CLYDE HEALTH AND SERVICES STRATEGIES
PROPOSED CHANGES AT THE VALE OF LEVENHOSPITAL
Report by Director of Planning & Performance
The Board is asked to:- Note the content of the submission to the Independent Scrutiny Panel developed through the work of the Helensburgh & Lomond Planning Group.
- Note the timescale for the completion of the Independent Scrutiny Panel’s work and the likely next steps.
1BACKGROUND AND SUMMARY
At its meeting on 4 September the Board received a report describing the outcome of reviews and proposal resulting from the Clyde Health and Service Strategies and recommended for consultation by NHS Greater Glasgow & Clyde. It was subsequently announced that these were to be the subject of independent scrutiny by a panel established by the Cabinet Secretary for Health & Wellbeing under the Chairmanship of ProfessorAngusMackay. NHS Highland agreed to contribute, as required, to the work of the Independent Scrutiny Panel and await the outcome and impact of the Panel’s scrutiny on the proposals which are still to be the subject of a formal consultation process.
2HELENSBURGH & LOMOND PLANNING GROUP
The Board’s engagement with the Independent Scrutiny Panel has been progressed through the Helensburgh & Lomond Planning Group, chaired by Bill Brackenridge, and whose role, remit and membership has been described in the submission to the Panel which is attached.
A summary of the submission and the key issues arising there from was subsequently presented by the Director of Planning & Performance to Professor Mackay at a meeting convened by the leader of the West Dunbartonshire Council on Monday, 19 November 2007 as a part of the Independent Scrutiny Panel’s process of direct engagement with key stakeholders.
3NEXT STAGE
The Independent Scrutiny Panel is expected to publish its report, in accordance with its terms of reference described in the report made to the Board on 4 September, by the end of November2007. This report will be considered by the Cabinet Secretary for Health & Wellbeing. The report, together with any direction from the Cabinet Secretary, is likely thereafter to be remitted to NHS Greater Glasgow & Clyde for their consideration in advance of them determining the proposals that will then be the subject of a formal consultation exercise with key stakeholders including NHS Highland.
An update will be provided to the Board on 4 December should the outcome of the Panel’s report and the Cabinet Secretary’s consideration of it be available.
4CONTRIBUTION TO BOARD OBJECTIVES
The submission to the Independent Scrutiny Panel contributes to the Board’s priorities on access and service modernisation and redesign, as well as ensuring a high quality, clinically and cost effective, outcome focused approach.
5GOVERNANCE IMPLICATIONS
The submission to the Independent Scrutiny Panel has been prepared by the Helensburgh and Lomond Locality Planning Group. The outcome of the Independent Scrutiny Panel will impact on all governance standards.
6IMPACT ASSESSMENT – EQUALITY AND DIVERSITY
A full equality and diversity impact assessment has not been performed on the submission; however, the outcomes and resulting proposals from NHS Greater Glasgow & Clyde will require impact assessment.
Derek S Leslie
Director of Planning & Performance
23 November 2007
APPENDIX 1
NHS HIGHLAND – ARGYLL & BUTE COMMUNITY HEALTH PARTNERSHIP (CHP)
HELENSBURGH & LOMOND LOCALITY PLANNING GROUP
INTRODUCTION:
When the Minister announced that NHS Argyll & Clyde would be dissolved on 31 March 2006 and the NHS Highland’s boundary would change to include the area of Argyll & Bute Council (Helensburgh & Lomond) he proposed that successor Boards commit to establish a Locality Planning Group for the Helensburgh & Lomond area to give residents a structured opportunity to make an input to the planning of hospital and specialist acute services in Greater Glasgow & Clyde.
This reflected that the population of Helensburgh and Lomond have traditionally accessed services within Greater Glasgow, Paisley and Greenock. There were significant local and political concerns that the patterns of those historic patient flows would change as a result of NHS Board boundary changes in a way which would create issues for the population or that desirable changes to Greater Glasgow & Clyde services are less likely to be achieved for patients in a CHP outside the new Greater Glasgow & Clyde boundary.
These arrangements describe the framework for a Locality Planning Group covering the population of Helensburgh and Lomond.
ROLE & REMIT:
The Group will be led by the Argyll & Bute CHP and will bring together senior staff from Greater Glasgow & Clyde and Highland NHS Boards to monitor acute services provided to the area and examine and agree any proposed changes. The Group will focus specifically on services provided by NHS Greater Glasgow & Clyde to residents in Helensburgh and Lomond.
COMPOSITION:
The Group will be chaired by a non-Executive Board Member with specific links to the Argyll & Bute Community Health Partnership and the Helensburgh & Lomond locality.
Greater Glasgow will be represented by the Acute Division Chief Operating Officer and Director of ASR (Acute Services Review) Implementation & Planning.
As well as senior representation both clinical and managerial from the Argyll & Bute CHP, Highland NHS Board will be represented by its Director of Planning & Performance and Director of Community Care.
The Public Partnership Forum (PPF) will propose two local representatives to the CHP for inclusion in this Group.
Argyll & Bute will have 3 places for local Councillors to reflect the future 3 multi-member wards. The role of Councillors in this forum in respect to the Argyll & Bute Council remains to be clarified.
The local MSP
Representation from professional and other advisory structures will be sought when appropriate.
Representation from Lomond Patients Group.
ORGANISATION:
The Group will meet formally four times a year.
Hold public meetings perhaps at the beginning and end of the year.
The Group will produce an annual report and forward plan to be submitted to the Minister for Health. The plan will set out any proposals to change the specialist services delivered to the local population for comment and debate.
CONSULTATION:
The proposal was the subject of consultation with interested parties. The composition, remit noted above reflect the outcome of the consultation.
MEMBERSHIP:
NAME / DESIGNATIONBill Brackenridge / Chairman, Argyll & Bute CHP
Derek Leslie / Director of Planning & Performance, NHS Highland
Fiona Ritchie / General Manager, Argyll & Bute CHP
Mike Hall / Clinical Director, Argyll & Bute CHP
Anne Helstrip / Locality Manager, Helensburgh & Lomond
Stephen Whiston / Head of Planning, Contracting & Performance, Argyll & Bute CHP
Al Reay / Councillor, Argyll & Bute Council
George Freeman / Councillor, Argyll & Bute Council
Vivien Dance / Councillor, Argyll & Bute Council
Robert Calderwood / Chief Operating Officer, Acute Services Division, Greater Glasgow and Clyde NHS Board
Helen Byrne / Director of Acute Services Strategy Implementation and Planning
Greater Glasgow and Clyde NHS Board
David Bruce / Helensburgh & Lomond Patients Group
Jim Proctor / Public Partnership Forum Representative
Mairi Harvey / Public Partnership Forum Representative
Jackie Baillie / MSP
APPENDIX 2
HELENSBURGH & LOMOND PLANNING GROUP
CLYDE HEALTH AND SERVICE STRATEGIES
SUBMISSION TO INDEPENDENT SCRUTINY PANEL
Report by the Director of Planning and Performance, NHS Highland
The Minister established the Helensburgh & Lomond Planning Group when NHSArgyll & Clyde was dissolved on 31 March 2006. It reflected the decision to preserve the integrity of co-terminosity between the Argyll & Bute Council’s area and NHS Highland as a primary factor in determining the population split but with acknowledgement of the communities close relationship with Greater Glasgow & Clyde with regard to the provision of services to that community. Its establishment was to give Helensburgh & Lomond residents a structured opportunity to contribute to the planning of hospital and specialist acute services provided by and in Greater Glasgow & Clyde. A description of the role, remit and membership is attached.
The Group has met on five occasions and most recently has, amongst other matters, focussed on the review and proposals for consultation resulting from the Clyde Health and Service Strategies published by NHS Greater Glasgow & Clyde on Tuesday, 26 June 2007.
The Group has noted the establishment and remit of the Independent Scrutiny Panel (ISP) chaired by Professor Angus Mackay and is seeking to engage directly with the Panel and contribute to its deliberations.
Although the nature and mix of membership of the Helensburgh & Lomond Planning Group inevitably results in there being a variety of views expressed during discussions about the Clyde Health and Service Strategies, there are a number of important matters on which the Planning Group is in agreement. For example, the Group is committed to achieve the very best, safe, sustainable patient care and services for the population. There is consensus in the desire and ambition that the Vale of Leven Hospital should provide the highest quality, safe and sustainable services.
This paper sets out the main issues that have arisen during the consideration of the proposals from NHSGGC which have exercised members in the expectation that they will inform the work of the Scrutiny Panel within the Terms of reference set by the Cabinet Secretary.
NHS Greater Glasgow & Clyde are core members of the Group and have wholeheartedly participated in discussions, the drafting and refinement of this submission. It is acknowledged, however, that there are areas of disagreement where consensus cannot be achieved particularly since NHS Greater Glasgow & Clyde take the view that the evidence and the case presented in the material already provided to the Independent Scrutiny Panel in support of the proposals is clear, substantiated and compelling. This applies particularly to issues numbered 1, 2, 5, 6 and 10.
1
NHS Greater Glasgow & Clyde wish to put in context and for clarity that they assumed responsibility for Clyde services in April 2006 when the implementation of the Integrated Care Pilot had already commenced. The Integrated Care Pilot was a response to the position concluded in August 2005 at the NHS Argyll & Clyde Health Board, the Clinical Director at the Vale of Leven having written to the Minister for Health in June 2004 to highlight that anaesthetics at the Vale could be sustained for only a limited period for a variety of clinical and professional reasons. It was during consideration of the implementation of the next stage of the Pilot in the period June to August 2006 i.e. the withdrawal of the anaesthetists from the Vale of Leven site when it became clear there was not clinical support (this includes physicians and anaesthetists from both the Vale of Leven Hospital and the RAH) for the withdrawal therefore the Pilot could not be progressed and the model could not be implemented.
Furthermore it is the physicians who have the responsibility for the patients admitted to the unscheduled care beds at the Vale of Leven Hospital. It is not a community hospital with GP beds.
The range of issues are as follows:
1Anaesthetic cover. The issue of anaesthetic cover is fundamental to the preservation or otherwise of the integrated care pilot and it is felt strongly that all options for sustaining anaesthetics must have been reviewed thoroughly including the number and nature of anaesthetic interventions, the ethicasy of the bypass protocol and any influence/impact of the Board-wide rotas and retrieval services.
2The drivers behind the decision not to proceed to implementation of the pilot must be understood. The declared clinical view on the part of secondary care clinicians of an unwillingness to support a model that they consider unsafe in the face of what is understood to be a contrary opinion on the part of local General Practitioners should be weighed up by the ISP.
3Sustaining skills. Confirmation or otherwise of the view that current activity in terms of critical mass and workload is insufficient to sustain the skills required by the anaesthetists. There should also be consideration of the issue about the ability to maintain training accreditation and the potential impact therefore of the withdrawal of junior posts.
4The wide impact. There is a need for further rapid consideration of the wider vision for the Vale of Leven in terms of the longer term viability and sustainability should the transfer of medical admissions proceed and more specifically the impact on services for the Helensburgh & Lomond population.
5Patient impact. The sickest patients already bypass the Vale of Leven Hospital. It is believed that a risk analysis should be undertaken of the clinical impact of discontinuing the integrated care pilot, the transfer of medical admissions, as well as including the travel and cost impact on patients and relatives, the clinical risk of increased patient transfers and the general economic impact of the consequences on the community.
6Remote & Rural Context. Whilst acknowledging the classification of remote and rural hospitals was the output of national work and will not be re-visited, the ISP are asked to weigh up whether any of the principles underwriting the classification might be relevant to the considerations of the future configuration of services at the Vale of Leven Hospital, despite its proximity to acute/specialist hospitals and if that might allow more flexibility in the services that could be provided/delivered. This would reflect the nature of the communities and population served rather than the hospital’s urban setting.
In this context some members of the Group have commented on the lack of regional planning apparent in the unilateral announcements by NHS Greater Glasgow & Clyde about that Board's intention to further downgrade services at the Vale of Leven Hospital.
In particular, the status of the Helensburgh and Lomond Health Needs Assessment exercise and the Vale of Leven Community Engagement Group has been discussed. Some members of the Group are of the opinion that regional planning and the historical and current significance of the unique deficit accrued by Argyll Clyde Health Board have not featured sufficiently in NHS Greater Glasgow & Clyde’s deliberations around the future of the Vale of Leven Hospital and its innovative Integrated Care Pilot.
7Alternative options. Whilst members of the Group have been briefed with regard to the Panel’s engagement with NHS Greater Glasgow & Clyde to date, it is expected that the Independent Panel will have been reassured that NHS Greater Glasgow & Clyde have examined and costed all possible options as part of their scrutiny including the sustaining of the current model and the potential of exploring and North/West Glasgow solution involving Gartnaval and the Golden Jubilee Hospitals.
8Midwifery Led Services. It is noted that proposals are in keeping with National Policy, provide local access to ante and post natal care whilst maximising the use of resources and delivering financial savings.
9Mental Health. There is a need to confirm the adequacy of local capacity and community mental health teams to underwrite the implementation of the proposed mental health strategy.
10Scottish Ambulance Service. It is requested that the Independent Scrutiny Panel assess the impact of changes on the Scottish Ambulance Service and its capacity and preparedness to respond to the proposed changes including the impact on travelling times in general of patients having to travel to an alternative hospital within the NHS Greater Glasgow & Clyde area.
In addition to the above points, we would ask the Panel to note the following:
11The proportion of activity undertaken at the Vale of Leven Hospital attributed to Helensburgh & Lomond residents was examined and analysed by the Planning Group establishing the extent of impact on the population of Helensburgh & Lomond and beyond should the services at the Vale of Leven be changed.
12The Chair’s correspondence with the Cabinet Secretary for Health & Wellbeing to advise her of the status of the Group, to express an expectation of the Group’s involvement with the Independent Scrutiny Panel and the reply from the Scottish Government.
13The Chair’s correspondence with Professor Mackay, Chairman of the Independent Scrutiny Panel, Clyde and his subsequent letter and reply.
14The statement from lay members of the Community Engagement Group stating that their views had not been properly canvassed nor had they had any influence on the proposals to discontinue the integrated care project, the proposals to withdraw the anaesthetic cover and the consequent impact on services at the Vale of Leven Hospital.
15The content of the paper prepared by the Lomond Patients Group, and endorsed by a majority of the Planning Group - The Vale of LevenHospital, A Different Cure.
Derek S Leslie
Director of Planning & Performance
7 November 2007
NHS Highland / Argyll & Bute CHPHelensburgh Victoria Infirmary
93 East King Street
Helensburgh
G84 7BU /
Nicola Sturgeon
Cabinet Secretary for Health & Wellbeing
The Scottish Parliament
Edinburgh
EH99 1SP / Date20th August 2007
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