8 May 2012

Community Council

Last night's Community Council meeting started on a bright note, with Donald Houston and Keith Falconer of Adelphi Distilleries announcing that they are giving a share of the Ardnamurchan Whisky Distillery business to the community. The mechanism for this will be worked out in due course - there's no hurry as there will be no financial benefit until some whisky is produced - but Adelphi wished to indicate its gratitude to the local community for its support.

All jobs except the still manager will be local. The whisky itself will be west coast in flavour, something close to Tallisker or Lagavulin, with both peaty and non-peaty versions. With the stills due to be delivered early next year, work on the building will start soon.

Donald Houston also agreed to have the Queen's Diamond Jubilee celebrations in the field by Mingary Castle. It was felt that access to the Lighthouse, the proposed venue, might be too problematic.

If anything, the situation with medical cover on West Ardnamurchan has gone from bad to worse. The one hopeful aspect is the 999 provision. Sam Harding is to be appointed technician, which means he will be able to operate at a very high medical level. The other Emergency Responders will be given 60+ hours of additional training to bring them up towards his standard. So far they have been called out ten times, and have operated very effectively. At present there are four ERs, and this will be increased to six - applications have been received for the two posts from well-qualified people. This side of the service still has its teething problems, so people need to be patient, but it looks promising.

The District Nurses arrangement is a shambles. No nurse is available in the Centre at 9am, the service which is being provided to those in need is poor, the Kilchoan Nurses' Base phone isn't being diverted to Strontian, our remaining local nurse is driving all over West Lochaber, 'our' other nurse is living in Shielfoot, the amount of waste - for example, of professional time driving around West Lochaber - is appalling...., etc, etc. WACC has given up dealing with Jill McVicar and is trying to talk to Garry Coutts, Chairman of NHS Highland, without much success. Mary Scanlon, MSP, is well aware of the situation and is furious with NHSH.

The situation with our Doctors is catastrophic. Both are resigning as of 11th August. A full text of their statement is available here, and it makes dismal reading. To summarise, their problem is lack of support from the Health Board in the provision of out-of-hours cover, something from which they resigned last November. WACC will be working with the other Community Councils, but we may face a prolonged period with locum cover.

The long-promised leaflet from SAS/NHSH which sets out to explain to us how the new 'system' is supposed to operate STILL hasn't been produced. No explanation is forthcoming.

The Scottish Ambulance Service and NHS Highland will be holding a drop-in session on Thursday 17th - date and time to be confirmed - to which all are invited. WACC urges everyone to attend and 'explain', politely but firmly, particularly to NHSH, how utterly dissatisfied we are with what is happening. In the space of a year a medical service which dealt with a remote community in an exemplary manner has been utterly destroyed, and only the 999 cover - with Nicola Sturgeon breathing down the SAS's neck - has shown signs of rising from the ashes.

We're going to need a further campaign to bring the problem to public notice. This needs to get going before Nicola Sturgeon comes down here in about four weeks time. Please write to Nicola Sturgeon, our MSPs, Charles Kennedy MP, your new Highland Councillors, and Garry Coutts, Chairman of NHS Highland - the addresses are in the right hand column of this blog.

11 comments:

  1. One good reason for Supporting the Scottish Nationalist Party in the past has been their competence in government. This "out of hours" chaos is however, gross incompetence on the part of politicians and NHS management like that of the "Bullingdon Club" government in London. Their ineptitude would be comic if people's lives weren't at risk.

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  2. Jon.

    Re. Responders.

    Following our phone conversation yesterday, I am, as requested setting out my thoughts on your comments. (And More !!)
    As you know I was reluctant to as I did not wish to cause ill feeling between us or indeed any one.


    My thoughts and understanding:-

    You stated ‘Sam Harding is to be appointed technician, which means he will be able to operate at a very high medical level’.

    Yes I understand Sam is to be given, the single advertised post for a Paramedic / Technician and I do and am sure it should be welcomed, that one of the responders has a good working knowledge of ambulance working practises and equipment like splints/stretchers etc. But he is only a Technician not a Paramedic and can only become a ‘Paramedic’ with further training including two years at University.
    I therefore feel your comment – ‘operate at a very high medical level’ is not valid.
    Further the Community was promised at Holyrood and since, that the responders would be lead by – either - Paramedic, Nurse Practioner, GP – trained personal and it was clearly ruled out that Technicians were suitable for this.

    ( It should be noted that generally in the Ambulance Service the post of Technician is being phased out and existing technicians can, as I understand it, have additional training and convert to the new post of Emergency Care Assistant. The general entry requirements for Emergency Care Assistant are higher than it was for Technician.
    Further the whole roll of the Ambulance Service seems to be changing from providing care at the scene to - fast transport to an Emergency Departments. This, as has come out time and again at our meetings can hardly be achieved here, in time, even with helicopters. ) I digress sorry !


    Your report continued….
    …….which means he will be able to operate at a very high medical level. The other Emergency Responders will be given 60+ hours of additional training to bring them up towards his standard.
    Yes, but not his ‘medical’ standard, to his standard of Ambulance procedures and use of equipment. I understand Sam is also to do this and additional training.



    Jessie is very very very highly trained medically even holding the so-called ‘Basics’
    training given to Doctors etc. who attend Emergency call outs. The other two ‘Local’ Nurses also have long in-depth medically based training and experience.
    …. So please, in case it causes offence to Jessie and the others do not compare Sam to being anywhere near their medical level of competence.

    CONTINUED – SEE COMMENT TWO



    Jonathan (Shop)

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  3. CONTINUED – FROM FIRST COMMENT


    However you are right that, the Ambulance Service DO see Sam as superior, as it has recently come to light;
    That they seem to be ignoring the vast training and experience the nurses have. Their pay for call outs is to be – Grade 3 ‘Care assistants’ - even less than the Technician.
    The Ambulance Service wishes to stop them currently, carrying out procedures they are already trained in and have been doing for years – until the Ambulance Service has trained them again !


    The Ambulance Service cannot have it both ways, reassuring the community that they have, the very well trained and experienced nurses as responders, (who have now been in place for over two months) but then not let them use there skills.

    I am beginning to be told, that this lack of understanding of Nurse skills is typical of the Ambulance Service, perhaps one of their Glasgow university trainers could study what SRN Nurse and the other extended training, teacher and gives competence for Nurses to carry out.




    Yes I agree with you, that the responder Team and Ambulance vehicle has great potential to be an asset to the area but, as was said at the council meeting at least two of the current team of 4/5 feel the ambulance is not yet holding the right equipment etc. and query whether it is ‘Fit for Purpose’. I feel before Nicola Sturgeon’s visit and the impetus is lost, the community must liaise with the responders and insure all their issues are resolved at this Friday’s meeting, by SAS (with a short time tables if necessary) and that this includes the operational on call and pay issues.


    If the Working Group is to be reformed for this and the other Nurse /Doctor issues I would very much like to be asked to join it and help actively seek the very best possible for the community.
    - ( and myself ? judging by my risk profile !) .


    Jonathan (Shop)

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    Replies
    1. Jonathan
      I think you need to remember that at the end of the day Emergency Response is provided by the Ambulance Service and as such, they are bound hold their own qualifications in high regard. We also have to remember that not all emergency responders will be practising in their particular professions any more and may no longer be, for example registered nurses. The SAS have protocols in place to protect them, i.e. not allowing them to do things that SAS have not trained them to do (and by the way, it has always been clear that this would be the case throughout the months of discussions with SAS and NHSH). I appreciate that this must be hugely frustrating for people, especially when it comes to more routine tasks that nurses and others will have done in the past as a matter of course but I understand from SAS that they are putting the appropriate training in place so that the ERs are as trained as they can possibly be. Yes, it would be good if previous qualifications/experience could somehow be recognised but the SAS seem to be fairly intractable on this and I can only assume it comes down to insurance etc. The general model is being set up in perpetuity and is not based on the skill sets of the specific individuals currently recruited.

      The SAS’s business is to train people to save lives in emergency situations after all and the very fact that Jessie put herself through BASICS training to allow her to operate effectively as an emergency practitioner in the past to me is indicative of the fact that health professionals from fields other than emergency medicine require additional training. No-one is saying that this means ambulance technicians or indeed paramedics have the same ‘medical’ knowledge as nurses or doctors but they have different knowledge and skills that are perhaps more relevant in the emergency situations that arise.

      As a matter of accuracy, at Holyrood the community was promised that SAS would advertise widely for Emergency Responders making it clear that they could be Paramedics, Nurse Practitioners, GPs etc, but clearly they could not guarantee who would actually apply for the posts. It was also agreed that a leader/co-ordinator would be identified from amongst the final team but there was no commitment as to who this would be. Being appointed as ambulance technician does not automatically make Sam the ‘team leader’.

      I think we are very lucky to have Sam as an Emergency Responder or as an Ambulance Technician, and as such, the community should welcome him. I think I am right in saying that he has more than just Ambulance Technician training and I understand he is very good at what he does.

      We might also remember that is early days of a new model that we have committed to trying, perhaps we should give it a chance to bed down and actually work. The emergency responders have not come to the community council with any issues, but they know where we are if they need us. In the meantime, we are facing much more serious matters when it comes to our nursing and medical provision.

      Delete
    2. Jac
      Sorry I thought I had tried very hard not to offend but it would seem from your tone I have, so SORRY.

      I accept a great deal of your reply is your thoughts and understanding as was, and is, my statements ( I certainly do not have the in-depth medical knowledge or a detailed understanding of Professional medical indemnity ) – perhaps more liaising needs to take place, the questions asked and then work to have the best possible for the community.

      To keep my own conscience clear, in case of a tragedy, I feel I must at the very least make the community aware of my understanding of the current emergency provision and what was agreed at Holyrood.

      So picking up on your comments:- Yes, Emergency Response is Ambulance Service but I thought all the meetings and public consultation with NHSH and SAS (Both as you correctly state above) was so our ‘New model’ would be cast wider. Yes Naturally Ambulance Service will tend to favour their own but is that best ? Should we not be pushing the implementers for the “new model”, to work out side their comfort zone, get them to do the groundwork, investigations etc. to integrate nurse qualification in to their structure and pay scale, for our and other communities’ benefit. Then it should be no problem to extend their professional indemnity to cover the nurses as does NHSH. Or – thinking as I type – Perhaps even more simply ( and certainly quicker) have NHSH do there bit by, covering the Nurses for their Nurse based skills.

      Re - remember that not all emergency responders will be practising in their particular professions any more and may no longer be, for example registered nurses
      I am not too sure what you are conveying here. If you are referring to say nurses, who following their training then specialise in one area of medicine. Then you may be interested to know that for their on going registration and professional development they have to show that they have kept up their basic skills, even to the extent of a annual course on basic life support (this requirement has recently become even more onerous).
      To practice they need to have Nursing & Midwifery Council Registration and yes they would loose this if they had not worked a set minimum of hours in the previous 3 years or were unable to show ongoing professional development ( I believe all the nurse Responders are or have the necessary requirements to be registered). ( Although ‘back to practice’ courses are also available). Of further interest is that they can be members of the Royal Collage of Nursing, which gives them (some ?) personal professional indemnity cover.


      Re - not allowing them to do things that SAS have not trained them to do (and by the way, it has always been clear that this would be the case throughout the months of discussions with SAS and NHSH).
      No, it was not possible for me to be aware, perhaps this information could have been made public knowledge. It dose seem crucial to the whole operation of the responders and leads to the question, why has such effort been made to have medically trained Responders as opposed to the SAS trained amateurs (i.e. the original ‘first Responders’), if only basic set Ambulance procedures can be carried out ?
      I certainly would like to reopen discussions with SAS and NHSH on this and your further comments would suggest you would to.
      I really feel, and pure logic would seem to dictate, that even if ‘ … they were at meetings ..’ “intractable on this”, - this all has to change following Holyrood and the successful agreement reached that that responders would be highly trained medical personnel. I do not believe Nicola Stugeon had accepted at the meeting, that the Nurses etc. were NOT going to use their additional knowledge and skills. She readily stated that the amateur ‘first responder’ model was unacceptable and should never have been proposed!
      Nobody I believe, is questioning the need for further training, but this should be to extend the role of the Nurses not restrict them.

      Continued - see Reply 2

      Delete
    3. I am sure that with the right effort, incentives the SAS could have met the obligation for six highly trained medical personnel by now.
      I am not aware of any Responder adverts that seek; GP or Nurse practitioner trained personnel and surely the advert (for one post and 6 posts) should have been on the NHS site as well as the SAS.

      Re - The general model is being set up in perpetuity and is not based on the skill sets of the specific individuals currently recruited.

      I am sorry but I must disagree with you here, The new Model should not be allowed to be set up as a ‘one size fits all’ to the ‘lowest common denominator’ (it is that type of thinking that took our original Nurse emergency cover away) but really must be flexible enough to make the, best use possible, of the training of all the community members, available for that community.


      With regard to the best suited personnel and training for emergencies. The research I have done and questions placed, (not to mention anecdotal information), would all indicate that; For our situation where an Emergency Dept is an hour and a half /two hours away at best. Of the responders we have available the NSH trained staff (with or even without the additional training) is more appropriate then the SAS.
      See:-
      http://www.nhscareers.nhs.uk/details/default.aspx?id=906
      …………Ambulance technicians are members of the accident and emergency crew, answering 999 calls. Working alongside a paramedic, they give patients potentially lifesaving care at the scene and then get them to hospital as soon as possible.
      More worryingly http://www.nhscareers.nhs.uk/details/default.aspx?id=907 for the up-graded position I mentioned before, of Ambulance care assistant, does not even mention that.
      also of interest;
      https://jobs.scot.nhs.uk/uploads/72/Technician.pdf
      Wikipedia and I am sure many more.
      {One site I can no-longer find at this time, for Ambulance care assistant. Stated …….transport etc…….. Then (something like) in emergency situations the primary roll was to monitor the patent and report changes in their condition to the attending medical practitioner. }


      With regard to Jessie and BASICS training - yes I agree – If she felt it was appropriate, then that is good enough for me. Should we not push for this for the other responder nurses, rather than the seemingly restricted training, leading to no recognised qualification, currently being undertaken?
      I understand at least part of BASICS course can be by remote learning.


      On the subject of the responder leader; My view is there is only one person appropriate, at least in the short/medium term and that is Jessie.
      Look at your own comments above, the way the SAS has behaved to date, and their very recent actions and answer, who is it they are putting forward as leader. My concern is to see that before an appointment is officially made the community expresses forcefully who they wish to see appointed. I feel we have very little time, once the appointment is made it could be very hard work to undo it.

      I really do not except the, wait and see/give it time, approach is acceptable any more.
      This really could be people’s lives and SAS has had over two months.
      Is it not time for this ‘Russian Roulette’ to end and fast ?
      Even with limited knowledge, I understand one previous emergency that occurred in the past at the Sonachan with 100% success - cannot currently be covered by the Ambulance !
      I feel the community should be actively participating and perhaps pushing hard, even to the extent of having the interim paramedic cover reinstated.

      Continued Reply 3

      Delete
    4. Reply 2


      I am sure that with the right effort, incentives the SAS could have met the obligation for six highly trained medical personnel by now.
      I am not aware of any Responder adverts that seek; GP or Nurse practitioner trained personnel and surely the advert (for one post and 6 posts) should have been on the NHS site as well as the SAS.

      Re - The general model is being set up in perpetuity and is not based on the skill sets of the specific individuals currently recruited.

      I am sorry but I must disagree with you here, The new Model should not be allowed to be set up as a ‘one size fits all’ to the ‘lowest common denominator’ (it is that type of thinking that took our original Nurse emergency cover away) but really must be flexible enough to make the, best use possible, of the training of all the community members, available for that community.


      With regard to the best suited personnel and training for emergencies. The research I have done and questions placed, (not to mention anecdotal information), would all indicate that; For our situation where an Emergency Dept is an hour and a half /two hours away at best. Of the responders we have available the NSH trained staff (with or even without the additional training) is more appropriate then the SAS.
      See:-
      http://www.nhscareers.nhs.uk/details/default.aspx?id=906
      …………Ambulance technicians are members of the accident and emergency crew, answering 999 calls. Working alongside a paramedic, they give patients potentially lifesaving care at the scene and then get them to hospital as soon as possible.
      More worryingly http://www.nhscareers.nhs.uk/details/default.aspx?id=907 for the up-graded position I mentioned before, of Ambulance care assistant, does not even mention that.
      also of interest;
      https://jobs.scot.nhs.uk/uploads/72/Technician.pdf
      Wikipedia and I am sure many more.
      {One site I can no-longer find at this time, for Ambulance care assistant. Stated …….transport etc…….. Then (something like) in emergency situations the primary roll was to monitor the patent and report changes in their condition to the attending medical practitioner. }


      With regard to Jessie and BASICS training - yes I agree – If she felt it was appropriate, then that is good enough for me. Should we not push for this for the other responder nurses, rather than the seemingly restricted training, leading to no recognised qualification, currently being undertaken?
      I understand at least part of BASICS course can be by remote learning.


      On the subject of the responder leader; My view is there is only one person appropriate, at least in the short/medium term and that is Jessie.
      Look at your own comments above, the way the SAS has behaved to date, and their very recent actions and answer, who is it they are putting forward as leader. My concern is to see that before an appointment is officially made the community expresses forcefully who they wish to see appointed. I feel we have very little time, once the appointment is made it could be very hard work to undo it.

      I really do not except the, wait and see/give it time, approach is acceptable any more.
      This really could be people’s lives and SAS has had over two months.
      Is it not time for this ‘Russian Roulette’ to end and fast ?
      Even with limited knowledge, I understand one previous emergency that occurred in the past at the Sonachan with 100% success - cannot currently be covered by the Ambulance !
      I feel the community should be actively participating and perhaps pushing hard, even to the extent of having the interim paramedic cover reinstated.

      CONTUED - Reply 3

      Delete
    5. Continued - Reply 3

      If it is the case, and for whatever reasons (like all the ones we know of time work, family) and I know it has been expressed at the Community Council that a certain amount of ‘Battle fatigue’ was setting in. Still please keep the community involved, there seems to be information we are not party to and a great deal of ‘apprehension’ amongst the members of the community I speak to. I am sure a number of them would carry the fight forward with you if they were asked. A public meeting would also allow for the community to express its feelings and perhaps give direction to how the responder model would be progressed.


      Knowing as well as I do, the deep reluctance of all medical Professionals to create even minor ‘waves’. I feel that rather then expecting responders to approach the Community council, the working group could reform and invite the responders. They may or may not attend and may or may not answer questions but I feel it would be the better approach.


      I acknowledge Fiona’s comments particularly re. the nurse and Doctor fight but I feel if the nurse cover is to be this patchy and the on-call doctor, a locum in Fort William in just over three months. Then it is even more vital that having worked so hard and won the basis for an excellent Responder Team, we must see through that it is the very best possible. I thought we had sometime ago reached the point where the community expressed that it could not work with the NHSH and SAS or just let them carry on with their plans, hence the campaign and Hollyrood.

      Lets not forget with the sun shining - The responder team needs to cover life/death , possibly multiple emergencies, when the Strontian ambulance is either unavailable or not full manned with a paramedic, the whether is bad so the road is slow and the helicopter cannot land !!!
      We have surely all envisaged this nightmare scenario – lets work again to avoid any tragedy.

      Jonathan

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    6. Please can comments be kept short and to the point. The above commentator's incomprehensible ramblings are doing nothing to help our cause. On the contrary, the negativity risks damaging what we have achieved in the way of SAS cover. I suspect a self-seeking hidden agenda!

      Delete
  4. Mairi Mcfarlane9 May 2012 at 12:57

    Perhaps Adelphi could put the money towards an adequate Health Service !!

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  5. Please don't let disagreements about SAS protocols and their relevance divert us or (worse) divide us. Of course it's mad that local medical/nursing people's existing qualifications and experience are not recognised and used to the best advantage to help the community.
    In any other line of business - though not, it seems, in NHS complacent, self-regarding and self-protecting bureaucracy - one-off transitional arrangements would have been made by now, to make the best use of ALL the resources available locally (Sam, nurses, Emergency Responders, volunteers etc) until the SAS/NHS ideal could be achieved. I think we should press for such transitional arrangements to be made, as strongly as we can. But I also think that the SAS (surprisingly) is actually fulfilling more of its promises that other bits of the NHS. If we want more from them, we should work with them rather than against them to get it.

    I am only one voice, but I think that we should URGENTLY be looking at the bigger picture right now, ready to present to Nicola Sturgeon. In just a few weeks, we are going to have:

    * No local GPs or practice manager - and who knows what in the way of important practice-based services. Maybe very little.

    * Partially-trained SAS staff and volunteers/Responders who are unhappy/very poorly-managed/disaffected/over-worked and exploited etc etc etc

    * District nurses that are NOT working as promised to Ms Sturgeon and - apart from our kind and helpful local nurse - rarely here, or late, or inadequate, or dangerously error-prone.

    I think we should get Alex Salmond here as well as Nicola Sturgeon, plus as much media as we can manage. I also think we should hire a PROFESSIONAL PR person to manage a campaign for us, as a matter of urgency.

    I agree with Mairi that Adelphi could help the community by being seen to join in our campaign and doing its best - though whatever channels of communication or influence that is has - to try and achieve a solution to our problems. It might also consider contributing to PR costs, as above.

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