REVIEW October 2008 A Report on NHS Greater Glasgow and Clyde s Consultation on Clyde Inpatient Physical Disability Services
Table of Contents 1. Summary 1 2. How NHS Greater Glasgow and Clyde conducted their 3 engagement and consultation exercise 2.1 Background 3 2.2 Informing and engaging phase 3 2.3 Development of options 5 2.4 Preparation for the consultation phase 6 2.5 Consultation phase 7 3. The views and comments the NHS Board received and what 9 happened as a result 3.1 Informing and engaging phase 9 3.2 Consultation phase: views of patients, carers and relatives 10 3.3 Consultation phase: views of the wider community 10 3.4 NHS Greater Glasgow and Clyde Board meeting 12 3.5 Feedback to consultees 13 3.6 Scottish Health Council verification 14 4. Analysis and conclusion 16
1. Summary 1.1 Between November 2006 and November 2007, NHS Greater Glasgow and Clyde undertook an informing and engaging exercise on proposals to change inpatient physical disability services in the area formerly covered by NHS Argyll and Clyde. Following confirmation from the Scottish Government that the NHS Board did not have approval to close Merchiston Hospital in Renfrewshire, the NHS Board undertook a formal consultation over the period 18 February to 5 May 2008. 1.2 On 24 June 2008, the NHS Board agreed, subject to the Cabinet Secretary s approval, that Merchiston Hospital, Renfrewshire, should be closed and inpatient care transferred to the Southern General Hospital, Glasgow. The NHS Board approved revised arrangements for rehabilitation, respite and continuing care in the Clyde area. The NHS Board also approved an allocation of funds to several local authorities to support community care. Inpatient physical disability care at Inverclyde Royal Hospital in Greenock remained unchanged. 1.3 In undertaking this consultation, the NHS Board followed the guidance contained in Draft Interim Guidance NHS HDL (2002) 42 (Consultation and Public Involvement in Service Change Draft Interim Guidance for Consultation). 1.4 During the informing and engaging phase of the consultation, the NHS Board sought the views and opinions of health and care professionals and a number of people from the community with a specific interest in inpatient physical disability services. There was general agreement by those involved in this exercise with the NHS Board s emphasis on developing community care. 1.5 During the main consultation, the wider community raised concerns over the impact of bed number reductions and resources allocated to local authority partners for community care. Many patients, their carers and relatives receiving treatment at Merchiston advocated the retention of the hospital. People receiving outpatient care at Merchiston wanted to know from which location this service would be delivered once this site was closed. 1.6 The NHS Board has agreed to work collaboratively with local authority partners to ensure that funds are allocated in the most effective manner. The NHS Board will also after one year of operation re-examine the new bed model and address any issues that have arisen. The NHS Board has made arrangements to deliver outpatient services for those with physical disabilities from the Royal Alexandra Hospital, Paisley. 1.7 The Scottish Health Council questioned whether the NHS Board had approval to close Merchiston Hospital and therefore questioned whether the NHS Board should restrict itself to conducting an informing and engaging exercise. Following discussion, the NHS Board agreed to undertake a formal consultation. 1
1.8 The Scottish Health Council recommends that: in any future major service change exercises the NHS Board checks with the Scottish Government the extent to which it has approval to close down facilities. at any meetings of patients, carers and the public and health and care professionals at the informing and engaging stage of any future consultation that the NHS Board seeks to ensure that there is more representation from patients, carers and the public. the NHS Board ensures that stakeholders are more directly involved in generating and appraising options for major service change. following the conclusion of any future consultation exercise, the NHS Board improves its feedback to the community by circulating information among a wider number of community organisations potentially affected by the changes. the NHS Board ensures that Public Partnership Forums are encouraged and enabled to be directly involved in all stages of the consultation process. 1.9 The Scottish Health Council encourages the NHS Board to undertake further work on transport issues to supplement the work it has already undertaken as this would help to mitigate the effects of additional journey times for relatives and carers over the often significant periods of time that patients remain in hospital. 1.10 The Scottish Health Council notes that the NHS Board employed an advocacy service to support patients, their relatives and carers and that the provision of this service was well received. The Scottish Health Council would encourage the NHS Board to ensure that independent advocacy services are available to all those who may benefit from them to facilitate their involvement when major service changes are being proposed. 2
2. How NHS Greater Glasgow and Clyde conducted their engagement and consultation exercise 2.1 Background 2.1.1 NHS Greater Glasgow undertook responsibility for health care services across Inverclyde, Renfrewshire, West Dunbartonshire and East Renfrewshire (the Clyde area ) on 1 April 2006 following the dissolution of NHS Argyll and Clyde. The NHS Board was renamed NHS Greater Glasgow and Clyde to take account of its extended boundaries. 2.1.2 At this time, NHS Greater Glasgow and Clyde established a series of service and strategy reviews. The NHS Board stated that it was undertaking these reviews for a number of reasons, including: the need to modernise services in the Clyde area and ensure the right balance of local community and inpatient care the need to address the 30 million deficit inherited from the former NHS Argyll and Clyde. 2.1.3 From January 2007, NHS Greater Glasgow and Clyde met with the Scottish Health Council on a regular basis to discuss arrangements for engagement on a number of health and service strategies in the Clyde area. These included the NHS Board s strategy for inpatient physical disability services. 2.1.4 The Scottish Executive Health Department issued guidance in 2002 contained in the Draft Interim Guidance NHS HDL (2002) 42 (Consultation and Public Involvement in Service Change Draft Interim Guidance for Consultation). The guidance outlines the procedures to be undertaken where an NHS Board wishes to undertake major service changes to ensure that the public have an opportunity to influence decision making. 2.1.5 The guidance states that at the initial stage of the consultation process the NHS Board should hold a number of participative sessions to discover the views of key interest groups. These should include service user groups, clinical staff and community organisations among others. Following this period of informing and engaging, the NHS Board should finalise its proposals. The guidance seeks to ensure that people have sufficient time to consider and respond to any proposals being put forward. The guidance states that it would be usual practise for a consultation to last for three months during which time the NHS Board should undertake public involvement activities within the wider community. It should in particular target any part of the community specifically affected by the proposals, receive comments and consider any suggestions submitted before making a final decision. 2.2 Informing and engaging phase 2.2.1 The NHS Board initiated its process of informing and engaging on adult inpatient physical disability services in the Clyde area on 29 November 2006 when it held a seminar, Patient Pathways in Physical Disability Rehabilitation Services. This seminar was attended by both NHS and local authority staff and a small number of 3
representatives from the community who had a particular interest in this area of healthcare. Around 40 people in total attended the event. The NHS Board had not advised the Scottish Health Council of its intention to hold this seminar and therefore the Scottish Health Council was not in attendance. 2.2.2 The seminar had two primary aims. The first was to identify what form the patient s journey through NHS healthcare, from first contact to completion of treatment, should take for physical disability rehabilitation services. The second was to explore issues around an overall strategy for care including how best to deliver healthcare in a community setting. The NHS Board offered to hold meetings with local voluntary organisations or patient groups unable to attend this initial seminar. Three such groups expressed an interest in meeting the NHS Board in this manner. The NHS Board subsequently met with the Glasgow Disability Alliance and the Inverclyde Community Care Forum. (Clydebank Disability Forum, rather than having a separate meeting with the NHS Board, opted to attend the 14 March 2007 event described below). 2.2.3 The NHS Board held a further seminar on 14 March 2007 to which it invited both NHS and local authority staff and a small number of community representatives. Around 40 people attended this event. The Scottish Health Council was also invited and attended this meeting. In advance of this event, participants and the Scottish Health Council were given a copy of the paper from the seminar held on 29 November 2006. The seminar paper produced by the NHS Board detailed the range and use of inpatient services it provided, and identified where gaps in service provision existed. The Scottish Health Council was also advised by the NHS Board in a separate note issued with the seminar paper that all learning disability services would be removed from Merchiston by the end of the summer of 2007. The removal of this service would leave physical disability care as the sole inpatient service left at the site. The seminar paper also explained how the earlier meeting had explored issues around models of inpatient care and community services. The event on 14 March sought to build on the work done at the earlier meeting in helping to identify the direction for inpatient physical disability care. The key issues identified from this event were the need to focus on addressing people s needs within a community setting, appropriate use of specialist inpatient care and closer working between the NHS and local authority partners. In common with the meeting held on 29 November 2006, the event on 14 March 2007 dealt with general issues relating to physical disability issues rather than developing specific proposals. 2.2.4 Following the seminar on 14 March 2007, the NHS Board issued a report to each of the participants summarising what had been discussed. The report highlighted the importance of individualised goal planning for those receiving treatment; the need to focus on addressing people s needs within a community setting; strengthening joint working between health and social work services; and the requirement by health and care professionals to prepare patients for admission to specialist inpatient care. Although the report also covered the need to extend current levels of service, the seminar report did not identify any specific service changes that would arise out of the seminar report. 4
2.3 Development of options 2.3.1 In October 2007, the NHS Board issued a paper Reprovisioning of Clyde Inpatient Physical Disability Services. The report invited comment on a number of options for its future delivery of inpatient physical disability services. The paper was issued to clinical staff involved in this area of healthcare, senior managers within NHS Greater Glasgow and Clyde (including senior managers throughout all the Community Health [and Care] Partnerships in the NHS Board area), social work departments, participants in the November 2006 and March 2007 meetings, patients in the Islay Ward at Merchiston Hospital and their relatives, MSPs and MPs, the Scottish Government and the Advocacy Project. The paper was not sent directly to the Public Partnership Forums. 2.3.2 The NHS Board presented three main options on where these services might be delivered: the first option was to deliver all continuing and respite care from the Southern General Hospital in Glasgow (26 beds); to deliver rehabilitation and assessment care from the Southern General (26 six beds), from the Larkfield Unit at the Inverclyde Royal Hospital (eight beds) and from the Vale of Leven Hospital in West Dunbartonshire (four beds). The paper noted that opening a separate unit at the Vale of Leven would either require displacing medical care from the hospital s care of the elderly or require opening a stand alone unit. A separate unit would require additional capital funding. Any service delivered for a four bed unit would be resource intensive and difficult to staff with appropriate specialists the second option was identical to the first with the exception that the four bed unit would be at the Royal Alexandra Hospital in Paisley rather than at the Vale of Leven. A four bed unit at the Royal Alexandra would potentially have the same problems as placing a unit at the Vale of Leven in terms of resources and the third option was to have all services delivered from the Southern General (26 continuing and respite care beds, 30 rehabilitation and assessment beds) and from Inverclyde Royal Hospital (four beds). The paper highlighted the advantages of providing services over two sites in order to make maximum advantage of staff skills and resources. The paper also outlined the options previously prepared by NHS Argyll and Clyde: to have physical disability beds located between Inverclyde Royal Hospital and Johnstone Hospital in Renfrewshire. This option required an additional 500,000 of revenue and 500,000 of capital funding, added to which Johnstone Hospital was subject to a public consultation exercise relating to the potential closure of that site to have all physical disability beds on a single site. The NHS Board had, however, been unable to identify a site that would suitably house all the beds that were needed, and to have two sites, one an NHS site and the other a partnership with the independent sector. The NHS Board had, however, been unable to identify a suitable NHS site. This final option would also have necessitated additional revenue and capital funding. 5
2.3.4 The paper stated that the three options prepared by NHS Argyll and Clyde would have resulted in mixing assessment and rehabilitation care with continuing care. The paper stated this was not considered best clinical practice. 2.3.5 Each of the options set out in the paper, in line with the belief stated in this document that NHS Argyll and Clyde had secured Ministerial approval for the closure of Merchiston Hospital in Renfrewshire, assumed the transfer of services away from the one remaining inpatient unit at the hospital, the Islay Ward, and the subsequent closure of the site by April 2008. The NHS Board invited comments in relation to how each of the options addressed the key issues identified by staff, service users and other stakeholders, and asked if there were other options that the NHS Board could consider. The paper also sought comment on the proposal to separate assessment and rehabilitation care from continuing and respite care as the best clinical practice. As a means of support to patients at the hospital, the NHS Board reported that it had commissioned an advocacy service to assist patients at Merchiston Hospital, their relatives and carers. The NHS Board sought comments by 30 November 2007. 2.3.6 The Scottish Health Council noted that community representatives had been invited to comment on the options put forward by the NHS Board and had been invited to suggest other options that they believed were appropriate. However the Scottish Health Council found that the NHS Board had not directly involved patients, carers and community groups in drawing up the options set out in its paper, rather NHS Board officers had generated the options based upon the previously expressed views of patients, carers and community groups concerning the elements of a desired service model. 2.3.7 The Scottish Health Council, in line with the draft interim guidance that requires Ministerial approval for the closure of existing premises, questioned the NHS Board over its statement that NHS Argyll and Clyde had Ministerial approval to close Merchiston Hospital. Following further discussion, the Scottish Government confirmed that although the previous NHS Board had had approval for its broad strategy in the area of physical disabilities, it had not been given approval to close Merchiston Hospital. 2.4 Preparation for the consultation phase 2.4.1 NHS Greater Glasgow and Clyde therefore agreed at its Board meeting on 22 January 2008 to undertake a full consultation exercise. The NHS Board suggested to the Scottish Health Council that it held its consultation over a six to eight week period. In support of its proposal to hold its consultation over this time period, the NHS Board stated that the consultation affected a relatively small number of people and that the key stakeholders had ongoing engagement with the NHS Board that enabled them to understand the issues and proposals for the services. The NHS Board proposed a targeted approach to engaging with key groups within the community rather than have a general open public meeting. The NHS Board did agree, nonetheless, that if sufficient demand arose for a public meeting it would consider arranging this type of event. The Scottish Health Council advised the NHS Board that given that this service change involved the closure of a hospital site the NHS Board should consider a 12-week consultation period. The Scottish Health 6
Council also asked for clarity on a number of issues raised in the NHS Board s draft materials around the wider impact on bed numbers, the impact on the patient population of East Renfrewshire and West Dunbartonshire and finance. The Scottish Health Council also asked that publicity should include other NHS Boards that may be affected by the proposals. The Scottish Health Council requested that meetings with patients, carers and relatives continue to be externally facilitated and the NHS Board arrange meetings with key stakeholder groups affected by the changes. 2.4.2 The NHS Board agreed to run a 12-week consultation. The NHS Board made some adjustments to its consultation publicity material sharing these details with the Scottish Health Council prior to final issue to the public. The NHS Board arranged meetings with key community groups providing the Scottish Health Council with advance notification of all meetings and invitations to attend. 2.5 Consultation phase 2.5.1 The NHS Board launched its consultation on 18 February 2008. The NHS Board made the following proposals: the closure of the Merchiston Hospital site with the loss of 16 beds the delivery of continuing care from Ward 53 of the Southern General Hospital with the provision of two additional beds for patients in the Clyde area the provision of an additional four rehabilitation care beds at the Southern General for patients in the Clyde area the continuation of rehabilitation care within the Larkfield Unit at Inverclyde Royal Hospital the freeing of resources resulting from the above changes to invest in increased staffing at the Southern General and to provide an allocation of funding to local authorities to support community services. 2.5.2 The consultation documents explained that, for patients in the Clyde area, the NHS Board was proposing a reduction in the number of assessment and rehabilitation beds from 39 to 38 and in the number of NHS continuing and respite beds from 35 to 26. The proposed bed numbers at the Larkfield Unit at Inverclyde Royal Hospital would remain unchanged. The consultation was the first occasion that the NHS Board made it clear to the wider community that it was proposing to close Merchiston Hospital and transfer inpatient services to the Southern General. 2.5.3 The consultation ran for 12 weeks until 5 May 2008. The NHS Board placed the main consultation document and a summary document on its website in addition to inviting members of the public to request the material in a variety of formats suitable to their needs. The website allowed the public to submit their comments online. The NHS Board also invited comments in writing, by telephone or by email. The NHS Board intimated its willingness to hold some form of public meeting based on the relevant requests received. Patients of Merchiston Hospital, their carers and relatives would continue to receive the support of the Advocacy Project. 2.5.4 The NHS Board arranged a number of meetings with key stakeholder groups and produced notes of findings from each of the sessions. The Scottish Health Council was represented at most of these meetings and was able to observe both the 7
presentation given by the NHS Board and the open discussions that took place. As the Scottish Health Council was present at a number of these meetings, it was able to confirm that the notes produced by the NHS Board represented an accurate discussion of the points raised by those present. The NHS Board did not hold any open public meeting: the NHS Board considered that insufficient requests were received from the public to justify holding such an event. As only two people requested an open public meeting, the NHS Board made alternative arrangements to ensure that both individuals could have input into the consultation. The meetings which the NHS Board held were targeted at groups most directly affected by the consultation: patients, carers and relatives at Merchiston, and community groups with local interests in the service changes or specific interests in the area of physical disabilities. 2.5.5 The Advocacy Project hosted a meeting on 12 March 2008 at which patients in the Islay Ward at Merchiston Hospital, their carers and relatives could meet with senior NHS staff. Patients, carers and relatives requested a further meeting with the Advocacy Project without the presence of NHS staff. This further meeting was held on 9 April 2008. These two events were specifically organised as part of the Advocacy Project s role of supporting patients, their carers and relatives through this period of change. 2.5.6 Further meetings were held at the Disability Resource Centre in Paisley (15 April), the Inverclyde Hospital Users Forum (16 April), Revive MS Support (29 April) and the Inverclyde Community Care Forum Board meeting (1 May). The meetings at the Disability Resource Centre (organised in conjunction with Quarriers) and at Revive were open meetings organised by these organisations at which those with an interest or involvement in the service changes could attend. The NHS Board gave presentations at the two Inverclyde meetings as part of these groups regular committee meetings. The NHS Board produced reports from each of these meetings that were made available to participants and shared with the Scottish Health Council. The final report presented at the NHS Greater Glasgow and Clyde Board meeting included summaries from each of these meetings. 8
3. The views and comments the NHS Board received and what happened as a result The NHS Board received a variety of views and comments from both its informing and engaging activities and also from its consultation exercise. 3.1 Informing and engaging phase 3.1.1 The seminars held in November 2006 and March 2007 highlighted the views held by NHS and local authority staff and the community representatives present. In terms of involving people, the three priorities were: for better information and communication a more systematic approach to providing care and a need to empower people in setting their care and health needs. In terms of rehabilitation, the three key areas were: greater engagement with the voluntary sector the role of carers and volunteers and a better understanding of the roles of staff and service users. 3.1.2 The participants addressed the question of planned admissions: it was agreed that this area of care needed a more structured approach and an openness to examine a wide variety of models of care. Participants, for example, considered the potential benefits of healthcare arising from closer working relationships between the NHS and local authorities. 3.1.3 The invitation to community groups made after the November 2006 seminar also generated additional feedback. The Inverclyde Community Care Forum produced a report derived from a focus group and one-to-one interviews with service users and carers resident in the Inverclyde area. This report, shared with the NHS Board, highlighted the importance of good locally based community care and the need to reduce the time that people spent in hospital as inpatients. The report made clear that the local population viewed the physical disability care provided at Inverclyde Royal Hospital as a valuable local service. 3.1.4 The discussion paper Reprovisioning of Clyde Inpatient Physical Disability Services produced in October 2007 did reflect many of the matters raised in the informing and engaging meetings held several months previously. It set the discussions with key stakeholders against the background of central government and Glasgow-wide policies on the care of people with physical disabilities. 3.1.5 The above paper invited those who had been involved in the November 2006 and March 2007 meetings, and others within the community to comment on the discussion report by 30 November 2007. The NHS Board produced a report outlining the responses to its discussion paper. The responses were drawn from comments submitted to the NHS Board and from a meeting hosted by the Advocacy Project with Merchiston patients, carers and relatives on 12 December 2007. Although the majority of the replies were received from health and care 9
professionals, responses were submitted by the Merchiston patients, carers and relatives and by one member of the public. The responses, overall, reflected the desire for physical disability services that were accessible and local to the communities. Responses from clinicians supported the separation of rehabilitation from continuing care. Other respondents highlighted the need for careful bed number planning. 3.2 Consultation phase: views of patients, carers and relatives 3.2.1 The feedback received from the local community during the main consultation phase was largely divided into two groups: first, patients at Merchiston Hospital and their carers and relatives; and secondly those with a broad interest in inpatient services for physical disabilities. 3.2.2 The main avenue used by patients, carers and relatives to express their views and opinions to the NHS Board was through the auspices of the Advocacy Project. Ten patients, relatives and carers met with NHS Board staff at the meeting hosted by the Advocacy Project on 12 March 2008. The main concerns of this group were the way in which the consultation had been conducted. Participants expressed views suggesting that the consultation had been conducted in a tokenistic manner and failed to address the concerns that service users had. Among the comments were: the consultation materials had only presented the positive aspects of the proposed changes and not the negative ones the consultation had not been carried out in impartial manner. 3.2.3 They also noted that the consultation documents had not been issued to them on an individual basis, but had been left at the hospital where the information could be collected. There were concerns around travel issues to the Southern General from the Renfrewshire area and how resources freed from the closure of Merchiston would be used. Some participants also questioned the NHS Board on the proposal to separate assessment and rehabilitation from continuing and respite care: the NHS Board was challenged in its view that there were clinical benefits in delivering care at the Southern General in different wards with the suggestion that a mixed unit provided a better environment for care. Service users also believed that the Islay Cottage unit at Merchiston was a well run service and its closure would be a major loss. 3.2.4 There was discussion at the meeting by service users of an attempt to garner support for a public campaign to support the retention of the hospital, but to date the Scottish Health Council is unaware of any further action in relation to this. 3.3 Consultation phase: views of the wider community 3.3.1 The second group of people involved in the consultation were those with a broader interest in the delivery of inpatient physical disability care across the Clyde area. 3.3.2 Participants at the meeting at the Disability Resource Centre in Paisley on 15 April 2008 raised 35 questions or comments. These can be broadly categorised under several headings. The first general area was around the loss of a valuable and distinct local service that was used both for inpatient and outpatient care. The 10
participants felt there were benefits in retaining a small local service which could give better and more individualised care than an impersonal large hospital, such as would be delivered at the Southern General. The second group of comments was around the fear that the removal of the Merchiston facility would result in bed shortage. The final set of comments lay around the services available within the community. Participants felt that there was a lack of communication between them and the health and care service providers over what was available in the community to support those with physical disabilities discharged from hospital. Some of those present had questions over whether there were sufficient resources within a community care setting to support the intentions of the NHS Board. 3.3.3 The Inverclyde Royal Hospital Users Forum Committee meeting raised similar issues to the Paisley meeting from the perspective of those living in the Inverclyde area. The community represented was reassured in the knowledge that the Larkfield Unit would continue to treat patients from Inverclyde and those from the Cowal peninsula as it had done previously. The Hospital Forum raised questions around the number of beds available, both in overall terms for the Clyde area and specifically in relation to respite care. It was stated that one of the consultants at the Inverclyde Royal had challenged the modelling figures produced by the NHS Board. The Forum also highlighted the importance of having emergency beds available in the event that these were required at short notice. 3.3.4 The meeting on 29 April 2008 at Revive MS Support addressed the needs of a discrete group of service users. Revive users raised questions around the provision of community services. In particular there was considerable disquiet over the length of time that it was taking to access community social work services and the resources that were available to support rehabilitation within the community, often after discharge from inpatient care. There was general agreement, however, that the NHS Board s emphasis on community care was the most appropriate means to support people with multiple sclerosis. Participants at the meeting believed this community-based approach allowed the NHS Board to utilise organisations such as Revive and its more holistic approach to care than was possible within the more institutionalised NHS setting. Participants also supported the idea that care, including outpatient care, was best delivered in the locality in which people resided. The participants also commented that they had liked the informal style of consultation that the NHS Board had used for this meeting. They found it easier to discuss sensitive care issues in a small group discussion setting. 3.3.5 The Inverclyde Community Care Forum Board meeting on 1 May 2008 raised many of the issues that had already been voiced at the other earlier meetings. Some expressed the view that the NHS Board should delay any changes until it could assure the public that a sufficient level of funding for community care was guaranteed. Similarly to the Revive meeting, the Forum raised questions on how effectively community care could be delivered when people were discharged from hospital. Some participants raised issues around the availability of suitable housing provision for people leaving hospital care. Some of those present had concerns over whether a sufficient number of beds were available to deliver continuing care. There were specific issues raised around support for carers and the delivery of community-based care to young adults. The NHS Board at this meeting and at earlier meetings acknowledged that funding was a key issue in dealing with community care. Those present at this meeting heard that the NHS Board s 11
proposed financial allocations to local authority partners represented only one part of the way that funding would be addressed and there would be ongoing work in this area to ensure the appropriate financial support for healthcare in the community. Those present were also made aware that the NHS Board had commissioned research into the area of work with young adults and was awaiting the findings. 3.3.6 The Scottish Health Council notes that the NHS Board presented their proposals in a clear format appropriate to the audience. The NHS Board ensured that it had sufficient copies of the consultation documents available to participants. At the two open meetings, (the Disability Resource Centre and Revive), the NHS Board agreed to make copies of notes of the meeting available to those who wished them. The presentations at the Inverclyde Hospital Forum and the Inverclyde Community Care Forum were given in the context of formal committee meetings. The NHS Board did, nonetheless, produce notes of its findings. 3.4 NHS Greater Glasgow and Clyde Board Meeting 3.4.1 The NHS Board met on 24 June 2008 to consider a report, prepared by the Board s Director of Rehabilitation and Assessment for the Acute Services Division, relating to the consultation. The appendix to the report listed who had responded to the consultation. The report noted that there had been 11 written responses, one response by telephone and five reports arising from meetings with the public. The report acknowledged that patients, carers and relatives were opposed to the closure of the Merchiston site and favoured the status quo. The report also reflected issues around whether a reduction in bed numbers for physical disabilities would present problems in the longer term and around whether sufficient resources were available to support community services. As Merchiston Hospital was also a centre for outpatient care, questions had been asked about the way that this service could be delivered in the Clyde area. NHS and local authority staff from the Clyde area did not support the NHS Board s proposal to separate therapy services across inpatient and community settings: the comments submitted supported the existing style where the service was provided by one team. The report presented to the NHS Board raised the issue of accessibility. The report highlighted that its original postcode analysis of people admitted to Islay Ward conducted between April 2005 and December 2007 showed that for the 13 people who lived closer to Merchiston Hospital than the Southern General each person, on average, would need to travel an additional five miles to reach the Southern General. The report highlighted that a number of respondents supported the separation of rehabilitation and assessment from continuing care. The report stated that there was widespread support among all contributors to the consultation for community-based care. 3.4.2 The NHS Board decided on several actions which were directly attributable to the consultation. The first of these related to bed modelling. The NHS Board had proposed that inpatient physical disability beds be reduced overall from 74 beds to 64. The NHS Board agreed, however, to re-examine its proposed bed model after one year of operation to ensure that its initial calculation on what was needed was accurate and thereafter to address issues that arise. The NHS Board also noted at its meeting on 24 June that the question over bed numbers raised by the consultant at the Inverclyde Royal Hospital had been satisfactorily addressed. Although the NHS Board held that transport links with the Southern General were better than for 12
those to Merchiston, the Board intends to undertake initiatives to improve transport links both during the day and the evening. The NHS Board hoped that these initiatives in the area of transport would mitigate some of the fears of service users around the removal of a local service. The NHS Board s proposals for a more community-based service would also, it was suggested, help deliver a service more attuned to the needs of people nearer to where they lived. In addition the NHS Board decided to retain outpatient services within Renfrewshire, delivering these from the Royal Alexandra Hospital in Paisley. The NHS Board has agreed to continue its closer working relationship with its local authority partners to deliver a system of community care suitable for people with physical disabilities. The NHS Board acknowledged the concerns over funding matters both from local authority partners and the wider public. It committed itself to work closely with the local authorities and Community Health (and Care) Partnerships to address these funding issues. In answer to comments around the redesign of therapy services, the NHS Board justified the changes because of the need to improve access to these services in the Renfrewshire area and to develop more robust working arrangements with health and care providers. 3.4.3 The NHS Board noted the process and the outcome of the public consultation on changes to inpatient disability services in the Clyde area. The NHS Board also recommended, subject to the Cabinet Secretary s approval, the transfer of services from the Islay Ward of Merchiston Hospital to the Southern General Hospital and the closure of Merchiston Hospital. 3.4.4 Despite the issue being raised by the Advocacy Project on behalf of the Merchiston patients, relatives and carers, the NHS Board did not, however, fully explain why it held that rehabilitation and assessment care should be delivered in separate wards from continuing and respite care. The NHS Board did not, for example, refer to any peer reviewed evidence to show why it believed that the clinical practice it sought to adopt was the best model of care. Nor did the NHS Board highlight in its final report that there was opposition to the proposal to separate rehabilitation and assessment care from continuing care. 3.5 Feedback to consultees 3.5.1 Following the NHS Greater Glasgow and Clyde Board meeting on 24 June, the NHS Board provided feedback in a variety of ways. The NHS Board produced a feedback note that it sent to each of the groups that had hosted meetings during the formal consultation. The Scottish Health Council considers that, overall, the feedback note represents a fair and balanced summary of the issues raised during the consultation, the ways that the NHS Board responded to these issues and the conclusions reached by NHS Greater Glasgow and Clyde at its recent Board meeting. Recipients of this feedback were invited to view the full Board papers on the website. The NHS Board advised the Scottish Health Council that every person who made a response to the consultation received an acknowledgement of his or her contribution and that every person received a written letter addressing his or her specific points along with a copy of the feedback note. Relatives of patients receiving NHS continuing care at Merchiston have been sent an individual letter explaining the outcome of the Board meeting, the implications of the Board s decision and a copy of the Board s paper. The NHS Board has also arranged to send copies of the Board papers and other relevant documents to the Clyde 13
Community Health (and Care) Partnerships in order that these bodies could advise their respective Public Partnership Forums. 3.6 Scottish Health Council Verification 3.6.1 The Scottish Health Council has sought to verify the views and opinions of the wider community on the consultation exercise conducted by NHS Greater Glasgow and Clyde. 3.6.2 The Scottish Health Council asked the Advocacy Project to issue questionnaires on its behalf to elicit the views of service users. Of the four people who expressed an interest in responding to this survey, only two people returned their survey forms. Both respondents were carers. With such a small return, it is difficult to undertake any effective analysis. Common to both replies was dissatisfaction with the printed information. Both people wanted to know where their relatives would receive their inpatient treatment and neither believed that their contributions had influenced the NHS Board s proposals. 3.6.3 The Scottish Health Council also sought to discover the views of the wider community. Questionnaires were sent both to people who had received information from the NHS Board at the informing and engaging part of the consultation and to groups within the wider community who would potentially have had an interest in the service changes surrounding the proposed closure of Merchiston. In total the Scottish Health Council sent out around 75 survey forms. Participants in the survey were also asked whether they would be prepared to take part in a one-to-one telephone interview. 3.6.4 Seven people returned their survey forms. Three people expressed their willingness to take part in a telephone survey. The Scottish Health Council from its investigation of the survey forms received and the telephone interviews found the following. None of the respondents had been actively involved in the informing and engaging part of the process. From those who did respond, the comments received generally matched those comments made during the course of the open meetings held during the formal consultation. Several comments are worthy of particular mention. Respondents generally felt that feedback from the NHS Board could be better, particularly in relation to outpatient services. A number of the respondents stated that they found the materials provided to support the consultation helpful. Participants were evenly divided between those who believed that they did make a difference to the NHS Board s final decisions and those who believed that they did not. 3.6.5 The Scottish Health Council contacted the chairs/lead representatives from the Public Partnership Forums most affected by the service changes. Comments were received from the forums based in West Dunbartonshire, East Renfrewshire, Renfrewshire and Inverclyde. None of the forums were involved in the informing and engaging phase of the consultation, although respondents did explain that during this earlier period the forums were at different stage of their development. Consequently the respondents did explain that the forums may not have been able to contribute at every stage of the NHS Board s informing and engaging exercise. 14
3.6.6 Two respondents stated their Public Partnership Forums had not been directly consulted in the main consultation phase nor were their Public Partnership Forums made aware by the NHS Board that it had put its proposals to the public. This included the Public Partnership Forum in whose area Merchiston Hospital lies. Two of the Public Partnership Forums were consulted with one taking the opportunity to submit comments. The two Public Partnership Forums who were not consulted stated that in all probability they would have liked to have been able to contribute to the consultation. Only one of the Public Partnership Forums has, to date, received feedback from the NHS Board. That Public Partnership Forum believed that the NHS Board had made efforts to take its comments into account in the NHS Board s final decision. 15
4. Analysis and conclusion 4.1 In terms of a broad strategy for the way that the NHS Board wanted to approach inpatient care for people with physical disabilities, the Board was largely in accord with the public in its greater emphasis on community care supported by local authority partners. The NHS Board s informing and engaging process was based on the assumption that Merchiston Hospital would be closing and services would be transferred to other sites. The informing and engaging part of the consultation effectively concentrated on the development of community care rather than addressing the closure of the hospital. 4.2 The NHS Board rectified the matter by ensuring that within the formal consultation that the public was provided with information on both its broader inpatient physical disability strategy and on the proposed closure of Merchiston Hospital. The public was allowed 12 weeks to comment on the proposals. In general terms, the public agreed in principle to a greater emphasis on community care and an appropriate allocation of funding to support this. The controversial element of the proposals continues to be the closure of a site with a high reputation within the local community. The NHS Board provided information that included an explanation of the rationale behind the service changes. The NHS Board has explained, for example, the background to the changes, its reasons for wanting to make the changes, and detailed information on the number of beds required to deliver a clinically appropriate and financially viable service. 4.3 Some members of the community continue to question whether they can influence the proposals that the NHS Board wishes to implement. The NHS Board has taken into account feedback from the public insofar as it has pledged itself to keep bed modelling and funding issues under review. 4.4 The Scottish Health Council would recommend a number of improvements. The NHS Board should have been more rigorous in ensuring with the Scottish Government what authority it had in relation to the work of the previous NHS Board. If NHS Greater Glasgow and Clyde had established the position of Merchiston Hospital before starting its informing and engaging activity this would have allowed the public to have contributed at an earlier stage in a more informed way into the debate. The NHS Board should in future clarify with the Scottish Government their joint understanding of the status of sites formerly owned by NHS Argyll and Clyde in the event that closure of a site may be an option that the Board may wish to follow. 4.5 The Scottish Health Council notes that at the meetings set up for the informing and engaging phase of the consultation the number of health and care professionals involved outweighed the number of representatives from the community by a significant degree. The Scottish Health Council recommends that in future the NHS Board endeavours to ensure that a greater number of community representatives are present at these types of meeting to help achieve a fairer balance of opinion. This would help to ensure that the views of the community are given equal weight to the views of the health and care professionals. Endeavouring to obtain a greater number of community representatives would be in line with the Guidance which calls on NHS Boards to encourage participation by awareness raising efforts and asks Boards to obtain a representative spread of local views. 16
4.6 The Scottish Health Council also recommends that in any future major service change exercise that the NHS Board has a clear structure for ensuring that stakeholders are directly involved in generating options for service changes. The draft interim guidance asks Boards to ensure that service users are involved in developing any alternatives/options and that service users and interested groups are supported in developing their own proposals. 4.7 The Scottish Health Council considers that the level of information provided to the public, the timescale for the consultation and the consideration that the NHS Board has given to the views of the public given by the Board during the formal consultation has generally been satisfactory. The Scottish Health Council notes that the NHS Board employed an advocacy service to support patients, their relatives and carers and that the provision of this service was well received. The Scottish Health Council would encourage the NHS Board to ensure that independent advocacy services are available to all those who may benefit from them to facilitate their involvement when major service changes are being proposed. 4.8 In terms of why the NHS Board wanted to deliver rehabilitation and assessment care separately from continuing and respite care, the Scottish Health Council recommends that the NHS Board should provide more detailed information on why it has adopted one clinical model rather than another. The Scottish Health Council would also recommend that the NHS Board undertake additional feedback to the wider community given that this service change involves the closure of a wellknown hospital site. This would be line with the draft interim guidance which asks NHS Boards to make the wider public, as well as people who have been involved with the consultation, aware of the outcome. The Scottish Health Council notes that the consultation documents were delivered to Merchiston for collection by patients, carers and relatives. In future consultations where relatively small numbers of stakeholders are involved, the Scottish Health Council would suggest that the NHS Board consider issuing its consultation documents on an individual basis to patients, relatives and carers at their contact addresses rather than leave the materials for collection at a health facility. 4.9 The Scottish Health Council recommends that throughout the whole consultation process that Public Partnership Forums are enabled to be more effectively involved by providing them with all discussion/consultation documents, inviting them to participate in planning meetings and encouraging them to contribute to the consultation process on behalf of the communities that they represent. 4.10 The Scottish Health Council notes the work done by the NHS Board in relation to transport issues. The Scottish Health Council encourages the NHS Board to undertake further work in this area to mitigate the effects of additional journey times for relatives and carers over the often significant periods of time that patients remain in hospital. 17