Clinically Safe and Specialist Services
What do we mean by clinically safe and specialist services?
At different times we will all need to access this specialist support to help us recover from illness, to manage long-term conditions, and to keep us safe. This could include access to primary care services, support with our mental health, timely access to rehabilitation services, or support to recover from alcohol or drug-related addictions.
We will help people to access appropriate specialist support in the most suitable setting. This could be in a hospital, but we are focused on shifting the balance of care and preferably people will be able to access such support in our communities. Care will be provided as close to home as possible and should help avoid unnecessary attendance and admissions to hospital. We will also continuously improve service quality, supported by Clinical and Care Governance.
In doing so, we also want to ensure that we do not over-medicalise the treatment and care we provide for people. Working with partners, we will build on individuals' strengths, skills and abilities to aid their recovery.
"Keep no patient in hospital a day longer than is absolutely necessary. The patient may have to recover not only from illness or injury but from hospital" - Florence Nightingale, 1878
The outcome we want to achieve:
Our services are clinically safe and people have access to the appropriate specialist support to aid them in their recovery and rehabilitation, where possible.
Key Challenges
Wait times across services have increased as a result of the pandemic and demand increasing following the easing of restrictions. We expect that some people will need more intensive support.
Maintaining low levels of delayed discharges within a pressurised system.
Primary Care services are facing unprecedented levels of demand with a significant increase in mental health problems and people suffering deterioration in chronic diseases because of the impact of COVID-19.
Tackling all forms of stigma around accessing specialist services.
Specialist skills across services, including but not limited to Primary Care, CAMHS, Psychotherapies and Mental Health, are in short supply nationally.
Expectations of what specialist services provide can differ from clinical opinion and the aim of preventing over-medicalisation.
Strategic Objectives
Reference
Enabled 1 (continuing activity)
Description
Work with NHS Greater Glasgow and Clyde (NHS GGC) and other HSCPs to continue activity to reduce unnecessary attendance at A&E, reduce hospital admissions and lengths of stay in hospital. This includes working to implement (i) opportunities to shift the balance of care; and (ii) joint commissioning plans for Unscheduled Care.
National Outcomes
- Outcome 1
- Outcome 2
- Outcome 3
- Outcome 4
- Outcome 9
Reference
Enabled 2 (new activity)
Description
Work with partners in NHS GGC and other HSCPs to build on and further coordinate the positive developments achieved in reforming urgent care during the pandemic, including Mental Health Assessment Units, GP Out of Hours, Urgent Care Resource Hubs and the flow navigation centre.
National Outcomes
- Outcome 1
- Outcome 2
- Outcome 3
- Outcome 9
Reference
Enabled 3 (continuing activity)
Description
Continue to embed multidisciplinary team working across HSCP services to enhance person-centred care, including but not limited to (i) progression of Renfrewshire's Primary Care Improvement Plan objectives; (ii) delivery of the Care Home Hub model developed during the COVID pandemic; and (iii) implementation of service changes identified through the 'winter funding' process.
National Outcomes
- Outcome 1
- Outcome 2
- Outcome 4
- Outcome 8
- Outcome 9
Reference
Enabled 4 (new activity)
Description
Work with NHS GGC and HSCP partners within the board area to deliver the Strategic Pharmacy Framework with (i) an empowered pharmacy workforce enabled to work at the highest level of practice and (ii) enhanced public awareness of the community pharmacy options available to them.
National Outcomes
- Outcome 1
- Outcome 4
- Outcome 7
- Outcome 8
- Outcome 9
Reference
Enabled 5 (continuing activity)
Description
Seek to minimise delayed discharges through the HSCP's programme of work to support prompt discharge from hospital. Within this we will continue to support the aim of discharging people for assessment through Renfrewshire's Home First approach.
National Outcomes
- Outcome 2
- Outcome 3
- Outcome 4
- Outcome 9
Reference
Enabled 6 (new activity)
Description
Work in partnership with Renfrewshire Council's Children's Services to implement the National Neurodevelopmental Pathway (NDP) and ensure linkages are developed to support transition across services.
National Outcomes
- Outcome 1
- Outcome 4
Reference
Enabled 7 (new activity)
Description
Improve patient experience of our services by reducing the waiting times for access to CAMHS. We will do this by investing in the expansion of the multidisciplinary team and streamlining patient pathways within Children and Adolescent Mental Health Services (CAMHS) to identify and eliminate delays.
National Outcomes
- Outcome 1
- Outcome 3
- Outcome 7
- Outcome 9
Reference
Enabled 8 (continuing activity)
Description
Continue to modernise the nursing, midwifery and allied health professions (AHP) workforce to be fit for the future and maximise their contribution to shifting the balance of care to community and primary care settings. This includes the continued development of Advanced Practice Roles across Mental Health, Addictions and Children's Health Services and we will evaluate emerging evidence to influence future delivery models.
National Outcomes
- Outcome 1
- Outcome 2
- Outcome 8
- Outcome 9
Enabled Futures: Some Examples
Mental Health Assessment Units (MHAUs)
MHAUs are a specialist service which provide assessment, diagnosis and management to patients who are in Mental Health crisis or distress and would have sought assistance at an Emergency Department or via Police Scotland and the Scottish Ambulance Service. MHAUs offer a single point of access for emergency mental health assessment 24/7.
Standardised care pathways have been agreed with Acute Hospitals to reduce footfall within Emergency Departments due to the impact of the pandemic. This has reduced the number of people who need to attend the Royal Alexandra Hospital Emergency Department.
Advanced Nurse Practitioners (ANP)
Our Advanced Nurse Practitioners (ANPs) work across multi-disciplinary teams and are clinical leaders who manage the complete clinical care of their patients. They aim to provide a person-centred approach to improve the patient's journey and experience, whilst moving work away from GPs.
Our ANPs have supported 75% of GPs so far in Renfrewshire and data between 2019 and March 2021 suggests 89% of consultations with ANPs were completed independently (i.e., did not require onward GP referral), contributing to avoidance of admission and unnecessary appointments where appropriate.
My Diabetes My Way
The local diabetes interface group aims to improve care for people with diabetes. The group promotes the use of My Diabetes My Way (MDMW) which gives people access to information to help them understand their diabetes, see their blood results and follow their blood pressure readings. Patients are also supported by Multi-Disciplinary Teams (MDTs) to access care in a seamless way, improving the care they receive.
Together, these support people to better control their diabetes with fewer complications. This leads to fewer admissions to hospital and longer and healthier lives.
Next page:
Empowered Futures
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