09 December 2013

A fraught atmosphere of anger and disillusionment surrounds the staff at Pitlochry Community Hospital.  In particular those staff, 15 in total, who work in the specialist Atholl Unit (AU) which is dedicated to the care of patients with dementia.
It has been caused by the news from NHS Management that the AU has been put ‘in a holding position’ until further notice - a situation which came to light following leaks published in the Perthshire Advertiser on 19 November. 
It appears that this means:
•  that there will be no more admissions of dementia patients to the AU, and
•  that those staff will be farmed out ‘temporarily’ to other locations.
AU WebComment has been in contact with a variety of local sources, some of whom are professional staff, all of whom insisted on remaining anonymous for fear of career/employment reprisals in what’s described as a ‘domineering culture of complicit silence’.
One source told Comment: “They’re going to close it, but they’re telling us they’re not.  They say there aren’t enough staff and that patient and staff safety are an issue, but they’re not recruiting any more staff. 
“We’ve been short-staffed before, here and at the old hospital (Irving Memorial), and we’ve just had to get on with it.   I don’t think this term, holding position, has ever been used before in the NHS.”
When the original Atholl Unit opened 12 years ago, it was to make the distinction between dementia patients and others, in recognition of the fact that each group needed different care criteria.

“...Even the GPs don’t know (about the closure) and the worst thing for us all is the uncertainty. What a time to spring it on local people!  Everyone’s getting busy for Christmas and there’s no time to set up a protest...”

The purpose-built 7-bed specialist facility in Ferry Road was opened in August 2010 and described by Nicola Sturgeon at the opening ceremony as representing  “...a new generation of community facilities designed to meet patient needs in the 21st century.”  She went on to add:  “I don’t think we can overemphasise how important it is to people to have access to local services and to avoid the need to travel to the larger centres.
“It’s therefore great to see a wide range of outpatient clinics and other services being delivered from a hospital in the heart of the community.” (ScotGov website 19.08.08).  

Demand Rising
With a nationally aging population and locally an above-average over- representation of senior citizenry (according to Community Council Chairman Andrew Holmes Pitlochry has ‘twice the number of pensioners than the national average’), why, therefore, is one crucial element of this state-of-the-art facility now being threatened with closure?
Some five weeks ago, another source revealed, a few staff learned that the unit was closed to admissions, although there are still a few patients remaining within the Unit. 
At an initial meeting on 13 November, the AU staff who were on duty that day were called into the Quiet Room.
Another source continued: “It was only the people working that day who were told – the others found out by word of mouth.  We’re very angry at the underhand way this has been done.” 
It appears that those who attended the meeting were also told that the plans would be instigated sooner rather than later. Yet another source remarked:  “I was working that day and the feeling of shock was almost tangible when word started to get round.”
Following this, a further meeting, for all Atholl Unit staff was held at the hospital on 22 November. It was led by Vernon Angus, NHS Tayside’s Service Manager for the Unit, and his line manager, Maggie Rappley. 
Staff Union representatives were also present on this occasion and, a source remarked: “It was a real help to have them there as, talking to the Management was like talking to politicians, but at least we got to vent our anger.”  
Another fraught informant told Comment: “The outcome of that meeting was that the AU wasn’t closed to admissions, but no-one has been admitted since. No-one wants it to close and all the staff, not just those in the AU, are feeling the stress and uncertainty. 
“Even the GPs don’t know and the worst thing for us all is the uncertainty.  What a time to spring it on local people!  Everyone’s getting busy for Christmas and there’s no time to set up a protest.”  
One further contributor added: “I’m surprised there hasn’t been more fuss about this issue in Pitlochry and the local area as, although there was a bit of opposition initially (to the dementia unit), people realise that it’s a really good thing. I can’t see how they can justify closing a small ward dedicated to dementia.”

“...NHS Tayside is saying that Care in the Community is the way forward, following experience in Blairgowrie.  But what they’ve forgotten is that Pitlochry has a much more rural catchment area. This means that, for someone in Fearnan or Rannoch who can’t drive, they’ll need up to three different journeys by bus and/or train to reach Murray Royal...” 

An NHS spokesperson quoted in the Perthshire Advertiser said: “This ....acute dementia assessment unit provides short-stay care to allow clinicians to assess patients’ need.” 
However, the opinion of one local citizen given to Comment was: “This statement gives the impression that patients are in-and-out quickly, but I personally know of someone who was in the Unit for five months and another who was on a waiting list as there were no beds available. That doesn’t sound like short-stay to me”

Centralising on Murray Royal?
One major cause for concern amongst the staff is what happens to future dementia patients.
One source told Comment: “People are coming in earlier and staying longer and, although most people would prefer to be cared for at home, sometimes it becomes impossible. 
“It’s very unsettling for the local community as, when we get older, we want to know what’s going to happen.”  
Another added: “NHS Tayside is saying that Care in the Community is the way forward, following experience in Blairgowrie. But what they’ve forgotten is that Pitlochry has a much more rural catchment area.
“This means that, for someone in Fearnan or Rannoch who can’t drive, they’ll need up to three different journeys by bus and/or train to reach Murray Royal. 
“What’s that going to be like for an elderly partner or relative, particularly in the winter?  This leads to social isolation and that goes against every NHS strategy.” 
Regarding the proposed transfer of future dementia patients to Murray Royal, this was the view of one of the sources: “They’re trying to justify the millions they’ve spent on Murray Royal but they’re not having much success with the patients there. 
“Only recently two of their patients in a secure unit were able to kick down the door and were eventually found at a bus stop.  They’ve also has to use the police and fire service to rescue their patients from railway lines and the Tay.” 
It appears that the catchment area for the Atholl Unit has been changed recently. This will obviously have implications for the numbers of potential admissions, and a contributor explained:  “The boundary used to start at Perth and come north but, about a month ago it was changed and now starts from Dunkeld so it’s a smaller area with, potentially, fewer patients.
Another source added:  “We wanted to invite the Friends of Pitlochry Community Hospital to the meeting on 22nd, as they have supported us and given us substantial amounts of money over the years, to make patients’ lives more comfortable and home-like.  They’ve even provided funding for things like ECG machines, air mattresses and hip protectors. 
“They’re so supportive of us and the patients – they’re like a community within a community and we wanted them, and local residents, to be included in the meeting but Vernon Angus said no.  He said they would be invited to future discussions.” 
Questioned about future plans for the Atholl Unit, once the current patients have been moved on, one of Comment’s sources added: “We were told by Management at the second meeting that Aberfeldy GP hospital patients would not be coming to Pitlochry to use the AU, as the facilities aren’t adequate.  There are no air-lines and so on. 
“We were also asked by Management for suggestions for future uses of the AU.”
The party line seems to be that ‘it’s not a closure, it’s a holding position’ and we’re now more confused since the meeting than before it.”  
Many of the staff have been with the Unit for a long time and another source remarked:  “Lots of staff actively choose to work here because community nursing is very different from mainstream hospital nursing. 
“The staff here are highly motivated and passionate about what they do and they don’t leave to go to other jobs – the only leavers are the people who retire! 
“I, for one, wouldn’t want to be involved in a (dementia) service that didn’t have an in-patient facility.” 
For clarification of the situation, Comment contacted Vernon Angus by e-mail on 27 November with the following request:
“This is obviously an issue of very great interest and importance to our local community, as closure would have an enormous impact, therefore we would welcome swift clarification of the current situation... on a matter of such concern among the demographic within our circulation’s footprint...we trust that you will address
•  Why is closure threatened when the Unit, which was purpose built, is only 5-6 years old?
•  Is any public consultation on the matter proposed?
•  What possible alternative use could be made of the Unit in the event of closure?
•  What timescale is envisaged should closure go ahead?
•  What will happen to the staff and how many are involved?”

He replied that he was unable to give a direct response and referred the request on to Louise Wilson, the NHS Tayside Communications Manager at Ninewells.

“...Our priority is getting the right services in the right place for our dementia patients. Over the past year, the Atholl Unit has admitted on average two patients per month. We are determined to continue to provide the most appropriate dementia services for the Pitlochry area and surrounding communities and we will look to provide the most clinically-effective care with the best outcomes for patients and their families...” (NHS Tayside)

On the point of going to press she responded:  “We would like to make it very clear that there is no decision to close the Atholl Unit at Pitlochry Community Hospital. This seven-bed acute Dementia Assessment Unit provides short-stay care to allow clinicians to assess patients’ needs. There are currently three patients in the ward who have undergone clinical assessment by doctors and may soon either be discharged or transferred to the most appropriate setting to meet their needs.
“If there was ever a situation where, on a particular day, we had no inpatients in the ward and no one waiting to be admitted we would sensibly deploy our staff in line with the clinical need and care requirements of our patients. I am certain that the public would expect us to ensure that our highly-skilled staff are working to enhance care and treatment for our patients.
“A meeting, attended by managers and staff representatives, has been held with staff in the unit to discuss the current position.
“Patients should be reassured, however, that if their doctor decides that they need an inpatient dementia assessment they will be admitted to an appropriate setting for that initial assessment and an ongoing care plan would be put in place.
“Our priority is getting the right services in the right place for our dementia patients. Over the past year, the Atholl Unit has admitted on average two patients per month. We are determined to continue to provide the most appropriate dementia services for the Pitlochry area and surrounding communities and we will look to provide the most clinically-effective care with the best outcomes for patients and their families.
“It is also important to for us to be clear that Pitlochry Community Hospital is a state-of-the art, purpose-built and high-quality facility which is part of the forward clinical and operational strategy for NHS Tayside within Perth & Kinross.”
A Pitlochry NHS staffer commented: “Our first concern is for the patients but the timing of all this is really bad and stressful.”

Other Local Provision
As the threat of closure would, more than likely, have a knock-on effect at the dedicated dementia unit in the adjacent Balhousie Care Home on the site, Caroline Bavey, the Balhousie home’s Manager, revealed:  “Here there are currently 11 beds, with one unoccupied. 11 more beds are planned for dementia patients and these are scheduled to open in the late spring 2016. 
“Work will start in the new year, followed by staff recruitment so that they’re fully trained before the opening.  We’ll then work with Care Managers to fill the beds with patients/residents.”

Pictured above is the Pitlochry Community Hospital completed in 2010 as one of “a new generation of community facilities designed to meet patient needs in the 21st century.” On the left is the specialist Atholl Unit wing which appears to be under threat of closure
  

 

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