Aberdeenshire Community Health Partnership
A consultation document about
Older People’s Services, Maternity
Services and Diagnostic and
Aberdeenshire Community Health Partnership (CHP) is responsible for the
organisation and delivery of NHS care for the population of Aberdeenshire.
Over the past few months the staff of the CHP have been considering if
there are better ways to deliver some of our services to the people of
Aberdeenshire. In particular this review has concentrated on three key
areas, namely, older peoples services (including both geriatric and old age
psychiatry care), maternity services (especially the local midwife led delivery
units at Banff, Fraserburgh, Peterhead, Huntly and Aboyne) and Diagnostic
and Treatment services (a mechanism to deliver specialist services,
normally delivered at Aberdeen hospitals), as close to Aberdeenshire
residents as possible.
This paper outlines a series of options for all of these services. It is very
important that the services are considered together as a “big picture”. The
NHS has a limited amount of resources (staff, physical capacity and money)
and our ability to improve how we currently deliver some of these services is
dependent upon us changing the way we deliver services. The options
range from presenting very little change through to quite radical change –
the more radical change is probably “harder to stomach” but offers the
greatest opportunity to deliver more services on a local basis.
1.1 Our vision for delivering care in Aberdeenshire
Aberdeenshire CHP, in line with the vision of NHS Grampian, - the Healthfit
programme, which is consistent with the recently published National
Framework Advisory Group‟s report led by Professor David Kerr, strives to
deliver services as close to the patient‟s home as is possible and sensible.
This means that we want to deliver as much as possible in community
settings, maximising the use of our primary care teams (including doctors,
nurses, and other health professionals), supplementing this with the skills of
specially trained community staff – including doctors and nurses who have
undertaken specialist training to enhance their skills. For example, some
nurses can be specially trained in the management of chronic diseases such
as diabetes and asthma, whilst some GP doctors become specially trained
in dermatology, minor surgery or cardiology. If a person‟s care
requirements can not be met by the skills (or available equipment) of the
community specialist then we would ensure that the patient is referred in to
the appropriate specialist centre (Foresterhill, Woodend or Dr. Grays). This
model of care provision ensures that patients are seen as quickly and as
near to their home as is possible. The reduced number of patients who
need to be referred to the specialist centres ensures that waiting times
are kept as short as possible.
1.2 Where has this come from?
For people who work in the NHS much of the thinking within this consultation
document will not be new. The issues have been raised and discussed in
many local strategy documents, including, The Grampian Primary Care
Strategy, The Joint Grampian Older Peoples Strategy, and The Community
Hospitals Strategy. However, for many members of the public some of the
information in this document will be new.
This consultation document starts to discuss a series of options about what
the strategic direction actually means in practice, and sets out a series of
alternatives about how this can be implemented in local areas throughout
Later in this document, factors which mean we have no alternative other
than to change how we deliver services are mentioned. For example, the
increasing number of older people in the population combined with the
reducing number of working age people mean we can not just do “more of
the same”. Specialist centres (such as Foresterhill) have limited capacity,
which means they can not always “do more”. However, the good news is
that developments in technology mean that we do more in the community,
closer to home.
1.3 Process and timing for consultation and detailed planning
This document presents a broad overview of possible options for the
re-design of services in Aberdeenshire. We intend to consult widely within
the NHS, with the public and other associated organisations about this broad
„direction of travel‟. Following this exercise, we will use the views we gather
to inform more detailed plans, on a local basis. We will then be in a position
to construct local implementation plans. A schematic representation of this
process is shown in Figure 1.
BROAD NHS G PUBLIC DETAILED IMPLEMENTATION
OVERVIEW PLANS PLAN
Now July - Sept 2005 Jan 2006 onwards
FIGURE 1. A schematic representation of the consultation process
1.4 Demographic Changes
The population profile of Aberdeenshire is predicted to alter dramatically
over the next ten years, and it is essential that we plan for these
changes. For example, the over 85 population is predicted to grow by
40% in the next decade. This is accompanied by a predicted 15%
decrease in the working age population. Given that the over 85‟s are
highly dependant upon NHS services, we need to rethink how our
services will be delivered in the future.
Planning is further complicated in that this very large expansion in
population is not the same throughout Aberdeenshire.
2 SERVICES FOR OLDER PEOPLE
Services for older people are planned and delivered in partnership
between the NHS, Aberdeenshire Council and various voluntary
In addition to the increasing number of older people and the reduction in
the number of “working age” people to support the older population, the
agreed Strategy for the development of services for older people
demands changes in the model of care. As a consequence of these
issues we need to redesign our services for older people.
We know that older people are very keen to continue to live in their own
homes for as long as is possible. The organisation of care has been
altered to try, where it is possible, to allow this to happen by providing
extended support from the NHS, Aberdeenshire Council and voluntary
These changes mean that the CHP needs to reduce the number of now
redundant long-stay hospital beds, enabling funding released from this
to be directed instead at improving community services for older people
and the wider community. This change can only happen in partnership
with the Council who are a vital partner in providing alternative
community based services.
This part of the paper sets out a series of options for this to happen.
2.1 Delivery of geriatric care
The initial phase in converting hospital beds from long stay care is to
re-designate the beds to „slow-stream rehabilitation‟. The immediate
effect of this is that nobody is then admitted to a hospital bed forever.
The person may remain in hospital for a long period of time whilst they
receive rehabilitation, but the aim is always to either move the person
back to independent or supported living outwith an NHS environment.
In order to enable people to continue living in the community as they
become more frail the NHS and local authority need to develop a series
of comprehensive community services.
Community-based services have considerable resource implications
(both workforce and money). In order to fund these services it is
important that we “free up” the resources associated with the buildings
and units which traditionally provided the institutional care for frail older
people. In addition to this shift in the balance of care it is important to
develop other services which will prevent the need for admission to
hospital, thus preventing the “revolving door” admissions.
2.1.1 Aberdeenshire North Local Community Health Partnership
Here the most significant planned changes are already
underway and concern two hospitals - Campbell Hospital at
Portsoy and Maud Hospital. Campbell Hospital will close in the
future, once the development of Chalmers Hospital in Banff is
concluded. A review of services in Central Buchan, which
includes Maud Hospital, is also underway. In partnership with
Aberdeenshire Council, we intend to plan how the services
currently provided in Maud Hospital can be more appropriately
delivered in a community setting.
2.1.2 Central LCHP
There are long stay beds at Inverurie hospital and Jubilee
Hospital (Huntly). It is our intention to change the use of these
beds and deliver services in community settings.
Almost all of our community hospitals also have what we call
„GP acute beds‟, which are used by local GPs for their patients.
While these clearly deliver far more than care for older people,
the patients using them are often older. The provision of GP
acute beds at Insch hospital needs to be examined in detail. A
group led by the Central LCHP Chairman, in partnership with the
Insch Hospital Action Group and the local clinicians, are
developing a series of options for the future provision of care in
2.1.3. South LCHP
Within South there are long stay beds at Kincardine Community
Hospital (Stonehaven) Aboyne Hospital and Glen O‟Dee
A group has been established locally, in partnership with Local
Authority colleagues to review the accommodation and services
for older people within South Aberdeenshire.
We intend to develop more community based alternative
services and accommodation, reducing the requirement for long
stay beds for elderly people in the area.
2.2 Delivery of old age psychiatry
The second major area for consideration for older people‟s services is
provision of old age psychiatry services. Currently we have small units
where patients with dementia are admitted for assessment and often for
long term care. Many of the patients who receive long term care in an
NHS facility should, after a certain period of NHS care (while they are
behaviourally disturbed), be cared for more appropriately within a
nursing home. This transition of care, (which does not currently happen
frequently enough), would enable the specialist NHS staff to concentrate
on other patients with a greater need for assessment and rehabilitation
and mean that less beds would be required to look after people with
This part of the paper sets out a series of options for the delivery of old
age psychiatry services.
2.2.1. Options for the delivery of psychogeriatric care
1. Status quo - Continue to have small local units. Currently we
have units in Banff, Peterhead, Fraserburgh, Huntly, Inverurie,
Banchory and Stonehaven.
Advantages: The main advantage for the status quo is the local
accessibility of the beds, which makes it easier for relatives to
Disadvantages: The units are small and do not provide any
economy of scale which would be achieved in slightly larger units.
With the changing workforce demography it is likely to become
harder and harder to recruit staff to many units. The physical
condition of some of these units requires substantial upgrading.
2. Develop community based “new style” accommodation in
partnership with the local authority.
Advantages: This is very desirable and is probably the
Disadvantages: This is a largely untested model for the delivery
of care and will therefore take some considerable time to develop.
It requires new buildings which would need new mechanisms of
funding and careful planning to make sure they are in the right
3. Develop a larger, more specialised rehabilitation unit in each of
the three local areas (north, central and south) and, in addition,
create one very specialist assessment unit for all Aberdeenshire
patients, based at Royal Cornhill Hospital.
Advantages: By centralising this function (to a degree) it could
be easier to recruit staff. The units could deliver more
specialised care with greater support from specialist clinicians.
Disadvantages: The benefits of local accessibility are reduced.
4. Develop one unit for all dementia care for all Aberdeenshire
patients, probably at Royal Cornhill Hospital.
Advantages: There is a good economy of scale in both terms of
staff expertise and other resources, including money.
Disadvantages: Removal of local accessibility.
2.2.2 What does this mean?
For all of the LCHPs the most radical option, would mean the closure of
all local units. The least radical option would see the status quo. The
“next most radical option” or “next to least radical” option is described
A specialist old age psychiatry unit would be established at one site in
each of the three LCHPs. All other units within the LCHPs would be
closed. All Aberdeenshire patients would be assessed and diagnosed
in one centralised unit based at Royal Cornhill Hospital. The
rehabilitation for all Aberdeenshire patients, who required hospital
admission, would be conducted at specialist units – one in North, one in
Central and one in South.
2.2.3 Requirements for Day Care
Day care would be provided more locally than the specialist units, to
ensure patients did not have to travel too far.
2.2.4 North LCHP
There are currently old age psychiatry beds in 3 Units based at
Chalmers Hospital, Banff, Ugie Hospital, Peterhead and Maud Hospital.
The options are:
One Large Unit at Fraserburgh
2 Units based in two locations at Banff, Fraserbugh or Peterhead
3 Units based in Banff, Fraserburgh and Peterhead
2.2.5 Central LCHP
There are beds at both Jubilee and Inverurie. The options would be to:
Maintain beds at both Jubilee and Inverurie
Maintain beds at both Jubilee and Huntly but reduce the number at
Remove beds from Jubilee and keep all beds at Inverurie
2.2.6 South LCHP
There are old age psychiatry beds at Glen O‟Dee (Banchory) and
Kincardine Community Hospital. Creating a centralised unit at Glen
O‟Dee Hospital for Old Age Psychiatry for South Aberdeenshire would
enable expertise to be concentrated in one place, thereby improving
services for this group of vulnerable patients. This change would be
part of the overall re-design of mental health services within South,
which increases the capacity of community teams to deliver an
appropriate service within the community.
3. DIAGNOSTIC AND TREATMENT SERVICES
NHS Grampian has an agreed vision for delivering services as close to
people‟s homes as is possible, provided this is safe, sustainable and
The principle we have adopted is that care will be
shifted out of Aberdeen and in to community
settings within Aberdeenshire.
To enable this to happen, NHS Grampian needs to develop Diagnostic
and Treatment Services. This means that services which were
traditionally delivered in the acute hospital in Aberdeen, can be delivered
in local sites in Aberdeenshire by specially trained local practitioners.
This will improve the patient experience by reducing waiting times and
the requirement to travel. All of these services would be delivered in
our community hospitals. Some hospitals would deliver some services
whilst others will deliver different services. A network between the
hospitals would ensure that ALL of the services are available in North,
Central and South. The development of these services is part of a
bigger programme of work being undertaken by NHS Grampian
described as “Planned Care”.
The development of these Diagnostic and Treatment Services is part of
3.1 Diagnostic and Treatment Services we wish to develop
3.1.1 Immediate Development (now to 2 years)
Aberdeenshire has already developed many diagnostic and treatment
services. However, these services are not equally distributed
throughout the area and are not fully operational in the areas where they
were piloted and established. The initial intention, therefore, is to
consolidate those services which have already started to ensure they
are available in North, Central and South and at an appropriate capacity.
Elderly People- further develop measures to prevent unnecessary
admissions to an acute hospital. Continue to develop
community-based alternatives to long stay institutional care.
Mental Health- complete the roll out of the new primary care based
mental health workers.
Diabetes- complete the shift of diabetic care into GP practices.
Cardiac (heart) assessment clinics - establish in all areas.
Endoscopy - Upper GI endoscopy and flexible sigmoidoscopy in all
Imaging - Improve access to general ultrasound examinations
Imaging - Install high-tech Picture Archiving and Communication
System (PACS) in community hospitals.
Dermatology- complete the development of a network of
Orthopaedics- develop a network of GPs and other health
professionals who have had specialist training.
Ear, Nose & Throat (ENT) - complete the development of “minimum
stop” clinics in all areas.
3.1.2 Medium (3 to 5 years) and Longer (5-10 years) Term Development
The development of some services within the community will take a
longer period of time. Some require fundamental redesign of services
whilst others will require considerable capital investment. This section
describes some of the services which will be developed over the
medium term (3 to 5 years) and longer term (5 to 10 years).
Unpredictable advances in technology and the consequent reduction in
costs may accelerate the development of some of these schemes.
Surgery - Develop day surgery facilities in the community for North,
Central and South.
Oncology – chemotherapy in community hospitals
Lung function tests (full) in all areas.
Imaging – Vascular ultrasound (carotid and DVT scans).
Imaging – Bone density scans and barium examinations.
Imaging – sophisticated imaging readily available within all areas –
(such as MRI, CT, and bone scans).
4. MATERNITY SERVICES
Within Aberdeenshire CHP there are five midwife-led units. These units
are based at Banff, Fraserburgh, Peterhead, Huntly and Aboyne. All of
these units form the base for all of the community-based midwifery
services, which includes the antenatal care and the post-natal care.
These units differ from the other community units (covering areas for
Team 1: Alford, Insch, Rhynie and Strathdon; Team 2:Fyvie and
Oldmeldrum; Team 3: Inverbervie and Laurencekirk; Team 4: Inverurie
and Kemnay; Team 5: Portlethen and Stonehaven) because they have a
unit within the community hospital where women can elect to deliver
their baby. Women, who are covered by the other community teams
have to choose to deliver their baby either at Aberdeen or Elgin
maternity units or as a home delivery.
Three of the five delivery units (Banff, Peterhead, Fraserburgh) are
staffed on a 24 hour per day, 365 days per year basis. The Huntly unit
is currently not being used, as there are not enough staff to cover the
unit and provide the community midwifery services. The Aboyne unit is
currently struggling, with their staff compliment, to staff their unit and
have moved to a position where the unit is only open when it expects to
receive a delivery.
Our busiest unit (Peterhead) is delivering 2 babies per week and our
least busy (Banff) less than one baby per week. In real terms, more
than 8 out of 10 Aberdeenshire mothers are currently delivering their
babies in Aberdeen or Elgin.
At a pre-consultation workshop, which included many of the midwives
and NHS managers, a series of options for these units were developed.
The options, which are most feasible and sustainable are detailed
4.1.1 North LCHP
Option 1. Status Quo / modified Status Quo
The modified status quo would have a delivery unit in each of the
existing sites but with reduced bed numbers.
Option 2. Close Banff and maintain Fraserburgh and Peterhead
Option 3. Close two of the three units and have all babies “directed” to
the remaining unit.
Option 4 Close all of the units
4.1.2 Central LCHP
Central has one delivery unit based at Huntly. The unit has been in
abeyance for a period of time as a result of staffing difficulties (see
above). There is only really one plausible option for Huntly which is to
close the delivery unit.
4.1.3 South LCHP
South only has one delivery unit based at Aboyne. This unit is having
difficulties with its staffing levels.
As a result, following public consultations, a pilot is on-going (at the time
of this review) to examine the viability of only staffing the unit when a
delivery is happening. The pilot will be evaluated in September 2005
when options for the future will be explored.
Benefits of closing a delivery unit
If the units were closed for the delivery of babies then the staff would be
able to give a far greater amount of time for the delivery of community
based services (both ante- and post natal care). Staffing the delivery
units, often when no babies are present, means that those staff are not
available for other community based duties. Such “staffing of an empty
unit” delivers poor value for public money and means the community
midwifery service can not be increased.
Disadvantages of closing a delivery unit
Local accessibility is lost. Pregnant women will have less choice about
where to have their baby.
5. OVERALL OPTIONS FOR CONFIGURATION
This paper has presented various individual options for older people‟s
services, maternity services and diagnostic and treatment services.
However, we want to consider what might be possible if different
combinations of these options were taken forward together. It is in this
combination or “big picture” of all three services that the greatest
advances can be achieved.
5.1.1 North LCHP
Most radical Option
Close all delivery maternity units, create one rehabilitation
psycho-geriatric unit in the North, create one centralised Aberdeenshire
psycho-geriatric assessment unit. This would allow for the relocation of
all psychogeriatric services out of Ugie Hospital and enable it to be
closed. The additional physical capacity at Fraserburgh hospital could
be used to develop both the rehabilitation psychogeriatric unit and some
other diagnostic and treatment services. The resource which is
released from the closures of Ugie and Maud hospitals could be used to
enhance community services for older people and further develop
Diagnostic and Treatment Services.
Least Radical Option
Maintain maternity delivery units at all three locations. There would be
no redesign of old age psychiatry services and we would continue to
deliver services from Ugie Hospital. There would be very limited
expansion of Diagnostic and treatment services because there would be
no physical capacity or resource available to deliver them.
5.1.2 Central LCHP
Most Radical Option
The beds for the old age psychiatry service would be closed at Huntly.
This would free up space which would be used for delivery of alternative
care. Additional community services would be established for old age
psychiatry. Additional diagnostic and treatment services would be
rolled out to Huntly and Inverurie on a networked basis. The additional
physical space created by the closure of the maternity delivery unit
would be available for diagnostic and treatment services, for example,
endoscopy and day surgery.
Least Radical Option
Old age psychiatry services would remain in both Huntly and Inverurie.
There would be very limited physical capacity for additional diagnostic
and treatment services.
5.1.3 South LCHP
Most Radical Option
One Aberdeenshire psycho-geriatric unit at Glen O‟Dee. Close the
maternity unit at Aboyne. Continue to rollout the diagnostic and
treatment services throughout South LCHP, using the additional physical
space at Kincardine Community Hospital and Aboyne Community
Least Radical Option
Maintain a maternity unit on a reduced “opening hours” basis and keep
old age psychiatry units at both sites. This will not create any additional
Aberdeenshire CHP is keen to hear the views of everyone about the
proposed options discussed in this paper. We feel it is important to
consider these options as a “big picture”, as they are all interconnected.
The development of these options and ideas will be led and taken
forward on a local basis (North, Central and South). Details of how to
become involved in a local consultation or how to respond to this paper
are described below.
Tel 01467 672788
Or write to:
Aberdeenshire Community Health Partnership
9th August 2005