LISMORE COMMUNITY COUNCIL

Minutes of the meeting held at 7pm on Thursday 23rd November 2006

 

 

 

Present

 

John Carmichael (Chair)                                     Archie McGillivray

Jim MacCormick                                                                Jon Derham

Mark Willis                                                                    Duncan Livingston

Johhny McFadyen

 

Mandie Currie (Secretary)

 

 

In attendance

 

Erik Jespersen (Clinical Director, Argyll Community Health Partnership)

John Lyon (Clinical Director, Oban, Lorn & Isles Locality)

Hilary Brown (Clinical Services Manager, Lorn & Isles)

 

Apologies

 

Cllr Elaine Robertson

 

Minutes of the meeting held on 12th October 2006-11-26

Proposed by Mark Willis, seconded by Jon Derham; the minutes were adopted as a true record.

 

Matters arising

Waste collection - Archie reported that he had spoken to Sandra Duncan and a skip lorry will be brought in approx. four times a year to collect large items; the first uplift will be on 13th January and notice will be given prior to subsequent uplifts. It would be helpful if anyone with anything to be taken could advise either Mandie or Sandra Duncan direct, to ensure that the appropriate size of vehicle is sent across. Sandra confirmed that anyone requiring builders’ rubble, bathroom suites etc to be uplifted, or anyone requiring items to be removed in-between the scheduled uplifts, should contact her direct.

 

Several people expressed confusion over the items that can be placed in the different recycling and waste bins. It was agreed that Sandra should be contacted to provide information. Action: Secretary to contact Sandra Duncan to request information for circulation. This has been done and notices have been placed on the noticeboards.

 

Archie also reported that Sandra had advised that some waste had been placed in one or several of the paper recycling bins, which had contaminated the paper, and this had resulted in the paper having to be dumped in the landfill. The Council will send someone to monitor the next uplift of paper, to ensure that none of the paper bins contain food waste or other inappropriate items, and to provide advice as required.

 

New Correspondence

There was no significant correspondence, but a number of items were dealt with under AOB.

 

Out of Hours Health Issues

The Chair welcomed Erik Jespersen, Hilary Brown and John Lyon to the meeting. Julian gave a brief outline of the Community Council’s concerns regarding the changes to out of hours services, primarily the loss of the relief nurse post. He also updated the meeting on the various meetings and correspondence that have occurred to date, covering the lack of cover of Lismore by the Scottish Ambulance Service; the development of a helicopter landing area with temporary lighting; ferry issues; response times; the appropriateness of NHS24 for the Lismore situation and the improved stability brought by the arrival of Dr Mary to the GP team. Full time (24/7) nursing cover has previously been provided on the island and islanders are concerned about the clinical safety of the situation on the island at weekends and other periods when the nursing practitioner is away/on leave.

 

Erik Jespersen then commented on the CHP’s position on health care provision for Lismore and Appin and specifically, on out of hours care on Lismore.  He explained that:

 

·       24/7 nursing cover is acknowledged as being the previous norm, but that the resignation of the relief nurse had led to a reassessment of the situation and it had been decided that available resources would be better spent on health promotion in the wider community of both Lismore and Appin.

·       The nurse practitioner (and any cover for the leave period) provides 5 day cover. There is a lack of suitably qualified/experienced staff in the current employment pool and no suitable training programmes that cover the responsibilities and the range of specialist skills involved in this type of post.

·       There is potential for a high degree of professional risk to the postholder, with a high risk of inappropriate clinical decisions being made.  The decision was taken to focus on public/community health and to concentrate on transporting patients to Hospital as quickly as possible.

·       The current situation allows for the nursing practitioner to have time to undertake training, skills development, networking etc.

·       The longer term plan is for the GP practice to be maintained in Appin. Some progress has been made by the Scottish Ambulance Service on developing the helipad/helicopter lights and the ambulance auxillaries.

·       The rapid response situation requires someone able to administer first aid and to operate the defibrillator. The view is that to use appropriately trained first responders would be the best use of resources. This first response situation doesn’t require nursing skills. Palliative care will continue to be provided at weekends and whenever required.

 

Iain McNicol was also asked to speak. He commented that:

·       The nursing practitioner post was a Scottish pilot, to support the sustainability of the island. However, he acknowledged that there is now a different social/economic climate, which recognises different working regimes and that finding the right person for this type of post is now a challenge.

·       Although preventative medicine is of great importance, medical problems are still likely to arise, some of them at weekends. The local population has less choice and flexibility than the mainland; they are unable to transport themselves to Hospital in the event of a delay with emergency services.

·       In poor weather conditions, there could be no medical cover on the island for hours and this puts the population in a vulnerable position. There are 72 hours in the week with no cover and until there is a pool of trained and skilled first aiders, there will be a serious gap in any form of emergency cover for the island. Glensanda quarry have 52 staff members with appropriate first aid skills and never require the doctor to attend any emergencies.

 

The SAS want to appoint three retained drivers with first aid skills and training in the use of a defribrillator – these would be first responder ambulance drivers and would receive some remuneration for their services.         

 

There was comment from the floor. It was recognised that there are higher costs in providing services to remote/island locations. CHP representatives emphasised that this was not simply a resource issue, and that Lismore was better resourced than other locations. There is a serious recruitment issue: appropriately skilled, professional staff are required. But it was pointed out that the nursing practitioner did not have the full range of skills when she first took up the post and that she had developed these over time. A relief nurse could also develop their skills/experience in the post and would not be expected to arrive with the full skills complement.

 

The CHP representatives emphasised again that there were serious demographic issues – the average age of nurses in the area is 51 and a serious skills gap is developing. Newly qualifying nurses and doctors have a different set of expectations and tend to specialise within large Hospitals. When the relief nurse post was last advertised, at least 35 people expressed an interest but there was ultimately only one applicant. The others were unwilling to take on the level of responsibility involved and the professional and personal isolation that the post entailed, at the salary offered. The Oban practice had also failed to get applicants, and with no out of hours duties – there is a general shortage of both doctors and nurses.

 

Members of the public re-emphasised the points already made, that a first responder would be in the same position of risk as a relief nurse, but without the same degree of appropriate medical training. Circumstances where there is no access to the island e.g. bad weather, would present a high clinical risk. There has always been 24 hour nursing cover on Lismore and this service has been removed. The islanders need and want a full-time nurse on the island. There is general support for the establishment of a helipad, provision of helicopters and first responders, but these should be additional to the local nursing/GP provision.

 

Counter arguments were that more would be expected of the nurse; they would feel that they would have to make a diagnosis, which they might not be qualified to do, whereas a first responder would phone the Doctor/Hospital to get a diagnosis. Dialling 999 would initiate the professional response and the first responder would get there first, followed by the Doctor. However, the nurses have always maintained close contact with the GP to reach a diagnosis and this could continue.

 

CHP representatives stressed that they take their responsibilities to the island seriously but that they had to carry out a risk assessment and balance the overall need. The island’s situation is relatively unusual, with a GP based on the mainland. Only Luing and Iona are comparable; and they do not have a nurse, whereas Lismore has always had a nurse - until recently.

 

All agreed that the ideal situation would be to have the GP based on the island. Ian has already agreed that he will time his retirement to meet the needs of the practice, in order to ensure that the right package of professional skills is maintained. Different options will be explored in a project being developed by the Community Council in collaboration with a health economist at UHI. This will cover all primary care services – including GP and nursing provisions.

 

Discussions returned to the nursing post. It was pointed out that there is increasing interest in living in rural locations, particularly the islands. The GP vacancy in Jura attracted a huge response.  Islanders requested that the post be re-advertised, with the community’s involvement, and that suitable accommodation should be identified - as the lack of accommodation had been a problem for the previous postholder. Mairi stressed that whatever happened, palliative care would be provided at weekends, as required. Concern was also expressed about the lack of consultation prior to the decision being taken to remove the relief nurse post.

 

After a great deal more discussion, the CHP representatives agreed to revisit the situation and to consider developing a job description with input from the community and the practice, and then re-advertising the post.

 

Ferry issues

 

No new information received on the STAG appraisal, other than that an announcement will be made at the same time as the ferry tenders are announced.

 

Jon Derham raised the fact that the 8pm ferry at Point costs £45 in winter but only £1.20 in summer. He suggested that the Community Council requests that in winter, the 8pm ferry could be bookable on request, at 12 hours notice, and at a £1.20 cost (as per the 9:30pm ferry on a Friday/Saturday). This would fit with working hours directives, as it does in summer.

Action: Secretary to contact A&B.

 

It was pointed out that the ansaphone message in the ferry house is not always updated to advise if the ferry is not running etc. Action: Secretary to contact the ferrymen to ensure that messages are updated in future.

 

AOB

 

Rural Post Offices are being closed and the Post Office Card Account will finish in 2010.

Action: Secretary to write to relevant Minister, emphasising importance of post offices in remote, rural and island locations.

 

Duncan Brooks advised that a post would be advertised on the island, for an additional person to work the airbrakes, in the event of a power cut.

 

Lights in Appin car park toilets – these lights switch on automatically when someone enters the toilet block and they are switching off after only a few minutes, leaving anyone in the cubicle in total darkness.

Action: Secretary to contact Sandra Duncan to resolve.

 

Date of next meeting: Thursday 25th January 2007 

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