Activity modelling. NHS Highland commissioned an external data analyst to examine the projected future demographics for Caithness and model the impact on Caithness General Hospital inpatient activity if we do not change. They also modelled the potential impact of implementing specific elements of the proposed local care model as detailed below.
1. Identification and management of patients with complex care needs by the LCM MDT;
2. Enhanced out of hours care at home (5pm to midnight);
3. Step-up beds; and
4. Clinical Decision Unit (formerly known as Ambulatory Emergency Care Unit) Full details are provided in Appendix SC12 and summarised in table SC15. This illustrates very starkly that if we continue to provide services in the same way and the local demographic going forward is in line with projections, we will need to increase the number of beds at Caithness General Hospital from the current complement of 43, to 54 in 2030, and 60 beds by 2040. Caring for patients in an acute hospital is expensive and for some of these patients their needs could be better met in a community setting. A shift in focus to preventative care could avoid unnecessary admissions and reduce the number of hospital beds required in the area. Scenario 0 (Do Nothing) 2,536 13,887 45.7 2,644 16,360 54.0 2,635 18,297 60.2 Scenario 1 (MDT Frailty) 2,391 12,725 41.9 2,470 14,911 49.2 2,448 16,626 54.7 Scenario 2 (OOH CaH) 2,239 11,493 37.8 2,288 13,373 44.1 2,247 14,823 48.8 Scenario 3 (Step-up Beds) 2,045 11,301 37.2 2,057 13,144 43.4 1,996 14,574 48.0 Scenario 4 (AEC) 1,851 11,109 36.6 1,826 12,915 42.6 1,745 14,325 47.2
1. No. of beds - assumes 83% bed occupancy 2. Total Population for 2019-20 = 25,144 3. Total population for 2030 = 23,095 4. Total population for 2040 = 20,616 The cumulative effect of the four local care model interventions detailed above indicates that if we invest in our community services, in 2030 we could manage within the existing Caithness acute bed complement, with a potential modest increase (four beds) required by 2040. This data needs careful interpretation, as the impact of the four interventions may not necessarily be cumulative. However, we also need to consider that this is not an exhaustive list and there will be additional changes implemented as part of this wholescale redesign which we were unable to effectively model at this time. What is clear, is that if we do nothing this will have a significant impact on hospital-based services, and the status-quo is not sustainable ...
