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Written by Gordon Neish
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Wednesday, 23 December 2009 12:27 |
VIV Smith, Cowal and Bute Locality Manager for NHS Highland, spoke to the Dunoon Observer on Monday about the ongoing closure of Cowal Hospice.
Present at the meeting in Dunoon Hospital were the Dunoon Observer (DO), Viv Smith (VS) and Pat Tyrrell (PT), Lead Nurse of Argyll and Bute CHP.
The conversation ran as follows:
DO: Why was no statement made before Cowal Hospice closed?
VS: It was, but it wasn’t printed.
DO: Who did that go to?
VS: The press. We sent it to you and you came back with lots of questions.
DO: Was that not after the event?
VS: It was within a few days.
DO: I remember the statement you are talking about, and I’m sure that was two weeks after.
VS: It was the Monday or Tuesday after.
DO: Was the hospice closed for financial reasons?
VS: Absolutely not.
DO: How many hospice patients have been cared for in the general ward since closure?
VS: One. There have been other patients who have been in the ward, had end-of-life care and died, but they would not have normally gone to the hospice anyway.
PT: There are criteria for admission to the hospice, and we do look after people who are dying in the general wards as well. The staff in the wards do, contrary to people’s opinions, have a lot of experience of looking after people with palliative care and end-of-life needs.
DO: Are relatives allowed to visit hospice patients in the general ward at any time, as they are in the hospice?
VS: There are visiting times, but if it’s someone who is poorly they can come in at any time.
DO: Several Cowal-based bank nurses have contated the paper to say they cannot get work at Dunoon Hospital, even though they have made themselves available. Should they contact the hospital again?
VS: Absolutely. We have exhausted our bank. If they are not registered with us we don’t know about them and can’t contact them.
It means they have to go through Disclosure Scotland and all the checks.
PT: They would have to go through the same process as anybody wishing to be recruited to the service so that we can check that they meet the standards we need for any nurses.
There is a fairly rigorous recruitment process that we expect bank nurses to go through.
DO: Is it cheaper to employ a nurse or engage a bank nurse for a shorter period?
VS: They get paid at the same rate. The only difference between a bank nurse and someone who is employed full-time is the annual leave allocation. It used to be that bank nurses didn’t get annual leave but now they do.
DO: Do you use agency nurses at all?
VS: We don’t use agency nurses - purely because it is very difficult to get them to come here. We would always use bank first. I think once or twice we have managed to get agency nurses down here, but it is difficult to get them here.
PT: There is a national drive to reduce and ultimately stop the use of agency nurses.
Obviously you would have somebody who doesn’t know the area, doesn’t know the people and doesn’t know the issues. They may never have worked in that clinical environment before.
We would try as far as possible to avoid the use of agency nurses and use people who know the local community and the local hospital.
Nationally, agency usage is a lot less than it was even five or ten years ago.
DO: How many front-line staff are off sick at Dunoon Hospital?
VS: I have the latest figure for you. It changes every day. The figure today - another nurse has just rung in sick - is 14. I have a breakdown - across ward one, ward two and the hospice, the three areas affected, between trained and untrained staff 11.7 full-time equivalents - the same as 14 individual members of staff.
DO: How does this compare to the national average?
VS: For sickness?
DO: Yes.
VS: There is a target for us to achieve - a sickness absence of four per cent. Unfortunately our figures aren’t up to date, but I think it was September/October our last figure was reported for six point five.
DO: Are people off with stress-related sickness?
VS: I can’t really comment on individual cases of staff sickness. What I can say is that five members of staff are off because of long-term things that are happening to them and won’t be back until next year, so that’s not stress-related. The other nine are off for a variety of reasons.
DO: When will the hospice re-open?
VS: Well. As we have said previously, we look at staff absence levels every day. We are currently doing the off-duty for January and what we are going to do - we have decided that, providing the staffing levels do not worsen, we will be able to temporarily move ward one and ward two to co-locate in Medicine for the Elderly. So we are bringing those two wards together into the old unit, and that means we can utilise our staff more effectively. That would then leave the hospice staff and patients, along with other patients who require that type of care but might not specifically meet the criteria, in up to four beds in ward one, as there are in the hospice, whilst the hospice is refurbished
We are hoping to do that on January 4. If staff sickness levels go above the 14 we have at the moment we will have to keep that under review. January 4 is a provisional date.
PT: The movement of the other wards into Medicine for the Elderly will increase the capacity to look after the patients.
VS: We’ll still need quite a lot of bank staff, but we think that’s manageable.
DO: When do you think the refurbishment of the hospice will be complete?
VS: As far as I know there has been one tender received and the trustees have accepted it. I imagine now that we are looking until after Christmas before they even start - but it shouldn’t be a long job, two or three weeks.
DO: Are you able to give a guarantee that it won’t close again?
VS: No.
I am not able to give that guarantee because we have had to close the hospice before, on occasion. Maybe a nurse hasn’t turned up, and as that tends to be at very short notice, a contingency needs to be made. If you haven’t got a trained nurse you then need to think about patient safety and you have to move them to where there is a trained nurse. So we can’t guarantee that.
It’s a rare occasion, and this (the current situation) is unprecedented.
DO: Is there anything else you would like to say about the situation?
VS: From my perspective I would just like to provide some clarity in terms of the operational responsibility of the hospice and the management of it.
As people know there is a partnership in place between the hospice and the NHS, and it has been a very, very good partnership over many years.
When the hospice was first originated there was a lot of fundraising and an extension was put on to the existing building that made the facility available. Since then there was an agreement in place that funding would be made available from the trustees to the NHS to support the staffing of the hospice.
That agreement expired two years ago so there has been no funding from the hospice trustees towards staffing in that time period.
So the NHS is responsible for all the recurring costs involved in the hospice, including staff, which totals £414,000 per year - for four beds. And, just to put that into context, that is more or less the budget I have for ward two - 14 beds. So it is the same as running a 14-bedded unit in the hospital. I think the community don’t quite understand that this is unique in that most hospices across Scotland and the UK are not funded by the NHS alone. They are usually stand-alone units with charitable status, or have special status, meaning that they are 50 per cent funded by NHS and 50 per cent funded by charities.
In Dunoon we have a unique position where a hospice is 100 per cent funded by the NHS.
We are very committed to that. but I think people need to understand that there are significant pressures on public sector budgets and, along with our other services, it will need to be looked at to ensure it achieves value for money.
We are happy with the service and with the partnership, but the partnership is 100 per cent funded by the NHS.
DO: So what happens to the thousands of pounds which are donated to the hospice each year?
VS: The hospice trustees do a massive amount of fundraising and we are very lucky to have that fundraising committee. They provide things like volunteer drivers, which Mr Pittman said in the Dunoon Observer costs £35,000 each year to run.
They also have volunteers who come into the hospice every day to help support staff, patients and relatives.
On top of that they will also often ask if we need any equipment over and above the standard equipment used by the NHS.
We kit things out to a standard NHS level and then it might be that the hospice trustees say: “Do you want a specialised bed or piece of bathing equipment for the unit?”
Refurbishment is another thing they always offer to do. The hospice hasn’t been refurbished for 10 years. It isn’t a heavy-use area.
Over and above that they do offer training, funding to staff if they want to do palliative care courses.
Those are the sorts of things they do.
Even though the staffing element has expired, the partnership still exists.
PT: In terms of palliative care as a whole within Argyll and Bute CHP we are working to national policy. We have an action plan built into that.
Across the CHP we are supporting as many people as possible to die as close to home as possible, within their own homes if that’s their choice.
We still have a higher rate of hospital admission in Argyll and Bute than other parts of NHS Highland and we’re really keen to drive that down because all of the evidence is that people want to die in their own home.
We don’t have any hospices in any other part of Argyll and Bute but what we do have are community hospitals and we are working very hard within these hospitals to create the right environment so that, if people do have to die in hospital, they can die with the dignity and care that they need.
On the whole we receive very positive feedback from all the other hospitals from the relatives and families about the care their relatives have been given at end-of-life so the issue of a hospice, it’s a fantastic facility that’s here, but I think people within our other hospitals receive high quality care as well without having a designated hospice.
It’s more about the knowledge and care that the staff give than having a designated unit.
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Last Updated on Wednesday, 30 December 2009 11:04 |
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