NHS Highland Argyll & Bute Health and Social Care Partnership Oban Lorn & Isles Locality Planning for the Future Group 23 May 2017 Bay 2, Nelson Ward, Lorn & Islands Hospital, Oban Present - Members of Group as per Terms of Reference Elaine Wilkinson (EW), Chair Lorraine Paterson (LP), Head of Adult Services West Dr Jason Davies (JD), Consultant Anaesthetist Donald Bruce (DBr), Public Representative Moira Newiss (MN), Head of HR Stella Cockburn (SC), Management Accountant Cllr Elaine Robertson (ER), Argyll & Bute Council Bill Staley (BS), Information and Projects Manager Chris Moran (CM), Senior Information Analyst Stephen Whiston (SW), Head of Strategic Planning & Performance Gillian Berry (GB), Occupational Therapist and Unison Rep Pamela MacLeod (PML),l Local Area Manager - Community Dr Mike Hall (MH), Associate Medical Director by VC Jackie McGeoch (JMG), Head of Planning for Clyde by VC Dr Chris Jones (CJ), Chief of Medicine for Clyde - by VC David Richie (DR), Communications Manager by VC Apologies Annie Macleod (AML), Locality Manager Dr Peter Thorpe (PT), Clinical Lead (Acute) Dr Richard Wilson (RW), Clinical Lead (Primary Care) John Colston (JC), Public Representative Linda Currie (LC), AHP Lead Dr Erik Jespersen (EJ), GP Dr Nicky Campbell (NC), Medical Associate Dr David Binnie (DBi) Dr Rod Harvey (RH), Medical Director Sandra Melville (SM), Pharmacist 1 Welcome and Apologies Action EW welcomed everyone to the meeting and introductions were made around the room and on the VC. Apologies were read out, as listed above. 2 Notes of Last Meeting These were agreed as a true record of the meeting. 1
3 Matters Arising 3.1 The Oban Times DR confirmed that he had met with The Oban Times and agreed that we would supply them with articles highlighting all the good work which is going on within the area. One article had been published recently and more are in the pipeline. 3.2 Emergency Admissions BS advised that the number of emergency admissions has decreased across the whole of Scotland during the year 2016/16?. He added that this is according to ISDN data, which is not yet confirmed. 3.2 Data It was noted that a lot of reports had been provided by CM for the Clinical Reference Group who had met last week. This had shown that there had been a general increase in admissions to hospitals across the whole of Scotland, again from information provided by ISDN. 4 Clinical Reference Group JD reported that the Clinical Reference Group had met for the second time last week and had looked at, amongst other things, the recruitment of a fourth consultant physician which could help with on call commitments and therefore make posts more attractive.. Enhancements for employing staff in rural areas was considered, and it was noted that this is common practice in other countries. JD also reported that interaction between community, primary care and secondary care was discussed and innovative ways of working with Glasgow is necessary. He asked if funds were available through NES and, if so, a plan is required to access this. He advised that originally we had been given six options to consider how we could make our service better. He said that in reality we are facing significant challenges. EW said that we need to look at our under and over capacity and that evidence is required to support models. JD said that although we do have physical capacity we don t have the staffing capacity at the moment as all areas of the service are understaffed. He felt that from the work being sent to Glasgow, there was not much that could be done here. Some discussion centred around 40 OOHs surgical cases treated over the last year, for which further information was required. CM advised that he had met with JA after the last Clinical Reference Group meeting to discuss this. LP said that we need to determine what data we need to determine what Oban is going to do in the future, although it was acknowledged that what service we offer will be determined by who we employ, eg consultants with specific specialities, eg respiratory, cardiology, pain etc. 2
5 Current Cost Base of the Hospital and Comparators SC advised that there was an underspend of 703,000 for the Argyll & Bute Health & Social Care Partnership in the year to 31 March 2017 but that Adult Services West (of which Oban Lorn & Isles are part) had an overspend of 2.2m. She advised that the budget for the locality is 20.1m of which 15m is allocated to the hospital. SC explained that the spend for L&IH was comparable to other RGHs and she had included stats for Caithness, Western Isles, Belford and the Gilbert Bain Hospital in Orkney. However, it was noted that small numbers can affect the figures. Much discussion took place around the stats supplied by SC and it was agreed that further analysis is required to look at any differences shown, and why they are there and what impact they may have on a model of service.. SC 6 L&IH Catchment Population Profile and Population Projections It was noted that the population in Oban is expanding, which is not the trend elsewhere in Argyll & Bute. It was felt that L&IH is crucial to the local area. It was agreed that we need to take into account the aging population for the area. It was agreed that the information provided was interesting and SW advised that there are Locality Profiles available for each area, if needed. 7 Acute Services Planning Assumptions Regional Delivery SW gave a short presentation to the group and explained that 20% of the acute budget needs to be transferred to community. JMG advised that work has already started in GG&C and that services may be provided outwith GG&C. An example was given where orthopaedic and ophthalmology services may be provided in future by the Golden Jubilee Hospital in Clydebank. SW explained that he is a member of the West of Scotland Regional Planning Group and that PT links in to the group for radiology. His presentation included a map showing the whole area which is covered by the West of Scotland Group. Much discussion took place around the work of the group and the meeting was advised that a high priority is being given to super-specialist work which includes brain surgery, transplant surgery etc which would be centralised. In answer to a question SW confirmed that we do have an SLA with the Golden Jubilee. SW referred to the low resident population for the area, compared to other areas, but it was acknowledged that we do have a large visiting population throughout the summer months. SW confirmed that this increase is planned for. Some discussion took place around the difficulty planning for our workforce 20-30 years ahead as we don t know what will happen. Improvements within technology were acknowledged as we don t know 3
how this will impact on services in the future. JD said that near patient testing had made a significant difference to patient care over the last few years. He said that there was no doubt that people will have to travel for treatment as services will be provided in specialist centres in the future 8 Present Picture of Community Services PML advised that all community services are based in Oban, apart for community nursing teams. However, she advised that plans are in place to move to neighbourhood teams in Oban, Easdale, Appin and Taynuilt. She also advised that there are 2 residential homes and 1 nursing home within the Oban area. PML advised that the 2 residential homes are no longer fit for service and the buildings are not sustainable in the long term. She advised that home care is being purchased from private providers and that currently there are 150 hours of unmet need where care is not being provided. PML advised that currently she is looking at mapping service requirements with different agencies. Generic posts for home and social care are being looked at with generic skill sets to avoid duplication of tasks and visits to patients. The Buurtzorg model is being implemented locally which will provide support at home. ER said that a generic health and care worker has been talked about for a long time and asked what qualifications would be required for this post. PML advised that the posts are currently being evaluated and we are waiting for them to be banded before being advertised. EW said it was interesting for her to see the shift in focus from hospital to community and asked what resources do we require in the community for this shift to take place at pace.? PML said that the ECCT team are supporting people to remain at home to avoid admission to hospital and to support discharges. LP said that a Service Improvement post has been created to look at what s needed to support this. GB said that some staff are being asked to do more and more and the need for supervision was discussed. She felt that the level of responsibility for some staff was worrying and mentioned lone workers at weekends. She said that generic workers must work as part of a team. It was noted that Oban is a pilot for work being carried out by ihub for workforce planning and the meeting was advised that the model for Oban is almost complete. This will predict the staff we will need in 3-5 years time. MN said that she was hopeful that this information would be available for presenting to this group in September 2017. MN 9 Glasgow Services JMG advised that a new Chief Executive has been appointed for GG&C, Jane Grant commenced in post in April 2017. She said that they are currently reviewing their demand and looking at efficiencies to ensure that there are no gaps in services. Work coming in from Argyll & Bute will be 4
included in the review. She asked that any pressures on service in L&IH be flagged to them as soon as possible so that they can look to see how the service can be provided,. Everyone agreed that services should be kept as local as possible. CJ said that Clyde had similar challenges to us with recruitment and said that services are developed depending on who you recruit. GG&C are also looking at OOHs work and have similar problems to us with covering the GP OOHs service. They are developing nurse specialist/consultant roles as not every patient needs to see a consultant. He said that they are looking at pathways and agreed that maintaining service is a challenge. He felt that shared networking and thinking is beneficial to both areas. MH said that he also agreed that meaningful discussions were required to see what we can do locally eg urology. He would like to see some services returning to Oban with the appropriate governance around what we can do here. He said that we need to rebuild the links we had in the past. He said that OOHs surgery should be carried out by staff who are used to doing that sort of work, that we should minimise the impact of work being sent to Glasgow but that we need to offer a good service to all our patients. DBr said that he goes to Gartnavel for a day case procedure and doesn t understand why he needs to go there for a procedure which takes 10 minutes and asked why he can t have this procedure carried out here. MH said that it is a complex answer to a simple question which is very much around following strict guidelines about what we can do here and patient safety is paramount. He said that Glasgow provide a high quality clinical care service and, if possible, he would like to pull some of the services back to Oban, but with the same high quality. However to do this we require clinical governance from Glasgow, which is not currently available.. The meeting was advised that PT is in discussions with Glasgow around this. The meeting acknowledged the distances involved for patients to travel. Unfortunately DBr said that he was not happy with this explanation. It was noted that there is a desire to have consultants network into Oban to ensure that any procedures carried out here are safe. Some discussion took place around the global contract for services with Glasgow but SW said that there is not a significant amount of savings to be made from this. The need to ensure that our medical acute activity remains in Oban was discussed as it was clear that GG&C could not cope with this if our service were to collapse. ER said that she was delighted to hear that discussions are ongoing with GG&C. She said that she had had been contacted by a number of concerned constituents regarding the urology service as they are now having to travel to Glasgow for a procedure which had previously been carried out here. ER said that people don t understand why this has changed but she is pleased that this is under discussion with Glasgow. LP said that she saw ER s role within the group to take this information back to the community. DBr said that he was a patient representative on the group, representing no one but himself. He outlined what had happened to him previously and 5
now has the same procedure carried out in Glasgow. He said that we are not facing the problems faced by the local community and patients who have a long and unpleasant journey to Glasgow and back for a very short procedure. However EW said that we must put safety for the patient first and foremost. JD said that we can provide a limited urology service here if we have the appropriate guidance, guidelines and support from Glasgow and this is currently being discussed with Glasgow. It was noted again that the relationship with Glasgow was key and it was agreed that CJ should link with the Clinical Reference Group to look at what GG&C can do to stop some of our patients going down to Glasgow for treatment. Again it was said that services should be kept local as much as possible. EW said that she felt that the discussions had been useful and we need to move on to look at the proposed model for L&IH. She said that the Clinical Reference Group was looking at the options and scale of activity and discussion were ongoing with GG&C about what is possible. Discussion took place around when we would be in a position toconsider potential future models and associated services and it was suggested that August or September was possible. It was agreed that AML/EW/PT would decide whether the group should meet in July. AML/ EW/PT 10 Public Meeting The meeting was advised that a follow on public meeting is being held in June and the planning for this is being taken forward through the Communication & Engagement Group in conjunction with Oban Community Council. 11 Next Steps and Future Meetings EW said that by September she was expecting that key elements of our plans would be coming together. A significant amount of data and information had been provided but she felt we needed an analytical resource put on to this to pull together the information to help inform decision making. LP said that we need to know what we are going to do, how is this going to be provided and how does this match up with the work of the West of Scotland Regional Planning Group. She felt that we need to see the overall picture. It was noted that 2 of the original options have been discarded and it was acknowledged that the scope of the review has changed, as expected. It was agreed that AML would decide if the group meets again before September 2017. AML 12 AOCB None. 13 Date of Next Meeting The next meeting will take place on 23 August 2017 at 10.30 am. 6
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