(Notes by JSS)

Present:

  • Dr Robert Cumming  (Stobhill, Chair)   (RC)
  • Nicola Sturgeon (NS)
  • Dr George Venters (Edinburgh, V-Chair)  (GV)
  • A,N.Other ?
  • Vivien Dance  (VoL)   (VD)
  • Liz Porterfield   (LP)
  • Julie McAnulty  (Lanarkshire HU)   (JMcA)
  • Rebecca   ?
  • James Sandeman  (HSFSE Glasgow)   (JS)
  • Dr Jean Turner  (Sc. Patients Assoc)   (JT)
  • John Winton  (LHC Fife)   (JW)

Apologies:

  • Dr Robert Milroy  (Stobhill MSA)
  • Ken Barr  (CATCHES, Cowal)
  • Dr Matthew Dunnigan  (Glasgow)  (MD)
  • Dr Patrick Trust  (VoL)

Preamble:

RC welcomed recent developments: Tobacco and Primary Care Bill (limiting candidature for GP practices) Patient Rights Bill Pilot Elections to Health Boards


Action Stobhill: transfer of acute services to Glasgow Royal Infirmary:Dr Robert Milroy was unable to attend, and in addition to points already submitted RC underlined the concern of clinicians in GRI as well as Stobhill, stressing the vacuum left by the absence of a Monitoring Group.  He indicated that a further attempt was being made to find common ground with management, and NS undertook to respond to further approaches thereafter.         RC/NS


Ambulance Services – Easdale: Ken Barr was unable to attend, having just been admitted to hospital.  In his absence NS agreed to provide written answers to the points he had raised.   NS


Healthcare Environment Inspectorate  (Visit toFife Health Board): JW reported on the lack of answers on inspections and follow-ups.  An Action Plan was to be in place by June, and he asked if inspectors would return.  NS stressed each hospital is to receive one announced and one unannounced inspection (the first was Aberdeen Royal Infirmary, well publicised) and inspectors would return “if HEI thought it appropriate.”        JW raised the lack of investigation of maintenance problems – should HEI be involved?

NS: HEI see relevant reports before visiting.  Under the Action Plan, Senior Charge Nurses would have some authority for immediate action.


Financing of scheduled developments (Fife): JW spoke to a late question on slippage of a Diagnostic Centre at the Queen Margaret and of elderly and mental facilities at Lynebank Dunfermline, reportedly due to a £2.8m drop in capital allowances.NS: Overall budgets are being cut, the main effect being on capital rather than revenue, but there is some room for local re-profiling of spend.


Elected Health Boards: JW referred to the pilot elections being run in Fife and Dumfries & Galloway.  The large number of candidates is likely to lead to difficulties a) in informing the electorate (one candidate’s statement is 50% blank) and b) in running the elections themselves.  NS welcomed the large number of candidates as reflecting public interest, and hoped that with a Single Transferable Vote these elections would go well.  She acknowledged that they are pilots, and lessons would of course be learned.


Vale of Leven emergency services:VD praised staff and cleaners on the work done on cleaning following the C-difficile outbreak.  She expressed concern over the lack of data on rates of emergency patients by-passing VoL, and asked for NS’ help in progressing Dr Trust’s work on an integrated working protocol.  NS reacted positively, and wished to see the protocol.       VD/PTNS spoke of the aspiration that 70 – 80% would go to VoL, with only the critically ill going direct to RAH Paisley, and the 70% rate reported so far is better than expected.NS emphasised that the scoring system used to direct patients is still being refined.  Patient safety must remain the guiding principle.


VoL Elderly Care/Stroke/Rehab:VD suggested that RAH’s investment in beds was undermining VoL’s rehab function.NS: the Board are responsive to patients’ wishes to remain local and have family access.   ?
Palliative Care (W. Dunbartonshire):VD referred to feedback that terminally-ill patients were being taken to RAH despite their end-of-life wishes. NS: Patients’ wishes against Intensive Care or CPR should be respected.  NHS Highland will respond. NS


VoL Mental Health/Christie Ward:VD stressed Christie Ward was running at maximum capacity, so its beds are clearly needed.  She requested a review.NS: the Monitoring Group framework has now been set, with a remit to “test the Board’s assumptions”.


VoL etc – Oncology/Outpatient reviews:It was confirmed that OP Chemotherapy  facilitees were functioning well as a decentralised service and would continue to be provided at the VoL.RC raised the validity of NHSGGC figures for patients from the Stobhill/Royal Infirmary area who might benefit  from a similar serviceNS: Board are checking this issue, including the possibility of re- instating chemotherapy  at Stobhill. NHSGGCChemotherapy: aim is to provide lung and breast cancer treatments locally, while the more complicated colorectal will remain centralised.


External Consultancy Services: GV stressed the need to save money, and IT and financial consultancies in particular are very expensive.  He asked how much was being spent in this way,NS has no figures, and collating them would take up valuable resources.  Sometimes it was necessary to go outside, although in the present financial climate this was to be avoided if possible.NS acknowledged the need for good management in the NHS, and referred to a capacity-building initiative which should lead to a reduction in outsourcing.      GV made the point that if you don’t know how much it cost you can’t know if it is worth it.


Confidentiality of Health Records: JS referred to the questions already tabled, adding that the introduction of TrakCare (just announced) raised questions over the future of G-PASS.NS stressed the unreliability/insecurity of paper records: she was keen to use IT, and to use it properly.  The E-Health programme included the possible replacement of G-PASS: GPs would be able run a dual system, but she would respond in writing to the points raised. NSJT emphasised the need for care in using IT – an error in an ECS (Emergency Care Summary) could have dangerous consequences.


Whistleblowing: JT stressed the need for a system which does not suppress information, and referred to anecdotal reports of staff who try to raise issues being re-located.NS agreed on the need to know when a service is not working properly.  Boards have whistleblowing policies, but these may be frustrated by a “blind-eye” culture.


NHS Continuing Health Care: JT referred to a lack of flexibility in handling of elderly patients, many of whom were not offered CHC or a hospice bed through lack of joined-up thinking or awareness on the part of clinicians.NS: “Pathway to Care” aims to address this issue.  An ECS could include the patient’s wishes on palliative care.  Useful initiatives include provision in NHS Tayside of a palliative care ambulance to facilitate outings, home visits etc.


NHS Lanarkshire – Monklands: JMcA warned that Monklands could lose another 48 beds, with fears that it is losing out to the PFI hospitals in Wishaw and Hairmyres.  GV drew a parallel with St John’s Livingston, which had lost services to the Western General for the same reason, although NS stressed that some services had returned to St John’s.NS: concentrating on outcomes and Waiting Times as indicators of efficiency, and there is no room for compromise.


NHS Lanarkshire – Mental Health: JMcA was grateful finally to have had a long reply from Colin Sloey, although it was not easy to follow- do people know what they are doing?  Patients are slipping through the net.  Caird House was reportedly “being closed”, then “being modernised” – what is the position?  Fears that 20 acute mental beds are being lost.  Mixed messages on substance misuse – plans “are funded by the Scottish Government”, yet beds are being cut.NS: Will respond to update on remaining questions. JMcA/NS


Nuffield Report: RC referred to Dr Matthew Dunnigan’s paper, which addresses findings on the relative efficiencies of the NHS in Scotland and England: Nuffield unjustifiably criticises Scotland.NS: Grateful to MD for his paper.  She described Nuffield as “a travesty”, it even included Dentists in Scottish figures but not in English, and made no allowance for distances.   ?GV reminded the meeting of Nuffield’s “consultancy” role.
A&E at Victoria, Kirkaldy:JW raised the lack of information to the public on the difference between A&E and Minor Injuries Unit.  The NHS Fife website provided no guidance, and even claimed the Victoria A&E was open 24 hours.NS agreed, again emphasising the goal of patient safety, including ambulance transfers.   ?LP highlighted a pilot scheme on NHS Grampian’s website (“No-one to turn to”), advising patients how to choose where to go.


RC wound up the meeting by thanking NS and her staff.  A further meeting will be arranged.