SHCN – meeting with Alex Neil MSP, Cabinet Secretary for Health & Wellbeing,

              27th November 2013 in Holyrood                                                   (JSS notes)


Present:                        Julie McAnulty                                    Alex Neil MSP Cabinet Secretary

Kenneth Barr                           Louisa Brown  Asst PA to AN

Catherine Hughes                    Liz Porterfield  )(Healthcare Planning Team

Dr Patrick Trust                       Chris Roberts   )(Planning & Quality Div.

James Sandeman                                              (SG Health & Soc Care Dir.


Integrated Care in a District Hospital (PT)                                                             Actions

PT’s paper had been submitted earlier.  He stressed that as things stand GPs are poorly placed to protect A&E, but the model pioneered in the Mid Argyll (Lochgilphead) and now being implemented in Vale of Leven shows how integration between Primary and Secondary can improve healthcare.

PT emphasised the role additional GP training plays: support in this is now coming from the RCGP, and the GMC are taking an active interest.

He stressed that the current over-centralised system is inhibiting progress, leaving a need to redress the balance.

AN recognised the pressures on A&E, with 1.65 million presenting to A&E and emergency admissions up by 15%: due principally to an ageing population, many with multiple morbidities, and the addition of norovirus.  The £50 million Unscheduled Care Action Plan aims to meet this challenge.

Delays have resulted from problems with patient flow, especially Delayed Discharges, but flow is accelerating and further improvements are coming.

One aspect is the use of A&E as a “drop in centre”, exacerbated by NHS24 issues, the inability to obtain early GP appointments and in urban areas the proximity of A&E.

AN accepted that rural areas in particular could benefit from the Primary/Secondary integration model.

He is already encouraging the BMA and RCGP to progress the GP training issue.  He cited the GP recruitment difficulties in Ardnamurchan, but PT and JMcA pointed out that Jura and Arran had obtained GPs by employing innovative canvassing methods.

PT reminded AN that the GP-led MIU in Vale of Leven is now open 24/7, in contrast to the units in Stobhill and Victoria which close overnight.

He repeated that the RCGP is enthusiastic, led by its Chair Dr John Gillies.

AN would continue his contact with RCGP, BMA, with every prospect of making early progress.                                                                                                                    AN


TrakCare (KB)

KB raised shortcomings in communication, mainly because in spite of initial aspirations TrakCare was not universal.  Argyll & Bute suffers because the vast majority of its patients relate to NHSGGC who cannot communicate with the ‘parent’ NHSHighland.

Forth Valley and Golden Jubilee do not currently use TrakCare, although LP indicated Forth Valley were introducing it.

AN stressed that NHSGGC had inherited 11 different systems: they now had it down to 3 and would soon be 100% on TrakCare.

Also Highland were working on the data sharing issue, including communications and data protection.  He stated the data protection ‘barrier’ was partly a myth: he would revert.      AN

KB insisted the solutions were not complicated: the NHS Portal offered a way of communicating, and a simple card held by the patient containing a CHI number and validated by a password (in emergency overridden by two doctors) could provide instant access to vital patient data.

AN referred to a national NHS, which should work on the basis of proper access, and cited the US Veterans system as offering guidance.  He favoured a web-based, patient-controlled system, and was keen to avoid the expensive failures experienced in England.

Stroke (JS)

JS repeated the two questions previously raised, regarding

a) public awareness of how to identify and react to a possible stroke, and

b) consistent failure to meet treatment targets.

He cited the 2009 awareness initiative led by Chest Heart & Stroke Scotland/BBC/NHSGGC and probably others, based on the F-A-S-T mnemonic, and urged periodic updates to refresh public memory.  Time is often crucial, both at the event and after the 999 call.

AN responded that the HEAT targets were under review, to establish whether they were still appropriate and/or to identify service improvements to achieve compliance.

LP would provide an update on work in hand.                                                                             LP

AN referred to possible ways of improving identification, citing opportunities appearing in other areas such as a ‘pacemaker’-type implant to control overeating or a device giving warning of an imminent epileptic seizure.


Chemotherapy in Stobhill (JS)

JS described the campaign as in limbo, because a) we had not found a way of contributing to the NHSGGC Clinical Services Review (as AN had suggested) and b) the CSR is reaching a critical stage, with an update to the Board in December and a public consultation early in 2014.

Agreed that neither AN nor SHCN could do much until more details appear on the models NHSGGC propose to adopt, but the consultation would provide an opportunity for input.     JS

AN emphasised that all proposals would be scrutinised by his Department.

JS added to previous circumstantial evidence indicating high potential demand in the North East of Glasgow for cancer services, with recent data showing that the NE provided the lion’s share of leading cancer admission rate hotspots.  These are indicators only, as they do not specifically refer to chemo, but they do highlight an apparent imbalance.


Homeopathic/Centre for Integrative Care (CIC) (CH)

CH thanked AN for his firm statement at the NHSGGC Annual Review on 18th November that the CIC would remain open.

She reported staff concerns over other boards’ withdrawal from homeopathy, which was only one part of the service provided – there is a need to make the public more aware of what else is done there, and proponents are very disappointed at the lack of media coverage.

CH had been unable to obtain relevant information, and AN would progress this once he had details.                                                                                                                          CH

AN understood the lack of adequate data on non-referrals, e.g. by Lothian, D&G who still want non-homeopathic services.

AN referred to the future of the CIC, and to the forthcoming consultation on a mooted Chronic Pain Centre.  CIC would be well suited to host such a unit, and one part of the consultation asks whether Scotland should have a single national unit or several.

CH agreed that many GPs appear unaware of CIC’s existence, and a patient may have to ask for a referral.

AN insisted that even if Lothian, Lanarkshire et al withdraw, CIC should remain, and that NHSGGC were sympathetic to its being retained.                                                   !

He is keen to prevent a “Post code lottery”, e.g. on access to new medicines: we need one policy for the whole of Scotland.


Integration of Health & Social Care etc (JMcA)

JMcA asked what standing the proposed Joint Boards would have, and in particular whether the Chief Officers would have statutory roles and responsibilities.

AN stated that we could not repeat previous failures to lay down adequate legislation defining these.

He insisted that if the new organisations were not set up as required by April 2014, including the Shadow Boards, they will not be given funding.

The Chief Officer will report to the Joint Board, and to the NHS and Local Authority Boards.

JMcA asked about commissioning powers – AN responded that yes the new Boards would have such powers, under funding ring-fenced to them without outside interference.

AN suggested she contact Cllr Johnson


Cross-Border Directive

JMcA raised the issue of England’s imposition of a 50% private cap, including GPs.  The fear is that English patients unable to get treatment there will come to Scotland.

AN replied that his powers on this are limited, but he would revert.                                 AN


Time was limited, and although our 30 minutes ran to 45 many topics might have been more fully explored.  However, we felt this first meeting with Alex Neil went well and ended with some actions to take forward and an atmosphere of respect on both sides.  No date was fixed for a future meeting, but with many issues being taken forward it will probably be reasonable to seek a further meeting around June 2014.