SHCN meeting with Nicola Sturgeon (Cabinet Secretary, Health & Wellbeing)

St Andrew’s House, 16th April 2008      

Present:  SHCN      SGHD
  Dr Robert Cumming (Chair)
  Nicola Sturgeon, Minister for Health and Wellbeing
  Dr George Venters (V-Chair)   
  Malcolm Allan (Stobhill, Glasgow) 
  Ken Barr (CATCHES, Cowal)   
  Dr Alistair Glen (HSFSE, Glasgow)  
  Julie McAnulty (Lananarkshire Health United, Airdrie) 
  Dr Jean Turner (Scottish Patients Association, Glasgow) 
  John Winton (LHC West Fife, Dunfermline) 
  James Sandeman (HSFSE, note taker)

            Action

RC opened the meeting with an appreciation of the positive results from the previous meeting.

Complaints (JT)  Complaints often have several aspects, Ombudsman is not well placed to handle them. Lack of back-up services (e.g. cases where test results not available at holiday times).
NS: Has commissioned an evaluation of the complaints process, arising out of the Ombudsman’s review.  Scots lack awareness, slow to complain. Patient Experience Programme aims to address points made by Sc.Pat.Assoc. - hoping to catch low-level dissatisfaction before a case can escalate. Sees complaints as integral part of standards monitoring. Need for better information.
 
GV: Lack of info at GPs etc. on CAB/IASS (Independent Advice & Support Service).
RC: Concern over the timescale for complaints going through their many stages.
JT: Complaints system is not working as intended (further meeting to discuss)     JT/NS

Maternity Services in Fife (JW)   Met NHSFife re Queen Margaret’s Dunfermline -
Chairman’s “disappointing” response to subsequent letter. Lack of communication (particularly consultation) with populace, despite NS’ emphasis
to Boards on the need.
 Midwife-led maternity - NHSFife stalled by quoting “Commercial & Confidential”, had to resort to Freedom of Information.
 New Victoria Hospital - again a lack of information from NHSFife.
NS: Contractual arrangements can impede release of information, but point taken. Public are integral to the process, not just bystanders.

Independent Scrutiny Panels (MA)  Disappointed that previous requests for ISP on Stobhill were  turned down, despite the implied support for scrutiny. Asks if there had been a costed appraisal of reversing the Stobhill decision?
NS: Would not necessarily have made the same decisions as previous Administrations, but  we cannot turn the planning clock back - to set up an ISP for Stobhill would have misled people by implying we could. Monitoring Groups to play a central role in auditing future decisions.        
GV: Stresses need for an evidential base for decision-making.
NS: Agreed - seeking consistency and transparency in future decisions.        
GV: Suggests SGHD could specify modus operandi for decision-making, including the  necessary datasets to provide unequivocal grounds.

Glasgow Monitoring Groups (RC) Groups not monitoring, due partly to the lack of hard  information (“bed model” a case in point).  Had raised with Chairman, who then told this  week’s Board meeting that following a meeting with the North and South Monitoring  Group Chairs he was assured that the Groups had all the information they need.
NS: Stresses Monitoring Groups’ independence of the Health Board
RC: Audit of Monitoring Groups (by Audit Scotland) has never happened.
NS: Will take up with NHSGGC - asks RC/JS for further input.   (RC/JS
 
Outpatient Chemotherapy (RC)  North Glasgow already poorly served, with existing  facilities overloaded, yet Stobhill and GRI outpatients are all to go to the Beatson.
NS: Welcomes relevant input to “Better Cancer Care” Consultation (Closing Date: 5th May)

            SHCN
Southern General OBC (AG)  Concern over lack of data on the OBC, now under study  by SGHD - understands the “sub judice” factor.
 Questions over the design and construction.            AG
NS: As local MSP she cannot express a view - Shona Robison will handle any questions.

BECaD as basis for ACADs (AG) Prof Darzi has lauded the BECaD as the model, yet two  years after its completion the promised reports on its performance are still awaited -
can NS get info?
RC: NHSGGC say they have no info from Middlesex or SGHD.
NS: Department will try to get an update.            NS

Primary Medical Services Act 2004 (JMcA)   NHS Lanarkshire in particular seem keen to bring  in private companies (e.g. GPs in Airdrie) - presses for amendment to the Act to remove  possible loopholes.  Other parties unlikely to oppose such a move.
NS: Confirms presumption against privatisation in any form.  Understands NHSLanarkshire  are concerned about privatisation.  She is reviewing the Act.         NS
 SGHD’s hands are tied to some extent by European Procurement legislation.
GV: GPs need to reassess their approach (as private contractors).

Rural Ambulance Services (KB) Targets set for response times are too soft (only need to  comply in 50% of cases).
 Press report last week that 15 rural ambulance stations were manned by one person over  a recent weekend.
 Some rural services suffer from anomalies related to ferry crossings.
NS: Keen that service levels in rural areas should match urban levels.          NS

Pharmacies (AM) Welcomes decision to abolish prescription charges (effective in 2010)
 Pre-payment scheme - need for wider information on this way to reduce cost to patients  in the meantime.
 Minor Ailment Service - welcome development, but question of privacy in some
premises.
 When will effectiveness be assessed? (Further meeting to discuss)  MA/NS
JT: Can SGHD provide guidelines on privacy?
NS: Health Boards can insist in the case of new pharmacies, not so easy in existing premises.
 Pilots (in Boots @ Central Station and Braehead) to be rolled out elsewhere.       NS

Tendering for Patient Experience Programme (RC)
 Scottish Government had appointed PriceWaterhouseCoopers as a private organisation to  act as coordinating centre for the Scottish Patient Experience Programme:
 Why, since some Health Boards are undertaking some studies already?
NS: PWC were appointed under European competitive tendering process, but are not  covering the Patient Experience Programme - it is chaired by SGHD Chief Nursing
Officer.
JT: Role of Scottish Patients’ Association etc in helping enhance patient-centred services?
NS: Wants to enhance/publicise role of PPFs (Public Partnership Forum).         NS
JW: Need for common standards for PPFs: e.g. on membership, specialist input and meeting
schedules.
KB: Argyll & Bute PPF devolves some discussion to seven local forums.
(Some asides re standing of PPFs - often too easily sidelined by clinical/admin. heavyweights).

NEXT MEETING: Six months’ time (date to be arranged)     RC/NS

SHCN meeting with Cabinet Secretary for Health and Wellbeing

24 Sept. 2007 at St Andrew’s House, Edinburgh.

Present: Cabinet Secretary, Nicola Sturgeon accompanied by four staff.

SHCN: Dr Robert Cumming, (Chairman SHCN)
James Sandeman, (Vice-chairman)
Malcolm Allan ( Press Officer)
Ken Barr, (Chairman, Catches)
Dr Alastair Glen (SE Health Forum)
Julie McAnulty ( Monklands)
Dr George Venters (Edinburgh)
Isobel Vernolini, (Fife)
Margaret Watt, (Chairman, Scottish Patients’ Association)

In the interests of brevity, those present will be referred to by initials.

N S opened the meeting by welcoming delegates and indicated that she wished to continue meeting with representatives of the SHCN at intervals.

RC, on behalf of the Network, began by thanking N S for agreeing to continue this procedure. He stated that we welcomed the decision of the new administration to review the decision to close the A&E departments at Monklands and Ayr hospitals. The SHCN also welcomed the publication of the discussion document, ‘Better Health, Better Care’ to which we intend to respond.

K B then emphasised the need to increase the number of ambulances operating in the Cowal peninsula, more centralisation requiring more ambulances from rural areas to take the sick to hospitals. He enquired as to how many hospitals had helipads, pointing out that in Cowal, if the Air Ambulance was being called because the only blue light was otherwise engaged, how would patients be transferred from hospitals to landing sites and vice versa without such a facility.

N S A helipad will be incorporated in the hospital at Dunoon.

R C commented that, as member of the north monitoring group (north Glasgow), he would draw attention to the slippage in the time scale of the building of the ACAD units at Stobhill in the north and the Victoria, in the south of Glasgow.
The number of beds for the area served by NHSG&C had not yet been established.
He stated the importance of the continued existence of the groups to ensure continuation of surgery and medical care at the units until full completion of the ACADs. He then enquired about the source of funding for the new Southern General Hospital.
At this point J S pointed out the lack of independent medical input in the monitoring groups. Although members of the two groups meet informally, J S suggested that they should merge. The monitoring group(s) should have a direct input to the health board, with particular regard to planning. J S also raised questions relating to transport, traffic, parking, NHS 24 and Minor Injury Units.

2
N S replied that, as far as capital costs were concerned, she did not favour PFI and would prefer a ‘not for profit’ type of funding. Re transport issues, she will meet with Tom Divers of NHSGG&C within the week and wishes greater involvement with SPT, particularly with access to the planned new Southern
General hospital.
Re future of monitoring groups, it has been agreed that these will continue at least until 2009.
Relationship between NHS 24 and ambulance service is very important.
There is also a need to engage more with patients about Minor Injury Units.

M A spoke on two issues relating to community pharmacy.
Was it time to review the Minor Ailment Service and its cost effectiveness?

N S replied that as it has been in existence only since July 2006, it was intended to allow more time for the scheme to settle in before reviewing its effectiveness.
At present about 800,000 patients have registered and the system appears to be working well. She agreed that further publicity would increase public awareness and this is being put into effect.

M A drew attention to the intention of the Government to abolish prescription charges, a proposal which will require the support of opposition parties. Was this to be phased in along the lines as in Wales where charges were abolished in April 2007? In the interim will N S confirm that any extension of the exempted categories will not be subject to the directive as in England of being ‘cost neutral’?

N S stated that it is planned to abolish prescription charges in Scotland by 2012. No decisions have yet been taken about the method of effecting this in the interim.

R C raised the subject of hospital acquired infections. The recently announced decision to screen all patients for MRSA ( as at the Golden Jubilee Hospital) was welcomed. The practice of staff wearing uniforms outside hospitals should, in his opinion, be discontinued as being a possible source of infection. R C has already raised this with N S’s predecessor, Andy Kerr.

N S emphasised that it was essential that all visitors to hospitals make use of alcohol based hand washes, both on entering and leaving. Supervision is required and containers must be replenished. She felt that there was little evidence to show that that uniforms were a major source of infection.

G V emphasised the importance of workload planning re new hospitals.
He also spoke of the need to engage with junior doctors and raised the issue of the number of part time doctors working as associate specialists.
He further drew attention to the need to encourage the training of more general physicians and surgeons essential to the provision of care in rural areas.
He drew attention to the situation in Norway and Sweden where there are more generalist. The Royal Colleges continue to place more emphasis on the training of specialists.

Julie McAnulty also welcomed the decision about Monklands Hospital but expressed concern that as a result of NHS Lanarkshire PFI contract
commitments, £45m had to be removed from its clinical budget.

N S observed that in this case, as in others, it was not possible to tear up PFI contracts already in place.

A G stressed how vital it was for stroke patients to reach hospital to be scanned within a target time of one and a half to three hours at the outside. 50 patients a day suffer a stroke in Scotland.

He drew particular attention to the Brent Emergency Care and Diagnostic unit (BECAD) which has been in action for about two years. Basically this is similar to an ACAD, but with the important difference that it has 250-300 beds for medical and surgical emergencies. This is designed to serve a population of 250,000 and may well serve as a model for parts of Scotland. (note appendix)

He also asked about progress in introducing a comprehensive IT system and spoke of concern about patient confidentiality. He suggested that patients should retain ‘control’ of the information.

The IT advisor to N S wondered about how ‘control’ was to be defined, but recognised that the principle of confidentiality was crucial.

I V spoke of proposed change to maternity services in Dunfermline where it is proposed to set up a midwife led unit although the main maternity led unit would remain at Kirkaldy some 15 miles away.
Concern was expressed at the level of usage, safety and cost effectiveness of such a unit.

NS stated that NHS Fife plans were too well advanced to change. She also stated that she was in favour of midwife led units. Time constraints prevented I V from presenting the facts to support her statements.

M W intended to raise the issue of the handling of patients’ complaints by the Ombudsman but unfortunately the time allocated to the meeting had run out.
She indicated that she would write N S who agreed to deal with the subject.

Similarly, R C, intends to write N S to ask why chemotherapy will not be made available to out-patients at the new Stobhill ACAD when it opens, whereas this will be provided at the corresponding Victoria ACAD unit.
Patients from the north of Glasgow, and beyond will need to travel to the Beatson Centre for both in-patient and out-patient treatment.
In-patients from the south of Glasgow and beyond will be treated at the new Southern General Hospital.

Appendix: Dr Alastair Glen has subsequently written Nicola Sturgeon providing fuller information about BECADs.

Malcolm Allan
25 September 2007

Report on meeting of delegates from the Scottish Health Campaigns Network and Health minister, Andy Kerr at the Scottish parliament, Holyrood, 3 May 2006.

Those present:
Dr Robert Cumming (chair, SCHN)
George Bruce (North Action Group)
Malcolm Allan (Press Officer/media representative, SHCN)
Rebecchi Luciano (Provost, Inverclyde)
John Winton (Local Health Concern, Fife)
William Lawrie (Cowal)
Vivien Dance (Lomond Health Care Concern)
Dr Alastair Glen (Health Service Forum South East)
Julie McAnulty (Lanarkshire Health United)
Dr George Venters (Health Planning Advisor)
Margaret Watt (Patients Association)

Note: In the interest of brevity, Health Minister, Andy Kerr, will be referred to throughout simply as AK.

There was considerable media interest in the meeting, both prior to, and immediately following it.

Individual delegates were interviewed on local radio (Saga fm, Radio Clyde) and on national radio (Good Morning Scotland). Interviews were also carried out for Reporting Scotland.

Journalists from the following newspapers turned up at Holyrood to interview delegates: The Scotsman, (Glasgow) Herald, Daily Mail, Aberdeen Press and Journal, Evening Times, Greenock Telegraph.

The meeting began at 3.30 pm and was scheduled to finish at 4. 30 pm, but continued until 4.57 pm, when AK had to leave to record his vote following a debate.

Dr Cumming raised two issues:

1) In implementing the Kerr report (Prof.David Kerr), there was no dispute about the centralisation of super specialities or about conditions which can be dealt with in the community.

The middle ground of acute ailments remained to be defined.

Dr Cumming asked if any progress had been made in this area i.e. the province of the local district general hospital.

AK replied that further work required to be done in this area.

2) The making available of lengthy Health Board papers only a very short time before meetings gave members no chance to make an informed judgement on the content. Often most contentious papers were tabled at board meetings. This did not appear to be open and transparent conduct by Health Boards.

In addition to this, the notice given about the Consultative Public Meeting to discuss the location of the new Sick Childrens Hospital in Glasgow was woefully inadequate.

AK agreed that Glasgow was a poor performer in producing board papers in advance of meetings. He also agreed that the consultative process in regard to the Sick Childrens Hospital had been unsatisfactory. He stated that he would check out both points.

John Winton raised the issue of greater use being made of elective, or planned, surgery, particularly in regard to the possibility of theatres being used for longer hours than is the case at present.

AK favoured the principle of separating emergency from elective surgery, as there was less likelihood of operations being cancelled through disruption caused by emergencies disrupting planned procedures. He had observed this system in use in other countries.

Dr Alastair Glen referred to Minor Injury Units (MIUs) in hospitals. He drew attention to reports which indicated that these nurse led units were unlikely to reduce numbers of patients attending A & E units and gave the reasons for this.

He stated that a medical presence at MIUs would enhance their function and take pressure off A & E units. It would improve training of doctors and nurses in MIU and improve patient confidence in those units.

Alastair questioned whether there had been slippage in the time scale of building the ACAD at the Victoria and asked for confirmation that clinical services at the Glasgow ACADs would be provided solely by the NHS.

AK stated that there had been no slippage and that the opening date for ACADs would be in 2009.

He gave a clear undertaking that clinical services would be provided solely by NHS staff.

Malcolm Allan referred to the new pharmacy contract. This will include a Minor Ailment Service, due to take effect in July 2006, and the clinical management of chronic conditions scheduled for April 2007. For these to be successful, patients will require areas for consultation within pharmacies where adequate privacy is available. Several existing pharmacies fail to meet this requirement at present.

Malcolm asked that Prof. Bill Scott, chief pharmacist, ensure that pharmacists will be encouraged to provide the necessary facilities and that there are measures to deal with those pharmacies which fail to meet the required standards.

He also asked that, while some system of prescription charges remains in place, increased publicity be given to increase awareness of the existence of pre payment certificates which can be of benefit to those who require several prescriptions for chronic conditions.

AK replied that he agreed with both points and would take steps to ensure the necessary implementation.

Julie McAnulty drew to the attention of AK the problems relating to transport issues in Lanarkshire. In particular she mentioned the higher proportion of over 65s in Motherwell compared to other areas in Lanarkshire and to the statistics of car ownership in Motherwell, East Kilbride and Wishaw. This emphasised the importance of an adequate public transport system.

Julie gave details of travelling times using various forms of transport and the effect that this would have on elderly people faced with repeated visits to hospital.

She reported the failure of Lanarkshire health board to consult with SPTE about providing better links between towns in Lanarkshire.

AK agreed that the transport policy was inadequate. He meets with SPT and the Transport Minister to try to improve the situation. He stated that it was not simply a question of giving more money to bus operators and that it would be necessary to “think out of the box�.

The main complaints relating to hospitals, which he hears about, are food, car parking and transport.

Provost Luciano felt that more co-operation should exist between Inverclyde and NHS Greater Glasgow and Clyde, particularly in regard to laboratory work. He argued for more flexibility in working practices and indicated that it was difficult to recruit staff when the future of a hospital, or departments within it, was insecure.

AK was in favour of more flexibility, but stated that it was up to Inverclyde to attract employment to the area—to make jobs attractive.

George Bruce asked if there was a policy of “centralisation by stealth� of maternity services in that there had been inadequate advertising of consultant posts at Caithness General Hospital. He referred to the threat of “downgrading� of the consultant led maternity service.

AK replied that there is no policy determining midwife or consultant led maternity units. Decisions are made locally.

He did not accept that a midwife led unit equated to “downgrading� and pointed out that people in many areas are well satisfied with these units.

He spoke in terms of the volumes and throughputs necessary to maintain skills and retain staff.

Dr George Venters raised two particular issues:

1) He asked what the Executive is doing to foster and develop the training of “Generalists� in surgery and medicine as valid sub-specialities by the various relevant Colleges.

Ak’s response was that the Executive was pursuing this agenda in co-operation with the Colleges. He recognised the need for developments both for District General Hospitals and also for rural hospitals. He indicated that consideration for discretionary awards would include generalist work as a substantial component of assessment for these awards. He spoke of trying to change the culture and to increase awareness of the positive aspects of “generalism�.

2) G V asked about patient engagement, consent and the necessary procedures to safeguard confidentiality of patient information.

AK replied that the Executive was in the process of implementing its clinical information and technology strategy and that direct public involvement in these issues would be addressed when it became clear who would hold what information, where it would be held, what purposes it might be used for and what type of safeguards might be acceptable.

The Executive would also take the opportunity to learn from experience acquired by the NHS in England.

William Lawrie quoted examples of incidents relating to the ambulance service in Dunoon. He questioned whether one “24/7� ambulance, in addition to one operating standard hours, was adequate for the area.

He also questioned the need for the amount of form filling and considered that there was scope for standardising the terminology in use by members of the public and the ambulance service.

AK indicated that he considered that, in most instances, the ambulance service performed well. He would want to investigate the individual cases mentioned before passing comment on them.

Perhaps some of the points raised could be further discussed at a future meeting, wherever that might be held.

Vivien Dance introduced the subject of appointments with GPs and the disparity between different practices in offering appointment times.

She also asked about the choosing of members for Citizens Advice Bureaus, who is responsible for this and queried the basis of distribution.

In addition to the above, Vivien asked about the situation in Helensburgh following the demise of Argyll and Clyde health board.

AK pointed out that the systems operated by GPs for offering appointments would be monitored.

There appears to be little public involvement about the constitution of CABs.

The numbers and distribution of CABs is now a “done deal�

He wants health boards to work together to avoid any fragmentation of service throughout the country.

Margaret Watt argued that people should be able to become more involved in decisions which affect them.

(At this point, the Minister explained that he had to leave very shortly).

AK The Executive is working with the Scottish Consumer Council. He tries to work with the public.

The meeting closed with the hurried departure of the Minister who had, as indicated, already extended the time allocated to it.

It was noted that the Minister had indicated his willingness to meet with the SHCN in the future.

Malcolm Allan 10 May 2006