Local Health Concern West Fife 3 April 2009
Since our Mtg on 14 February 09 the shambles re signing the PFI deal for the New Build Hospital at Kirkcaldy goes on. A deadline of 28 February 09 to sign up was missed for the 6th time. At a Mtg of Hospital Board on Wed 18 March 09 the Chair stated that the deal would be signed by Friday 20 March 09,however, since then no statement has been made by NHS Fife to the media or on its website to confirm this fact. The Board had claimed that although not signed an Advance Work Agreement had been made with Consort Health Care to start work on the project allowing it to finish as per schedule at the end of 2011. From looking at site after 4 months a tower crane has been built and fencing put round the site. We feel this must put NHS Fife at a disadvantage when finally trying to agree the terms. More concerning was a Report on BBC Newnight Scotland when talking about the Forth Road Bridge funding that the Westminster Government was now bailing out PFI companies who could not raise the funds. It then cited that the Victoria Project in Kirkcaldy was one of them. Neither NHS Fife nor Consort Health Care would comment on this fact when approached by the local paper. This would not surprise us as further delays to the Project would be an embarrassment to one Gordon Brown who is the Kirkcaldy MP. Re single room beds in new builds NHS Fife claims 50% for the new Victoria citing the fact that the contract was agreed prior to Nicola Sturgeon's announcement. I have since found out that the new Forth Valley Hospital which originally claimed 50% of single bedded rooms is now telling the local community it will be 75%. This Hospital is over 50% built which makes Fife's claims look silly. John WintonLocal Health Concern
CATCHES group report for AGM Feb 2009
C.A.T.C.H.E.S.
Ken Barr reported that there had been a lack of consultation about the possible closure of a Care Home in Lochgilphead. As a result of protests, no decision will take made until such time as a consultation exercise has taken place.
LHC Report
LHC REPORT FOR SHCN MEETING ON 14 FEBRUARY 2009
Since last Meeting LHC has met with Scottish Health Council (Fife) and Chair of NHS Fife to discuss lack of public engagement re changes at Queen Margaret Hospital. Whilst the discussions were cordial we still wait for real evidence of public engagement.
The final signing of Contract for the new PFI build at Kirkcaldy has been put back yet again from mid-January to 28 February 09. This is the fifth time in 12 months the signing has been postponed. It is all to do with financial arrangements in the current climate. There are obvious worries that the financial settlement will impinge on Fife's budgets affecting all non-PFI arrangements including Queen Margaret.
...............................
John Winton
Chair LHC West Fife
HSFSE Report for AGM Feb 2009
HSFSE Notes for SHCN AGM on 14th February 2009
Issues of concern include: MRSA Screening: NHSGGC will not firm up on measures to be taken until the Health Department guidance comes out, yet:
A) The ACADs (800,000 patients a year, with lots of Day Surgery, Endoscopies etc) are due to open in 5 months,
B) The Golden Jubilee Hospital (Clydebank) already routinely screens all inpatients before admission, and
C) The national MRSA screening programme will only start to roll out in April 2009, with final guidance maybe early 2010, and it seems to target inpatients only. Donor organs for research: a recent headline “UK scientists hit by lack of brains” highlighted the need for thousands more brains for research on Autism, Alzheimer’s, Motor Neurone Disease, Parkinson’s etc, some of which are on the increase.
A donor card relates only to organs for transplant surgery, and there is said to be a huge shortage of both affected brains for research and unaffected brains to provide control groups.
While there is a national transplant organ system, no such network seems to exist for research purposes. The Forum has contacted Edinburgh University Pathology Department (the only relevant bank in Scotland - as empty as other banks) for advice on how to fill the gap and publicise the need. IT: The Forum is expecting to be addressed by NHSGGC’s Director on 10th February, and among other concerns we hope to highlight:
a) The ACADs (between them expecting 800,000 patients a year) are to have “paper-lite” systems. NHSGGC apparently claim that a system will be in place before opening end June, yet a design contract will only be awarded in May or June.
b) G-Pass (used by 85% of Scottish GPs) seems to have an uncertain future, with the Cabinet Secretary quoted as saying that it will be kept and built up, and NHSGGC that it will be killed off. Single rooms: The new build at the Southern General will have all 1109 adults in single en-suite rooms, and in total there should be some 66% of patients in singles (the Health Department aims for 50%). Some 1350 toilets in all: that’s a lot of Toilet Duck. Evening Visitor Transport: Launched two years ago, this free service was rolled out to cover Glasgow, Cambuslang, East Dunbartonshire, Renfrewshire and East Renfrewshire, but has not been adequately promoted and we now hear it is to end. NHSGGC spend on taxis: Press reports claim £2million spent (16% more than the previous year). This must be the equivalent of 50 to 100 cars working a full single shift, yet it is “cost effective”. There is no breakdown of where the £2m went.
E&OE/JSS-5/2/09
HSFSE-notes-for-SHCN-Feb09
HSFSE (Glasgow) 11 Oct 2008
SHCN 11th October 2008 HSFSE Report (Glasgow)
IT systems in NHSGGC
We are assured that a “paper-lite” solution for the ACADs will be ready by the time they open (mid-2009), even though a supplier will only be appointed in May/June. Now there’s a target!
Palliative Care
An Audit Scotland report shows that almost half the spend is from the voluntary sector, and that most hospital-based palliative care is provided by generalists. As the population gets older this bodes ill for the most vulnerable, unless the NHS can enhance the levels of a) expertise and b) night and weekend cover). The Scottish Government Action Plan is due out in October, and could be a suitable case for examination.
Day Surgery
The holy grail of day surgery has so far eluded NHSGGC, which is reported (again by Audit Scotland) to be well below target, although figures seem to be 10 years old. All hopes are pinned on the ACADs, but if there is pressure on them to make up the lost ground it must be matched by post-op care systems (see next item).
Discharge letters
Members have raised concerns over the delays in issuing these vital hand-over letters, with GPs sometimes not knowing the patient is out and in need of healthcare assistance until said “centre of NHS services” turns up at his surgery. An approach has been made to the Cabinet Secretary.
Stroke victims
Scotland seems to have lost its way, with the current guidelines (CT scan within 48 hours) over 10 years old - albeit under review for most of that time. Meantime in England a NICE draft in January recommends a brain scan within 3 hours. We hope to have a Consultant’s views at an early HSFSE meeting.
SHCN-HSFSE-11thOctober2008
LHC West Fife
REPORT FROM LOCAL HEALTH CONCERN FOR SHCN MEETING ON 11 OCTOBER 2008 Things are fairly quiet in Fife just now. There have been further delays to signing the PFI deal for the New Victoria Hospital in Kirkcaldy. As such getting schedules for all work associated with Fife's changes is proving difficult. Following Nicola Sturgeon's comments at Annual Review re engaging with the public we now see possible signs of movement from NHS Fife, however, time will tell. On that basis and following promises of meetings with Local Health Council and NHS Fife I will obviously delay any further comments on Queen Margaret Hospital Services in our Meetings with the Health Minister. Worryingly following the C-diff problems at Vale of Leven and Paisley we have now had two instances of enforced ward closures at Queen Margaret in as many weeks. It is obvious some sort of National strategy is required. ................................. John WintonLocal Health Concern
CATCHES 10 MAY 2008
CATCHES Report The third Annual General Meeting took place on the 22nd April 2008 at the Argyll Hotel. Since our last AGM Members of Catches have attended two CHP meetings, three PPF meetings, 2 locality PPF meeting, 3 A&B CHP eHealth Working Group meetings, two NHS Scotland meetings in Clydebank one on healthy living and one on HAI, one A&B CHP website meeting, two meetings with Nicola Sturgeon and two SHCN meetings. In addition members have attended CCCF management meetings and public forums. At both meetings with Nicola Sturgeon the chairman raised the question of the ambulance service here in Cowal but in particular in the remote and rural communities. At the most recent one he posed the question that was printed in the paper and got the reply that the new chief executive was looking into the situation. He also brought up at the request of the North Action Group, a similar group to CATCHES based in Caithness, the report that the P&J had made on the 9th April which stated that 15 ambulance stations in Highland were manned by only one crew member the previous weekend for a period of at least 24 hours and in another ambulance station there had been no crew member at all. Her response was that she could not comment on individual cases. He retorted that this situation was utterly unacceptable. The Chairman also handed her a paper giving some concerns on the Document "Delivering for Health in Remote and Rural areas" which Bill Lawrie had prepared for him. These were again relating to proposals regarding the ambulance service suggesting additional roles for the crews. As they cannot meet their current targets it seems odd to us that additional responsibilities are being considered.
The Chairman handed her another paper regarding an eHealth Problem that has arisen in Argyll and Bute which emanated from a recent eHealth Working Group meeting. Basically Argyll and Bute CHP are trying to trial a data transfer system from patients home to the consultant/care team to reduce the necessity of the patient having to travel to the relevant hospital. Unfortunately the service provider does not have an approved server within the NHS firewall system nor does the NHS have a server within the firewall able to access the system. So the trial, the training of staff, and the purchase of equipment has had to be put on hold. The problem is that there is within NHS Scotland an organisation that is meant to help - The Scottish Centre for Telehealth - but to date that help/advice has been lacking. So he asked her for an explanation of the role of the SCT.
Regardiing the Continuation of CATCHES Bill Lawrie said we are part of the Scottish Health Campaign Network and should continue with CATCHES as it is the bigger picture we are also interested in and allows us to speak directly to the Secretary For Health at the twice yearly meetings organised by the SHCN..
The AGM was followed ba an OPEN MEETING Around ten members of the general public attended. One lady voiced her concern for the Medicine for the Elderly ward at the Dunoon Hospital. She was greatly disturbed that those patients needing 24 hour nursing attendance were being sent to Paisley and that her friend was in the process of being moved when the patients lawyer stepped in and advised the authorities that it was against her human rights to move her from an area where she had friends to a place where no one would be able to visit her. She also understood that there were only two beds for the Elderly in Dunoon Hospital Evelyn Hide informed her that there were ten beds in Dunoon Hospital that would cater for the elderly. Another member of the meeting also spoke out about the closure of the Medicine for the Elderly Ward and he said there appeared to be some confusion arising around care within and care without the hospital and also on the availability of money for this purpose to care for patient care in the home and patient care in the hospital. Evelyn said there were two areas that we ought to be fighting for i.e. patients who need 24 hour intensive nursing care and medical care and those patients who only need daily care and no medical care or intensive nursing. Further discussion on the Dunoon Hospital and its services followed.
Save Stobhill 10 May 2008
SAVE STOBHILL CAMPAIGN REPORT 10-5-08 The Chairman of the Save Stobhill Campaign and the SNP party leader in East Dunbartonshire had met unsuccessfully with the Cabinet Secretary for Health in an attempt to get a review of the current situation at Stobhill Hospital.
Similarly a request for an Independent Scrutiny Panel to review Greater Glasgow and Clyde’s Acute Strategy Review was rejected on the grounds that the Review was too far advanced to be changed.
Nicola Sturgeon did however state that the decisions being implemented would not necessarily have been her choice.
She explained that the Monitoring Groups were very important and should be seen to report to her, and not to Greater and Clyde Health Board.
The question of the audit of their functions required review.
Signatures from the public in the Stobhhill catchment area are being collected with a view to presenting a further petition to the Scottish Parliament.
Parking in the hospital continues to be major problem.
LHC Group Report 10 May 2008
REPORT FROM LHC FOR MEETING ON 10 MAY 2008
Little to report this month other than NHS Fife have now admitted that financial close for PFI contract which should have completed Dec 07 is now forecast up to Oct 08 meaning further delays.
Attempts to get a full Schedule of activities for PFI Build and subsequent non-PFI modifications at Kirkcaldy and Dunfermline have been put on hold by Board until Contract is signed.
Fife is due its Annual Review mid-June. At Board Mtg end of April the target figures to be presented to the Minister were discussed . The delayed discharge figures which have been classed as impossible to meet for the last year have miraculously been met. I wonder if the figures next reported after the Review will still meet the target.
John Winton Local Health Concern
HSF South East (Glasgow)
SHCN 1st March 2008 HSFSE (Glasgow) report
SHCN-HSFSE-mar08
New South Glasgow Hospital (aka new Southern General, aka new Southern Campus, aka new South Acute Hospital - don’t blame us, read “Health News”):The press have eagerly published half-understood snippets from Press Releases, including artists impressions of what it may look like.
The design may or may not be final, but we have been told that the proposed 14-storey tower will require 30-metre piles through alluvial silt to bed rock. It is not clear that comprehensive test bores have been sunk to ensure no nasty (=expensive) surprises. Successive Press Releases have appeared to contradict each other, particularly on bed numbers, but the anticipated socio-economic benefits of £40m for Govan (£290m for Greater Glasgow) look good.
Financing of this £842M project is still to be determined, but the Outline Business Case apparently favours “traditional procurement” as opposed to PFI. This OBC was expected to gain Capital Investment Group approval by end February, with Cabinet approval within a month and FBC approval in Summer 2009.
Completion 2014, with close to 2000 beds on campus. We have urged the Cabinet Secretary to apply the same ISP review process as elsewhere, but despite a similar apparent lack of clear bases for decisions there seems to be little appetite for reviewing decisions already made.
Related issues include transport and access, with the prospect of hundreds of thousands of extra journeys (including those to the ACAD). We take little comfort from the prospect of a “Fastlink” service running through the campus linking Glasgow city centre (Royal Infirmary territory) to Braehead (Royal Alexandra territory), as most patients do not live anywhere near this axis. Much more work remains to be done.
Care on discharge from hospital - Further concern is rising over the transition of care as a patient is discharged from hospital into the community, and the question of GP responsibility for the elderly in care homes - if anecdotal reports are anything to go by, too many vulnerable people are left to orchestrate Primary Healthcare and Social Work cover for themselves at a time when they are least able.
Local Health Concern Report for 1 March 2008
LOCAL HEALTH CONCERN REPORT FOR SHCN MEETING ON 1 MARCH 2008 Since January Meeting LHC has following the Ayrshire and Lanarkshire decisions publically called for an Independent Review of NHS Fife Centralisation Proposals. This attracted local media publicity and an element of public support but with one exception an eerie silence from local Politicians of all Parties. Following LHC's Meetings with the Health Minister last Autumn we wrote to the Chair of NHS Fife informing him of the extra facilities asked for at Queen Margaret Hospital. The reply was disappointing in the extreme where the Chair merely reiterated the 5 year old NHS Fife Plan and did not even comment on the public engagement insisted on by the Health Secretary at NHS Fife's Review. Copies of letter and reply have been sent to Nicola Sturgeon. On the new PFI Build front at Kirkcaldy we are now told the final contract with Consort Health Care is unlikely to be signed until mid-Summer. This represents a further 6 month delay and rumours still abound that contractural problems are being encountered. In general information on progress has virtually dried up. The Queen Margaret Re-Configuration Group Meetings have now been cancelled for the third time in a row. We gather this is due to complete lack of guidance or decision making by the Board of NHS Fife.
LOCAL HEALTH CONCERN REPORT FOR SHCN MEETING ON 29 SEPTEMBER 2007
On 13 August 07 following NHS Fife Review Local Campaigners met with Health Minister Nicola Sturgeon re the situation of Queen Margaret Hospital Dunfermline. This Meeting had been arranged through the local SNP Candidates and Officials. Whilst Ms Sturgeon as expected would not reverse the Right for Fife decision at this late stage she did take on board some of our requests to enhance the facilities currently planned at the Hospital. This included extending Day Surgery to more extensive Elective Surgery, enhancing the cover at the proposed Minor Injuries Unit and forcing through initiatives on transport to hospitals which has become completely bogged down. We now wait to see what pressure can be put on NHS Fife to improve the facilities. In general she seemed supportive.
Towards Christmas NHS Fife is expected to sign a PFI deal on major new builds at Kirkcaldy and St Andrews worth some £150m. At last Board Mtg the Financial Director gave warning that these new Schemes could lead to massive deficits and proposed a cost cutting exercise to negate this problem.
Over the last 3 years NHS Fife have shown a surplus (mainly on capital) of £5m. It is projected that by 2012 (when the PFI is expected to kick in) Fife will be running a deficit of £10.5m. To get round this cuts of £2.6m per year starting next April are proposed. We don't know where the cuts will come but it causes concern for the even limited amount of money to be spent at QMH turning it to a Diagnostic & Treatment Centre. I think that says it all about PFI.
For those interested in the privately run Treatment Centre at Strathcatho I recently sent a Press Cutting stating worries that due to patients refusal to go would lead to the private firm being paid for nothing. At last Board Mtg it emerged that in Fife some 75% of those patients eligible for treatment have turned down their operations (mostly orthopaedic) at Strathcatho. As such, the Board has introduced providing transport for patients attending and hotel type facilities for relatives at hospital with a follow up veiled threat to pull those who refuse to attend off the Waiting List. It is thought that Tayside and Grampian are having similar problems. We did get a shock last week when hearing that Fife patients were being offered vasectomies at Strathcatho (which was never discussed or even announced to people in Fife).
HSFSE(Glasgow)
SHCN HSFSE (Glasgow) Report for 29 September 2007 A&E: While we are pleased that Inverclyde Royal A&E has been reprieved, we see little logic in closing the busy and efficient Victoria A&E, but the Cabinet Secretary tells us centralisation decisions already made will not be reversed.
NHSGGC insist that the disruption from closing IRH A&E would have been greater than closing Victoria, with patients facing traveling 20 miles to Paisley against 6 to the Southern General. Travelling time is in fact not that different, and our numbers are much greater - 40,000 from the Victoria against maybe 13,000 from IRH
(based on 41% of IRH’s A&E total of 30,000).
NHSGGC at last have a figure for the number of A&E patients to be treated at the Minor Injuries Unit in the ACAD: 41%, against previous guesstimates ranging from 25% to 60%. This means around 30,000 a year and we “will be told” how to decide whether we are MIU or A&E material. ACAD: Work is “ahead of schedule” (give or take a couple of years), and a definitive list of services will appear at the beginning of 2009. Meantime we are delighted to have confirmation that the ACAD will have a full suite of scanners, and hope that NHSGGC will be able to come to a satisfactory agreement with clinicians on extended opening hours.
Suggestions that lessons might be learned from the Central Middlesex BECaD have so far fallen on deaf ears. Things like beds, night cover, A&E etc. New Southern General was due to open in 2011/12, but unconfirmed reports now talk of 2014, and we are pushing for confirmation that the Victoria will stay open till then. Fears are that services will slowly migrate and the fabric deteriorate as the Victoria is run down (as in Vale of Leven).
We estimate that increased traffic will result from over 500,000 extra journeys to/from SGH. SPT have told us the roads around the SGH are inadequate, and NHSGGC may be asked to provide £10 million for improvements. We have asked for a copy of SPT’s transport study.
Bed numbers remain a mystery, with a definitive figure now expected in December. The OBC was said as recently as June to be going to the Board in July, but it is now to be a Christmas present. Ho, ho, ho. Beatson W of S Cancer Centre: the publicity given to the new centre seems justified, and for once we applaud the centre of excellence approach. South Glasgow Monitoring Group seems to be running out of steam, and MSPs and others appear to be losing interest (the September meeting saw only half of the core members attending, and no MSPs). Nice to see they’re all so busy.
29Sept2007 - HSFSE
North Glasgow Acute Services Monitoring Group
In Patient Bed Modelling: Discussion Paper
Leaving aside (a) the manner in which this paper was presented to the Board meeting on the morning of the last meeting held on 26 July 2005, with no prior opportunity being afforded to the members to study the document and (b) the guillotining on the 3 September 2005 by the Chairman of the combined North and South Acute Services Monitoring Groups, of the discussion on Robert Calderwood's presentation of this paper,I would make the following points:
1: The consultation period for a document with such potentially far-reaching consequences for the future provision of health services in Greater Glasgow is remarkably short ,and also encompasses a holiday period.
2: The re-designation of some medical beds into specialties is probably a good idea, but there are no previous baseline figures with which to make definitive comparisons. Most medical admissions are acute, unlike surgical procedures, the majority of which are planned.
The proposed greatest reduction in bed numbers seems to involve general medical beds. Currently this aspect of the hospital health service is under the greatest pressure,and continues to provide the greatest problem leading to unacceptable trolley waits. A significant contributory factor to this is caused by delayed discharges. This problem has been unsuccessfully addressed for many years and whilst the Community Health Partnerships and the Inter-Disciplininary Response and Intervention Service(I.R.I.S.) in North Glasgow are excellent initiatives,they are still not fully developed.
In the absence of full patient support in the community there must remain a major question mark as to the number of beds required, particulary in General Medicine. Perhaps the prime example of bed numbers being trimmed to a level where there is now unacceptable pressure on backup services is the situation which has developed in relation to the new Edinburgh Royal Infirmary. Glasgow also has major poverty and deprivation problems which add a further dimension to the provision of health care.
3: No bed occupancy figures are shown in the paper.These have to be realistic,otherwise the proposed model is a non-starter.
4: Whilst improved care in the community is essential, it may only delay the inevitable need for hospitalisation as the ageing population increases.
5: The short timescale for this consultation paper appears to be linked to the pressing need to establish an outline business case for the redevelopment of the Southern General site. Some flexibility in bed numbers is hinted at in the future, but to what degree, since altering a PPP contract can be extremely expensive? It is essential that the mistakes of the past do not repeat themselves. The transfer of maternity services from the Stobhill campus which had the "gold standard" of an acute adult care facility with an ITU and a paediatric unit is perhaps the current prime example. GGNHS Board would not now be facing its present problems in maternity / child care if a sensible decision had been made!
6: As presented the bed model gives no indication as to the distribution of the acute beds between proposed sites North and South of the river, albeit there is an indication as to where it is hoped specialty facilities will be provided.
7: The Appendix 3 states that: "supporting documentation will be available online". This refers to Clinical Model Groups,CHKS Bed Modelling Report, Analysis of Emergency Growth and Minutes of Group meetings. At the time of writing these do not appear to be accessible. These documents are essential in assessing the validity of some of the assumptions in the Bed Modelling report.
8: A cornerstone of the document’s assumptions is S.M.R. data. My personal experience over many years is that unless there is a major improvement in coding input such data can be severely flawed.
9: Paragraph 2.16 - Clinical Model Groups: states that 14 groups were established yet in paragraph 2.18 only 12 groups are mentioned. What are the other two? Could it be that one of these is Clinical Haematology - quoted in the tables but not in this context? This discipline was often miscoded in S.M.R. data under "Medicine"!!
10: The implication of the incorporation of some of the services of Argyll and Clyde is mentioned, but with the close proximity of the new Southern General hospital and the Royal Alexandra Hospital (which will in future be incorporated in Greater Glasgow) this must surely mean some revisitation of the plan?
Dr Robert L. C. Cumming
North Glasgow Acute Services Monitoring Group
14 September 2005
Member Group Reports: January 2005
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