the ahp national delivery plan in the western isles
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The AHP National Delivery Plan in the Western Isles
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At 31 March 2015:At 1 October 2014:
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Our indicators:
Our red indicators:
Joint working with social care not fully developed;
Informatics recording poor
What we changed:
Implementing Topas system
Working with health intelligence team to improve recording and reporting
Working with Social Care around reablement, discharges, multi-disciplinary training
What we did:
• No big secret• Most of the work was being done already• Mapped and co-ordinated our activities • Identified gaps• Developed plans and pathways
What we do very well:
Deliver services seamlessly across health and social care throughout hospital and community
Meet 18 week waiting time target
Open referral, including self referral, to all servicesInnovative and flexible, exploring alternative solutions
See patients!!
7117
new patients across five services in the last year!!
We saw …
That’s 27% - 1 person in 4 living in the Western Isles saw one of our
AHPs in the last year!
Examples of local change
in the last three years:
Motiv 8Jump StartHenry – (Healthy Eating and Nutrition for the Really Young)Jungle JourneyEarly Years CollaborativeMaternal & Infant Nutrition
Children and Young People
Pain Management
• Extended Scope Practitioner - the only physiotherapist in Scotland carrying out spinal injections, freeing up orthopaedic surgeons’ time and cutting waiting times for patients
• Chronic Pain Programme
Falls, Reablement and Older People
Multi-agency Falls Policy
Dementia Pathway
Development of multi-service falls pathway – Physio, OT, Podiatry, A&E and Scottish Ambulance Service
OT Reablement Project – now delivering training to Social Care
Nutrition and DieteticsLow FODMAP diet for Irritable Bowel Syndrome
Breath testing to identify intolerances
Nutritional Care Pathway in the Community
Working with care homes to improve nutritional status of residents
Speech & Language Therapy
Dementia: “Caring to Communicate” Training for community nursing staff, carers and voluntary sector
AAC Roadshows: Promoting Access to Alternative and
Augmentative (AAC) communication support
Keeping your feet sweet
Developed programme for carers, of personal footcare and skin care, working with Western Isles Community Care Forum to train trainers
Development Posts for Extended Scope Podiatrists for MSK and Diabetes
RadiologyDEXA Service: - patients no longer have to travel to Dingwall for a bone scan
New high end ultrasound machines – parents can see high definition 3D scan of their unborn child
An existing member of staff trained as a sonographer and qualified in obstetric ultrasound in July 2015, to beat the recruitment challenge
In the wider community • Fully integrated multi-disciplinary cardiac rehab and
pulmonary rehab service in Stornoway and Benbecula
• Fatigue Management Programme
• Vocational rehabilitation
Joint Improvement Team Review of Community Equipment Service – creating a modernised, more effective and efficient service for all
Developing Technology
Telehealth – using Jabber for dietetic clinics and offering telephone appointments and email reviews
Expansion of Telecare
Topas appointments system – now we can track patient journeys and arrange dual appointments so patients
can see everyone they need to at the same time
Next StepsIntegration – will help us support older people and those with disability and complex needs to live independently in their own home/homely setting for as long as possibleDementia Managed Care NetworkEarly Years CollaborativeBuilding a sustainable workforce – making sure we always have the people with the right knowledge and skills to support people to live active and independent lives in community settings