The AHP National Delivery Plan in the Western Isles

At 31 March 2015:At 1 October 2014: 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 services Innovative 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 8 Jump Start Henry – (Healthy Eating and Nutrition for the Really Young) Jungle Journey Early Years Collaborative Maternal & 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 Dietetics Low 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

Radiology DEXA 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 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 Steps Integration – 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 possible Dementia Managed Care Network Early Years Collaborative Building 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