Response to Fox letter (Ian Kinniburgh)

I am taking this opportunity to respond to the recent letter from councillor Billy Fox following the Speakeasy broadcast on Tuesday evening but I am not intending to go into a lengthy exchange of letters.

Indeed, I am happy to support the suggestion contained near the end of his letter which is to continue to have the adult conversations since these led to the creation of the Integration Joint Board initially.

I strongly agree these must continue if we are to build a genuinely shared and transparent understanding of the issues facing all three organisations and of the options available to continue to provide safe and high quality services to our community.

This particular issue clearly arises from the organisations not having a shared understanding and I am of the view we must seek to avoid this happening again.

However, Mr Fox has made a number of statements I believe to be incorrect and potentially misleading so I shall respond for the public record.

Having sought clarification from several of the people in attendance, I can confirm that at no point at the IJB meeting did the director of nursing and acute services, Kathleen Carolan, say that the closure of the Ronas Ward would be immediate.

She did say that the process of discussion with staff would begin formally and that staff would not be redeployed to new roles until the patients currently in Ronas Ward had been appropriately discharged following their rehabilitation. In other words, there would be a phased approach to implementation.

This is entirely in accordance with the comments made during the <i>Speakeasy</i> broadcast which were made following the considerable discussion and subsequent agreement reached at the NHS Board meeting earlier that day attended by three voting and several non-voting IJB members.

At that meeting everyone agreed that there needed to be more done to bridge the gap in understanding that was acknowledged to exist, clarify the message contained in the report and obtain the additional information requested by the IJB.

I am therefore unable to recognise the statement towards the end of the letter about NHS Shetland senior management team having difficulty coming to terms with this.

I do acknowledge that the casual use of language around “done deal” and “no brainer” was entirely my language and with hindsight it could have been better but I find your casual assertions about the NHS senior management team disrespectful at best and not likely to support the development of mutual trust.

I remain of the view that having received a strategic commissioning plan from the IJB that recommended strengthening the intermediate care team, enhancing community rehabilitation and reablement and reducing dependency upon a hospital based service there would be support for this clinically backed and jointly developed proposal that had been discussed widely with various stakeholder groups when it was submitted.

The second point to clarify is that we have not yet re-allocated the money to run Ronas Ward. However, it is true that there is a fundamental requirement for the IJB and the Health Board to maintain financial balance and with the current way in which the joint service is configured we are overcommitted on our budget.

Therefore, while existing money could be used to continue to run Ronas Ward the IJB will then be required to find equivalent savings from elsewhere within the joint IJB budget allocation.

Since the intermediate care team has already been shown to work, is safe and delivers better outcomes for people it appears to make sense to strengthen that service and that is the essence of the proposal from the joint team employed within the integrated service and backed by the professional and clinical advisors.

The other implication in the letter is that the Shetland Stroke Support Group has not been consulted. While the group has yet to provide any comment on the information provided it was contacted in July to arrange to meet but the meeting scheduled for September unfortunately had to be cancelled by the stroke support group. It is agreed that their views are important and every effort is being made to obtain that.

So I would conclude by going back to the beginning and welcoming the suggestion that the way to take this forward is through adult conversations and I look forward to these taking place.

Ian Kinniburgh
NHS Shetland
Burgh Road,


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