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Improvements to Highland Rheumatology Service

Issued: 1 Dec 2010

NHS Highland Board members will next week be asked to endorse an action plan for improvements to the rheumatology service in Highland that will enable the service to reach more people with many of them receiving their treatment closer to home.

A review of the NHS Highland rheumatology service began in 2008 in response to new national standards of care, the need to safely administer new drug treatments, known as “biologic treatments”, and to meet new waiting time targets.

This confirmed that the current service was of a high quality, but it identified ways to make the service more sustainable and recommended the initial steps towards developing a comprehensive service, emphasising quality and safety while encouraging self management.

The review also recommended equity of access to appropriate levels of care and, where appropriate, that care should be delivered closer to patients’ homes.

A number of proposals were put forward, an action plan has now been drawn up and a project manager has been appointed to implement the plan. A redesign team will continue to work with her and will advise on the specialist aspects of this work.

The action plan includes the continuation of the seven-day inpatient facility at Highland Rheumatology Unit (HRU) in Dingwall and access to medical beds at Raigmore Hospital in Inverness for complex cases, with outpatient clinics continuing to be provided in a range of settings across Highland.

In addition, a biologic infusion service is being developed across Highland. This service is now up and running at Belford Hospital in Fort William and it is hoped that a similar service can be established at HRU by January/February 2011. In HRU, this will necessitate the reduction of beds from 14 to 10 in order to free up a four bedded bay to equip as an infusion unit.

It is hoped that this will give specialist nurses time to undertake more follow-up work, thus allowing the consultants more time to undertake necessary early identification and intervention work.

The next stage will be the development of a day case service based at HRU, but potentially linked by telemedicine to other centres to prevent patients having to travel.

Underpinning all of this will be educational development for patients and their families and clinical skills training for clinicians in the primary care and community teams to enable them to identify early rheumatic conditions and to provide help and support with the management of chronic arthritis.

NHS Highland Board members will be asked to endorse the proposed redesign process at their next Board meeting on Tuesday December 7.

Consultant Rheumatologists Dr John Harvie and Dr Malcolm Steven said they were optimistic that the extensive work done in collaboration with management and patients would lead to the provision of an effective and sustainable plan for patients with rheumatic diseases.

Dr Harvie, who is Head of Service, said: “We are now reaching a stage where we are able to progress with new developments. We will be encompassing national standards of care and developing solutions for challenges provided by our own unique local geographical area.

“This is an exciting time when new therapies have led to increased therapeutic options but also emphasised the need for maintaining the quality of non-pharmacological management and the importance of the multidisciplinary team for both new and established patients.

“Opportunities for education of patients, carers and the wider multidisciplinary teams will enhance the services already available for patients.”

The action plan is the result of extensive work with rheumatology patients, their carers and everyone involved in their care.

Two workshops involving patients, GPs and representatives of all relevant clinical disciplines and management in primary and secondary care were held in 2009 and an independent consultant with rheumatology expertise was appointed and presented a report in spring 2009.

This report stated that the service was stretched by the introduction of more stringent clinical standards and by new waiting list targets, whilst sustaining a regional service through peripheral clinics, and suggested options for change.

A meeting of the Friends of HRU, hosted by the consultants, is be held tomorrow (Thursday December 2) and the original working group will be invited to an event in January to inform them on the outcomes of their early work and to give them an opportunity to comment on the action plan.

Mid Highland CHP General Manager, Gill McVicar, said: “I am pleased to see the fruits of all the hard work and commitment of everyone involved in the review, including patients and staff, and I am very grateful to them.

“Some of the things we want to do will take some time to develop, others will happen quite quickly, but it is good to have a vision for services for the future.”

© 2010 Highland Public Services Partnership.
Project part-financed by the European Union (European Regional Development Fund) within the INTERREG IIIB Northern Periphery Programme