Galloway Community Hospital: the Truth by Angus Cameron

Dear Colleagues,

Recent Concerns regarding the Galloway Community Hospital.

There are two issues that have attracted public concern:

1. The Emergency Department

The Emergency Department (ED) handles approximately 12,000 cases per year.  It is staffed by a suitably qualified doctor and experienced ED nurses.  In addition to that, the ED doctor can call on the services of an on-call anaesthetist if he is faced with a need to ventilate a severely ill or injured patient.  Alternatively, the ED doctor can seek help from the Emergency Medical Retrieval Service based in Paisley: This service is manned by consultant level staff 24 hours a day and has a helicopter on stand-by able to rapidly transfer medical staff to the Galloway and transport seriously ill patients to Glasgow Hospitals.

The Emergency Department has good working relationships with Scottish Ambulance Service paramedics based in Wigtownshire, who are often faced with critical decision making, deciding whether to transport patients to the Galloway Community Hospital for stabilisation, or to transport them direct to Dumfries & Galloway Royal Infirmary where definitive treatment is available.

Anaesthetic on-call cover used to be provided by two anaesthetists who lived in Stranraer.  One retired several years ago and the other last year, and it has not been possible to recruit replacement anaesthetists. As a result, the 12 hour shifts in the rota have been staffed by locum consultants and by consultant anaesthetists from Dumfries & Galloway Royal Infirmary.

We have had increased difficulty recruiting locum anaesthetists to the Galloway, which reflects a national shortage of locum consultants.  In addition, with 3 vacant posts in the anaesthetic department in Dumfries & Galloway Royal Infirmary we have had difficulty in rotating consultants out to the Galloway Community Hospital.  Obviously sending an anaesthetist out to the Galloway Community Hospital could result in theatre sessions in Dumfries & Galloway Royal Infirmary being cancelled – causing distress to a number of patients (some of whom could have come from Stranraer.)

In the last month there have been 3 occasions where an anaesthetic shift has not been covered as a result of failure to recruit locum doctors.  In these cases the impact has often been reduced by a doctor staying on longer after his shift ended, or a doctor agreeing to arrive earlier for the start of the next shift.  The dates when there was no anaesthetic cover were overnight were 4^th July, 5^th July, 6^th July and 11^th July 2017.

I would like to stress, however, that at no stage has the Emergency Department been closed.  It has not been “downgraded to a Minor Injuries Unit” – the usual doctors and nursing staff were present and seeing patients normally.  Children with asthma or patients with fractures for example could still be treated normally.  While we regret that we were not able to provide the fall-back cover of an anaesthetist it should not be concluded that this was from lack of trying – we have spent a total of £1.5million on providing medical locum cover for the hospital in the year to April 2017 and will continue to maintain a rota for the foreseeable future.

Being truthful, I cannot give an absolute guarantee that we will never have this situation again. We will, however, continue all efforts to recruit anaesthetists both to Dumfries & Galloway Royal Infirmary and to the Galloway Community Hospital and it is likely the situation will ease as locum availability improves after the holiday season.  However, we do face a very difficult medical workforce market.  I can confirm that we have a working group led by the Deputy Medical Director working on efforts to improve our recruitment and retention in a highly competitive market.

2. The In-Patient Wards

 You will be aware that there are two in-patient wards in the Galloway Community Hospital. One ward, the Garrick Ward, deals with more acute medical cases, whilst the other, the Dalrymple Ward, tends to deal with rehabilitation cases and care of the elderly.

Arranging a safe level of nurse staffing in the wards has been made difficult recently by 4 longer-term vacancies, and more recently by 3 nurses forced to take sick leave.  The nursing staff have worked exceptionally hard and flexibly providing extra shifts to help maintain the full service.  However, a decision was taken to move all patients into one ward (the Dalrymple Ward) for the period 5^th – 12^th July 2017, in order to allow for safe nursing levels to be maintained and for patients to be treated with dignity and compassion.  This was achieved by declining admissions to the Dalrymple ward for a week prior to this to allow the numbers of in-patients to decrease as patients were discharged.  During the period when the two wards were combined it was possible to admit acute patients to the ward from both ED and from GPs.

I am glad to say that following a very intensive weekend recruitment drive we have now managed to appoint to nursing posts and the new staff will start in September 2017, easing the pressure on ward staffing.

A statement from the General Manager was emailed to Councilors in Wigtownshire on Tuesday 4^th July 2017 informing them of the situation.

A Senior Manager is carrying out a review into the Galloway Community Hospital at the request of the Chief Executive.  The remit is to look at how services can be made more resilient and sustainable and to consider what services could be increased in the hospital, particularly out-patient appointments, diagnostic investigations and day-case surgery.  Increased services in the Galloway Community Hospital may, however, be delayed if we remain unable to recruit consultants to the region.

The Health Board is committed to the Galloway Community Hospital.  This is evidenced by the fact that we have budgeted for routine renovation and equipment upgrade of the theatres and a renovation of the dialysis unit later this financial year. In addition, further money will be spent in the Galloway Community Hospital on equipment for endoscopic examinations.

On a personal level, I feel that ultimately, the stability of services within the hospital relates directly to medical recruitment in a very difficult recruitment environment where we are forced to compete with hospitals across the UK.  The Board will continue to work hard to recruit to what are unfortunately

perceived as professionally isolated and clinically challenging posts.  I believe that there is a role for community leaders of all persuasions in helping to promote very positive messages about the hospital, the community and the environment to help us attract the best possible staff to the area.

Again on a personal, and professional, level I feel it is extremely important that none of us unnecessarily promote avoidable anxiety or confusion in patients and the public.  I think it is, therefore, important that the language we use in public fora is accurate at all times.  The Emergency Department has not been closed and patients should attend there as normal.  They will be treated by suitably qualified doctors and trained nurses. They should not be led to believe that they are required to travel to the Emergency Department in Dumfries & Galloway Royal Infirmary.  Patients who are mistakenly led to believe that may make seriously inappropriate decisions to delay seeking help or travelling to Dumfries – decisions that could have significant adverse effects on their health.

Dr Angus Cameron is Board Medical Director for NHS Dumfries and Galloway

The Doctor can see you virtually now by Chris Fyles

While Googling recently (for Technology Enabled Care related reasons!) I happened to come across PawSquad.  They provide “instant, qualified online vet advice” through the provision of video or text chat consultations to keep your pet “as happy and healthy as they can be”.

Amazing! Whatever will they think of next?

How about similar services for you, me and everyone else? Wouldn’t it be nice to be able to use these options to support you and your family’s health or to deliver services differently?  We can do that… can’t we?

YES WE CAN!

There are other health and social care partnerships in Scotland that support people to manage their health and wellbeing by video consultations and text message.  There is also demand from the public with the rise of commercial companies that offer GP appointment by video with the ability to deliver medication to your door the next day or email you a prescription.  Need a Physio? Initial and follow up consultations can be provided through video and exercise packages sent to your device for you to follow.

Now, some of you will be thinking “that’s all well and good but the internet connection at where I live and work is terrible!”  While that may be the case right now in some of the areas across our region, it is getting better.

Don’t just take my word for it – there is an ongoing programme of work being led by the Scottish Government and Dumfries & Galloway Council to support the roll out of superfast internet access and improve the speed of regular broadband.  It began in early 2014 and is planned to continue to the end of March 2018 enabling access to superfast broadband for 95% of premises in the region.  The Scottish Government have also committed to deliver 100% superfast broadband by 2021.  At the moment, our region looks like this:

Maybe you are thinking that the people that use your services don’t access the internet? It may surprise you to know that the internet was used daily or almost daily by 82% of adults (41.8 million) in Great Britain in 2016, compared with 78% (39.3 million) in 2015 and 35% (16.2 million) in 2006.

Or that during 2016, 70% of adults accessed the internet ‘on the go’ using a mobile phone or Smartphone, up from 66% in 2015 and nearly double the 2011 estimate of 36%.  It’s not only young people using the internet, recent internet use in the 65 to 74 age group has increased from 52% in 2011 to 78% in 2017, And finally, of those people using the internet, 51% of them were looking for health related information and 43% of people are using the internet to make telephone or video calls using applications such as Skype or Facetime.

If you wish to see some statistics on Internet users in the UK click here

If you wish to see some statistics on Internet access click here

So if we have connectivity, people are familiar with the internet, they are using it to access health information, and they are using it to make video calls why are we not offering our health and social care services via video?

In some places they already are. NHS Attend Anywhere was launched at the end of 2016 and has been developed by NHS24 in collaboration with Healthdirect Australia to enable video call access to Health services as part of normal day to day practices.  Instead of going to a health facility and physically sitting in a waiting room patients just use their device to access a virtual waiting area which the clinician comes and ‘collects’ them from to  begin the consultation. Services delivered elsewhere in Scotland include Pharmacy Reviews, Speech and Language Therapy, Dermatology, Endocrinology, GP appointments, Out of Hours care and more.

“What do I need to be able to do this?” I hear you ask.  For video consultations both the clinician and the person using the service need nothing more than a device (PC, laptop, Android or Apple tablet or Smartphone) that can access the internet with Google Chrome or an Attend Anywhere app installed and internet access of course.  NHS Attend Anywhere doesn’t need superfast internet access to work and generally speaking if you can watch a video on YouTube then you will be able to participate in a video consultation.

Curious to find out more and have a go?

https://nhsattend.direct/dandgtest

If you already have Google Chrome installed on your device just copy and paste the link above into your Chrome browser address bar, press the return/enter key on your keyboard and follow any onscreen instructions to take a seat in our Demo Waiting Area.

Once you are placed into the waiting area a notification will be sent to me and if I’m free I’ll come in and join you for a quick video call.  If I can’t make it you will at least have seen how easy the system is to use and begin to see opportunities to use it within your service. Preliminary results from a national survey in Scotland completed by people that have used NHS Attend Anywhere already indicate that 95% of them would use it again.

Video consultations give us options for flexible services going forward. It can help to reduce travel for people using our services and it could be a tool to help us to recruit to specialist posts from elsewhere to link in to Dumfries & Galloway. If we were offering video sessions into the home, it is possible to think that the person providing the service could also be at home and not in Dumfries & Galloway?

We expect to be able to use technology to buy shopping, make travel arrangements, manage our banking, communicate with our friends and to keep up to date with what’s happening in the world. Hopefully this blog post has made you think about new ways to use technology to deliver your service or to access a service. So what are you waiting for?

For more information or help with any of this, please contact Chris Fyles, Technology Enabled Care Project Lead for Dumfries & Galloway by email: chris.fyles1@nhs.net
LYNC:  cfyles@citrix.dghealth.scot.nhs.uk  or by phone:      07979357010 / 01387220006

Video consultation is one of four areas of focus for the Dumfries & Galloway Technology Enabled Care Programme. The others include Telecare, Digital Apps & Services and Home and Mobile Health Monitoring (HMHM).