YOUR VIEWS! Community Feedback REPORT

Transcription

1 Scottish Ambulance Service Short Listed Options - Isle of Mull and Iona Thank you for talking to us, your views are important to us. YOUR VIEWS! Community Feedback REPORT 15th June 2015 Mull & Iona Health and Care Review Website: 1

2 Background Providing high quality, safe and affordable health service to remote and rural communities across Scotland is challenging. It is a challenge for the present and for the future. The Mull & Iona Health and Care Review Group was established in October 2014 to ensure a high quality, person centered, sustainable and affordable integrated health and care service (in and out of hours) for the communities on the islands by October The action plan is in line with the Scottish Government s 2020 Vision for Health and Social Care. The review will run for a period of twelve months. Once approved, the Oban Lorn and Isles Locality Management will put in place a plan to implement the recommendation(s). The review does not include day to day operational issues. This element of the review has been examining the Scottish Ambulance Service (SAS) provision on the Island. Agreement was reached to assess the current model against alternative options to ascertain: Does it meet current and future need, What alternative service models are there Does it require redesign and / or enhancement? Is it sustainable and affordable A number of alternative options (long list) were identified and assessed by the review group and a short list of options was agreed to go forward for formal assessment via an option appraisal process. To inform the option appraisal it is essential to gather feedback from communities and staff across Mull and Iona on the various options, identifying their preference or issues and any other points to consider. The review group, the SAS, stakeholders and the Communications and Engagement Group developed a public information pack detailing the short listed options. This was widely circulated to residents and publicised in the local island magazine Round and About. In addition the SAS hosted a number of number of road shows / drop in events as detailed in Appendix 2. Residents were asked to complete a feedback form or an online survey to collect their views on the options. As of 15 th June 111 feedback forms and on line survey results have been returned. These returns have been incorporated into this report, which details the quantitative and qualitative information collected. Addendum 1 details the feedback received post the 15 th June and the Mull and Iona Review group asked for these to be included in this report 2

3 Your Views! Feedback Results The evaluation of the feedback received has provided both a quantitative and qualitative feedback. A total of 111 forms were received as at 15 th June, by post. 2 by 60 by survey monkey 20 from events In terms of both quantitative and qualitative feedback, given the volume of responses received the detailed unedited written ( Your Views! ) has been included in this report. The options: Option 1 No Change Continue with the response model which is in place. This entails one vehicle on the Isle of Mull and Iona providing some live cover and some on call cover Option 5 Paramedic Model In addition to Option 1, this is an alternative model for responding to emergency calls. Paramedic is a highly skilled practitioner who can assess and treat minor illnesses / injuries, can respond to some callouts that a GP would undertake in the community, can work in the hospital and respond to 999 calls Option 6 Joint Model of Response In addition to Option 1. A response vehicle staffed with a Paramedic and Nurse Practitioner. Support patients to remain at home rather than being admitted to hospital unnecessarily Option 8 Mull Community Council Option The model centres around the current resource plus a fast Paramedic Response Unit (PRU) shadowing the same hours. Improves skill mix. At any given time there would be an Ambulance with a Technician plus a Driver 2 3

4 Further information on the options and the survey/feedback form and drop in events can be found in Appendix 1 and 2. Responses to Questions Q1. Is each option easy to understand, what it would provide, strengths, weaknesses? No of Responses Yes 45 No 26 Don t know 4 n= 8 If no or you are unsure, what information would be helpful? General Comments Please supply Round and About with regular updates about progress, including any set-backs. Is funding arranged and from where? Some strengths and weaknesses in equal measures. Big confusion. Information provided in advance of meeting so it can be studied and considered carefully. The information was made clear in Round and About by means of a very helpful article provided by the editor. No, Practical examples Thanks you for an explanation of the Paramedic response unit by the consultation group. Issues of staffing, recruitment make all other options difficult form what we already have so it feels like experts need to do the best with what resources emerge. Display was poorly pretend too much information on each panel. The bulk of the info was only available at the drop ins, the info supplied to the community in the local press was incomplete, scant, and unbalanced in terms of how the options were presented. It would have been simple and very low cost to provide the full info on a website for those with internet connection to see, and still be catering for those without internet at the drop ins. There was no financial information about the different options. The taxpayer is not stupid, we understand we live in a time of austerity where we all have to watch spending, and so to patronise us by not providing financial comparables is despicable. A child may want to choose the biggest slice of cake, or the shiniest jewel, but as adults we are able to choose between voting for an all singing all dancing option which looks great in theory but is not financially viable and a lost cost 4

5 simple model option which offers almost as good a spread of capability for the spend. But you do need to provide us with the an outline of the costings which you must have. Preferred Option 1 No. An opportunity to make comments would be very useful. Where does it tell anything about strengths and weaknesses? Preferred Option 5 No, Vague -poorly worded Preferred Option 8 No, Information is misleading No, Cost to implement for all models. Time required to implement for all models. Very unclear that this has a fast response vehicle manned by a paramedic as well as an ambulance with a technician and a driver. It is an enhancement of the status quo utilising all the current staff plus a second paramedic. Costings would be helpful Clear as mud. Remarkably badly presented. Also, this on-line survey was not mentioned in the published information. Why? No, If one cannot go to the consultation events, it would have been good to understand the potential costs of new options as well as the timetable for implementation, how soon each new option can be implemented should be, and is for me, the critical factor in the decision making process. I am also assuming that an enhanced service is to be provided. No. The swot analysis on the posters at the meetings should have been available in Round and About, on a website and or other social media. There should have been an explanation of the cost options. There is a danger that we could select the most expensive when there is no chance of it being implemented. It is also unacceptable that the weightings will not be known until after this stage of the process again making it impossible to decide on the preferred option at this stage. The Community option (8) was given scant attention in the Round and About. Overall all unless one was able to attend a drop in any preference of option could not be based on an objective assessment. I was also concerned and surprised to learn that the actual people who do the job and will be expected to adopt the new model have not been involved in the preparation of the options. In my business experience all the best implementation ideas came from the staff involved. The second advantage would be greater acceptance since they had at least been involved. Overall it feels as if this process will enable you to tick the box to confirm that the community has been involved where the reality is they were inadequately advised and most people will have to make a subjective choice of option. 5

6 Q2 Please rank the options from 1-4. Your preferred choice = 1, next best = 2, etc with least favourite = 4 Options Rank 1 4 Survey Monkey Responses Option Description Total Option 1 - No Change - Continue with the response model which is in place. This entails one vehicle on the Isle of Mull and Iona providing some live cover and some on call 7.87% 7.87% 7.87% 76.40% % cover Option 5 - Paramedic Model - In addition to Option 1. Alternative model for responding to emergency calls. Paramedic is a highly skilled practitioner who can assess and treat mino rillnesses / injuries, can 7.14% 36.90% 45.24% 10.71% % respond to some callouts that a GP would undertake in the community, can work in the hospital and respond to 999 calls Option 6 - Joint Model of Response - In addition to Option 1. A response vehicle staffed with a Paramedic and Nurse Practitioner % 51.22% 32.93% 3.66% % Support patients to remain at home rather than being admitted to hospital unnecessarily Option 8 - Mull Community Council The model centres around the current resource plus a fast Paramedic Response Unit (PRU) shadowing the same hours. Improves skill mix. At any given time there would be an Ambulance with a Technician plus a driver 2, 78.57% 4.08% 8.16% 9.18% % plus a PRU Commentary The respondent feedback ranking the options shows overwhelmingly that Option 8 has the greatest preference with 79%. Options 6 ranked second with 51% Option 5 ranked third with 45 %. Option 1 is ranked the least favorable by 76% of respondents 6

7 Q3. Please say why the option you ranked 1 would best meet the needs of your local community? Option No: 1 Enough to cater for current needs. Has worked well for many years. What we have now works well. There are few occasions when another vehicle would be justified. it s nice I m sure there is no money for 5, 6, and 8. Option Number 1 I am satisfied with it. Option 1 versitle but more affordable. Quicker to implementit appears to be the best option Option 1 so.. should the ambulance be called to the other end of the Island there would be a response team nearer to Tobermory in a life threatening emergency Option 1 Use PRU. As existing system Option 1 would give best all round cover. Option 1 do try and fix something that isn t broken, the doctors are the problem not the ambulance service. Option 5 No advantage in having paramedic and end on same shift as skills very similar. Would leave hospital short of emergency care provision so better with paramedic on each am crew -and more cosy effective As care in the community seems to be the way forward and because of the lack of facilities for progressive and terminal care no longer exist as provided on the island previously. More specialised targeted assistance. Option 6 The skills of paramedic and nurse practitioner will complement each other. The added advantage of the NP being used to treating patients with all sorts of problems is not to be underestimated, and will allow many patients to stay at home. Being married to a retired nurse with extensive experience I can vouch for that. With proper heath care support staying at home is less disruptive Option 6 this increases the potential service to more areas geographically at any one time where multiple incidents may occur. Option 6 seems to offer most flexibility and easiest option to attract staffing. Option 6 feel it is the best option for rural community. Option 6 in some cases the patient would be better off at home but just needs attention and/or medication. Saves moving them hospital unnecessarily 7

8 Option 8 Option 8 sounds most practical in that it could be implemented reasonably quickly, and would offer an improvement in the current situation. It has also been proposed by people who actually live on Mull and Iona, and who understand well the issues affecting daily life here. Best suits the level of response required on Mull & Iona Because it understands community needs Having a second vehicle would allow a wider geographical coverage of SAS emergency cover on the island. Would be good for Ross of Mull. Option 8 is the only one that would be affordable, sustainable and could be implemented within a short space of time. It would be best for the specific geography of the island, the single track road and its hazardous travel conditions and would save lives This builds on what is in place now, stands the best chance of succeeding as it requires less new staff to be recruited and other than option 1 will have the lowest cost burden. This option gives improved cover, especially in the speed at which the person will receive vital and in some cases life saving care. Gives a greater coverage fast PRU a definite advantage in a wide rural location It covers the needs the most while ensuring someone can respond, and quickly. It can be a long way from one end of the island to the other. Seems the most likely to be enacted and an improvement on the current and sadly lacking service. Because of the geography (rural) and size of the area that needs to be covered I feel that capacity to cope with possible emergencies is important. It appears to be the option that is capable of being implemented the quickest at a time when permanent GP services are being redesigned.should give much more confidence to the community. A fast paramedic response is needed considering the long distances involved Is the most affordable, sustainable and implementable The Community Option (8) can be built upon in the future and it looks the easiest to implement at this stage. If the out of hours is changing to Craignure rather than Bunessan we need a second vehicle. I believe that even if a helicopter is called an ambulance is required to transfer a patient to it and this can cause considerable delay if the single ambulance is busy elsewhere...delay that could be life threatening. This option provides a second vehicle in a way that seems realistic in terms of timescale and hopefully cost. It is the option which has been worked out carefully and with great thought by local people with local knowledge. It is not an "all singing all dancing" option which would be prohibitively expensive, but seems to be a pragmatic thoughtful balance of resources and need. Option 8 seems to be the best balance between affordability, sustainability, and meeting the needs of the community. Probably the least expensive. Better emergency coverage of large geographical area than currently available. attainable in the short term and likely to continue in the long term 8

9 affordable and doable Such a wide geographical area with almost entirely single track roads requires more than one ambulance/paramedic to be available for emergency calls The topography of Mull & Iona means that any realistic cover will have to include 2 vehicles; distances are long and roads are slow. Providing a PR can be maintained at each centre of population a trained, knowledgeable person should be available throughout the islands within a reasonable time to give relief and comfort. All members of Mull Community Council has done a thorough analysis of the options from the point of view of the user and agreed option 8. Better access on the terrain; less wear on the ambulance. Paramedic the best person to arrive 1 st. Option 8 is the only sensible one. The Community Council have done a thorough study of the needs of island residents and I trust their judgment. Quick response is needed otherwise golden hour is lost and possibly life. Can we implement from option 8 to 6 in time? Quick response is needed otherwise the golden hour is lost. The distances an ambulance would need to travel are too great for Option 1 to be safe. Options 2 and 3 are good but expensive, so Option 8 seems a good choice bearing in mind the hours. It offers improved skills to be available, flexibility of direction involving 2 vehicles and possible more rapid response in some cases. An extra vehicle on the island would reassure the local community. With the size of the island the least we need is option 8. In an island context the fastest response has to be the best option, especially as there will be no local doctor on call with the hub & spoke. Seems to be the best level of coverage for the island and can be upgraded in the future if necessary. Obviously in our retrieval situation and the nature of infrastructure and the mileage around Mull a fast option response would be best option to reach point of need. Fast effective and fully responds to all needs of the island. Offers better coverage for Mull & Iona. Offers more complete coverage of Mull & Iona using 2 vehicles and crews. Best suits more remote areas and farthest away from Craignure. It offers the best service of what the other options can offer but will we get this option i.e. 8. Taking into account the influx of tourists and pilgrims, to ensure a happy and efficient workforce the island requires the option that would best suit its population geographic position and infrastructure and single track roads. For rural community. This option redeploys staff that are already under contract. It makes better use of their skills while also introducing a fast response car which would be available at times to work with GPs and / or the hospital in Craignure, and to support Community First Responder. Option Number 8 - provides cover of a flexible nature. Coming from the perspective of a varied population with its needs maternity children, aged 9

10 issues (heart/stroke) huge number of tourists short term visitors trauma etc. Option Number_8_ More skilled Service available than at present but hopefully realistic costing and according to the sporadic needs. Option Number 8 It allows flexibility for a fast response anywhere on the Island with highly trained professional. It is best suited to the geographical area to be covered Option 8 Mull georgraphy make an emergency at one end of the island not being able to respond to other emergencies elsewhere. Two response vehicles is essential Option 8 may be a greater chance of this becoming a reality. Comment 10 Option 8 - It improve skill mix./ one ambulance and PRU with the air ambulance provision gives flexibility for wide variations in population between summer and winter population of residents and visitors. Comment 12 As a local who understands the needs of the community Option 8 would best suit these needs. Option 8 Option 8 ease of provision. Speed of initial response. Possibility of response to more than one issue. Option 8 assessment by locals,aware of the local situation Option 8 because it is recommended by the Community Council and they have looked in detail at all the options. I think option 8 meets the needs of the community better than the other options. Option 8 - this is the closest option for having an ambulance for the Ross of Mull which is what is actually needed. Option 8 - I feel this is the best option. Option 8 a fast PRU would be ideal on top of what we have already Option 8 It sounds right Option 8 best option for the community improves existing cover without large increase in costs. Because it would take little in comparative terms re cost and training to introduce and so could be quickly implemented and is sustainable as it can be built on and augmented in the future. It provides flexibility, skills mix and is least open to skill atrophy 10

11 Q4. Do you have any other comments, ideas, concerns or questions? No other ideas the thinking has been done at grass roots level, with professional input. Whichever solution is selected must be kept under review and XXXXXX / improvements introduced over the years when necessary. Congratulations to all. It would appear that efforts are being made to spend money unnecessarily if the funding is already available at all. An increase in population could mean option 6 is necessary. Option 6. If a nurse can sort the problem an emergency call out should not be actioned. Social response team for old people who cannot stand etc, ambulance not required. Long distances on single track roads results in low holiday traffic speeds etc. In the future looking forward to the future to improve from option 8 to option 6. Has a motorcycle response been discussed? Ideally 2 ambulances on the island would make even more at ease. My serious concern is the total lack of Patient Transport for the Ross of Mull. Eighteen months after the CHP Joint Transport Solutions Group identified the problem. Speaking from past experience is the need for a fast response to emergencies. I wholly understand and agree that a fast response unit is needed in our community. Need to consider the impact of R.E.T come October Increase in people numbers, busier roads. Option needs to be kept under review once preferred option is implemented. Would a local GP respond to emergency if available? If so, would he/she be asked to respond via the 999 service? I cannot help wonder, that after all the meetings, info etc will we in the outcome receive what we are given regardless? My concern is a rise in the death rate if the incorrect option is implemented, and the possible rise in law suits against the NHS. One ambulance from Tobermory to Iona is absurd. The distance is 60 miles apart, need ferry to reach Iona, half is single track roads, during tourist season even with a blue lamp flashing there will be hours and hours of delay. Essential there is two ambulances available. Where will the (hoped for) PRU be based ideally centrally and not Tobermory. My concern is that the cover takes into consideration the complexity of the geographical location/single track roads/resident diabetic and population resident age range and visitors fracture, heart, stroke meningococcal etc. Availability of means to get home post treatment. The first responder system is also a further improvement and must be encouraged. 11

12 My daughter has sever allergies we are in Tobermory should the ambulance be call for Finnoport/Iona it could take over an hour to reach us even if it left immediately- should she have a life threatening reaction. Any competent personal contact is helpful at a time of emergency need but a double check is always advisable if at all possible. Used ambulance service on Mull three times in last two years something of an expert unfortunately. option 8 is sustainable and implementable. The community first responder scheme will not replace existing service but will fill in time gap and chain of survival. need to implement then bolster first response scheme. I would prefer to see SAS recruit and adapt to service so it is the best it can be. If the service we receive will be the same, then I think these decisions are best taken but SAS rather than by the community. Don t feel as if I could chose an option knowing the challenges of island provision. I don t think any of the options are the way forward I would look at recruiting staff appropriate and build the job around their experience/skill set. more cover and possibly faster response by skilled Paramedic/Nurse would help in emergency situations. some parts on the mainland have a far worse service than we do most of chose to live in rural areas The entire presentation to the community in drop ins and the press was totally jargonistic. Because I care, I spent well over an hour before going to the drop in researching your jargon so that I could even understand what the difference in skills and responsibility was between your different job titles. It is unreasonable and lacking in transparency to expect the ordinary tax payer to know the important differences in terms of care that be can provided between say a ACADriver 2 and a Technician. This may be your day to day language, it isn't ours out here in the community. By not being clear about the constraints of care available in certain roles I believe you were misleading in what reasonable members of the tax paying public might assume in good faith. I am flabbergasted that you had not discussed the viability of the options with the personnel on the ground actually doing the job and knowing the constraints and local challenges of Mull. Organisations have been managing vast change programmes for ever and during the last 30 years much has been learnt and documented around how best to manage and implement change in organisations where people and communication must both come first in the process. I was horrified to 12

13 hear that your people were only finding out about these options by coming to these drop in events with all of us. That is diabolical man management, change management and quite frankly if that's the best you can do, I despair. Change management is tricky, but it is not rocket science, for goodness sake get into the 21st century with this or all your change initiatives will fail spectacularly. Preferred Option 1 We do need FIRST RESPONDERS in place as soon as possible so that there can be fast response before an ambulance arrives. Road quality and traffic are the biggest problems as well as the geography of the island. The likely costs of the other options are going to be prohibitive so it's hardly worth considering them. Preferred Option 5 We need more than one ambulance for this large island, whose population grows hugely in the summer, and has an increasingly elderly population I question the cost of a PRU and also the use of the paramedic in the hospital, would this result in the loss of nurse working hours especially for bank staff as they depend on regular staffs holiday and sick days to give them hours, also who would cover if the paramedic was called out would this leave the hospital a staff member down and patients at risk. To have the paramedic on shift at all times with a full nurse team would run into high costs. We also need better communication between hospital and ambulance both on and off the island as patients have been left stranded on boat and at ferry terminals and this results in a lot of stress for both patient and family. Preferred Option 6 An increase in population could mean option 6 is necessary. Option 6. If a nurse can sort the problem an emergency call out should not be actioned. Social response team for old people who cannot stand etc, ambulance not required. We live at Leacann, Croig, Dervaig, PA75 6QS and have a great deal to thank our wonderful ambulance personnel for over the past three years. We prefer option 6 in the long term and option 8 for the meantime if this is possible it certainly seems the best combination. Option 6 can support patients at home rather than an expensive hospital admission and delivers care in the community. This is our reason for supporting 6 as a final deal. Option 6 is not immediately obtainable but option 8 is. That should not be the reason for settling on option 8 but should be seen as an interim course of action until option 6 can be rolled out. Fast response is my main concern especially in the summer months when our roads are so busy. 13

14 Preferred Option 8 Thank you for caring, and providing us with good service from remarkable & capable people on the ground. Consideration should be given to Patient transport services and how community transport could support some of this work. A contract with community transport and SAS to provide this service. Currently the emergency response vehicle also does patient transport, so some patients are left at Craignure ferry, which is not acceptable. What is the time scale to implement any change? This option has been thought out by community consultation with people who know the island and the problems and not based on a model working in another area with a different set of problems. Communities furthest from Craignure are still going to be very poorly served with any of these models. Average response time on the mainland, 8 minutes. On Mull 30 mins, 60 mins, 90 mins +? If you cannot provide localised GP out of hours cover (which worked well for decades), then retained Paramedics living in these communities could be acceptable. Otherwise emergency cover is always going to be second rate. Why should places like Iona or Bunessan have to have second rate services? I found the explanations in R&A quite difficult to understand to the uninformed...too much jargon..no explanation between a paramedic and a technician..also can someone explain what role NHS 24 has in this? No information given on relative costs...worried that options may be discounted on the grounds of cost would be better to have the full picture now. I question the cost of a PRU and also the use of the paramedic in the hospital, would this result in the loss of nurse working hours especially for bank staff as they depend on regular staffs holiday and sick days to give them hours, also who would cover if the paramedic was called out would this leave the hospital a staff member down and patients at risk. To have the paramedic on shift at all times with a full nurse team would run into high costs. We also need better communication between hospital and ambulance both on and off the island as patients have been left stranded on boat and at ferry terminals and this results in a lot of stress for both patient and family. No option selected I will not vote for any of these options, as none are suitable for the Ross of Mull. If we have no out of hours GP, then we MUST have a dedicated ambulance and driver and paramedic based in the Ross of Mull. 14

15 How is this feedback used? The feedback is used to inform the option appraisal and is crucial to ensure the local population is given the opportunity to have their voice heard, this is in line with Statutory Guidance CEL (4) 2010 and Option Appraisal best practice. This report is sent to all members who will be participating in the option appraisal and will be reviewed as part of the programme for the day. The feedback received is therefore very important and of great value. Many thanks to all those who returned their completed feedback forms or responded using other methods to do so. Once the option appraisal process has been completed this report will become a public document. Stephen Whiston Head of Planning Contracting and Performance NHS Highland (Argyll & Bute) 12 th June

16 Appendix 1 Mull & Iona Health & Care Review - Scottish Ambulance Service The detailed service option descriptions and information can be found here: s/randa%20gf%20information%20publication%20final21may15.pdf The feedback form/ online survey can be found here: 16

17 Addendum 1 Additional Feedback responses received after 15 th June 2015 MULL & IONA HEALTH & CARE REVIEW YOUR VIEWS Q1. Is each option easy to understand, what it would provide, strengths, weakness? Yes 16 No - 1 Don t know 2 If not what information would be helpful It would have been helpful if the fuller information available at the meeting had been more widely available. There is a great deal of detail so the drop in session should help to demystify this. Q2. Please rank the options from 1 4. Your preferred choice = 1, next best 2 etc with least favourite = 4 rank Option 1 Option 5 Option 6 Option Q3. Please say why the option you ranked 1 would best meet the needs of your local community Option 1 I think at the moment there is a fear that an ambulance would not get to the patient on time. Option 1 would meet that fear, by having a fast response unit in addition to ambulance I m satisfied with it. So that should the ambulance be called to the other end of the island, there would be a response team nearer to Tobermory in a lifethreatening emergency. Versatile but more affordable. Quicker to implement Option 5 It appears to be the best option. More skilled service available than at present, but hopefully realistic cost and according to the sporadic needs 17

18 Option 6 This increases the potential service to more areas geographically at any one time where multiple incidents may occur. it s the best option for a rural community Option Number 8 This is the only option that would bring a significant improvement to the existing cover quickly and should be affordable. It augments the existing resource and makes good use of the employed staff. 5 & 6 remain aspirational and likely to be unaffordable. Status quo is not an acceptable option. only feasible option to provide a significant improvement. Option 5 & 6 desirable but to feasible. this appears to be the most workable, achievable and economical and best adapted to our unique situation (I do not wish to rank option (1) at all as I believe it is unsafe) Feels this would give faster response for Ross of Mull area. Option number 8. Because of the geography of the island. A fast paramedic response unit suitably trained will give greater cover especially if there are a few PRU. best suited to the Island For the reasons appearing in the Ambulance Service Appraisal in Round and About! Well thought out by local people (in many of which I have great confidence). Assessed by locals aware of the local situation. Ease of provision. Speed of initial response. Possibility of response to more than one issue. Need PAV as well as recruiting provision. May be greater chance of this becoming a reality. Mull geography makes an emergency at one end of the island not being able to respond to other emergencies elsewhere. 2 response vehicles is essential. Provides cover of a flexible nature. Coming from the perspective of a varied population with its needs + maternity, children, aged issues (heart, stroke) huge number of tourists / short term visitors, trauma etc. It allows flexibility for a fast response anywhere on the island with highly trained personnel. It is best suited to the geographical area to be covered. Q4. Do you have any other comments ideas concerns or questions? There would still only be one paramedic level of trained staff available. If there was two 999 emergencies at the same time (unlikely but more likely in summer when the island s population grows) this could be a concern. Concern: only 1 paramedic available I hope that this is a real consultation (not just a way of meeting targets) and that real and positive change will result. Ideal cover would be 2 ambulances and crews based at each end of 18

19 the island. We have been very well cared for by Mull ~ambulance and hold it in high regard. I hope it will continue to give us assurance and satisfaction in the years to come. I would prefer to see SAS recruit staff and adapt the service so it is the best it can be. If the service we receive will be the same, then I think the decisions are best taken by SAS rather than the community. Don t feel I can choose an option knowing the challenges of island provision. I don t think any of the options are the way forward. I would look at recruiting staff appropriate and build a job around their experience/skill set. Maybe having an idea where the ambulance is at any time, to help alleviate people s fears about how close it is if they needed it. A bit like RNLI has a shout on their facebook page, it keeps people informed of its whereabouts and the frequency it is used. The improved skill mix. 1 ambulance + PRU with the air ambulance provision gives flexibility for wide variations in population between summer and winter population of residents and visitors. Used ambulance service on Mull 3 times in last 2 years for something urgent. The Community First Responders Scheme will not replace existing service but will fill in a time gap in chain of survival. Any competent personal contact is helpful at a time of emergency need, but a double check is always advised if at all possible. My daughter has severe allergies. We are in Tobermory. Should the ambulance be called to Fionnphort / Iona it could take over an hour to reach us even if it left immediately should she have a lifethreatening reaction. Availability of means to get home post treatment. The first responder system is also a further improvement and must be encouraged. 19

20 APPENDIX 2 Mull & Iona Health & Care Review SAS Options Appraisal Schedule of Community Engagement Activities Dervaig Village Hall Conversation Cafe Tuesday 9 th June 2pm 5pm June 2015 Aros Hall, Tobermory Information Drop in Event (come & talk to us) Friday 12 th June 12noon 3pm Aros Hall, Tobermory Information Drop in Event (come & talk to us) Friday 12 th June 4pm 7pm Ulva Ferry Primary School Conversation Cafe Thursday 4 th June 5pm 8pm Salen Church Centre Information (come & talk to us) Tuesday 9 th June 10.30am 12noon Isle of Iona Library Information Drop in Event (come & talk to us) Thursday 11 th June 1pm 4pm Craignure Village Hall Information Drop In Event (come & talk to us) Wednesday 3 rd June 12noon 3pm Pennyghael Village Hall Information (come & talk to us) Monday 8 th June 3pm 5pm Bunessan Village Hall Information (come & talk to us) Monday 8 th June 6pm 9pm 20