Highland Health Board

Highland NHS Board 3 February 2009 Item 5.3

A SUSTAINABLE FUTURE FOR THE VALE OF LEVEN HOSPITAL Response to formal consultation by NHS Greater Glasgow and Clyde

Report by Derek Leslie, General Manager, Argyll and Bute Community Health Partnership

The Board is asked to:

 Note the draft response, and APPROVE it for submission to NHS Greater Glasgow and Clyde.

1 Background and Summary

The Board received a paper in December 2008, describing the consultation in progress by NHS Greater Glasgow and Clyde. Briefly, this followed the development of a series of proposals aimed at creating a sustainable future for the Vale of Leven Hospital.

The Board was assured that the NHS Highland response would be developed through the participation of NHS Highland officers, leaders, and staff in the consultation process, and informed by comment from local patients, carers, members of the public and community groups.

2 Consulting on the vision for a sustainable future

The Vale of Leven Hospital serves communities in the West Dumbarton, Helensburgh and Lomond areas. Clinical leads and managers from the Argyll and Bute Community Health Partnership (CHP) were closely involved in helping to shape the proposals, especially those relating to GP run services. The consultation included a number of public meetings, and officers of NHS Highland were involved in those held within the Helensburgh and Lomond area. The draft NHS Highland response, which is attached as an appendix to this paper has therefore been informed by a wide range of comment from the clinical community within the CHP, and local people.

The consultation by NHS Greater Glasgow and Clyde closes on 30 January 2009. However, they have agreed to allow time for consideration of the draft response at the February NHS Highland Board meeting, to be submitted immediately thereafter.

3 Contribution to Board Objectives

The subject of this paper refers to services provided by a partner Board. The NHS Highland response reflects NHS Highland’s corporate objective to have safe, sustainable services for local communities served by the Vale of Leven Hospital.

Working with you to make Highland the healthy place to be 4 Governance Implications

This consultation refers to services provided by a neighbouring NHS Board.

5 Impact Assessment

This is a consultation by a neighbouring NHS Board, therefore impact assessment has not been conducted by NHS Highland.

Derek Leslie General Manager Argyll and Bute Community Health Partnership

23 January 2009

Chair’s Office NHS Highland Assynt House Beechwood Park Inverness, IV2 3BW Telephone: 01463 717123 Fax: 01463 235189 Textphone users can contact us via Typetalk: Tel 0800 959598 www.show.scot.nhs.uk/nhshighla nd/

Mr John Hamilton Date xx February 2009 Head of Board Administration Your Ref NHS Greater Glasgow and Clyde Our Ref GC/CC/SPW Dalian House 350 St Vincent Street Enquiries to Garry Coutts GLASGOW Extension: 4838 G3 8YZ Direct Line 01463 704838 Email [email protected]

Dear Mr Hamilton,

VISION FOR VALE OF LEVEN HOSPITAL - CONSULTATION

Introduction

Thank you for the opportunity to comment on this consultation by NHS Greater Glasgow and Clyde regarding the Vision for Vale of Leven Hospital. This response, on behalf of NHS Highland, reflects significant input from the Argyll and Bute Community Health Partnership (CHP), as well as feedback and comments from NHS Highland Board’s governance, management and joint NHS Board and council planning structures.

NHS Highland welcomes this strategic plan, detailing a suite of service proposals to provide a sustainable future for local services at the Vale of Leven DGH. This plan has helped remove uncertainty over its future, thereby reassuring the public and wider clinical community over the quality, viability, clinical safety and sustainability of services and the commitment of NHS GG&C to the hospital.

Board members have also considered the feedback and comment from stakeholders and the public in its area from its own networks and the extensive consultation process NHSGG&C has conducted and has formulated the following response to the specific proposals made:

Vision for Unscheduled and Planned care.

NHS Highland recognises that this has been the most contentious area within the work undertaken by Greater Glasgow and Clyde to develop a modernised service for the Vale of Leven DGH. NHS Highland would like to acknowledge the significant time and resource that Greater Glasgow and Clyde’s team has put into responding to the previous consultations, independent scrutiny boards and public concerns in developing and consulting on these new proposals for unscheduled and planned care.

Working with you to make Highland the healthy place to be

Headquarters: Assynt House, Beechwood Park, INVERNESS IV2 3HG

Chairman: Garry Coutts Chief Executive: Dr Roger Gibbins BA MBA PhD Highland NHS Board is the common name of Highland Health Board Proposal Impact New arrangements Removal of onsite anaesthetic services at the Vale of Leven Hospital to sustain 70% to informed by outcome of independent scrutiny reports, recommending 80% of 24hr existing 24/7 provision as unsustainable. unscheduled medical acute care Defined number of patients range 1100-1900 to bypass Vale of Leven currently delivered Hospital – work not yet complete to detail exact number – equivalent to at VOL 33% from Helensburgh & Lomond catchment area. 30 beds transferred to RAH

The new service requires the establishment of a GP led medical service model with routine daytime consultant support with 20-30% circa 1100 -1900 patients bypassing the unit. This is a significant level of additional activity for the SAS to transport. Comment

Service model operation – Unscheduled Care

NHS Highland agrees with NHSGG&C recommendation, informed by the conclusions of the independent reviews on anaesthetic services, that anaesthetics and the current model of emergency/unscheduled care cannot be maintained at the Vale of Leven Hospital.

NHS Highland has extensive experience of the GP led medical acute unscheduled care model proposed. Such a model provides intermediate medical acute care and supporting step down care from specialist centres. However the scale and profile of activity expected at the Vale of Leven Hospital is significantly higher then what is delivered in our Community hospitals and would require full time GP input. The model is also different from our RGH’s, which are consultant led.

This new model is dependant on critical mass of trained and experienced GP’s from both primary care, salaried and post graduate training programmes. NHS Highland believes that the commitment made by local GPs and secondary care consultants and management of NHS GG&C will engender confidence from the public and referring clinicians in the quality and safety of the service.

To ensure this, we understand that NHSGG&C will put in place the following, and would agree that all are essential:

 Consultant support and on-site presence 7-days-a-week, for 1 session per day.

 Ward rounds and discussion of all patients who would benefit from Consultant review.

 All admissions seen by consultant within 24 hours of admission.

 All patients requiring consultant review seen on request of lead Vale Clinician.

 Adequate GP medical staffing levels to provide safe care and meet peaks in demand. Current estimates of 3 Doctor on during the day, 2 in evenings in addition to current

2 OOH arrangements day time and overnight.

 Staffing rotas to ensure continuity of care for patients on a day to day basis.

 Adequate training provision with protected time and funding to ensure staff are up to date with knowledge and skills necessary for the role. This incorporates ALS in addition to regular group education and scenario based training. Training package to be overseen by NES.

 Medical staff who have undertaken additional training and are independent GPs with appropriate training. All employed staff who have either MRCGP / MRCP.

 Posts that are adequately funded with job descriptions and links to GP Practice that ensure that retention of staff is not compromised.

 ST1 provision for daytime and evening rota involving 6 ST1s in additional year of GP Training overseen by Professor Stuart Murray and the Department of Postgraduate Medical Education for General Practice.

 Retrieval service for any patients requiring transfer who would benefit from expert stabilisation prior to transfer.

 Appropriate time and resource are allocated to ensure leadership and Clinical Governance arrangements are firmly in place and reflecting the role of Clinical Director.

 Arrangements that will ensure the GP leadership of the service will be in partnership with Consultant Physician colleagues and reflect a new and innovative way of working to design the service to meet local needs.

 Marketing, review and audit of the new service once operational with findings shared with stakeholders Workforce Planning

NHS Highland welcomes the commitment by NHSGG&C to enhance local primary care capacity and believes the staffing model is best provided by drawing from community based GP principals. However, we would like clarity/confirmation that NHS GG&C has in place sufficient medical resource to staff the rotas required to ensure a sustainable service. Otherwise there is a risk that the proposed GP model will affect local primary care provision by simply transferring this resource to provide hospital doctors.

NHS Highland welcomes the instigation of the 5 GP training posts in intermediate medicine as it recognises this as a potential training stream for practitioners wishing to gain experience and skills to consider working in remote and rural health care. It could therefore provide one of the foundation stones for developing the obligatory networks as detailed in the Remote Rural Health Care report responding to “Better Health Better Care”. As a consequence NHS Highland would wish to continue to work closely with NHS GG&C in taking this forward.

SAS Resource

3 NHS Highland are anxious that appropriate deployment of additional SAS resource to ensure the safe and timely transfer of the 33% of the 1,100-1,900 patients who will bypass the Vale of Leven Hospital into Greater Glasgow & Clyde from its catchment area is not done to the detriment of 999 ambulance provision in Helensburgh & Lomond and the wider Argyll and Bute catchment area (notably Inveraray, Arrochar, Lochgoilhead, Garelochhead and Kilcreggan). We would therefore like confirmation and involvement in the deployment of the additional SAS resource for the 33% of the 1100 - 1900 patients who will now bypass the VOLDGH into Glasgow and Clyde from its catchment area.

Proposal Impact Planned Care

Continuation & expansion to the range of Enhancing local service provision for planned planned outpatient, day case & diagnostic procedures by 18,350 – new services such as services provided at VOL 18,000+ dental and expanded services e.g. Renal Dialysis appointments, operations & treatments which patients currently have to travel to Glasgow or Paisley hospitals for will, in future, be provided at VOL Comment

NHS Highland welcomes this significant enhancement to local service provision.

Proposal Impact Community maternity unit will be Unchanged sustained and promoted Comment

NHS Highland welcomes the retention of the birthing suite at Vale of Leven Hospital.

Proposal Impact Minor injuries unit which treats 9,000 Unchanged patients each year will continue

Proposal Impact Elderly Rehabilitation inpatient services Reduction in Bed number – 59 to 37 realigning will continue to be provided at VOL, bed provision to RAH and profile of patient need although the number of beds will reduce Medical cover provided from GP Medical establishment

Comment NHS Highland recognises the importance of rehabilitation services as part of patient recovery. The reduction in beds will require an increase in through put and so place an additional challenge on the local rehabilitation team e.g. Integrated care team, existing Physiotherapy and Occupational Therapy services.

4 We request confirmation that the realignment of resources to/from RAH has taken this into account, with appropriate enhancement of staff resource in Vale of Leven Hospital and community teams. We would also like confirmation that this is within existing financial resources with no impact on the SLA costs between the Boards.

5 Adult Mental Health

For adult mental health inpatient services, NHS Greater Glasgow and Clyde propose the following;

Proposal Impact Retention of elderly mental health acute Improved facilities and further integration with older admission beds at VOL peoples services Comment NHS Highland supports the location of all elderly beds on the Vale of Leven campus, but the model of mixing dementia assessment and functional elderly in one ward is inappropriate and should be reconsidered.

Proposal Impact Reduction in the number of acute Reduction in inpatient bed numbers takes account of inpatient beds for adults from 18 down to impact of enhanced crisis and community services 12 preventing admission

2 Options for service delivery Continue impatient provision at Vale of Leven Hospital or transfer the 12 Beds to Gartnaval Royal Hospital Comment NHS Highland previous response recognised the impact of community services on specialist inpatient bed numbers and considered the advantages and disadvantages of centralising services in Glasgow.

The additional work undertaken in defining and articulating the proposed service for Adult Mental Health has produced a much more informed debate by our community and professionals over the pros and cons of each option. There remains however, a consistent view that there is little support for transferring acute adult mental health inpatient care to Gartnaval.

NHS Highland recognises the issue of sustainability of a small 12 bed unit if isolated from specialist support. However, we believe that within the current profile of demand and care needs the retention of an adult mental health unit at the Vale of Leven Hospital should , on balance, be the preferred option.

It would also be preferable to employ trainee doctors rather than GPs as first on-call overnight. The trainees should have access to consultant cover and the resident GPs could attend to medical emergencies and physical ill health if needed. The on-call trainees need not be resident but should be able to attend within 20minutes, the time set down by the Royal College of Psychiatrists for deadline with emergency restraint.

Notwithstanding this NHS Highland would recommend that an ongoing audit and review of this service in 2 years time be undertaken to evidence the impact of the enhanced community and crisis service on inpatient activity.

We seek clarity over the location of mental health rehabilitation service for Helensburgh and Lomond patients to ensure continuity of patient pathway. Currently patients receive Rehabilitation in the Argyll and Bute Hospital (estimated 5 p.a.).NHS Highlands preference is for this to be delivered in NHS GG&C.

6 In addition to the comments above we would request that you take cognisance of and respond to the following observations and feedback we have collected from the public and professionals within NHS Highland

With particular reference to the proposals for mental health services, we are aware that ACUMEN has submitted a response separately highlighting a number of concerns including:

. Should Christie Ward close, can Gartnavel, Argyll and Bute Hospital in Lochgilphead or elsewhere accommodate additional demand? . Rehabilitation for Christie Ward patients is provided at Argyll and Bute Hospital. If they are up to capacity rehabilitation is not available . If Christie Ward is to be refurbished, service users/carers should be involved throughout the planning and redesign process . Importance of continuity of care with familiar surroundings and people is essential. Hospital staff require access to patients’ case notes to ensure appropriate care is provided . Support workers providing care/visiting patients in Christie Ward essential but will not be possible if the patient is located elsewhere

Transport

Transport and access for patients, relatives and visitors to the Vale of Leven Hospital, RAH Paisley and Gartnavel Hospital from the Helensburgh & Lomond area, has again consistently featured in feedback to NHS Highland. We particularly note the rural hinterland that Vale of Leven Hospital serves and the access challenges faced by communities such as those in Cove, Kilcreggan, Garelochhead, Lochside etc.

We therefore welcome the changes to the bus timetable and destinations that NHSGG&C have agreed with SPT to provide a direct transport link to the Royal Alexandra Hospital, Paisley from the area. Equally the proposed changes and developments re car parking at the RAH and disabled parking and access are welcomed and supported.

NHS Highland is also pleased to reaffirm its commitment in working with NHS GG&C within the local transport group for the area, developing, publicising and ongoing review of hospital and site travel plans.

Conclusion

Overall, NHS Highland would like to record that it welcomes this “Vision” from NHS GG&C which clarifies the future role of services at the Vale of Leven Hospital. NHS Highland agrees that the proposals to shape the long-term future of the Vale of Leven Hospital are compatible with National policy and innovative in maximising and ensuring sustainable local services. Further NHS Highland welcomes the “Vision of the Vale” guaranteeing a future for this valued local service and facility.

Whilst we have highlighted a number of points for consideration, confirmation and clarification, NHS Highland wishes to record that it supports the proposals for providing unscheduled medical acute care at the Vale of Leven Hospital. The support and commitment of local GPs in developing this model of care, cements the future of the hospital and provides reassurance to the public over the quality and safety of the service to be provided.

7 Retention of local mental health services at the Vale of Leven Hospital at this point is appropriate and NHS GG&C are asked to revisit its proposals and look to retain acute care on site. NHS Highland does recognise however, that the impact of enhanced community and crisis services may further reduce the number of acute inpatient beds required. However, for the 90,000 population they serve it is important that this is evidenced and so would suggest that the service be reviewed in 2 years.

The developments in Planned Care are welcomed and NHS Highland note that this could see Vale of Leven Hospital develop an Ambulatory Care and Diagnostic Centre type role.

Finally the action taken to address transport and access to car parking are welcomed and NHS Highland is pleased to reaffirm its commitment to work with NHSGG&C to continue to develop this.

I trust you find this response useful however if you wish to discuss this further or have any queries, please do not hesitate to contact me.

We look forward to the outcome of the consultation, taking forward an implementation plan in partnership with you.

Yours sincerely

GARRY COUTTS Chair

Mrs Elaine Mead, Chief Operating Officer, NHS Highland Mr Derek Leslie, General Manager, Argyll and Bute CHP Mr Bill Brackenridge, Chairman, Argyll and Bute CHP Mr Stephen Whiston, Head of Planning, Contracting and Performance, Argyll and Bute CHP Dr Michael Hall, Clinical Director, Argyll and Bute CHP Anne Helstrip, Locality Manager - Helensburgh/Lomond, Argyll and Bute CHP Dr Brian McLachlan, Clinical Lead, Helensburgh/Lomond Argyll and Bute CHP Argyll and Bute CHP Committee Argyll and Bute CHP Management Team Caroline Champion, Planning and Public Involvement Manager, Argyll and Bute CHP David Ritchie, Communications Manager, Argyll and Bute CHP Gill Keel, Head of Community Engagement, NHS Highland