Health & Social Care

This continues from my 2 previous posts, here and here. These posts dealt with the same subject but focussed on the antics of Cllr Walsh and his refusal to submit a motion to the next council meeting. He has been reading my blog and has taken offence at what I have said. He’s asked me to print an email from him which I’ll happily do this week some time.

For the moment, though, I want to concentrate on the correspondence with the chief executive of the Interated Joint Board for Health & Social Care (IJB). This is not all of the correspondence but it gives you a flavour of the efforts made to try and get the IJB to change its mind over the closure of Struan Lodge in Dunoon and the cessation of dementia services at Thomson Court in Rothesay.

From Michael Russell MSP to the IJB chief executive on 6 August:

Dear Christina

I write in connection with the decision to close the above facilities made by the IJB.

You will be aware that at the Argyll & Bute Area Committee held in Rothesay on Tuesday a member of your staff admitted that the “consultation” process announced regarding these closures was a sham and confirmed that the  decision to close had been made on 22nd June before the “consultation” was even announced. 

It is utterly unacceptable for an accountable public body to behave in this way.  “Consultation” means “Consultation”.  it does not mean attempting to perpetrate a confidence trick on the community by using warm words to cover up actions which are strongly opposed by those to whom the body is accountable.   

In addition it does not mean presenting figures and information which is not verified and robustly refuted as if it had  official imprimatur.

The IJB has got off to a very bad start.     There is no doubt that the public will refuse to place its confidence and trust in a body which operates in this way.  and that would bode very ill for the delivery of vital health and community care services in our area.

I therefore write to ask that you immediately revoke the closure decision (which I also understand will save virtually no money in this financial year) , apologise openly to the communities affected for operating in this way, undertake a review to ensure that your governance is radically improved and confirm that there will be no repetition of such actions.,

I am copying in your Convener and Vice Convener, the Bute and Cowal Councillors and the local media.

Yours sincerely

Michael W Russell 

Before Christina replied, I added the following on 12 August:

Since I was copied into this I think it’s reasonable that I make a point here Christina.

It was the total lack of consultation prior to the decision that is the issue, not how you intend to consult from now on having made the decision.

Not only was there a lack of consultation, the decisions on Thomson Court and Struan Lodge were based on absolutely no evidence of demand. Closure of Struan Lodge today would leave no spare bed capacity at all for Dunoon and Cowal. In 25 years the numbers over 75 will double across Argyll & Bute but I don’t know what the position will be in Cowal, do you Christina?

Pasted below is what I said on 28 July to the locality planning group when I was unable to attend the first group meeting.

Regards

I have not, as yet, seen any evidence that supports the proposal to close the care beds at Struan Lodge. Let me be clear about what I would need to see before I could support any such decision:

• A long term, ie 25 year minimum, projection on the numbers of elderly people in Cowal.
• Within this, I’d need to see a breakdown of the numbers in various elderly age groups based on best projections of increasing life expectancy.
• The next key part of the information needed would be projections of the elderly who would need care of some type, split by care type. Having a larger percentage of the elderly cared for at home is accepted but with the growth in the numbers of elderly people, this could still mean an increase in the absolute number of care beds that are needed.
• All of the above needs considered against current and projected future capacity.

As of today, there are 10 bed vacancies in Cowal. I got this from the papers for next week’s area committee. I am told that one of the care homes with 8 of these vacancies can’t actually fill them due to either finance or staffing issues. Even if that information is incorrect, closing Struan today would fill current spare capacity.

3 years ago, when the ill-conceived proposal to close Struan first surfaced, we were told there were 38 bed vacancies. We have a maximum of 10 today so demand has increased in 3 years; what will happen over the next 25+ years?

The empirical evidence to support the closure of care beds needs to be both long term and as sound as it can be before any decisions are taken. It’s far harder to create new capacity than it is to shrink it.

Michael Breslin

On 12 August, Christina West replied as follows:

Thank you for your email Mike,

the IJB have carefully considered the difficult decisions to progress the urgent transformation of health and social care. As part of proceeding with the redesign of these services, in line with national policy, the IJB have directed that there will be full public involvement and engagement with users, stakeholders and the public as we progress implementation of our new model over the next three years.

As stakeholders we will keep MSPs and elected members appraised of our process for involving and engaging with the users of services and the public. This will include meetings with those stakeholders and my office will be in touch in due course.

Yours sincerely

Christina

Michael Russell then replied as follows on 16 August:

Dear Christina

Thanks for your reply to my email regarding the above. 

I have the greatest of admiration for your skills and this is a skilful reply not least because it answers questions I didn’t ask, but in so doing fails to answer the ones I did.

I am absolutely sure that the IJB will include relevant stakeholders going forward but that was not the point at issue.   The trouble is it didn’t include them when it made the decision on closing Struan Lodge and Thompson Court .   Moreover, to add insult to injury, it pretended that it was going to consult on the closures but instead only intended to consult on the consequences of closure and how those might be best managed.  In addition your answer seems to imply that consultation after decisions are made will be the norm going forward. 

That is – in terms of public accountability and public trust – very unfortunate.   You cannot be unaware of the huge public outcry in Cowal and Bute both about the substantive issue and this slight of hand and your answer has done nothing at all to help the situation.    

Accordingly let me be more explicit regarding the issues I would wish to see addressed by the IJB , and answered by yourself.    These were contained in the final paragraph of my email but I will separate them out to make clear the information, and changes, that I am seeking :

1) I am asking the IJB to immediately revoke the closure decision.   

2) I am asking the IJB to apologise for the way it has handled the closure decision.   The Provost told the Area Committee in Bute two weeks ago that you were “very sorry” for this and wanted to apologise.  If that is so, please do so.  If that is not so, perhaps you can explain why the Provost was so explicit about it and about his conversation with you regarding the matter.  Certainly your response to me contains not a hint at apology. 

3) I am asking the IJB to review the governance of the organisation to ensure that such a flawed process cannot be repeated – in other words when closures decisions are made they are announced as such and are pre-ceded by consultation, not followed by consultation.   The organisation also needs to be open about closures as I am told that press requests for the minutes of the meeting on 22nd June were evaded .  That is not the type of open, transparent decision making that is expected of public bodies in Scotland. 

4) I am asking you to confirm that there will be no repetition of these actions.  In other words I am asking that 3) above informs all future processes with regard to closures.

The points that Michael Breslin has made in response to you are also germane.  I would therefore add two further requests

5) I am asking for full information on the cost savings in this financial year, and in future financial years, from the closure of Struan Lodge and Thompson Court.

6) I am asking for all the information used to assess the consequences of closure and in particular the projections for care of the elderly and available high quality spaces in Cowal.

I look forward to hearing from you.   I have copied this to the original copy list and added in the new Chair of the IJB who , when he takes office, will have to address this major difficulty. 

Yours aye

Michael 

Christina’s reply was sent on 23 August, as follows:

Dear Mike,

I can confirm that the IJB reviewed the decisions made on 22^nd June at their meeting on 4^th August and concluded that they would not revoke their decision regarding Struan Lodge and Thomson Court as they are in accord with the 3 year Strategic Plan. The Board has acknowledged the timing of the announcement was poor and has apologised for this at its meeting on the 4^th August, which will be captured in the publicly available minuted record. It has also directed its officers to reflect this in the planning and engagement events going forward.

The IJB is and will continue to review its processes and systems as it develops as a Board and tackles the urgent service delivery challenges it faces across Argyll and Bute. In line with the legislative framework of integration, the IJB expects the 8 Locality Planning Groups, as they develop in capacity and capability, to be at the forefront of the engagement and involvement processes with communities over the next 3 years, which should prevent a recurrence of this in the future.

The Head of Service is overseeing a period of engagement with the current residents and service users, their family and carers to ensure the plans that are developed are person centred and meet the needs of the individuals.

We are currently pulling together the detailed information detailed in points 5 and 6 of your email, as requested by the Locality Planning Group, as part of its information gathering and analysis. This will be brought to future meetings to inform the redesign of local services in line with the strategic plan. We will share this with you and other stakeholders either at a meeting or via a briefing note.

Yours sincerely

Christina.

On 9 September, I emailed Christina, cc all the people copied into all the above correspondence, with the following:

Good morning Christina. As you have not replied, and since I attended my first meeting of the locality planning group yesterday, I think you should know the following:

There is still precious little evidence of demand but some information has come to light which suggests a shortage of around 30 care home beds in Cowal at some point in the future. This came with a caveat to the effect that this what would happen if the way we do things doesn’t change. I am all for doing things differently and that is why I support the changes that have been ongoing here for around 3 years, where more home care is being provided rather than residential care. Despite that shift in the way we do things, the number of available care beds would be zero if we closed Struan today. See below to see what has happened in 3 years.

There is still an information deficit here Christina and until we have year by year projections as outlined below, I regret I have to retain my stance of opposition to the closure of Struan Lodge.

Regards

Michael Breslin

Lastly, Michael Russell wrote as follows on 11 September:

Dear Christina

I am afraid I am not prepared to accept that the issue is concluded.

There is a public meeting in Dunoon next week at which I will speak and I will indicate my continuing opposition to the closures and in particular to the way in which they were decided upon and implemented.  That, to me, is almost as big an issue as the decision itself.   No such decisions should be able to stand if they are so flawed in execution and if they are based on such flimsy financial and community evidence.   

Moreover this is an appalling way to start the business of the IJB.  The IJB will require all the public backing it can get to undertake the difficult task of adapting health and social care provisions to the increasing needs of our time and the particular difficulties of this place.   For its first significant impact to be one that speaks so strongly of  distant , unaccountable bureaucracy can do nothing but undermine its potential for success and erode public confidence in its actions and processes.   You cannot hope to tackle what you rightly categorise as “urgent service delivery challenges” without the strongest degree of public buy-in and that will be impossible to secure unless you are willing to re-consder these decisions and start afresh with genuine consultation. 

Accordingly I have written to the Cabinet Secretary for Health to make these points and to support the overwhelming opinion within Bute and Cowal which continues to oppose the closures.  In so doing I have also backed the approach to the Cabinet Secretary made by Cllrs Macintyre and Strong who I am certain reflect accurately the views of the Island of Bute. 

Yours sincerely

Michael Russell MSP
You will see that there appears to be an impasse here but the fact remains that, with no evidence base for closure nor any consultation, the IJB has not exactly got off to a good start. There’s another angle to this too which is that the IJB is not the employer of the council staff employed at Struan Lodge and Thomson Court. Can it be right that a body that isn’t the employer takes a decision that could make someone else’s staff redundant? Is this not a decision for one of the partners in the IJB, ie the council itself?