Balfour Hospital, Kirkwall

NHS Orkney is the smallest health board in Scotland serving a population of 19,860. There is one hospital, Balfour Hospital, Kirkwall which has 6 wards (male, female, maternity, Piper (Rehabilitation), St Ninians, MacMillan Unit) and a Casualty & Outpatients Department.

Hospital A&E Information

Trauma cases are seen in the Casualty and Outpatient Department in the Outpatient Treatment Room. However, as there is no CT scanner on Orkney all moderate or severe head injuries requiring CT scan are airlifted to Aberdeen Royal Infirmary (ARI). Those not requiring transfer are seen by one of the two general surgeons and admitted if necessary. Those with milder injuries are referred to occupational therapy and can be reviewed by the surgeon.

Hospital Post A&E Information

Patients returning from neurosurgery may be admitted to either a surgical ward or the Piper rehabilitation ward if unable to go directly home. Those who do not require neurosurgical intervention are returned to Orkney as soon as possible principally to return to their families. There is variation in the notice given to the Balfour Hospital of those returning.

Occasionally patients with severe disabilities may be transferred for rehabilitation to the Maidencraig Unit, Woodend Hospital, Aberdeen from ARI before returning to Orkney. While in ARI only the minority of patients will be seen by the neuropsychologist.

Individuals with mild or moderate injury with no significant physical problem but some cognitive impairment (Scenario A) might be identified in the Casualty and Outpatient Department at Balfour Hospital and be referred to the occupational therapists. Others would have to rely on GP to identify problems and refer them on.

Those requiring rehabilitation for combined physical & psychological issues (Scenario B) would receive in-patient input in Piper ward or might be picked up by the NHS rapid response/early supported discharge service. This service is usually available for two weeks post-discharge but occasionally extends to about six weeks. A small number may go from ARI to the Maidencraig Unit, Aberdeen before returning to Balfour Hospital or home in Orkney. Very occasionally individuals with complex problems at a later stage may be referred and admitted to the Maidencraig Unit (estimated two or three over last seven years). One recent case has been sent to a private rehabilitation facility in Leeds.

People with acute challenging behaviour (Scenario C) are managed locally and no cases of chronic/severe challenging behaviour (Scenario D) have been referred to the Scottish Neurobehavioural Rehabilitation Service, Edinburgh. Both types of case are a common reason for seeking telephone or e mail advice from the neuropsychology consultant based in Aberdeen.

There is no specific resource for managing those in a vegetative/minimally conscious state (Scenario E) and they would remain in hospital.

The consultant neuropsychologist based in Aberdeen visits Orkney for 3 days four times each year. At these visits in-patients and out-patients are seen, with occasional home visits, and educational sessions delivered. All forms of neurological disorder are dealt with in these visits although an estimated 75% of the work relates to Acquired Brain Injury (the majority of which is TBI).

The frequency of these visits has been reduced from 4 to 2 times annually. A proposal has been made to enable videoconferencing facilities so that the neuropsychologist can advise the local team from Aberdeen between visits. There is a clinical psychologist locally who is given NHS contracted services to provide cognitive behavioural therapy but, to the best of our knowledge, this has not been used for head injured cases.

Reviews, Plans and Strateigies

Orkney Community Care Plan 2006-2009 describes current services and areas for improvement

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