West Lothian Public Partnership Forum for Health & Care
Chairman’s report for October 2016
Ian H Buchanan, Chairman, West Lothian Public Partnership Forum for Health & Care Member, West Lothian Integration Joint Board
M: 0771 672 1069
I sat in on the NHS Lothian Board meeting at Waverleygate on 22 June:
Councillor Harry Cartmill replaces Councillor Frank Toner as the WLC representative on the NHSL Board.
Susan Goldsmith (Director of Finance) replaces Dr. David Farquharson as an NHSL representative on the WL Integration Joint Board and Lynsay Williams replaces Julie McDowall on the WL IJB.
Martin Hill becomes Vice Chair of WL IJB.
Professor Alex McMahon is confirmed as the substantive NHSL Nurse Director.
The March meeting of the Healthcare Governance Committee was told by Dr Farquharson that GP Contracts would be changed with implementation of the new GMS contract in 2017. The GP would be part of a multi-disciplinary practice team working with other community services, and the GP would not necessarily be the first point of contact for patients.
The same subject was discussed at the April meeting of the Strategic Planning Committee which was told there were a number of GP practices across Lothian with restrictions to access to their lists. This is a symptom of the difficulty in recruiting new GPs. The new GMS contract will change the focus for GPs to become expert clinical generalists focussing on complex care in the community.
The March Strategic Planning Committee was told that a funding bid had been made for interpersonal therapy as a distress brief intervention which it was hoped would be rolled out in both Edinburgh and Addiewell Prisons.
At the same committee, Martin Hill commented on a meeting he had attended in respect of food poverty and food banks. It had been reported at that meeting that there had been an alarming increase in the number of young men reporting with mental health issues. He questioned in this respect whether NHS Lothian’s approach to partnership building and working was as robust as it could be.
During a discussion on IJB Directions Martin Hill questioned whether there is the same degree of discussion around the IJB table as had just occurred at the Strategic Planning Committee. He went on to say that this was not happening in West Lothian and he felt there was some way to go before that level of debate could happen.
It was interesting to see Edinburgh IJB minutes. Their Communications and Engagement Strategy was approved. A key point during discussion was that effective resourcing would be key to ensuring there was capacity to deliver the plan and they agreed to present an implementation plan to the Joint Board once resources had been identified.
During their consideration of the Finance paper, Members of the Board talked about the relationship between the IJBs and NHS Lothian. The Chief Executive gave an example of an IJB being over budget and issuing a Direction to NHSL to reduce bed numbers. He said the NHSL responsibility to provide safe care would trump the IJBs financial need. Rather than have this conflict, IJBs and NHSL need to work together.
I sat in on the School Bank West Lothian launch at the Almondbank Centre on 24 June.
Over the period I went to 3 sessions organised by Community Planning on the subject of Engagement:
- Planning Community Engagement @ Livingston Station Community Centre on 27 June.
- Effective Communication Skills at Howden Park Centre on 30 August.
- Tools and Methods for Community Engagement at Strathbrock on 6 September.
I attended the WL Integration Strategic Planning Group at Strathbrock on 30 June. The main item on the agenda was a presentation on Health Inequalities by Margaret Douglas. It was the same presentation she had given to the PPF Core Group meeting the previous day. I was pleased that the item took up over an hour of the Group’s time.
I sat in on the SJH Stakeholder Group on 27 July. Other than paediatrics, the main item on the agenda was the Development of Ward 20 and it’s Refurbishment.
An additional theatre with laminar flow is to be built within the footprint of Ward 20. This supports re-designed patient pathways for ophthalmology and hand elective and trauma patients through the development of an efficient satellite day surgery unit along with the supporting pre and post-operative care. It also supports the development of a dedicated ophthalmic pre-assessment clinic. Ward 20 currently has a 10 session theatre, mainly used by ophthalmology. This re-design will give an additional 10 theatre sessions.
Currently, because access to emergency theatre cannot be guaranteed, poor patient experience results in delayed treatment, fasting for a number of days and an unnecessary hospital admission.
Opthalmology sessions will increase from 5 to 8 per week. There will be 3 additional elective hand sessions and 3 additional and dedicated hand sessions. The remaining session will be used for Head and Neck recruitment. The additional sessions will support 16-18 opthalmology patients per week, 12 elective hand patients and 9 trauma hand patients.
Once the project starts there is a requirement to decant the existing theatre services from Ward 20. It is anticipated the construction programme will last 6 months. It is proposed that ophthalmology moves to Princess Alexandra Pavilion, minor paediatrics goes to the Sick Kids, vascular goes to RIE, hand, gynaecology and urology stay at SJH, all until work is finished.
I met with Bridget Paterson (new CEO of Voluntary Sector Gateway) on 28 July and with Steve Field (WLC) on 29 July.
I sat in on the NHS Lothian Board at Waverleygate on 3 August:
Jim Crombie stood in for Tim Davison (Chief Executive).
This was the last Board meeting for Alison Meiklejohn (Non-Exec) and for Allan Boyter (HR Director).
The May meeting of the Healthcare Governance Committee was told that funding had been withdrawn for the future referral to Private Healthcare services to treat NHS Lothian patients. This would affect waiting times, but work was in progress to increase capacity, particularly in orthopaedics, plastics and ENT, which were areas of the private sector most used currently.
Improvements in the response time for complaints were being made but caution was urged on expecting rapid improvement as there had been more sickness and resignations in the Complaints team. The committee were interested in what changes and improvements were taking place as a result of patient feedback.
The Board’s Corporate Risk Register contains an item categorised as Very High – General Practice Sustainability. It reads – There is a risk that the Board will be unable to meet its duty to provide access to primary medical services for its population due to increasing population combined with difficulties in recruiting and retaining general practitioners, staffing and premises difficulties.
The Director of Finance’s report contained the following section under the heading Involving People – The implementation of the financial plan and the delivery of a breakeven outturn will require service changes. As this particular paper does not relate to the planning and development of specific health services there was no requirement to involve the public in its preparation. Any future service changes that are made as a result of the issues raised in this paper will be required to adhere to the Board’s legal duty to encourage public involvement.
A question was asked by a non-exec as to whether NHS Lothian is geared up to engage given the urgency of making savings. Following the meeting I emailed the Director of Finance and received a reply as follows -“I can confirm that if there is any major service change we would definitely liaise with the Scottish Health Council. At this stage, managers across the Board are attempting to support the delivery of our financial targets through efficiency plans although you will have picked up from the Board that this is extremely challenging and we do not yet have sufficient savings identified to meet our financial target. Hence the discussion regarding service change. In response to your very specific concern, I can give you an assurance that the Board’s duty to engage is regarded equally with the need to achieve savings.”
Paediatrics had been a major subject at the June Board and an update was given at the August meeting.:
- A Paediatric Programme Board had been set up with one of the senior Non-Execs (George Walker) in the Chair.
- 8 Consultant posts are to be advertised, all of them with commitments to provide residential consultant cover at SJH as well as ton support the Sick Kids Medical Receiving unit. This group of posts includes the one vacant SJH post.
- Internal adverts were circulated in July inviting nursing staff at RHSC and SJH to consider the Advanced Paediatric Nurse Practitioner Master course. This course takes 16 months. It is expected that two places will be taken up this year.
- The Paediatric Programme Board has considered the RCPCH recommended interim option (option 2) and has concluded this option should not be recommended as an interim position because of concern about the potential clinical risk.
- Instead, the SJH clinical team have been working up an alternative interim Resident model rota which could be put in place from September 2016 until January/ February 2017 while recruitment to the new posts takes place. This would involve most of them committing on a time-limited basis to work in a resident model.
I attended the WL Strategic Planning Group at Strathbrock on 11 August.
There was a report on the Technology Enabled Care Programme. Much of the meeting was taken up with consideration of the draft WL Participation and Engagement Strategy:
I spoke at some length about this.
I started by thanking Steve Field for the work he has put in on this over the last few months. He has been patient, accommodating and mostly able to help.
He assures me this is a work in progress and it is on that basis, that assurance, that I am able to endorse this report.
I accept the proposal to establish a health and social care network. Two points on that. Firstly, there is a need to remember that significant numbers of people have no computer access. Secondly, some proper thought needs to be given to the launch of this next year, how best to encourage people and groups to sign up. They need to be persuaded at the start this is going to be something effective and worthwhile.
I welcome the proposed look at the role of the PPF. This is variously described in the report as an assessment, an appraisal and a review. That therefore gives enough scope for it to be a look at the issue that is wide enough for me to see this as an opportunity, not a threat. I particularly welcome the involvement of the Scottish Health Council in this work. Also I welcome the recognition that a patient group requires support.
I agree that arrangements for participation and engagement with the third sector need to be reviewed. It is a work in progress. Specifically, I am pleased to see mention of ALISS within this section of the Plan. Again however thought needs to be given to how this is promoted with the public.
Regarding localities, I absolutely support the point that our locality plans and WLC regeneration plans need to be interlinked.
Mention is made of a proposed Communications Protocol and that the NHS and WLC will prepare a programme of issues which require proactive communication and engagement. This is key to the success of any Engagement Plan (identifying what it is you want to engage about) and I look forward to the development of such a programme.
I am interested in the section on joint working with other Lothian IJBs. It would be good to have a report on any good practice identified and any joint projects proposed. Perhaps this could be put on the Workplan.
One issue not specifically covered is the future of the St John’s Patient Forum. It’s maybe a bit sensitive just now, and it’s maybe not an urgent matter, but I do think that, at some point in the future, how that group links in should be addressed.
Another issue not covered is accountability. The PPF put this forward as something to be addressed in our original submission to the Scottish Government on the integration proposals and we again raised the matter in our responses to the draft Integration Scheme and again to the draft Integration Plan.
Lastly, there is the issue of engagement with Community Councils. The Plan refers to the laudable aim of engaging with the WL association of Community Councils, which is WLC policy, but admits that the WLACC isn’t currently in existence. I know that there are no plans currently to refresh that association. This section of the Plan therefore, while strictly accurate, does nothing to promote or enable engagement with the county’s nearly 40 Community Councils. This being a work in progress, I would hope that some thought can be given to seeing what other practical steps can be taken to engage with these organisations.
I come to my one major concern about all this, which is to do with commitment to implement the Engagement Plan. The Introduction to the Plan says “The Strategy will ensure that the public and local interest groups have meaningful input to the way services are provided.” I agree BUT what is actually happening?
On Tuesday 2 August, Katrina Ross issued an email cancelling the scheduled quarterly meeting between NHS Management and Community Councils. The reason given “no agenda items have been received”.
Later the same day the papers for the next day’s NHS Lothian Board became available online. The Finance paper from Susan Goldsmith (NHSL Director of Finance) says that delivery of a breakeven position for the year will require service changes and she goes on to remind the Board that any future service changes will require to adhere to the Board’s legal duty regarding involvement.
The next day, Wednesday 3rd, when I sat in at the NHSL Board, I was told that the Courier would be running a story on Thursday regarding cuts in West Lothian. During discussion by Board members, concern is raised about whether NHSL is geared up to engage with the public about the cuts given the need to make cuts.
Next day (Thursday 4th) Courier runs story that there will be cuts to bed numbers at St John’s and cuts to mental health services.
Monday 8th was the day the meeting with Community Councils would have taken place.
The result is that, in the knowledge that cuts were coming, senior staff told members of community councils that they had no items they wished to discuss, nothing they wanted to engage about. This is plainly not right. It fosters distrust and rumours and is bad practice.
While I am happy to endorse Steve’s Engagement Strategy, I am not hopeful it is going to be a success.
Since then, my concerns seem to have some justification. The Strategic Planning Group agreed a 21-day consultation on the Strategy. Officers sent it out on 21 September with a deadline for responses of 30 September – a 9-day consultation period. Pressure had to be put on to get this changed to a deadline of 12 October. I accept it is not a contentious document but you would think the authorities would realise that a consultation on a Participation and Engagement Framework should be done in an exemplary fashion – a shining example of how it should be done.
Regarding Accountability, Steve Field tells me he has discussed this with James Miller (WLC) but has nothing to add on the subject to the wording in the last section of the strategy.
Since the SPG meeting of 11 August the draft has been amended to reflect the discussion at that meeting. In particular the sections relating to the PPF and to Community Councils are strengthened and corrected respectively.
Along with other members of the IJB I visited Colinsheil Court, Armadale on 23 August and Rosemount Gardens, Bathgate on 20 September.
I attended the meeting of the WL Integration Joint Board at Strathbrock on 23 August:
In the time I have been on the IJB we have considered Needs Assessments/ Commissioning Plans for 4 specific groups – Physical Disability, Learning Disability, Older People and Mental Health. This meeting was no different but it was part of the discussion which seems important to me.
The Board had under discussion the Adults with Mental Health Needs Assessment. This has been drawn up after involvement with users, carers, professional staff and voluntary sector representatives. It forms the basis on which a commissioning plan will be prepared. The plan is for the final commissioning plan to be approved by the IJB at its meeting on18 October.
Dr Elaine Duncan is a GP at Craigshill Health Centre and is the WL Clinical Director. She said that the Needs Assessment recommendations were important but that they would be difficult to implement. She asked Board members to familiarise themselves with the recommendations. She said that if they are to be implemented they need support from IJB Board members.
I view her comments as important so I outline below a shortened version of what those recommendations are:
- Joint Strategic Priorities. Should be needs led, not service led. Work with the voluntary sector needs strengthened. Support for Carers should be a priority.
- Current Configuration of Services. A comprehensive review is needed in regard to capacity, capability and flow. A review of management arrangements is needed. Also a review is needed of services for the “Distressed”. There is a need to consider the underlying model of engagement and to document an agreed model.
- Adult Psychology. An enhanced psychological therapies service should be developed where a broader range of specialist staff and organisations (including the third sector) deliver psychological therapies.
- Joint Working. Given the evidence of some poor examples of joint working (between agencies, disciplines and individuals) an urgent review is recommended of joint working across MH services and the development and agreement of a joint set of principles for joint working going forward. All relevant stakeholders should be represented and consulted in developing the joint set of principles.
- Service User and Carer Involvement. Given this study has noted variable (at best) engagement with, and empowerment of, service-users and carers, a Service User and Carer Involvement/ Strategy needs to be developed.
- Staffing. Significant attention needs to be paid to the challenges created by the issues of (1) recruitment, i.e. the difficulty in recruiting new staff; (2) retention, i.e.the challenge of retaining the best staff in the sector; (3) absence, i.e. the strain on staffing caused by extended staff absences (sickness etc); and (4) retirement, i.e. an ageing workforce is leading to higher numbers of staff approaching retirement age.
- Transitions. A review is needed of transition arrangements between CAMHS and Adult services.
During discussions regarding the IJB Budget, I asked Jim Forrest (IJB Director) if he would take the opportunity to update members of the Board regarding the recent report in the Courier that cuts in bed numbers at SJH and cuts to mental health services are under consideration. He responded that he would not comment on a press story!
There was a big report on Alcohol and Drugs Partnership Funding for 2016/17:
In 2015/16 Scottish Government provided £69.2 million from across health and justice portfolios to support the work of Alcohol and Drug Partnerships across Scotland. The figure for this year is only £53.8 million, a 23% cut. The Lothian share has reduced from £11.470 million to £8.887 million. The West Lothian share of that cut is roughly £400k.
Shona Robison MSP wrote to NHS Chief Executives in January, stating her expectations that existing services, resources and outcomes would be maintained at 2015/16 levels! The IJB decision is to do that for this year but it cannot be continued for the future, a review is being done and a revised commissioning plan will go for approval to the 29 November IJB.
I wasn’t able to attend the Health Improvement Health Inequalities Alliance meeting on 23 August as it clashed with the IJB. Highlights as follows:
- The WL Citizens Panel consists of approximately 3000 people and is currently being refreshed.
- There is a revision of the Quality of Life survey, hopefully to be distributed in October for online completion. There will be a further 1000 hard copies.
- There was a discussion on health equalities indicators.
- There was also a discussion about progress in relation to the Group’s draft Food Policy.
- There was a presentation from Voluntary Sector Gateway West Lothian about the role of the voluntary sector in relation to health improvement and the promotion of community led health.
I sat in on the SJH Stakeholder Group on 24 August:
- It was reported that Cllr. Frank Toner had stood down from the Stakeholder Group and would be replaced by Cllr. Dave King.
- Paediatric staffing. 8 Consultant posts for SJH and the Sick Kids had been advertised. In addition, 2 nurses had been selected to go on the Advanced Nurse Practitioner Course.
- The Group were told that there had been a temporary loss of paediatric out-patient capacity but management want to get this back working as soon as possible.
I went to the WL Third Sector Forum in Bathgate on 31 August. After an introduction from Bridget Paterson (VSGWL CEO), there were presentations by Elaine Cook (WLC Deputy Chief Executive) on engagement with the third sector, by Maureen Mcateer (Barnardo’s) on the National Third Sector GIRFEC project and by Raymond Branton (Family & Community Development West Lothian) on the terms of reference for the Third Sector Strategy Group.
I attended the Epilepsy Scotland AGM in Glasgow on 3 September. I am a former Chairman of the charity.
I sat in on the Homestart West Lothian AGM at Forestbank Community Centre on 7 September. Homestart is a family support charity. In the last year they supported 96 families (including 225 children) across West Lothian by way of a Befriending Volunteer offering support and friendship through weekly home-visiting.
There are also family support groups in Blackburn, Craigshill, Broxburn, Deans and Ladywell. There are currently 30 families on the waiting list. The organisation has 57 volunteers.
I attended the Xcite 1st Steps Project Steering Group in Bathgate on 13 September:
Referrals to their various programmes for May to August were:
- Cardiac – 17
- Exercise Referral – 505
- Keep Going – 27
- Pulmonary Rehab – 9
- Ward 17 – 7
- Get Going Xcite – 23
- West Calder – 5
- Physio – 167
From April 2017, the following facilities will transfer over to Xcite: Howden Park Centre, Linlithgow Lowport Centre, Polkemmet Golf Course and recreational facilities in 11 secondary schools.
I sat in on what may have been the shortest ever meeting of the St Johns Hospital Stakeholder Group on 21 September. Paediatrics was the only subject under discussion:
8 applications have been received for the 8 Consultant Paediatrician posts for SJH and Sick Kids.
The interim Resident rota has been in operation since the start of September with no issues. A new Clinical Fellow is expected to take up post at SJH shortly.
I attended the WLC Voluntary Organisations PDSP (on which I represent the Senior People’s Forum) at the Civic Centre on 22 September:
- There was a presentation on behalf of the Almond Valley Heritage Trust, during which we were reminded the Almond Valley is both a farm and a shale oil history museum, incorporating the BP Shale Collection.
- There was a report on gala committee allocations for 2016.
- There was an update on the work of the WL Social Enterprise Network and 2 reports on Voluntary Sector Gateway West Lothian.
The WLC Partnership & Resources PDSP, at its meeting on 23 September, considered the quarterly report on Welfare Reform:
- The Council’s actual and committed Discretionary Payment Fund spend for 2016/17 is £2.001 million on 3585 clients.
- Scottish Welfare Fund expenditure April to July was £403,000 on 1557 clients.
- Of the West Lothian total of 15,003 Housing Benefit cases, 75 have so far moved to Universal Credit.
- Of the 17,632 on the Council Tax Reduction Scheme, 136 have moved to Universal Credit.
- Of the 1039 people in West Lothian on Universal Credit, 340 are in employment.
- The timescale for full migration of claims to Universal Credit is now forecast to be complete by March 2022.
- There is uncertainty over how the process of leaving the EU could impact on Welfare Reform. A lot of spending reductions look less deliverable than they did 6 months ago. The Prime Minister has stated that she would not keep the target to reach public spending surplus by 2020. Certain limits on spending already announced, e.g. the household benefit cap, the two-child limit to tax credits and changes to Universal Credit will continue as planned.
- It looks as though 140 households in West Lothian may be affected by the new Household Benefit Cap of £20k which comes into effect on 7 November. Most will be households with a large number of children.
I sat in on the WL CAB AGM at the Almondbank Centre on 28 September:
In the past year the CAB dealt with 8,013 clients who had 15,158 issues. 574 clients were assisted at outreach venues. Client financial gain amounted to £1.9 million and £3.4 million of debt was rescheduled.
They work with Almond Housing, NHS Lothian, Addiewell Prison and deal with Armed Services advice, Domestic Abuse advice, money advice, pensions issues and fuel poverty, to name just a few.
Ian H Buchanan
Chairman, West Lothian Public Partnership Forum for Health & Care
Member, West Lothian Integration Joint Board
M: 0771 672 1069