Public Consultation Gathers Pace on Future Health & Care Services

NHS Tayside and Perth & Kinross Council, together with various partner bodies, are rolling out a programme of community engagement in Highland Perthshire which started last October in Pitlochry. Its purpose is to map and discuss the locally existing health and social care services and to collaborate with residents to shape services adapted to a rapidly changing future.
NHS flannelpanel2WebAs reported in Vol 33 nos 9 & 12, students from Duncan of Jordanstone School of Art & Design assisted the process of exploring how more varied and personalised care and support options could be developed for people living in and around Pitlochry.
Public sessions have been held there to support people share and advance ideas/proposals and, to help enterprises get off the ground, there is a £10,000 challenge fund to help test out new ideas.
The latest afternoon and evening community workshops were held in the Atholl Centre on 8 April where the focus was on developing business plans for new ventures and initiatives and how to implement these.
The progress of the Pitlochry developments can be followed on blogs.iriss.org.uk/pitlochry or through contact with Fiona Johnstone, Community Engagement Worker (PKAVS) on 01738 567076 or Joyce McQuilken, Growbiz on 01250 870170

Radical Realignment?
NHSmeet1WebIn Aberfeldy the start of the process was less auspicious. The poorly managed pre-publicity for the first town hall meeting was robustly and widely criticised at the gathering on 26 March. This had amounted to a thin smatter of posters and press announcements just the immediate day-before it was held.
Despite this, and with last minute word-of-mouth mustering, 90 attended amongst whom scepticism and suspicions of hidden agenda persisted in the face of denials by the meeting’s convenor (see letters on page 24).
However, for all its shortcomings this did launch the public engagement process, the extent of which requires to be progressively more inclusive.
But this event did lead to a repeat meeting on 5 April attracting 43 attendees and follow-up contacts with the local community are planned during the summer. Open to all, the NHS & P&K assure that the timing and details of these, when finalised, will be properly publicised in good time.
The first town hall meeting was ostensibly to gather community views on the needs and desires for care of the elderly in the area, assisted by officials providing significant and relevant facts. It became clear that closing down Aberfeldy hospital and possibly transferring services to an altered Dalweem Care Home would likely be seminal rationalisation steps. This raised fears that the public is being consulted too late to have an impact on any final decision.

Urgent Need for Reorganisation
At both the gatherings in Aberfeldy John Gilruth, Head of Community Care for P&K, and Evelyn Devine, Head of Older People Services for the NHS in Perthshire gave lengthy explanations about the urgent need in the local area for cost cutting, coping with bigger numbers of older people, and the transfer of services from ‘institutions’ to care in the community.
Both were forthright about the chicken-and-egg dilemmas that are faced in the health field in Highland Perthshire (along with many other sectors such as housing, transport and education). The high per capita cost of existing service delivery arises from the gaps between demand and supply - in this case for both hospital and residential home care provision.

“This is distinctly promising for future developments and I look forward to tracking progress as it unfolds... it is now a question of everyone working together to find the best way forward...We are all aware of the need for integrated services...” 

The speakers drew attention to the fact that the 105yr-old Aberfeldy cottage hospital is no longer considered fit for purpose with one wing out of use, citing difficulties moving beds about, providing separate accommodation for male and female patients, and its distance from the local GP’s health centre.
It presently costs £870,000pa to run and would need at least £1m to bring  even those parts that are still being used up to modern standards. Neither made direct reference to any consideration of the transfer of services to Dalweem.
Built in the 1980s, that single story complex, according to the speakers, has running costs of over £800,000 but has no nursing care facilities and only 16 of its 32 beds are usually occupied.
When the meeting was divided into seven discussion groups many had grasped the message that the present cottage hospital is under threat.
References were made to the recent closure of the specialist Atholl Dementia Unit in Pitlochry which, Ms Devine claimed, continued to be staffed although it had no plans to admit further patients.
Several protested that there had been no consultation over it being abruptly taken out of service, and conjectured that the same might be happening with the axing of the Aberfeldy hospital.*

Public Feedback
NHSGroup3WebMeetings’ convenor, retired local GP Hamish McBride, summarised for Comment the feedback from the discussion groups at the first gathering as follows:
•  One group was deeply suspicious of the whole thing, fearing a cost-cutting exercise involving the closure of the hospital.
•  There was recognition that the provision of care is quite disjointed; a need for some combination of efforts and a single point of referral to all services would make use of service easier.
•  There was a strong wish to preserve the different services presently in place, especially in the hospital. These include palliative care, end of life care, acute care, rehabilitation care for illnesses in the elderly which occur at the same time as other diseases, and care which is a ‘step-down’ from full hospitalisation.  This last could be further encouraged.  There is also the valued care in Dalweem, which wants to be retained. The group discussing this proposed a multi-functional building at Dalweem, with hospital and nursing home provision augmenting the present care.
•  There is in the community a strong ethos of care, by family members and by local volunteer groups. This needs to be promoted and protected.
NHSGroup2Web•  Although the demand for use of hospital and residential care has reduced, there is a coming increase in the numbers of over 70s in the area. This will increase needs which should be factored into forward planning.
•  Mental health issues are liable to require increasing attention as is dementia care in our increasing elderly population
•  Support for those needing help, but not residential care. There should be sheltered housing, sheltered accommodation like Abbeyfield, and better co-ordinated home support for medication, personal care and cleaning.
•  There was discussion in relation to Out Of Hours (OOH) provision and how it could be improved, using all the resources currently available, such as paramedics, OOH medical cover and extended Accident & Emergency hours.

Purposeful Engagement
After the second town hall event local participants from four of the discussion groups unanimously described the sessions as ‘very useful’. Merrill Sylvester of Aberfeldy observed: “This is distinctly promising for future developments and I look forward to tracking progress as it unfolds. I felt this was a positive meeting. Points made at the previous meeting had been noted and it is now a question of everyone working together to find the best way forward.

“...We have to cooperate to work out the best local solution to meet our needs. If we don’t, services will be withdrawn anyway because of financial exigencies, and the planning will be done centrally. This is a good start. We now need to respond in a
cooperative manner...”

“We are all aware of the need for integrated services and the requirement to work within a reduced, and further reducing, budget, alongside older buildings which are difficult to adapt to meet today’s standards.”
Sue Hoare of Fortingall remarked: “Organisers of Saturday’s meeting had clearly taken on board the mood and feelings of the March meeting. In their initial presentation they summarised many of the concerns and suggestions voiced there, Among others these included the single point of contact for services on offer, the single site of Dalweem for hospital, day care, respite and residential care and the addition of sheltered care on location there as well as better transport facilities.
“Many of those who had attended the first meeting were angry at its lack of publicity and so the mood was antagonistic at the start. By contrast most of those present on the Saturday meeting had received feedback from the initial meeting so knew what to expect. Thus the discussions homed in on those issues, with some new proposals put forward. Particularly emphasised was that full publicity should be given in advance of such public consultation meetings if they are to gain any credibility.”
Susan MacDonald of Aberfeldy spoke of the meeting as being ‘positive’. “It is now a question of everyone working together to find the best way forward”, she said.
“We are all aware of the need for integrated services and the requirement to work within a reduced, and reducing further, budget, alongside older buildings which are difficult to adapt to meet today’s standards.”

Good Progress
NHSmeet2WebNorman McCandlish, of Ballechin, commented: “The second meeting was well organised and resourced with the group sessions well led - listening not steering. The feedback session reiterated the synopses from each group for everyone to hear. As no real questions arose from these they must have been broadly satisfactory.”
His discussion group had identified the need for a local ‘focal point person’. The former role of the hospital Almoner had been cited as one who knows the services and facilities available in the area and could act as the first point of contact for Health and Care Departments and patients and applicants.
His group had also agreed that the whole Dalweem site needs to be redeveloped as an all-services location, perhaps including dementia patients and even sheltered housing.  A rider was noted with this that no relocation steps should be taken until all such new facilities should be in place.
Among further suggestions were:
• the need to exploit technology so that some webcam consultancies could minimise patients’ and specialists’ travel;
• the need to review Volunteer Hospital Car system - some patients can afford to pay, some can claim back the ‘fare’ by virtue of their Welfare status, but there is a group in the middle who are stretched to find the cash and have to rely on public transport or the kindness of friends. This is especially true for repeat chemotherapy treatments at Ninewells.
Norman stressed: “P&K and NHS Tayside are both to be commended for their openness to local opinion. I think part of this comes from a realisation, which we must all acknowledge, that in the present financial climate, some forms of centrally directed Health/Welfare provision are unsustainable.
“We have to cooperate to work out the best local solution to meet our needs. If we don’t, services will be withdrawn anyway because of financial exigencies, and the planning will be done centrally.”
“This is a good start. We now need to respond in a cooperative manner.”
Others remarked that the officials and agencies’ staff must swiftly reverse their ‘birds’ eye view’ of local communities, citizens and patients and both recognise and adopt a genuine partnership approach. They affirmed that there should be no ‘hierarchy of information’ and that proper consensus among all participants must be formed and pursued.

Blueprint for Flexibility
NHSFeldy2bWebIn a personal view, Hamish McBride said: “It does seem obvious that the hospital in Aberfeldy is no longer fit for purpose. All my professional life, I have considered that community hospitals are the best way to deliver intermediate care in the patient’s own town, the care being given by known and, presumably, trusted medical and nursing staff.
“I think that the strategy group (being formed) has to take the given information and develop a plan for the next fifty years. With that, it will then have to find funding. An innovative plan for a building with residential, nursing and medical care would be appropriate for our rural community. 
“Over and above that, it needs to be jointly run and administered by Health and Social Work, with an emphasis on flexibility. It would also form an ideal place for basing the delivery of home care, medical, nursing and personal care with co-ordination of the voluntary groups. 
“If this is innovative enough to form a pilot study, then funding may well be forthcoming in the longer term.”

 

* A poll is currently running in the online edition of Comment http://www.gocscotland.org.uk/ 
“Opened in 2010, the 7 bed dementia assessment unit in Pitlochry is under threat of closure. The 15 specialist staff would be ‘sensibly deployed in line with clinical and care needs’ (NHS Tayside). Should this happen?”
YES:
Specialist, scarce resources must be located where they meet the needs of the greatest number. Centralising upon Perth away from sparsely populated areas is both rational and necessary. 7 (10%)
NO: There is a substantially disproportionate number of ‘oldest old’ residents in Highland Perthshire. Demograhics clearly refute the centralising ‘rationale’.  63 (90%)
Total votes cast to date: 70


Pictures are of the plenary and group sessions at Aberfeldy Town Hall over the two meetings so far held

 

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