, multimorbidity is high – for example, 20% more people on Arran live with 2,3 or 4 chronic conditions than in Ayrshire as whole.
- There is a high Dependency ratio (0.66 Arran – 0.58 Ayrshire) meaning there are less people available for carer roles, including employment. A 2017 NAC report has projected a 47% fall in the working population in the coming decade based on current demographics. This is likely to have profound implications for the economy of the Island and is highly significant to Health & Social care workforce planning.
- There has been a 32% fall in children living on Arran from 2001-2013; children represent a significantly lower percentage of population than Ayrshire and Scottish averages.
- More than 50% of population is aged 16-64.
- The Arran housing market is pressured with high costs and a limited housing supply. The average house price in 2017 was £215 000 compared £133 000 for all of Ayrshire. Home ownership is beyond the financial means of many health and social care workers. Rental markets are distorted by the demand for holiday rentals and private rentals are difficult to find.
- Arran is a very popular visitor destination, is getting busier, and is by far the busiest route on the Caledonian MacBrayne network. CalMac transported 844K passengers on the Brodick-Ardrossan route in 2017. Following the introduction of the Road Equivalent Tariff (RET) Scheme there was a 9% rise in passenger numbers in 2016 and a further 5.6% rise in 2017.
- Arran is the seventh largest Island in Scotland and covers an area equivalent to the rest of North Ayrshire. The population is spread around the 56 mile circumference of the island, travel times by car are significant and very much longer for those dependent on public transport.
- There is low crime on Arran and, apart from geographical access; there are lower markers of deprivation than in other areas of Ayrshire. There are high levels of educational attainment and low unemployment.