Minutes of SMART User Group held on Friday, 3rd October 2014 at 2.00pm in the Margaret Scott Room, SMART Centre

In Attendance: David Gow, Head of SMART Action Les Malone, Modernisation Manager, SMART Keith Ferguson Mark Chapman Katrina Sweeney

1. Apologies: David Loughlin

2. Minutes of Previous Meeting – 22 nd August 2014

2.1 The minutes were approved as a true and accurate record of the meeting.

3. Matters Arising

3.1 It was noted that there was no matters arising which were not already on the agenda.

4. Presentation from Heads of Service

4.1 Prosthetics Service David Gow provided a presentation on the Prosthetics Service to the group. The following key points were noted: • There are 5 National Centres in for Prosthetics. • The SMART Centre provides Prosthetic Services to patients in Lothian, Fife and the Borders. • Approximately 23% of the patients attend the SMART Centre. • SMART has a number of services under one roof which provides greater integration across the services. • Prosthetics Service was previously based at the Princess Margaret Rose Hospital until the Hospital closed in 2002. The Service temporarily moved to the Eastern General Hospital following the closure. The Service then moved into the purpose built SMART Centre in February 2007. • The in-patient amputee ward was located 60 yards from the SMART Centre which improved access and more flexibility for the patients. • The SMART Centre has a suite of rooms which include walking bars for male and female patients, privacy rooms, plaster rooms and cast rectification room.

• The following statistics were noted:

o Approx 25% of Scottish population

o 26000 wheelchair users

o 1500 prosthetic users

1 o Centre based outpatient services 20000+ p/a o Domiciliary services o Mobile unit for driving assessment o Multi-disciplinary staff (80 plus) • Patients attending the SMART Centre for Prosthetic Services: o Patients attending 562 o Patients with 1 appointment 146 o Patients with 2 appointments 119 o Patients with 3 or more appointments 297 o Patients with 10 or more appointments 42 o Appointments for this group 539 o 42 patients (7%) used (22%) appointments o Ambulance patients (142) 25% o Average appointments/patient 4.4 • The National Centre for Prosthetics and Orthotics is based at Strathclyde University which is one of only two institutions in the UK offering undergraduate and postgraduate education in Prosthetics and Orthotics. • The process consists of: o a cast of the residual limb o a check socket is made from this o the cast is then rectified by adding or removing plaster o Workshop manufacture the socket in different ways depending on what is required i.e. lamination using resin which solidifies • The SMART Centre is one of two centres in Scotland who see Veteran patients for State of the Art Prosthetics since June 2013. • The Service also use new technologies such as Tracer Cad which is used for scanning limbs instead of taking a plaster cast.

KF asked if it would be possible to have a similar presentation provided to the ELLA Group. DG commented that he would be happy to attend a future meeting.

4.2 Orthotics Service Kirsty Sutters, Advanced Orthotist provided a presentation on the Orthotics Service to the group. The following key points were noted: • Definition of an Orthotist is a person who having completed an approved course of education and training, is authorised by an appropriate national authority to design, measure and fit an orthosis. • Orthosis is an externally applied device used to modify the structural or functional characteristics of the neuro-muscular and skeletal systems.

• All Orthotists are dual qualified in Prosthetics and Orthotics at the

National Centre for Training in Prosthetics and Orthotics, Strathclyde

University or Salford University.

• 4 year course, Honours degree in Prosthetics and Orthotics. • All Orthotists are registered with the Health and Care Professions Council. • The Orthotic team Consists of 8 Orthotists and 5 Technicians. • The Orthotists are supported in clinic by 5 technicians. They carry out manufacturing as well as waiting repairs and walk in repairs on a daily basis. • The Orthotics Service moved into the SMART Centre in July 2011. • All Orthotists are based at the SMART Centre but travel to various satellite clinics.

2 • The Orthotists provide clinics for Outpatients at the SMART Centre, Roodlands Hospital and the Royal Infirmary of as well as covering the wards at Royal Infirmary of Edinburgh, Royal Hospital for Sick Children, and the . • Examples of some of the items provided include: o Footwear o Insoles o Ankle Braces o Knee Braces o Spinal Braces • The Service also uses new technologies which include a system called Paromed to scan patient’s feet. This is a much quicker process and the scans are emailed directly to the manufacturer so the order is received the same day as the patient is seen. • The Service is also currently being trained on a new system for scanning limbs called Rodin which produces a 3D scan. Orthotists can then model the scan online to produce an appropriate device for the patient. • The Service received an award in October 2012 at the NHS Lothian Celebrating Success Awards in the category ‘LEAN in Lothian’.

The group thanked KS for attending the meeting and providing a presentation on the Orthotics Service.

4.3 Technical Services Donald Stewart, Head of Technical Services provided a presentation on Technical Services in SMART to the group. The following key points were noted: • DS joined Lothian Health Board in October 1985. • DS became SMART Lead Technician in September 2009.

• DS became SMART Head of Technical Services in July 2012.

• SMART brought together the workshops and stores under one Head of

Technical Services in 2009. • The Orthotics Service was added in July 2011 when the moved into the SMART Centre. • The Wheelchair Repair Service was brought in-House in October 2014. • The sharing of skills and the workshops have benefitted the patients journey across the services. • The Workshops are located in West side of the SMART building. • The Wheelchair Repair Service is based at the Community Equipment Service Store at Peffermill Industrial Estate, Craigmillar. • There is also a small workshop in OPD6 at the Royal Infirmary of Edinburgh and satellite stores throughout the Lothian's. • Technical Services if made up of the following staff groups: o Rehabilitation Technical Staff o Mechanical Engineers (5) and Electronic multi skilled Engineer (1) o Prosthetics (7) / Orthotics (5) Technical Staff o Mechanical / Artisan Craft Technicians o Wheelchair Repair Staff o Mechanical Technicians (Mobile – 8 {inc Vans}, Workshop Based – 3 and stores staff - 2) o SMART Stores o Multi skilled stores staff with responsibility for own areas (3)

3 • Technical Services is responsible for ordering, manufacturing and repairing bespoke devices provided to patients. This includes the delivery of stock devices.

The group thanked DS for attending the meeting and providing a presentation on Technical Services.

4.4 Admin Services Gail Wishart, SMART Centre Manager provided a presentation on the Admin Service in SMART to the group. The following key points were noted: • Patients access all Services in SMART via Admin • Admin responsibilities include the Reception Area in SMART where we meet and greet patients who are attending appointments. Admin staff are the first point of contact and look after the patient when they are in the reception area. • There is a dedicated repair line for wheelchairs were staff rotate. • Both electronic and paper referrals are processed. • Appointments and arranged and letters typed and sent to patients. • Some services hand out follow up appointments to patients before they leave the building.

• The service carried out a telephone audit over a year ago and found that

approximately 1,200 calls were taken per week by the Admin out of

approximately 15,000 out-patient appointments which take place in

SMART.

• The volume of telephone calls has increased since other services have

moved into SMART i.e. Podiatry, Blue Badges, Neuro Rehabilitation

Clinics etc. • The Admin Team are responsible for ordering other equipment in addition to Stores i.e. wheelchairs on behalf of clinicians. • The Service is currently looking at other communication systems: o new telephone system to improve access to a member of the Admin Team. o Text Messaging o E-mail – ensuring compliance with Data Protection requirements • The Service also co-ordinates appointments where patients use more than one service so that patients can attend on the same day for multiple appointments if necessary.

KS commented that there have been a number of occasions when it has been difficult to get through to the Admin Team. Either the telephone was engaged or a message to say pleases call back later. KS asked why the Service did not use an answer machine. GW explained that this had been trialled in the past, however it was found that messages which were left on an answer machine did not include the necessary information to be able to identify the caller or to call them back. There were a number of instances where this had happened and it was decided not to use an answer machine. GW commented that this only appears to be an issue in the wheelchair service and that other services in SMART use an answer machine and don’t have this problem.

GW explained that a general e-mail address would be setup within the next 2-3 weeks which would enable service users to contact the service via e- mail.

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KF commented that concerns had been expressed within the ELLA Group about how appointments were issued. KF explained that patients would leave a message on an answer machine about making an appointment and that instead of being contacted to discuss this they would be sent a letter in the post with an appointment which may not be suitable. KF added that it would be more courteous for calls to be returned and acknowledged. GW commented that she had spoken to staff about this and that all messages left by patients should be returned. GW agreed to remind staff. KF commented GW that he would ask members of ELLA in 6 months time if this had been resolved. KF

The group thanked GW for attending the meeting and providing a presentation on the Admin Service in SMART.

4.5 Mobility and other Assistive Technology Services DG provided a presentation on Mobility and other Assistive Technology Services in SMART to the group. The following key points were noted: • The following services were currently provided at the SMART Centre: o Mobility and Special Seating o Upper and Lower Limb Prosthetics o Orthotics o National Driving Assessment Service o Blue Badges o Disabled Living Centre o Assistive Technology Services • The Wheelchair and Special Seating Service was part of a National Review and Modernisation Programme over 4 years ago. £16million had been allocated to modernise the services across the country. • The Wheelchair Service issues more than 5,000 wheelchairs across Lothian, Fife and the Borders. • Approximately 50% of wheelchairs which were issued were refurbished with the other 50% being purchased from new. • The Service has approximately 26,000 wheelchairs on issue • A wheelchair contractor has provided refurbishment, repairs, uplift and delivery services. The service will transfer in-house on 1 st October 2014. • The Service has a satellite clinic at Lynebank in Fife. • The Service provides a variety of wheelchairs, buggies and special seating for wheelchairs. • The Service also provides powered wheelchairs to patients who meet the eligibility criteria. • During the modernisation programme the service had setup a user network of approximately 250 wheelchair users. • There is a Disabled Living Centre in SMART which provides independent advice to patients or members of the public who are thinking about purchasing mobility products i.e. stair lifts, scooters, reclining chairs etc. • The SMART Centre has a National Driving Assessment Service which carries out assessments on whether patients are fit to drive e.g. patients who have had a stroke or had their license revoked due to other medical conditions. • Other Assistive Technology Services provided at SMART include: o Electronic Assistive Technologies/Environmental Controls

5 o Special Needs design o Gait Analysis

The group thanked DG for providing a presentation on Mobiility and other Assistive Technology Services in SMART.

5. SMART User Group/Sub-Groups – Draft Terms of Reference and Membership

5.1 A copy of the draft Terms of Reference and Membership for the SMART User Group/Sub-Groups had been tabled. It was agreed that LM would circulate a copy of this to members of the group with the draft minutes for any further comments. LM

6. Re-Provision of Astley Ainslie Hospital

6.1 DDG presented a map of the site and indicated on the map where it was proposed to relocate the Astley Ainslie Hospital. DG explained that a Working Group would be setup discuss and agree the Clinical Brief for SMART Services. Representation was being sought from Service Users and it would be useful if someone from the SMART User Group could attend. DG commented that provisional meetings of the Working Group had been arranged for 30 th October 2014 and 27 th November 2014. There would also be another meeting arranged for January 2015. It was noted that this piece of work was to be concluded by February 2015.

6.2 KF commented that he would be happy to volunteer and suggested that there should be two user representatives. KS and MC indicated that they would be interested, however they would need to check their other commitments. It was agreed that DG would forward on the contact details for KF, KS and MC to the organisers. DG

7. Any Other Competent Business

7.1 There was none.

8. Date and Time of Next Meeting

8.1 It was agreed that the group would meet again in 6 weeks time. The next meeting will take place on Friday, 14 th November 2014 at 1.30pm in the Margaret Scott Room .

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