Report on Right For Fife NHS Fife Consultation September 2001

Hopes and Expectations

HOPES:

- that services would not be cut

- that PFI or PPP projects would not be needed

- that Queen Margaret Hospital, Dunfermline and Victoria Hospital, Kirkcaldy would remain open

EXPECTATIONS:

- drastic cuts in services

- removal of one or both of the existing general hospitals

- the building of a centralised super hospital under PFI/PPP

- slick presentations dressing up cuts as improvements

DECISIONS OF NHS FIFE

1. General Hospital Services

Public opinion was strongly against a single centralised general hospital. This option was immediately ruled out. It was agreed that both hospitals should remain open, but the resources available in terms of consultants and junior doctors are not enough to support acute services at both hospitals. (We don’t have enough resources, so we’ll "centralise" – NOT "cut" – "CENTRALISE")

Emergency care will be available on both sites, but this is NOT acute care.

The issue of which hospital would house the acute services was announced in stages. Travel times had to be considered before a final decision could be made. This decision favoured Victoria Hospital as Kirkcaldy made 30-minute maximum arrival times possible for most of Fife.

The problem that I have with this is that, as mentioned at the meeting, serious head injury cases tend to be treated at Edinburgh Royal Infirmary. Where a patient sustains a serious head injury in the Dunfermline area it will be the responsibility of paramedics to assess whether the injuries warrant immediate transport to Edinburgh, or whether to take the patient to Kirkcaldy first for assessment.

Centralising acute services is tantamount to having a centralised hospital in emergency cases. The increased workload on paramedics needs to be rewarded. Training was an issue that was mentioned as a priority, but the specifics of what training will be given appears not to have been considered as yet. This is what was being referred to as "a direction of travel", one of a number of references to a journey metaphor intended to make those present feel that NHS Fife were moving services along in the right direction.

The Right For Fife plan will hold for ten years in line with Fife Council’s Community Plan. What happens to either hospital after this time is anyone’s guess.

2. Maternity Services

Forth Park Hospital in Kirkcaldy will be closed, and two new midwife-led maternity units built in Dunfermline and Kirkcaldy - Funding will be supplied by the Scottish Executive.

This hopefully will lead to increased quality of maternity care. However, where acute treatment is needed for patients in Dunfermline, patients will require to be transferred to Victoria Hospital.

3. Primary and Community Care

Traditional Primary Care services will be expanded and extended Primary Care and community services developed. This will incorporate diagnostic centres and access to intermediate care beds.

EXTENDED SERVICES:

Main area of development is chronic disease management run by Nurse Practitioners in GP surgeries, providing services for:

- diabetes

- asthma

- ischaemic heart disease (IHD)

- chronic obstructive pulmonary disease (COPD)

- mental health

DIAGNOSTIC CENTRES & INCREASED COMMUNITY CARE FACILITIES:

- to be developed within existing premises (community hospitals/district general hospitals)

- new premises to be developed for diagnostic centres if space is unavailable in existing facilities – proposals are for four new diagnostic centres in Dunfermline, Kirkcaldy, Glenrothes and St Andrews.

This will provide a way manage patients efficiently and to prevent unnecessary referral or admission to acute services. (Are you noticing the pattern yet?)

Locally sensitive crisis intervention and rehabilitation services, caring for patients appropriately in the community, wherever their place of residence, and avoid acute hospital admission (because there aren’t enough nurses, doctors and consultants.) This should build on the introduction of Integrated Response Teams as part of the NHS Fife response to Winter 2000.

These measures are all fine, but no-one mentioned anything about the effects that poverty had on the sharp increase in deaths of older people in Winter 2000.

Local rehabilitation services require to be increased to sustain patients within their own homes and to support increased care being delivered in communities.

If resources are made available, plans for diagnostic centres and increased community care facilities could be implemented in 2-3 years.

INTERMEDIATE CARE BEDS:

Possibly in local nursing homes, or possibly by designating beds in general hospitals for use by GP’s.

The beds could be used flexibly for nursing care, rehabilitation or respite. Patients could be admitted from home or from acute care in a local hospital (step-down care).

4. Services For Older People

Moving more into community based care, placing greater emphasis on maintaining older people’s independence.

Stroke unit to be built at Victoria Hospital (assuming Victoria Hospital is confirmed as the acute centre). Again to be funded by the Scottish Executive (We’ll wait and see though).

90 Continuing Care beds for older people with quite complex medical problems, although the hope is that by building up the health of older people that not all 90 beds will be used.

The obvious thing for the SSP here is that older people’s health is dependent on more than just health facilities. Pensions are a joke just now. As the proportion of older people in society is set to rise significantly in the coming years, something will need to be done now by government to eradicate poverty in society.

Quote of the day "exercise and health eating improve the health of the elderly.."

NHS Fife preferred option for older people’s services was many smaller units within non-hospital environments.

5. Services For People With Mental Health Problems

Preferred option was to have a Fife-wide integrated Mental Health Service.

Requires full partnership across Social Work Services, Primary Care and Specialist Mental Health Services, the Voluntary Sector, housing services and employers.

The strategy comprises three main strands:

- The development of services in Primary Care for people with, or at risk of having mental health problems, by both improving existing Primary Care services and developing a psychological therapy service;

- The strategic reversal of the present hospital (secondary) / Community (primary care) balance of care;

- The reprovision of specialist secondary care services from Stratheden Hospital into the patients’ respective Fife localities.

This will mean the gradual phasing out of Stratheden hospital and the de-institutionalisation of mental health services. This is a positive move, but may involve a number of new build projects for which around £5 million would be required. (If Stratheden is closed down, a wealthy construction company will give NHS Fife a fair bit of money to build houses on the land.)

CONCLUSIONS:

The Right For Fife process was designed to discover public opinion on health matters in a limited way. The issue of a centralised hospital has been resolved by NHS Fife in such a way as to mask the real problems facing healthcare at the moment:

Severe shortage of consultants,

Lack of funding,

Low staff morale,

Certain buildings requiring to be extensively renovated or replaced,

Overall lack of resources.

Centralising acute services at Victoria Hospital, could have dire consequences. An article in The Courier on Saturday 13^th October 2001 quoted a damning statistic relating to heart attack deaths, saying that 69% of these deaths occur BEFORE THE VICTIM HAS SEEN A DOCTOR. NHS Fife wish to extend the travel time to acute care for residents of West Fife by removing acute services from the Queen Margaret. This is unwise.

As regards Midwife Led Maternity Units (MLU’s), there have been serious difficulties in the past which I believe led to the closure of the MLU at Queen Margaret some years ago. If it failed then, why will it work now?

No reference was made to increased pay awards for nursing and paramedic staff who will need to be trained further to take on greater responsibility for treatment and assessment of patients. The shortage of consultants and junior doctors has to be a result of a series of cuts in education, and the increased financial strain on students. Many capable young people cannot even consider further education because of the cost, and the requirement for most students to work whilst studying to support themselves impacts severely on their ability to give the necessary commitment to their studies.

NHS Fife’s proposals amount to nothing more than a cost cutting exercise. The expenditure on building new MLU’s at Kirkcaldy and Dunfermline is a facade designed to mask the overall cutting of services.

The increase in GP’s as first port of call is a measure designed to take the strain off hospital services, and place that strain on GP’s who are already overworked. Even training up community nurses to share this workload, can only be a relatively short-term measure as the funding crisis within healthcare leads to greater and greater workloads, and more and more nurses leaving the profession.

The Right For Fife proposals once ratified by the Scottish Executive will hold for ten years. If there are no radical shake-ups in how the NHS is funded, I dread to think how little will be left.

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