REDRAWING NHS BOUNDARIES IN ARGYLL AND
CLYDE - A PUBLIC CONSULTATION
Fort William Public Meeting, 13th October
2005
How do we get the additional funds to support a 'Greater
Highland'?
The population of NHS Argyll & Clyde was queried.
The Scottish Executive clarified that the rural population
of Argyll and Clyde is some 90,000, which does represent
challenges in providing services; the urban population is
some 330,000 and includes significant deprivation. The deficits
of all health boards were wiped out in 2001. NHS Argyll
& Clyde continued to overspend at the rate of £25-£30
million annually and in 2003 the management team was changed.
The Auditor General reported earlier this year that a continued
deficit could by 2007/8 reach £100 million. The question
to be considered was therefore whether the geographical
structure of the board area was the fundamental issue, rural
and urban areas having very different needs.
What money will go with the rural population? People were
keen to be supportive of the Argyll & Clyde area, but
were concerned about its bad credit record.
The Scottish Executive stated that the financial information
was currently not available but that it would be circulated
to all who had registered interest as soon as it was.
It was suggested that there is a clear financial requirement
in the urban area. Is the Arbuthnott formula refined enough
to reflect this?
The Scottish Executive reported that the Arbuthnott Formula
is currently under review and the group looking in to it
is due to report in around 18 months.
Will Accident & Emergency access improve between Fort
William and Glasgow? The Vale of Leven hospital was seen
to be important.
The population for each of the three options was queried.
The Scottish Executive stated that this had not been calculated
as yet.
One of the big problems for NHS Argyll & Clyde was
cross-border charging, so is the correct option number three,
as it was seen that the problem could continue with options
1 and 2?
The Scottish Executive stated that this problem was not
confined to NHS Argyll & Clyde and the system was under
review.
Will NHS Argyll & Clyde come without debt?
The Scottish Executive stated that the Minister is happy
to wipe out the debt provided the status quo changes, i.e.
there is no longer an NHS Argyll & Clyde. There is a
financial recovery plan which is available to everyone and
NHS Highland and Greater Glasgow is asking where the funding
is going to enable them to plan appropriately. Timescales
are tight, but the Minister wants public input into a quick
solution to get over uncertainty.
Patient flow is not a big issue - patients go all over
Scotland for treatment.
'None of the above' options were preferred as NHS Argyll
& Clyde was perceived to be in difficulties because
of its remote and rural areas, especially the islands. It
was suggested that the solution is a 'super health board'
with Orkney, Shetland, Western Isles, the island of Argyll
& Clyde, as rural and remote problems cannot be addressed
in "bits and pieces". The current consultation
was not seen to go far enough in addressing the number of
health boards.
CHPs are beginning to have an impact; so what is the purpose
of health boards? The extra tier was perceived to be uneconomical.
In response it was stated that a north of Scotland planning
group meets every six weeks and a lot of effort is going
into regional working. Western Isles want to be in the West
of Scotland planning group as their travel routes go to/from
Glasgow.
A suggestion was made to take patient flows out of the
picture as they change anyway. There was also perceived
to be a difference between schedule and unscheduled care
so they should be separate in the discussion/thinking. It
is important to remember that 90% of health care is community
based.
There was seen to be a need for standard charges for care.
It was queried how support could be provided to local
services as all have similar, but slightly different problems.
There was concern how NHS Highland would be able to manage
such a large area. It was currently seen to do a good job
and there was concern over how additional responsibilities
would affect that. The police were perceived to have problems
in managing such a large area. It was considered that CHPs
would help with this problem as decisions would be devolved
and managed locally, closer to patients.
CHPs are co-terminous with local authorities to make social/health
care planning easier. Not all services are delivered through
health care, so joint planning is crucial. This is made
even more important with the increasingly ageing population.
So far NHS Highland CHPs have not pooled budgets. Argyll
& Bute could form a 4th CHP if Options 1 or 2 are pursued.
Someone queried which option represented the Highland
and Islands Enterprise area and Option 2 was considered
to be the closest.
Cambletown was seen to have a locality structure, accountable
to NHS Argyll and Clyde which makes sense.
The Scottish Executive explained that there is now a duty
on health boards to involve the public in a meaningful way
and the Scottish Health Council will be working with communities
to monitor this.
There was perceived to be a bias in the presentation of
options and it was not considered to be the best way to
consult the public, as it was not perceived to be patient
focussed.
Someone asked how much the restructuring would cost. People
do not want extra management if transport needs resources
- they want a faster, better service. The service in Fort
William was rated very highly.
The Oban Times had run a story suggesting there was a
threat to the Belford Hospital. NHS Highland refuted this.
The restructuring was seen to present opportunities for
wider networking of services, e.g. Oban, Fort William and
Lochgilphead working better together. This collaboration
will be about sharing ideas and training, not passing patients
between the hospitals. The audience sought public statements
from the Chair and Chief Executive of NHS Highland to this
effect.
People were keen to see less infighting and bureaucracy
as this was perceived to suck funding out of frontline services.
The comment was made that Dunoon needs a locality like
NHS Highland has, with Council input, not a separate health
board. There was a call to be more creative e.g. by using
tele-medicine, IT etc.
There was concern that NHS Highland would inherit the
overspend problems, particularly if the structure is not
the issue. The financial figures are required before it
is possible to make a decision and it was therefore queried
whether the Minister can in fact make a decision in November.
The Scottish Executive responded that the Minister is not
making decisions on finance, but issues which impact on
finances. It was noted that NHS Highland have a well developed
finance system and they will be keeping a close eye on spending.
Most people want to know what difference it will make
to them. The NHS Highland direction reflects that of the
Kerr Report - better, quicker, more local so there is an
improvement in services.
Audience felt there was too little information on which
to make a decision
It was suggested that NHS funding should be increased,
but Pennie Taylor pointed out that NHS funding has doubled
over the last five years.
Travel time from Fort William to Inverness is two hours
but travel time from Kintyre was seen to far exceed this.
The point was made that the logistical issues of getting
patients in a room with clinicians need to be addressed
first then bureaucracy can be addressed. The Scottish Executive
reiterated that existing consultants used by NHS Argyll
& Clyde, will continue to see people in the Argyll &
Clyde area.
Dunoon and Cambletown relied on military support in the
past, but this is not there now, which will impact on transport
costs.
Patient care is central but won't happen if there is financial
dysfunction. The point was made that understanding the issues,
e.g. older people's care in rural areas,doesn't solve them.
It was noted that NHS Highland has a better record on care
in the community than NHS Argyll and Clyde.
This consultation was seen to be about strategic issues,
not about patient flows.
People expressed the need to be positive, not negative,
with enough confidence in the system that people will get
care if they need it. There was concern that decisions are
not linked up.
The Scottish Executive stated that the Minister is aware
of the lack of confidence that exists and arrangements were
now in place to ensure that NHS Greater Glasgow and Highland
were involved before decision were taken that could affect
the areas they might inherit. It was noted that following
this consultation there would be a need to formally consult
staff and place an Order before Parliament it is this which
is driving the timescales for the consultation.
There has been recent investment in Belford, e.g. the
renal unit, but this needs to be provided locally.
A lot of older people are retiring to Fort William; their
needs have to be addressed. This is re-enforced in the Kerr
Report.
