Annual review gives a clean bill of health to NHS Shetland

NHS Shetland received an excellent report of its performance in an annual review by Scottish public health minister Shona Robison, who said Shetland led the way in some areas.

Ms Robison was unable to visit Shetland in person this week due to flight delays and the review was carried out by teleconferencing, an experience she found interesting for its potential uses in health care.

Director of medical services Ken Graham told the minister that nasal endoscopy and the CT scanner produce images that are diagnosed in Aberdeen in real time, and there is also a tele-neurology service.

Dermatology, which has a high rate of referrals from GPs, is another area that lends itself to “telehealth”, and this will be introduced shortly.

Ms Robison said other health boards could learn from Shetland and NHS 24 will be using telehealth from March. “Shetland’s got a lot to contribute”, she said.

In a follow-up from last year’s review, the spotlight was turned on crisis intervention for mental health, with NHS Scotland chief executive Kevin Woods asking if services met the needs of the population.

Although NHS Shetland chief executive Sandra Laurenson admitted “we’re not there yet”, care is available in the event of a crisis, including from the voluntary sector. NHS Shetland director of public health Sarah Taylor said services could be accessed from NHS 24, the local out-of-hours service, hospital or health centres, and back-up is avail­able from Aberdeen.

Regarding anti-depressant pre­scrib­ing, Dr Graham said the rate in Shetland was historically low and is on target to stop any increase. There is also a “strong” counselling service available through primary care.

The diagnosis of dementia and Alzheimer’s was also raised, with Dr Graham saying it was a challenge to identify patients, especially in remote areas. The meeting heard that people attending the hospital’s A&E department, or being admitted to an acute medical or surgical ward, will have their mental health assessed in a “holistic” approach.

Ms Laurenson said she was “confident” that the health board’s target would be reached in this area as the mental health team had been restructured and a full-time lead nurse had been freed up to focus on dementia.

Obesity, including childhood obesity, is an area that Shetland is tackling with great success, Ms Robison heard.

After a period with no dietician in Shetland there is now one in post, and people, including whole families, are “knocking on the door” to access services in the “Counterweight” programme, according to Dr Taylor.

Another area of success is in decreasing delayed discharges among elderly patients – and Shetland is projected to have a higher than the Scottish average rate of people over 60 soon. Director of clinical services Simon Bokor-Ingram said that work is on-going to enable people to remain in their own homes for longer.

Ms Robison was impressed that 120 new care places (either in a care centre or care packages at home) are to be created.

Shetland has also done well on waiting times, with the target of 18 weeks referral to treatment being achieved. The 62-day target for cancer patients to first treatment has been met in 100 per cent of cases. Dr Graham said these patients’ “pathway” had been “micro-managed.”

However, in orthodontics there remains a “challenge” in waiting times, and recruitment of dentists is still difficult.
Shetland is achieving good results in tackling hospital acquired infections, with each indivudual case of MRSA, MSSA and C-difficile being scrutinised in detail and being followed up.

Ms Robison was told that most cases originate in the community or at another hospital, but Dr Taylor said: “We are not complacent.”

A management team is in place to ensure levels of anti-microbial prescribing are kept low, there are also two part-time infection control staff and a virologist and microbiologist from Grampian are available by video link in the event of an outbreak.

Finance director Nick Kenton said savings had been made in the board’s budget this year by prescribing efficiently. He forecast a break-even in this financial year, although it would take years to reduce the board’s underlying deficit.

The board also told the minister that staff sickness absence is being “very actively managed” in an effort to get it down to the national target of four per cent.

Chairman of the NHS Shetland board Ian Kinniburgh said that although Shetland would like to “shift the balance of care” so that more services are available locally, it was important to make sure services were sustainable.

In general Ms Robison declared the board to be “well-performing”. Although NHS Shetland still needs to do more in certain areas including “alcohol intervention”, she was very impressed with its meeting national targets, including those for waiting times.

Mr Kinniburgh said he had come away with a “very positive message” and he hoped the board would continue to perform at a high level.