18th November 2018
Established 1872. Online since 1996.

Disrespectful comments

Listening to Good Evening Shetland, followed by the NHS Shetland Speakeasy on Tuesday evening, I was very disappointed with some of the comments relating to the proposal to close Ronas Ward rehabilitation unit which came from NHS Shetland chairman Ian Kinniburgh.
I feel I must set the record straight in relation to his statement that this is not about closing Ronas Ward until the Intermediate Care Team (ICT) (covering Lerwick and central area only) was fulfilling its function satisfactorily. This was not how the proposal was presented.
At the Integration Joint Board (IJB) on 26th September the first question I asked was when would Ronas Ward be closed and I was informed by Kathleen Carolan that closure would be immediate. The reason being that the money to run the unit had already been re-allocated and there would also be a requirement to redeploy a number of the staff to help populate the under resourced ICT. I have to say, having given that answer to the IJB on 26th September, it did come as a surprise when Mrs Carolan concurred at the Speakeasy debate with Mr Kinniburgh’s view on a meeting which he did not witness.
It can only be the case that Mr Kinniburgh did not have a proper grasp of how the report was presented to the IJB as he surely would not be inclined to mislead the public.
He also said that “certain members of the IJB certainly weren’t in a position of knowledge around this” and were at a “different level of understanding” – very derogatory and disrespectful comments.
Any lack of knowledge was due to the unsatisfactory level of information in the report, which is why we deferred to gather further information on how this proposal would affect outlying patient care and also to gain an understanding of the impact on community care.
I would remind Mr Kinniburgh that the IJB’s decision was by consensus; no-one was otherwise minded to approve the recommendation.
Far from having a “lack of understanding” the IJB does understand and supports the strategy of providing more health care and rehabilitation in the home and community setting.
What was raised on 26th September was a note of caution regarding the assumptions made in the report and the intention to close Ronas Ward immediately in the process. This removes any safety net should the ICT and Montfield Support Services provision fall short – which would particularly affect the outlying areas. To launch the strategy on such a fragile basis would be inviting failure from the outset.
Another serious omission in the report was that the Shetland Stroke Support Group had still not been consulted meaning this proposal was being presented without their extremely important input, a gap in the process which I also raised at the IJB.
The fact of the matter is we are now in a process of partnership working between Health and Social Care, something we have been doing informally in Shetland by necessity and for a number of years. The Public Bodies (Joint Working) (Scotland) Act was granted royal assent on 1st April 2014 and has now legalised this process.
However, there is an issue when different cultures combine constitutionally and with common governance and accountability, it is a difficulty we must manage and quickly, working together to improve patient and client care more efficiently is the aim.
It would appear that certain elements of NHS Shetland senior management are having difficulty coming to terms with this, illustrated by Mr Kinniburgh’s reference on Tuesday night to a “done deal” which the NHS senior management team patronisingly thought was a “no brainer”.
This is no longer how it works. I sincerely hope we can move on from here and begin to have adult conversations which recognises the IJB as an entity in its own right and not as two disparate organisations.

Billy Fox
SIC councillor and voting member on the
Integration Joint Board
Brennek,
Quarff.

6 comments

  1. John Tulloch

    NHS Shetland produced similar language to drive through the IJB at the start. Councillors were rightly cautious then about the potential for government to hi-jack and centralise a locally accountable service. Now NHS Shetland appear to be trying to dominate the new arrangement at a time when NHS centralisation is very much on the cards, a general policy the SNP Scottish government has pursued relentlessly, during it’s time in office.

    Substituting the Ronas Ward service with care in the community may be a ‘no-brainer’ to Mr Kinniburgh however it isn’t clear to me how moving patients out of a central location and scattering them randomly around Shetland where medical and support staff must travel to them, is necessarily going to save money? It can surely do so only if somebody else does the necessary work for nothing?

    Or agrees to pay for it?

    Reply
    • Yvonne Graham

      I suggest John Tulloch searches the ISD website for the cost information which is published every year by the government. This shows various costs for health boards including the cost per day of keeping a patient in hospital. This may provide him with some clue as to how “substituting the Ronas Ward service with care in the community may save money”

      In addition to releasing funds for reallocation providing care for people in the community is a more desirable model of care. Not only do people prefer to remain in their own homes with their own possessions around them doing so also helps maintain their independence.

      Many years ago I worked in nursing and even back then it was acknowledged that spending any length of time in hospital lead to older patients “going off their feet”. There are times when a hospital stay is necessary but the shorter the better and to provide the services in the community there has to be resources to do so – both financial resources and staff resources. After all the most valuable resource the health service has is it’s staff and inevitably at some point in all our lives we will have occasion to use it.

      Reply
  2. John Tulloch

    Thank you, Yvonne Graham. I don’t dispute that the sooner people can get out of hospital, the better. However, this is about people who still need special care and assistance, unavailable at home. That’s why the Intermediate Care Teams are being set up.

    No, thank you, I won’t bother looking up the average cost of keeping people in hospital as this bears no relation to that. The hospital will not close if these patients go away, all that will be “saved” is the people treating them will no longer treat them. So it is only costs directly related to actual treatment/support that will be saved. How many jobs will go?

    That treatment and support will be provided by the newly-created Intermediate Care Teams who will travel all over Shetland to patients.

    It was suggested that another two care teams are needed, four in all. Most of their time will be spent sitting in cars and SOMEBODY will have to PAY for that AND their associated management/office overheads. How many jobs is that?

    “Care in the Community” may be desirable from some perspectives but we are being told of savings. Where is the saving?

    Reply
  3. ian tinkler

    Yvonne Graham, excellent care in the community is indeed a highly desirable objective however it is as an absolute matter of fact nearly impossible to match home/community care with the care that can be given in a hospital environment. As a former nurse, you should be well aware of that. Now your qualifications and day job appears to be one of accountancy, indeed, not those of a qualified nurse. Could you with your professional knowledge give us a breakdown of the cost comparison of “Ward care”, 24/7 with fast access (2 minutes) to medical care with that t of “community care” 24/7 with access (next day) to a fully trained medical staff in a home environment? I have very little doubt which would be the most cost-effective and health-effective care.
    I would like to add , a family member suffering from, severe postnatal illness was very poorly treated under “are in the community.” Lack of mental health staff, poor finance, and distance from help, rendered that care truly dreadful and absolutely ineffective (in fact nearly lethal). Only by returning to her birthplace, was she offered real treatment. that was in the mother and baby unit Queen Elizabeth Hospital Birmingham ( baby and mum inpatient, many weeks). An anecdotal case that may be, but the 25 or so air ambulance evacuations to Royal Cornhill from Shetland (acute incidents) under Section Mental Health Act could hardly render her “Care in the Community” cost effective, health effective or competent.

    Reply
  4. paul barlow

    community staff can and do treat complex care needs. the new team are meant to support the needs of folks that require more intervention. properly staffed and funded home is the preferred place of care for a lot of people. its not cheaper care but its more holistic and does show quicker recovery times.

    folks in Shetland are lucky they have some very dedicated staff. it takes special folks to care for your family members. simply ask folks how they rate the care from community nursing.

    your family member was never suitable for care in the community a case like theirs is normally always requiring hospital care. again the cpns are dedicated but seriously overworked you cant expect a couple of folks to cope with the needs of 23000 people. so unless a lot more money is invested into community nursing don’t expect a perfect service. but you’re needs will be met by a lot of truly dedicated staff.

    more money and more staff are needed. but those in post are doing their best to provide the care your loved ones deserve.

    Reply
  5. Margaret forrest.

    Mareel verses Garrison. Should the garrison be aloud to put on in equal measure as the mareel I feel the results would be different.

    Reply

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