Fetlar Community Council
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Fetlar Community Council MINUTES OF A REMOTE WEBEX MEETING HELD ON WEDNESDAY, 4TH NOVEMBER 2020 AT 7PM PRESENT IN ATTENDANCE Murray Cooper Kirsty Brightwell, NHS Shetland Mike Fogarty, Vice Chair Brian Chittick, NHS Shetland James Rendall, Chair June Porter, SIC Community Development Tom Thomason Jo Robinson, SIC Community Health & Social Care Marvin Smith, Shetland Telecom Bridgette Thomason, Clerk Edna Mary Watson, NHS Shetland 1. APOLOGIES Apologies had been received from Frances Browne, Michael Duncan, PC Angela Manson and Emma Perring. 2. MINUTE OF THE PREVIOUS MEETINGS Minutes of the previous Meeting held on the 15th September 2020 had been circulated and were taken as read and adopted. Proposed – Murray Cooper, seconded – Mike Fogarty. 3. DECLARATIONS OF INTEREST No declarations of interest were made. Agenda items 4.1 and 4.4 were discussed first on the Agenda. 4. ONGOING BUSINESS 4.1 Islands with Small Populations Healthcare Ms Edna Mary Watson, Chief Community Nurse, NHS Shetland had previously been contacted regarding nursing provision following the nurse resigning from her post. A circular had been sent to every household on the island asking for comments, views and feedback on nursing and recruitment, with responses collated and forwarded onto the NHS ahead of the Meeting. The responses were unanimous in that there should be a full time resident nurse with additional comments summarised below: Since March this year, the island has not been adequately supported by the NHS Residents have been let down by the NHS, especially on such a small, rural and fragile island Totally inadequate level of nursing cover at present, which amounts to only 10% nursing time - currently Fetlar is being provided with a visiting agency nurse service twice weekly from 9am to 5pm Fetlar is a non-doctor island with a predominantly ageing population, with varying health and care needs It is crucial to have a trained medical presence/nurse on the island, especially in the face of a global pandemic and given the escalating Covid-19 cases in the UK at present The resident nurse should be an Advance Nursed Practioner What would happen in the event of a cardiac arrest if there was no resident nurse? The lack of a resident nurse exposes the First Responders to potentially working beyond their competence with resultant demoralisation and stress for them, resulting in a significant negative impact on the health of a Fetlar resident if they should develop a serious medical illness or injury requiring immediate/emergency attention Has a decision already been made not to replace the nurse full time? It would therefore make this consultation pointless, if this has already been decided 4. ONGOING BUSINESS 4.1 Islands with Small Populations (cont) Healthcare (cont) It is unacceptable to not have resident nursing cover – recruitment for this is both essential and urgent The NHS should be actively recruiting and make this a priority appointment – if there are difficulties with recruitment, could a ’rolling system’ of nurses be considered, similar to the joy-hub model for GPs which has been successful in GP recruitment in Shetland The school has had a high level of involvement with many of the former post holders, with the nurse delivering many sessions on cardiac arrests, hand washing, nutrition, good hygiene and such like whilst also on hand to explain and train staff regarding individual pupil issues. This has also formed a valuable part of the school’s inter-agency working There is no one else medically trained and with full child protection training on the island in the event of an emergency at the school There should be a GP visit every fortnight as was previously done, notably with the lack of resident nursing cover at present There is accommodation available on the island for a resident nurse to stay The basic drug store at the clinic is not replenished adequately these days, with basic drugs such as Ibuprofen not available – is there a stocking policy in place? This is unsatisfactory, especially with access to getting medication limited with living remotely Alongside the comments from the wider community, Members unanimously agreed that it was essential to have a full time resident nurse on the island and welcomed the opportunity to discuss this further with NHS Shetland and the SIC. The NHS passed on their thanks to those who had put forward their thoughts on nursing and recruitment and for the very real and genuine concerns which had been expressed by the community. Currently, the nursing service has seen the resident Nurse Practioner from Skerries retiring in July, followed by the resignations of both the resident Nurses from Fair Isle and Fetlar, with all three post holders leaving their respective posts by the end of October. The resident nurse on Foula remains in post, with only one non-doctor island relief post holder also in post. The resignation of three post holders in quick succession, combined with the increasing challenges posed in providing a sustainable and safe nursing service on a 24/7 basis, has led the NHS to review their current nursing model. Initial discussions with Fetlar, Skerries and Fair Isle are being held in order to explore the potential for a change in the delivery model for nursing and create a more sustainable, affordable and clinically appropriate service model which meets the health and care needs of residents in both the short and longer term. The NHS discussed in detail the potential future service models and planned care as follows: Resident nurse – potential options for a different model of nursing cover Health promotion/improvement activities Supported self-care/use of NHS inform & other resources Use of local clinic facilities Visiting professionals Enhanced access to care by utilising technology (digital first) A range of data such as population health data, service activity levels for both scheduled and unscheduled care presentations will also help inform further discussions and progression in partnership between the relevant statutory and voluntary sector agencies and communities with an aim to deliver on the aspirations identified within the IWSP Locality Plan. A nursing model is to be developed which is compliant with the requirements of the Working Time Regulations and which will enable staff to maintain their skills and competence to practise in line with the Nursing and Midwifery Council (NMC) Code. 2 4. ONGOING BUSINESS 4.1 Islands with Small Populations (cont) Healthcare (cont) The Meeting discussed the following points, issues and challenges as summarised below: Historically, there has always been a resident nurse who has lived and worked in the community and it has therefore been difficult to come to terms with only having a visiting nursing service twice weekly It’s both unfair and unsustainable to expect post holders to provide 24/7 cover both during the week and at weekends over prolonged periods of time Essential that there is sufficient time off for post holders in between periods of nursing when models are scoped Whilst full time resident nursing rotational models would not provide the same continuity of care as Fetlar has had in the past, it would provide a team of nurses on a full time basis which would better serve the needs of the community than the present twice weekly nursing service There is a broad range of skills and competence required for working remotely The resident nurse will be lone working, with limited peer/direct support, especially working on a non-doctor island Fetlar has an ageing population with a wide variety of health and care needs Managing acute/emergency needs, eg, cardiac arrest or car accident – whilst there may not be many emergencies of this nature, when they do happen it is essential that safe and effective care can be provided Emergency care can be a concern for potential candidates if experience and skills are not maintained and kept up to date Continue working with the Scottish Ambulance Service to ensure that First Responders are trained appropriately and can continue to provide support to the nurse to help alleviate the dependency on one individual in an emergency situation Due consideration to grading of the post, the skills required are more specialist working remotely, eg, an Advanced Nurse Practioner (ANP) Detrimental impact of working remotely on continued professional development Recruitment at an ANP level provides an enhanced level of skills with due consideration needed on how knowledge, skills and experience is maintained and kept up to date – experience would be required in other environments to enable this, eg shifts undertaken at the Gilbert Bain Hospital to upskill and work as part of a wider team as was previously undertaken A varied skill set and experience gained working remotely and within a wider team could be attractive when recruiting Consideration of sickness and annual leave when scoping nursing models to ensure sufficient time off High revenue costs with agency staff having to be used, which further impacts on ongoing budget constraints and resources within the NHS Owing to the pandemic there have been no fortnightly visits by the GP from Yell and consultations are now being held either by phone or video, with patients having to travel to Yell if a face to face consultation is necessary Face to face GP appointments are preferable for a number of folk, who may not have the means or wherewithal to use technology for consultations Use of Attend Anywhere, telecare and other technology for consultations can be problematic owing to connectivity issues with broadband and mobile signals Consider ways in which the post can be made more attractive – promote both Fetlar and Shetland as a place to live and work The lack of a resident nurse and being a non-doctor island can have a negative impact in attracting folk to move and is an important factor when considering community development and regeneration 3 4.