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Introducing NHS Ayrshire & Arran

In recent years there have been many other exciting developments, following our reviews of Community Health Partnerships, Mental Health Services, our Review of Services and the Chief Executive's recent 'refocusing' of the organisation to underpin integrated patient pathways. All of these have galvanised the organisation and set a strategic direction based on continuous improvement and services that are centred on the patient or service user. 

Over the years we have invested in modern community and hospital facilities, and our highly trained and qualified staff provide health care to almost 400,000 people. Our expenditure in 2011/2012 will be around £700 million. We also have a duty to protect public health throughout Ayrshire and Arran. 

Working in partnership 

NHS Ayrshire & Arran works in partnership with the three local authorities in East, North and South Ayrshire, and other community planning partners. The Single Outcome Agreements between the local authorities and NHS include a range of actions and outcomes designed to deliver high quality health and social care. These are agreed through the Community Planning process and, among other things, form an agenda for our Community Health Partnerships as they oversee the development and improvement of our community based activity. The plans outline the objectives, strategies and actions for each organisation to improve the health of the local population. 

Caring for people at home and in hospital 

In 2009 our review of primary care services - 'Your health - we're in it together' - put the public at the heart of healthcare. 'Your health' focuses on getting the balance right between caring for people close to their homes, and looking after people who come into hospital as an emergency, or because they need specialist treatment. In the past two years we have introduced some exciting health initiatives to support this shift. For example: 

• Telehealth systems that harness the power of technology to enable people with long term and complex conditions to be monitored and even treated in their own homes.
• Health and wellbeing advisors working alongside general practice staff to offer people support with health issues related to alcohol, tobacco, obesity and mental health.
• Better communication between hospitals and general practice, including more effective planning for discharge.
• Transforming relationships between clinicians and patients to give patients the information and support they need to take more control of their conditions and to live safely but independently. 

Health care close to home

NHS Ayrshire & Arran is responsible for making sure the people of Ayrshire and Arran get community health services from: 

• almost 300 General Medical Practitioners and their practice teams providing a full range of general medical services across 90 sites, stretching from Ballantrae in the south to Wemyss Bay in the north, and including 10 sites across Arran and Cumbrae;
• more than 160 general dental practitioners providing NHS dental services at more than 70 sites, includingArran;
• more than 90 community pharmacies providing a range of pharmaceutical services, including minor ailment services and public health services, across Ayrshire and Arran; and
• 60 optometry practices providing services ranging from NHS eye tests to diabetic retinopathy screening and cataract follow-up across mainland Ayrshire, Arran and Cumbrae, with seven practices providing care in people's homes. 

The Managed Dental Service also offers accessible dental care to local residents who have not yet registered with a General Dental Practitioner or who require more care, time and support to benefit from dental treatments. 

These services are offered from Access Centres at Ayrshire Central Hospital in Irvine, Miller Road Clinic in Ayr and North West Kilmarnock Area Centre, as well as from a range of community-based facilities across the mainland and from two facilities on Arran. The service's portable dental surgeries can be used in schools or taken to areas where the local population have no access to dental services. This was most recently used in response to a request from the local community on Cumbrae. 

While these are the people who provide core primary care services, many more people are involved in providing care in our local communities, including practice nurses, community nurses, health visitors and Allied Health Professions such as physiotherapists, occupational therapists and podiatrists. Other, more specialist services are also based in the community, such as our Primary Care Mental Health Teams and midwifery services. Looking ahead, services like diagnostics (scans, x-rays and so on) and rehabilitation could also be community-based. 

The Allied Health Professions provide services to people in hospitals and local communities and to those with a mental illness or learning disability, whether they are living in their own community or in a hospital environment. 

The hospital services provided within the community are for the mentally ill, the elderly - both frail and with mental health problems - and people with a learning disability. GP acute services are provided at hospitals on Arran and Millport, Girvan and East Ayrshire Community Hospital in Cumnock. 

Other services provided in the community include Child and Adolescent Mental Health services, psychology and sexual health services and the out-of-hours general medical service, NHS Ayrshire Doctors on Call. 

Health care in our hospitals 

More than 9,000 staff work in our hospitals - two university hospitals at Ayr and Crosshouse near Kilmarnock, Ayrshire Central Hospital in Irvine and Biggart Hospital in Prestwick- almost 1,300 beds. We also have community hospitals in Arran (War Memorial Hospital), Cumbrae (Lady Margaret), Cumnock (East Ayrshire Community Hospital), Girvan (Girvan Community Hospital) and Kirklandside. 

They are committed to providing the highest standards of patient care to the people of Ayrshire and Arran. 

Our two university hospitals provide a wide range of acute services including Accident and Emergency, Anaesthesia, Breast Screening services, Cardiology, Care of the Elderly, Clinical Haematology, Dermatology, General Medicine, General Surgery, Plastic Surgery, Gynaecology, Intensive Care/High Dependency Unit, Maternity and Neonate Services, Oral and Maxillofacial Surgery, Oncology, Ophthalmology, Orthopaedics, Paediatrics, Pharmacy, Radiology, Renal Medicine, Urology, Sexual Health, Neurology and Vascular Surgery. 

Care of the Elderly and Rehabilitation services are based at Biggart Hospital in Prestwick, Ayrshire Central Hospital, Irvine; East Ayrshire Community Hospital, Cumnock; and Kirklandside Hospital, Kilmarnock. 

GP-managed services are provided at the Arran War Memorial Hospital, Isle of Arran; Lady Margaret Hospital, Cumbrae; Girvan Community Hospital and East Ayrshire Community Hospital, Cumnock. 

The university hospitals also have a number of community midwife bases, and clinicians hold outpatient clinics in a number of hospital and clinic locations throughout the area. 

Putting it all together 

Three directorates - Primary Care and Mental Health Services, Integrated Care and Emergency Services, and Integrated Care and Partner Services - work together as an integrated team across traditional geographical and departmental boundaries. Removing traditional barriers helps us put patient care at the heart of the organisation with the development of integrated patient pathways. Integrated care pathways involve care professionals from a range of disciplines working together to plan and provide care for patients with a specific condition and set of symptoms. 

The breadth of their portfolios illustrates the emphasis on the development of integrated patient pathways and joined-up working with partner agencies across health and social care services in Ayrshire and Arran. 

Integrated Care and Emergency Services 

This Directorate is responsible for delivering a range of hospital and community-based outpatient and inpatient services. The specific areas managed by the Directorate are emergency and urgent care services, which include Accident and Emergency, Out-of-hours urgent General Practitioner services, Trauma and Orthopaedics, Radiology, Diagnostic and Laboratory services, Medical Specialties and Care of the Elderly and Vulnerable Adults. 

The Directorate has embarked on a major development of how we provide services in the future. This will include a redesign of 'front door' services, underlining our approach to developing integrated patient pathways and transforming working practices across community and hospital care. This development will bring about change in our approach to treating patients - moving away from 'admitting to decide' to 'deciding to admit'. This approach will offer extensive opportunities to develop more care in people's own communities. 

This development programme includes: 

• the creation of a single point of entry to emergency/urgent care services at both Ayr and Crosshouse Hospitals;
• the development of combined medical and surgical assessment units to provide rapid access to assessment, diagnosis, treatment and discharge if possible; and
• for those patients who require admission there will be a determined length of stay which will be safe and sensitive to their needs. 

Integrated Care and Partner Services 

The Directorate of Integrated Care and Partner Services has responsibility for community services and a range of traditionally based acute services. This includes the following disciplines: 

Anaesthetics, Critical Care, Dermatology, General Surgery Specialties, Vascular and Urology, Plastic Surgery, Head and Neck Specialties, Obstetrics, Gynaecology and Sexual Health Services, Ophthalmology, Paediatrics, Neurology, Outpatient Services, Theatres, Day Surgery Units, Community Hospitals on the mainland and islands of Arran and Cumbrae, Neurology and Rehabilitation Services. 

The Director also has management responsibility for Community Nursing and Health Visiting services and for the Allied Health Professions who provide services across Ayrshire and Arran's health care directorates. These services include Nutrition and Dietetics, Occupational Therapy, Physiotherapy, Podiatry, and Speech and Language Therapy. The director has delegated responsibility for the three Community Health Partnerships. 

The service is involved in developing new ways of working within community services, making best use of the Change Fund for Reshaping care for older people to shift the focus of care away from institutional care to care in local settings. 

The Integrated Care and Partner Services Directorate also hosts work with the other service delivery areas and partner agencies, to develop the agenda around shifting the balance of care and long term conditions management. 

Mental Health Services 

In mid-2007, NHS Ayrshire & Arran embarked on a major review of mental health services, involving all key stakeholders and community groups. From this review, a proposed strategy and model of care for the future of Mental Health Services was approved by the NHS Board in January 2009 and is currently being implemented. This has led to a series of bold initiatives to build effective teams who are committed to delivering excellence in mental health services and improving the mental wellbeing of our communities. 

Clinical Mental Health Services in NHS Ayrshire & Arran offer a mixture of community and hospital-based services based on a multidisciplinary model, with the majority of services being provided in the local communities of East, North and South Ayrshire. 

Inpatient services are based at: AilsaHospital, Ayr; University Hospital Crosshouse, Kilmarnock; Ayrshire Central Hospital, Irvine; ArrolPark, Ayr; and East Ayrshire Community Hospital, Cumnock. Inpatient beds for continuing care elderly mental health are also provided from Cumbrae Lodge in Irvine. Regionally based beds are provided from Rowan Bank Clinic, Glasgow and from the State Hospital, Carstairs. An Advanced Nurse Practitioner Service also is based in University Hospital Crosshouse. 

Community-based services comprise three Adult Community Mental Health Teams (CMHTs) and six older people's CMHTs, an area-wide Crisis Resolution and Home Treatment Team and three Primary Care Mental Health Teams who share the same geographical boundaries as the three local authorities. This enhances joint planning with our statutory and third sector partners. A range of specialist addiction teams are also available East, North and South Ayrshire. 

In addition, we have community Child and Adolescent Mental Health Services (CAMHS) in East, North and South Ayrshire, with inpatient beds provided regionally from Skye House in Glasgow, and three community learning disability teams. 

Liaison psychiatric services are based at University Hospital Crosshouse and University Hospital Ayr. This service provides support for adults with mental health issues, older people with mental health issues, especially dementia, and those with a learning disability, who are attending either of the university hospitals or Ayrshire Maternity Unit at Crosshouse. 

Executive Medical Directorate 

The Executive Medical Directorate is at the forefront of a range of clinical improvement and quality initiatives that support NHS Ayrshire & Arran's commitment to providing safe, effective and person-centred care and ensure that our statutory responsibilities are met.

Areas of responsibility include: 

• Healthcare Quality, Governance and Standards
• Infection Control
• Patient safety
• Research and Development
• Waiting times
• Litigation
• Medical workforce
• Patient Management System
• Appraisal 

The Executive Medical Director is the Board's Responsible Officer and the Assistant Director - Healthcare Quality, Governance and Standards is our Caldicott Guardian. 

Executive Nurse Directorate 

The Executive Nurse Directorate works hand-in-hand with the Medical Directorate in driving forward continuous clinical improvement and quality initiatives in support of safe, effective, patient-centred care. Areas of responsibility include: 

• Clinical improvement unit (incorporating a range of services from cancer, epilepsy and resuscitation, to non-medical prescribing, pre-registration mentorship and clinical guidelines and policies)
• Scottish Patient Safety Programme
• Education and performance management
• Allied Health Professions
• Service Futures corporate programme office (leading, supporting, co-ordinating and integrating the varied strands of transformational service change activity across NHS Ayrshire & Arran). 

The Nurse Directorate also has responsibility for Patient Focus Public Involvement, incorporating Patient Relations and Complaints and Communications; Equality and Diversity, Chaplaincy and Staff Support services. 

Pharmacy 

The Pharmacy Directorate is responsible for delivering integrated, equitable and accessible pharmaceutical care that meets the needs of patients, service users and healthcare providers. The Directorate is particularly noted for its needs-based, patient-centred approach to pharmaceutical care, provided in partnership with patients, staff, the public and other health and social care providers. 

The Directorate plays a significant role in the governance of medicines and work closely with the Medical and Nurse Directorates and clinical colleagues to improve safety where medicines are used. The Directorate also supports the financial management of the £100 million budget for prescribed medicines within the NHS Board area. 

The Directorate is recognised both locally and nationally for its innovation. Crosshouse Hospital's Pharmacy was the first inScotland to introduce robotic dispensing and Ayr Hospital remains the only Scottish site to have deployed electronic prescribing and administration in the hospital environment. Within Community Pharmacy NHS Ayrshire & Arran led national work around the minor ailments service now part of the core contract for Community Pharmacy. 

Our hospitals 

Ailsa Hospital, Ayr 

Ailsa Hospital lies on the southern outskirts of Ayr on the Dalmellington (A713) Road,Ayr situated parallel to University Hospital Ayr. It currently combines modern clinical accommodation with older mental hospital accommodation. Ailsa Hospital currently provides adult and elderly acute admissions services for South Ayrshire and parts of East Ayrshire and at times for patients from other parts of Ayrshire and Arran. Area-wide services include Non-acute Rehabilitative Care, Intensive Psychiatric Care Unit (IPCU), Elderly Mental Health Continuing Care, Day Therapies Unit, Occupational, Physiotherapy and other Allied Health Profession services; an area-wide Inpatient Dual Diagnosis and Addictions Assessment and Rehabilitation Service, and a number of outpatient services. 

University Hospital Ayr 

University Hospital Ayr lies on the southern outskirts of Ayr on the Dalmellington (A713) Road, It is a District General Hospital providing medical and surgical services on an inpatient, day case and outpatient basis. It is the main Accident and Emergency service for South Ayrshire. It provides a number of Ayrshire-wide services including Vascular Surgery, Ophthalmology and Audiology. 

Ayrshire Central Hospital, Irvine 

Ayrshire Central Hospital is situated within Irvine New Town. It currently provides Young Disabled/Rehabilitation services, and a number of assessment beds for Elderly Mental Health Services. Recent years have seen significant developments on the site with a new General Outpatient Department and Rehabilitation Centre. All have excellent facilities with the Rehabilitation Centre being recognised as one of the best in the country. Ayrshire Central will be the site of new Community Hospital planned for the area, as well as a state-of-the-art mental health adult inpatient facility. 

Biggart Hospital, Prestwick 

Biggart Hospital is situated in Prestwick, close to all local amenities and public transport and is the local hospital for the care and rehabilitation of the elderly. It provides a wide range of Vascular, Orthopaedic and Stroke Consultant-led rehabilitation inpatient and day care facilities.  

The 30-bed day hospital provides facilities to care for patients after discharge from acute care or directly from the community setting. The purpose-built Stroke Rehabilitation Unit was opened in September 1993, enhancing support and continuing patient care within the medical unit, providing 15 beds for stroke patients requiring varying degrees of rehabilitation. 

University Hospital Crosshouse, Kilmarnock

University Hospital Crosshouse is situated two miles from Kilmarnock town centre. It is a large District General Hospital providing a wide range of services, including paediatric inpatient services. It is also home to the national Cochlear Implant Service. It is the main Accident and Emergency Centre for North Ayrshire.  

The UNICEF-accredited Ayrshire Maternity Unit is also based at University Hospital Crosshouse. 

Community hospitals 

Arran War Memorial Hospital is a 19-bed acute hospital with Accident and Emergency services, Maternity, Theatre and a range of outpatient services. It is staffed by local GPs supported by other professions, both visiting and in-house. 

Lady Margaret Hospital in Cumbrae is a 10-bed hospital with integrated NHS/local authority day service staffed by local GPs supported by other professions, both visiting and in-house. There are separate outpatient facilities on the island. 

Girvan Community Hospital is a 26-bed hospital with Minor Injuries service, Diagnostic facilities, Rehabilitation suite, day service and outpatient department, It is staffed by local GPs supported by other professions. The Scottish Ambulance Service is based on site and it is hoped that pharmacy and local authority social services will transfer to the site to provide a multi-agency hub. 

East Ayrshire Community Hospital in Cumnock has 24 beds staffed by local GPs, an outpatient suite, 13 frail elderly beds and 16 elderly mental health beds, Rehabilitation facilities, Social Work team and day hospital. 

Kirklandside Hospital is situated on the outskirts of Kilmarnock and provides consultant-led inpatient and day care services for frail elderly patients. The hospital has 25 long stay beds and a day hospital which provides assessment and rehabilitation facilities for patients after discharge from acute care or directly from the community. 

Protecting the public health 

The Public Health department, including Health Promotion and Health Equalities, is responsible for protecting the health of the people of Ayrshire and Arran through its focus on three main areas: 

• Health promotion - for example, reducing inequalities in health, lifestyle and education. Specialists are responsible for delivering health improvement programmes in the communities in support of the four key public health priorities - alcohol, tobacco, obesity and mental health.
• Health care and governance - for example, surveillance and monitoring of specific diseases and risk factors, and disease prevention, including screening programmes such as the Human Papilloma Virus (HPV) screening programme.
• Health protection - for example, infectious diseases, environmental health hazards and emergency response. 

Support functions  

Other departments provide support and professional advice as well as operational support across NHS Ayrshire & Arran, also working with local authorities and other statutory organisations and the independent and voluntary sectors. 

• Finance

Provides high quality professional advice supported by robust systems to ensure that NHS Ayrshire & Arran fulfils its statutory obligations. 

• Information and Clinical Support Services

Supports the delivery of healthcare through a wide range of non-clinical services ranging from estates and facilities to eHealth. 

• Organisational and Human Resources Development

Provides best organisational and human resources practice and ensures staff governance standards are met in NHS Ayrshire & Arran. 

• Policy, Planning and Performance

Provides a single reference point for strategic, operational and capital planning, ensuring that the strategic direction of NHS Ayrshire & Arran is co-ordinated to improve health, reduce inequalities and increase social inclusion based on the patient's journey.

Click here to download the document;  An introduction to NHS Ayrshire and Arran