Caithness General Hospital services

The accident and emergency department sees on average 9,000 patients a year. The department is staffed by Rural Emergency Physicians who have a General Practitioner background, and experienced nursing staff.

Patients attend the department with a wide range of acute and less acute physical and mental health concerns. The majority of patients are treated at Caithness General. Some patients will need treatment in Raigmore Hospital and will travel by road; those needing ventilation or intensive care are transferred to other hospitals by air. The Emergency Medical Retrieval Team provides intensive care in the air to transfer adult, paediatric and neonatal patients when needed.

Other patients that need input or assessment from other specialities can link to them via video within the department. The Rural Emergency Physicians readily consult with specialist colleagues in other hospitals when required.

Whenever possible patients are admitted to Caithness General Hospital or are discharged directly from the department.

A large part of the department's activity relates to minor injuries. These require a range of treatments and follow-up care. This is managed within the A&E and outpatient departments at Caithness General Hospital. Again when necessary, specialist support is available.

Rosebank Ward is a 17-bedded inpatient ward for acute medical and surgical admissions. There is a 3-bedded Enhanced Care area within the ward for patients who require a higher level of intervention for either medical or surgical presentations.

There is a close working relationship with specialties within Raigmore and other acute hospitals to provide input and guidance in managing more complex care needs.  If required, patients will be transferred for further interventions.

Multi-disciplinary team meetings are held daily to ensure patients receive a holistic approach to their care and to facilitate discharge planning.

Once patients are past their acute stage of illness, if they require rehabilitation or step down care they are transferred to Bignold Ward for further assessment and input.

Anaesthesia for elective and emergency surgery at Caithness General is provided by a full-time permanent consultant, supported by locum consultants. As well as providing anaesthesia for operations, the consultants support patients in the enhanced level of care unit, caring for severely ill patients prior to transfer for more intensive care. The anaesthetist department also supports care in the Accident and Emergency department and Community Midwifery Unit.

Located in the theatre department on the second floor of Caithness General, the cataract service has been up and running at the hospital since 2007. Around 300 people a year benefit from the service, so avoiding having to travel to Raigmore Hospital.

Patients referred to the cataract service will initially receive a half-hour pre-assessment appointment with an ophthalmologist.  This will then be followed up with the surgery if necessary. The surgery is carried out as a day case procedure.

The service is provided by specialist trained local nursing and theatre staff in partnership with visiting ophthalmology surgeons from Raigmore.

The Chronic Pain Management service is a Highland-wide service with clinics held remotely via telephone or Near Me video, as well as in person across the Highland area. The service requires all patients to attend a group online Pain Education Session, where patients are given early education on pain management strategies to help them while they wait for their first appointment. 

A maternity service is provided by midwives at the midwife-led CMU.

The Community Midwifery Unit is a low risk birthing unit. This comprises a LDRP room (Labour, Delivery, Recovery and Postpartum) complete with pool, a neonatal stabilisation area, scanning suite, consultant clinic room and assessment room.

The unit is staffed by midwives with a visiting consultant clinic service weekly, either by video call or in person.

The unit operates between 08:00 and 18:00 with an overnight on-call service.

The day case surgery unit at Caithness General is located on the second floor and is part of the theatre team. It has four beds and six scope trolleys.

The unit is open Monday to Friday providing pre and post-operative care, pre-operative assessment, bowel screening, infusions and trial without catheters.

A pre-operative (pre-op) assessment may be carried out face-to-face or by telephone appointment. Pre-op is carried out for surgery, dental and bowel screening.

There is a wide range of doctors who work in the hospital to provide medical cover 24 hours a day, seven days a week. These include a consultant surgeon, a consultant physician, consultant obstetrician, an consultant anaesthetist, rural emergency physicians, clinical fellows and junior doctors.

The doctors may be either permanently based at Caithness General, on rotation from Raigmore Hospital in Inverness, or locums.

The dietetic department covers the Caithness and Sutherland community, including all the hospitals in this area. The dietetic department is a ‘cradle to grave’ service and also has a role in health promotion and training other members of staff and the public.

Dietitians translate the science of nutrition and interpret biochemical and haematological indices into practical information that can be applied in clinical and health promotion settings.  In this way, the dietitians aim to positively affect the health and quality of life of the population by both treating and preventing disease via diet therapy and nutrition education.

Referrals are received from various sources including inpatient settings, fellow colleagues and also GPs.

Caithness General enjoys a strong team of nurses and employs a number of different grades and specialities. The majority are  permanent members of staff, but some bank and agency staff are also used.

The nursing team includes the charge nurse (the most senior grade) for each of the wards, departments and units; staff nurses and auxiliaries. There are also a number of specialist nurses, midwives and advanced nurse practitioners.

Occupational therapy (OT) provides practical support to enable people to overcome the effects of disability caused by illness, ageing or accident. The aim is for the individual to participate in everyday activities or occupations that are purposeful and meaningful to them.   There are a small team of occupational therapists and health care support workers based in Caithness General who work across the hospital and the community.

The work of the occupational therapist includes:

• functional assessments – for both personal and domestic activities of daily living
• rehabilitation programmes – including individuals who have had a stroke, amputation or hand injury
• standardised assessments e.g. cognitive, perceptual deficits
• outpatient service including hand splinting
• provision of equipment and adaptations – both minor and major
• discharge planning – including home visits and liaison with the multi-disciplinary team including social work and district nurses
• wheelchair assessments and training

The out-of-hours centre for the whole of Caithness is based at Caithness General. The service runs from:

• 6pm in the evening to 8am in the morning, Monday to Friday
• all day on Saturday and Sunday

The outpatient department is located on the ground floor at Caithness General. Clinics are usually run from Monday to Friday, 9am to 5pm. The service is organised by a team of nurses with a wide range of clinics, as noted below, provided by specialist nurses, local and visiting consultant staff.

A wide range of outpatient clinics are provided, including video conferencing clinics which mean patients don't have to travel but can still get specialist input: 

There is Near Me access to specialist virtual clinics if patients do not have access at home.

• baby and adult vaccinations
• biometry
• cardiology
• cataract screening
• chronic pain management service
• coil clinic
• community paediatrics
• dietetics
• diabetes
• diabetic eye screening
• diabetic paediatrics
• drug and alcohol rehabilitation
• Ear, Nose and Throat (ENT)
• fracture
• geriatric medicine
• glaucoma screening
• gynaecology
• health improvement
• Investigation Treatment Room (ITR) - bloods, dressings, ECGs
• lymphoedema
• medical
• mental health
• Optical Coherence Tomography (OCT)
• oncology
• ophthalmology
• optometrist
• orthopaedics
• orthoptist
• orthotics
• pacemaker
• paediatrics
• Parkinson's
• psychiatry
• rehabilitation
• renal
• respiratory
• Special Care Baby Unit (SCBU)
• sexual health
• smoking cessation
• surgical
• urinary flows and residuals
• visual acuities
• visual fields

9am-5pm Monday to Friday

Out-of-hours provision is from the Raigmore on-call pharmacy team.

All services to Caithness General Hospital and the peripheral hospitals are provided from the pharmacy department at Caithness General.

Caithness General Hospital

• ward clinical pharmacy service
• inpatient discharge prescription provision
• outpatient prescription provision
• supply of medicines to all hospital wards and departments
• ordering of medical gases
• vaccine holding centre for all vaccines (COVID vaccines, childhood and school immunisation programmes, flu vaccines)

Peripheral hospitals

Town and County Hospital (Wick), Dunbar Hospital (Thurso), Lawson Memorial Hospital (Golspie) and Migdale Hospital (Bonar Bridge):

• supply of medicines to wards, inpatients and departments
• inpatient discharge prescription provision

Physiotherapists at Caithness General help people affected by injury, illness or disability through movement and exercise, manual therapy, education and advice. They provide specialist assessment, treatment and management of adults requiring rehabilitation due to conditions like stroke or COPD.

The physiotherapist has a lead role in falls prevention, working closely with people who have mobility and/or balance problems, and with the rest of the multi-disciplinary team to ensure that no-one has to stay in hospital longer than necessary, or that the patient can remain independent at home for as long as possible.

The physiotherapist works as an integral multi-disciplinary team member in both the hospital and the integrated community health and social care team. Referrals for physiotherapy are received on a daily basis from various sources including ward rounds and self referrals.

Specialised clinics and classes facilitated by physiotherapy include:

• cardiac rehabilitation
• Otego
• pulmonary rehabilitation
• pelvic health

Podiatry staff based at Caithness General provide a comprehensive high quality service for patients with foot and lower limb problems, to encourage a pain-free and active healthy lifestyle.

However, the podiatry service is not located in the hospital, apart from a workshop for making foot orthoses. Any service to the hospital is provided on request in the main for urgent cases.

The Bignold Wing is a 21-bedded post-acute and rehabilitation ward, accepting patients from our acute admissions ward (Rosebank) and hospitals across Scotland.

Bignold ward works with a multi-disciplinary team of physiotherapists, occupational therapists, dieticians and a community team.

Our consultant geriatrician regularly reviews all patients, and we discuss each patient’s care as well as rehab goals during our regular team meetings.

Bignold liaise with community services and community hospitals daily to co-ordinate care needs for patients following discharge. The team has recently developed a weekly pre-discharge meeting involving patients, relatives, the multi-disciplinary team and community services.

We operate and encourage open visiting.

The X-ray department provides a general, theatre, mobile and dental X-ray service, CT scanning, ultrasound and abdominal aortic aneurism (AAA) screening. Obstetric ultrasound including early pregnancy is performed on site, housed within our dedicated scanning suite at the Community Midwifery Unit.

24-hour emergency on-call cover is available for CT and all X-rays, and provided by radiographers travelling in from home (they are not based on site).

Some more specialised examinations in musculoskeletal (MSK) ultrasound are covered by a visiting radiologist from Raigmore Hospital - these are generally every two months.

The echocardiography scanning service is also based within the department at Caithness General and is staffed by visiting colleagues from Raigmore Hospital.

This service aims to rehabilitate people at home, preventing hospital admissions and getting people home from hospital quicker. It involves a multi-disciplinary approach with all the healthcare professionals at the hospital - occupational therapy, physiotherapy, speech and language therapy, nursing staff, care at home, GPs and allied health practitioners - working closely together with patients and their families.

The RaSTU is a nurse-led service that offers care to patients who require some form of care on a day case basis -  that is, they walk in for treatment over a few hours and they go home on the same day, thus avoiding unnecessary admissions into hospital.

We provide scheduled treatment for the following needs:

Renal dialysis

4 days a week:

• Monday/Wednesday/Friday 8am to 8.30pm
• Thursday 8am to 2.15pm

We also cover the renal clinic once every 6 weeks and provide post-renal transplant care/advice.

SACT clinic

• Monday 9am to 5pm
• SACT treatments on Wednesday 9am to 5pm

Systemic therapies

• Friday 9am to 5pm

This would include different intravenous infusions (drips) to manage a wide range of symptoms and conditions, including:

• anaemia
• colitis
• Crohn's
• haemochromatosis
• iron deficiency
• multiple sclerosis
• polycythaemia
• renal vasculitis
• rheumatoid arthritis

The RaSTU was formerly known as the Ambulatory Care Unit.

The Speech and Language Therapy (SLT) team cover different parts of Caithness and Sutherland and have different specialist skills.  They work directly with individuals and with others involved in their care - parents, teachers, family, health professional and allied health practitioners - and tend to do most of their work in hospitals, nurseries, schools and health centres, although home visits are available.

The team works with a huge variety of people - from young children who have difficulty communicating to people recovering from stroke and other brain injuries to reduce the impact of these often isolating difficulties on people's wellbeing and their ability to participate in daily life.

They also work with others including parents, carers and other professionals perhaps providing training to make the therapy and support more effective, and to improve the recovery or independence of  the clients.

Elective surgery patients will be admitted to the Surgical Suite located on the second floor. If your proposed procedure requires you to remain in hospital post-operation, a bed will be arranged for you in the Rosebank Ward. You will be transferred in the late afternoon.

Patients attending the Surgical Suite on a day case basis who require sedation or a general anaesthetic will require to be accompanied home by a responsible adult.

There are two well-equipped theatres which provide a range of surgical procedures. In general there is one operating session per day with the second operating theatre available for emergencies. 

• Monday: gynaecology
• Tuesday: general surgery
• Wednesday: general surgery
• Thursday: oral surgery / general surgery / ophthalmology
• Friday: general surgery (minor operations)

Surgical procedures include:

General surgery

• appendectomy
• cholecystectomy
• circumcision 
• excision of anal polyps
• excision pilonidal sinus
• hemorrhoidectomy
• hernia repair
• rectoplexy
• THD procedure
• umbilical repair
• vasectomy

Gynaecology

• anterior/posterior vaginal wall repair
• coil fitting and removal
• diagnostic laparotomy
• diathermy for endometriosis
• dilatation and curettage (D&C)
• oophorectomy
• sterilisation

Endoscopy 

Scheduled procedures.

Intravitreal injections

This is a nurse led clinic held every Wednesday for the treatment of macular degeneration.

If phoning or visiting the hospital it is very likely that one of the 10-strong team of switchboard operators will be involved. The team cover a range of duties including switchboard, main reception and medical records.

Switchboard duties include:

• monitoring the hospital’s alarm systems
• call out of on-call staff
• instigate the communications procedure if someone has had a cardiac arrest
• handle calls to the ambulance radio
• field calls diverted from NHS 24 and other sources

The tissue viability team have an office based at Caithness General. This team provides a service for teaching and promoting wound care interventions that is evidence-based and in line with national and local guidelines. For patients, there is the opportunity for face-to-face visits to support in the treatment and management of complex wounds, alongside clinicians alike.