SHCN Meeting with Cabinet secretary for health and well-being on the 14 April 2010.

List of topics and attendees:
Dr Robert LC Cumming (Chairman)
Dr Robert Milroy – Chair of Stobhill Medical Staff Association – concerns regarding the transfer of acute medical services from Stobhill hospital to Glasgow Royal infirmary.
Ken Barr- Ambulance Services  - Easdale.
Julie McAnulty – Health Services in Lanarkshire.
Dr Patrick Trust – Services in Vale of Leven Hospital.
Dr George Venters – Management Consultants in the Health Service
Dr Matthew Dunnigan – Nuffield Trust Report on hospital services .
James Sandeman – Confidentiality of patients’ computerised medical records.
Doctor Jean Turner – Scotland Patients Association (topics attached).
John Winton – Hospital Inspections and Elected Health Board Membership

Question for Nicola Sturgeon:-1: – Is NHS Lanarkshire attempting to shut Monklands Hospital by stealth? Orthopaedics has lost 24 beds, 16 surgical beds have been mothballed for nine months of the year, and it is losing its acute mental health beds to Wishaw.2: – Is there any information as to where the 18 psychiatric patients without allocated beds are going to go after the mental health reshuffle? This was not answered in the letter sent by Colin Sloey in the response to my previous question regarding mental health and Lanarkshire.

Julie McAnulty

Suggested Question on Confidentiality of the NHS health Record for the Scottish Health Secretary 14th April 2010
What progress has been made on the process of transferring patient’s NHS health Record to secure electronic form? Can you confirm that Opt-In to be the process and will Public Key Encryption be the minimum basis of security. Security of the individual patient’s record can be enhanced by partition of the record and confidence improved by the patient holding their own private encryption key on chip and pin card. James Sandeman

Questions from Local Health Concern( Fife)
1:- When HEI teams carry out previously arranged hospital inspections, and pick up many items, do they carry out  an unannounced follow-up inspection once the hospital has completed its action plan?Should the team also be given access to inspections carried out in-house (with public input) and should the team not asked to see the repairs and maintenance books, filled in by ward charge nurses to see what has or has not been attended to?
This question is raised following the inspection of Queen Margaret Hospital in Dunfermline in January this year. We are sure that maintenance is being skimped on at Queen Margaret Hospital and the Victoria as the acute areas of these hospitals will no longer be used after Spring 2012.
2:- Elected Health BoardsIn Fife we still are awaiting for the information pack for candidates which is being produced by NHS Fife. This is important to any prospective candidate in order drawing to excess any restrictions which they could encounter if they are successful. At present any candidate assumes that  the same conditions/restrictions as would apply to a local authority councillor will apply to a health board member. Would it be possible to clarify the situation?
John Winton

Scottish Health Campaign Network (SHCN)Response to the Nuffield Trust report on the Funding and Performanceof Healthcare Systems in the Four Countries of the UK before and after devolution
Matthew G Dunnigan

1. The Scottish Health Department did offer some comments following the report’s appearance.  Could NS be asked if the SHCN might have sight of any further responses to the document?
2. The trends identified by Nuffield are similar to these demonstrated in my own comparative study of relative trends in hospitalisation rates in Scotland and England between 1986-2008 and are potentially damaging to the case for public sector provision by block grants vis a vis the restoration of the purchaser-provider option, payment by results and progressive privatisation.  There is considerable interest by the defenders of public sector provision such as the NHSCA (and the SNP and “old” Labour) and the SHCN in considering the implications of these trends.  They have also been identified by believers in the market approach such as Julian Le Grand of LSE, and, not least, the Tory party who seem likely to form the next administration.
3. A possible hypothesis, which is potentially testable, is that the levelling out of hospitalisation rates in all Scottish specialties from devolution (1999 to 2008), with an annual rise of only 0.5% per annum following more rapid rises of about 2.5% p.a. in the preceding decade, represents a state of approximate equilibrium between supply and demand.  This hypothesis is supported by the reduction of waiting times to parity with English levels and the absence of severe problems with emergency admissions (resulting from rapid assessment units, more rapid clearance of blocked beds, attainment of 4 hr targets for acute admissions).  It is also possible that demand for hospital care  has been reduced by a better staffed Scottish primary care sector and personal care cost provision for the elderly, though empirical evidence on these points is lacking.
If this hypothesis of a broad equilibrium between demand and supply is true, the more rapid increase in hospitalisation rates in England may be viewed as a catch-up phenomenon from a relatively under resourced NHS provided with lavish financial resources by Gordon Brown.  These would be expected to level out at roughly the Scottish level of hospitalisation rates in the near future (Scottish rates for all specialties were 98% of English rates in 2007-08)
4. There are a number of other unresolved issues which are peripheral to the above hypothesis.  Superior staffing levels (medical and nurse staffing in particular) increase differences in productivity between the Scottish and English NHS when assessed by patients treated per doctor or nurse.  This reflects superior, but declining relative funding under the Barnett formula and is made much of in the Nuffield report.
A second concern is the loss of the relationship between Scotland’s higher Standardised Mortality Rates (SMR) and higher hospitalisation rates reflecting increased morbidity; this was described in detail in Carstairs and Morris’s classic monograph on Deprivation and Health in Scotland and has formed the basis for NHS funding formulae such as SHARE.  In keeping with this relationship, Scottish hospitalisation rates prior to the mid-nineteen nineties exceeded English rates by 10-15% and in medical specialties by 30-40%, justifying superior funding for increased need.  This relationship has now been lost.
A third concern is that crude parameters of NHS performance such as hospitalisation rates and waiting lists do not assess variations in the quality of health care.  These include the UK’s relatively poor record in cancer survival, Scotland’s unenviable records as the unhealthiest nation in Western Europe, poor hospital hygiene, and the UK’s relatively low ranking in the OECD’s assessment of health care quality (? 18th or 19th; France 1st).
In relation to English hospitalisation rates, there remains speculation that rising rates may be in part driven by perverse incentives to increase turnover under the payment by results funding formula, competition rather than cooperation between hospitals and poorer care for the elderly, increasing referral to hospital.  There is little or no empirical evidence for these scenarios at present.
5. Despite the above alternative issues, the principal hypothesis which seems worthy of attempted validation or refutation is that the slowing of Scottish hospitalisation rates since devolution reflects a steady-state equilibrium between demand and supply.  The alternative possibility that it reflects capacity constraints which seemed likely in the nineteen nineties with rising admissions and reducing bed numbers now seems less likely.  The stabilisation in hospitalisation rates applies equally to inpatient admissions, day cases, and new and return outpatient referrals.  Physical capacity constraints apply only to the first of these categories, and reducing lengths of stay and reductions in blocked beds seem to have reduced acute pressures on beds (but not abolished them, particularly in new PFI-financed hospitals such as ERI).  If this assumption is correct, the Scottish NHS exemplifies a success for the public sector model since referrals to the private sector remain small (about 5000 inpatient and day cases of 1,502,000 inpatient and day case admissions in 2008 (0.33%)).
6. It remains important to validate the hypothesis, if possible, and since demand for elective hospital admissions, most emergency admissions and day care and outpatient referrals is generated by the primary care sector, it seems logical to ascertain from Scotland’s general practitioners whether in their opinion the secondary and tertiary care sectors are meeting demand or not.  This might be facilitated by the BMA, which under the chairmanship of Hamish Meldrum has taken up a strongly anti-market stance, no doubt partly driven by moves in England to create privately managed health centres and polyclinics, as in the Darzi plan for London.  The Chairman of the Scottish BMA, Brian Keighley, has also written in the Herald strongly defending the Scottish Health Service and might be willing to consider a structured review of Scottish GPs’ opinions of the ability of the hospital service to meet demand.  This might also be put to NS to consider as part of the further investigations required to defend the Scottish NHS from the attacks of the neo-liberal marketeers.  These are likely to be reinforced by a change of government and the impending draconian financial climate in the public sector resulting from the excesses of the casino bankers and the self-same neo-liberal consensus.
Matthew Dunnigan

SCOTTISH HEALTH CAMPAIGNS NETWORK – proposed meeting on Wednesday 14th.April 2010 with Secretary of Sate for Health .Questions for submission to the Secretary of State for Health on behalf of the Vale of Leven Hospital(VOLH) Groups supporting retention of local services for patients in West Dunbartonshire and Argyll & Bute Community Health Partnerships.ACUTE MEDICAL SERVICESThe patient groups note the allocation of £1.6m to providing new acute medical beds in Royal Alexandra Hospital(RAH) in Paisley.  The groups also note the closure of Ward F for stroke rehabilitation at the Vale of Leven Hospital and other ward closure proposals.  All nursing staff at VOLH have had to undertake interviews to retain posts and this has caused considerable anxiety regarding future plans for the hospital.  Can the Secretary of State inform the groups of the planned proposed percentage of Acute Medical Admissions who are to continue to be admitted to the VOLH ?ONCOLOGY TREATMENTS AND OUTPATIENT REVIEWS.At present there is a much valued service led by nurse practitioners who administer chemotherapy with supervision from visiting consultant oncologists and the local Heamatology consultant.  It is vital that this local service continues as it is very much easier for patients from Argyll & Bute to attend the Vale of Leven Hospital.  We note with concern the severe pressure on the Beatson Oncology Centre and wish to ensure that treatments continue to be delivered at all local hospitals in the former Argyll & Clyde Health Board area.   Can the Secretary of State reassure patients with cancer that local treatments will continue to be available where it is appropriate? PALLIATIVE CARE.There was an understanding that the closure of the Jeannie Deans Hospital in Helensburgh, with the loss of respite and palliative care beds for General Practitioners(GP), would lead to four beds being available for these patients in the Vale of Leven Hospital.  Consultant cover for these beds could be available from the present team in RAH/Accord Hospice.  Can the Secretary of State assure local patients and GPs that plans for these palliative care beds are being progressed?ELDERY CARE /STROKE/REHABILITATIONProvision had been made in the ‘PREAMBLE SCORING SYSTEM’ for elderly patients who did not wish intensive care or active Cardio Pulmonary Resuscitation to be admitted to the VOLH despite being more severely ill than would normally be admitted, and thus avoid  being sent to RAH for medical care.  Patients understand the potential requirements for acute stroke patients to be admitted to a specialist stroke unit but this should only be required for a maximum of 48 hours. Can the Secretary of State reassure patients that their wishes for local treatment and rehabilitation are to be respected with especial reference to end of life care decisions? MENTAL HEALTH/CHRISTIE WARD.We appreciate the advances made with local outpatient services especially with the Crisis Team and 24 hour specialist nursing cover from Glasgow to the VOLH  GP out of hours centre. We are however struck by the support and positive patient comments with regard to local inpatient facilites in the Christie Ward when these are discussed in local forums. It should be noted that in NHSGG&C option appraisal process Christie Ward was the preferred option apart from the financial costs.   We hope the Secretary of State will continue to support the views of patients who wish to see the ward retained  for inpatients with acute mental health problems.
Patrick Trust

Scotland Patients Association (founded 1982) Questions for the Cabinet Secretary for Health and Wellbeing: April Meeting with SHCNWhistle Blowing. As the Cabinet Secretary knows, SPA has handed in tapes relating to patients’ and relatives’ experiences in ward 42 Ninewells Hospital. SPA thought that the Cabinet Secretary had put in place a procedure for people to “whistle blow” in such a way that investigation of their concerns could take place, without fear of repercussions. (Patients and staff often fear raising serious concerns and therefore do not formally complain.)
The Craigforth Research highlighted that many patients could complain but do not because their perception is it is not worthwhile, because “nothing will be done.”  • Since the complaints procedure is so slow and speed is required to correct bad habits developing within the NHS;  what measures has the Government taken, which SPA is unaware of, to encourage speed of action to fix a concern when it is raised and so avoid the need to formally complain?• How many NHS hospitals ask their patients for anonymous feedback? If there are any, how are outcomes measured, and lessons learned shared, with all health boards?NHS Continuing Health CareSPA is still very concerned that patients who need full nursing care are being transferred into private sector Care Homes. How does the Government assess the outcome of this change in care for vulnerable patients?  SPA approves of all who wish to die at home being able to do so but is aware that it will not be suitable for all. If more people have to be looked after in the community then those patients still need choices. SPA would anticipate a need for more hospice beds and NHS Continuing Care beds in the future, to cope with this specialist care.  As a result of the vastly increased workload transferring from hospital beds to the community  this will require more qualified district nurses, not just more care assistants, if people have to be cared for at home or by private care companies. SPA believes it is essential to retain and recruit more district nurses because of the increased number of aging people who live longer with more complex medical conditions. • What provision has the government made to increase district nurses?• SPA supports the charity LIFEBLOOD in its attempt to raise awareness of the vast number of hospital patients who die from deep venous thrombosis (HAT). Since many have their thromboembolic episode after their hospital stay, it is within the community where there needs to be experience and awareness to diagnose DVT/HAT and save lives.  The vast majority of deaths due to DVT can be avoided. St Margaret of Scotland’s Hospice• What research has the Health Secretary seen from NHSGG&C to prove NHSGG&C’s conclusion that it will need fewer NHS Continuing Health Care Beds in the future despite the fact, which is well accepted by all , that we are an ageing population living longer with more complex medical conditions?  It is this research which NHSGG&C has stated proves to them that they will not need the beds at St Margaret of Scotland’s Hospice but will need NHS continuing care beds only at Blawarthill, not yet built. • What safe guards are there for the vulnerable patients who leave NHS Continuing Care and who are much in need full nursing care, but can only receive that care in the private Care Home Sector?• What regular medical supervision do these patients have, unless solicited by them, their next of kin or by the care home staff? What grade of Care Home does the Health Secretary think fit to look after people who need full nursing care? What provision is made for patients who need full nursing care in care homes if   the care home they are in cannot make a profit and so ceases to trade or raise fees?