In reviewing progress with the Integrated Care Pilot a number of clinical concerns about withdrawing the anaesthetic cover have emerged from anaesthetists and physicians.It has become clear that the implementation of the next phase of the pilot cannot proceed.
As the pilot offered the only possible alternative solution for maintaining the out-of-hours emergency cover required for urgent inpatient admissions NHS Greater Glasgow and Clyde now has no alternative but to plan the transfer of these services to other hospitals in Greater Glasgow and Clyde.
These changes will not happen immediately and in the meantime, we will maintain the existing out-of-hours cover at the Vale of Leven Hospital.
We are committed to maximising the level of rehabilitation and planned inpatient care that can be transferred to the Vale of Leven to maintain the highest possible level of local access.
This briefing also contains additional background information on the pilot project, quotes that can be attributed to NHS Greater Glasgow and Clyde and details of a planned public meeting.
You can view the Vale of Leven Integrated care Pilot leaflet by clicking the following link, however the text below outlines the same information provided in the leaflet.
This briefing note provides information about the outcome of the Vale of Leven Integrated care Pilot
A few years ago it became clear that it would no longer be possible to maintain the out-of-hours anaesthetic and medical cover required to treat medical emergencies at the Vale of Leven Hospital through traditional models of inpatient care. This is because of national changes to junior doctor working hours and difficulties in recruiting permanent anaesthetic staff. Currently the out-of-hours cover at the hospital relies totally on short-term locum anaesthetists and locum doctors also provide much of the consultant cover.
The Integrated Care Pilot Project was put forward as an innovative solution to these problems, bringing together the skills of primary and secondary care with overnight cover at the hospital to be provided by local GPs who had undergone additional training.
The pilot project has been implemented in stages from January 2006. On 1st April 2006 NHS Greater Glasgow and Clyde took over responsibility for the pilot and since then we have been working with local staff to take forward the pilot.
To-date the pilot has not been fully implemented and the medical staff and GPs have continued to have access to immediate anaesthetic and junior medical cover. The next stage would be to withdraw this cover to pilot the full model. However, in reviewing progress with the pilot so far a number of clinical concerns about the safety of withdrawing the anaesthetic cover have emerged from anaesthetists and physicians.
In the light of those clinical concerns it would not be safe to proceed with the pilot project and this means that the integrated care model cannot be fully implemented.The pilot offered the only possible alternative solution for maintaining the out-of-hours medical cover required for emergency inpatient admissions. We now have no alternative but to plan the transfer of these services to other hospitals. It is very disappointing that the pilot project cannot proceed as planned, however, safety is our top priority.
We are also committed to maximising the level of rehabilitation and planned inpatient care that can be transferred to the Vale of Leven to maintain the highest possible level of local access.
-It has become clear that the implementation of the next phase of the pilot, which would see the removal of immediate anaesthetic support from the Vale site, cannot proceed because of concerns about clinical safety.
-This means that the integrated care model, as it was developed, does not represent a safe way of providing emergency inpatient care for the Vale's population.
-The clinical safety concerns are not about the pilot, as it is currently operating, but about implementing it's next phase. The present arrangements will remain in place until alternative services have been carefully planned, looking at potential provision of the emergency inpatient service across Glasgow and Clyde hospitals.
-NHSGGC are committed to retaining consultant led, inpatient services, at the Vale of Leven.
-While we need to plan alternative arrangements for emergency inpatient care our objective will be to maximise the inpatient activity which can be provided at the Vale and to aim to retain the present level of staff at the hospital.
-We also continue to see a central role for primary care physicians in the future clinical arrangements for the Vale, building on the expertise and skills which local GP's have developed during the pilot.
This outcome of the pilot is a major disappointment, particularly for local staff, who have worked very hard to develop the model. Three things are important to emphasise:
-It is important to acknowledge the contribution of hospital staff and their primary care colleagues to the development of the integrated care model and that the learning from that work and the pilot so far, has clearly improved patient care. We will be looking at how that learning can be used in our other hospitals as well as be further developed for the inpatient services which will continue to be provided at the Vale.
-The changes which will be required to arrangements for emergency medicine will not threaten or undermine the provision of the other services at the hospital.
When will the transfer of urgent medical emergencies take place?
This will not happen immediately as we need to carefully plan the replacement service. The present arrangements for emergency inpatient care will remain at the Vale of Leven until alternative arrangements are put in place.
What will this mean for local patients?
Once these alternative arrangements are in place, all emergency medical patients currently referred to the Vale of Leven Hospital will be transferred to other acute hospitals in Greater Glasgow and Clyde. This means that in the future if you suddenly become ill and need to be admitted to hospital for urgent treatment you will be taken to another acute hospital. After you have received the treatment or operation you require you will then be transferred back to the Vale of Leven hospital for follow-up care. This will make it easier for family and friends to visit you as you recover. Seriously ill patients with head injuries and breathing problems are already being transferred to other hospitals to ensure they have access to intensive care facilities.
What services will continue to be provided by the Vale of Leven?
The Vale of Leven Hospital will continue to provide inpatient care for non-urgent treatment, operations and procedures. In addition, it will continue to provide a wide range of outpatient and day services. These include kidney dialysis, cardiac and x-ray investigations and day surgery services.
What out of hours services will patients be able to access at the Vale of Leven?
The GP out-of-hours service will remain at the hospital. This provides care and treatment for local people who require assessment or treatment by a doctor out-with normal GP surgery times. In addition, local patients will continue to have access to the Minor Injuries Unit at the hospital from 9am to 9pm, 7 days a week. This unit provides assessment and treatment for adults and children over 5 with minor limb injuries (including X-rays for suspected broken bones), wounds requiring dressings or stitches, minor burns and minor eye, ear or nose injuries.
Aren't there any other options for out-of-hours cover that could be explored?
No, the former NHS Argyll and Clyde Board explored a wide range of options and the Integrated Care Pilot Project offered the only possible alternative solution for providing out-of-hours medical cover at the Vale of Leven Hospital.
Who will be involved in taking forward plans ?
We are committed to working with local staff, patients, GPs and the ambulance service to take forward plans for the Vale of Leven Hospital over the next few months.
We are making this briefing widely available to ensure that local interests are kept fully informed and the public meeting will also offer an opportunity to get further information. A planning group will be established to take forward work on the development of the inpatient services as well as the alternative arrangements for emergency inpatient care. We will ensure that the planning process involves local clinical staff and that it's work is visible through our web site and other communications.
Dr Brian Cowan, Medical Director of NHS Greater Glasgow and Clyde, said: "As a result of the clinical concerns it is clear that it would not be safe to proceed with the move to the full pilot project and, therefore the integrated care model cannot be implemented. As the pilot offered the only possible alternative solution for maintaining the out-of-hours medical cover required to provide emergency inpatient admissions at the Vale of Leven Hospital we now have no alternative but to transfer these services to other hospitals as soon as possible.
"It is important to point out these changes will not happen immediately and we will therefore take steps to maintain the out-of-hours cover at the Vale of Leven until a replacement service can be put in place. We are also committed to working with staff, patients, GPs and the ambulance service to put in place the very best alternative arrangements for local people and their families.
"A lot of hard work and effort has gone into developing this pilot over the last two years and we are very disappointed that it cannot be taken forward as planned. Patient safety, however, is paramount and we cannot proceed with piloting a model of care where there are concerns about clinical safety.
"We are also committed to looking at the extent to which we can maximise the level of rehabilitation and planned inpatient care at the Vale of Leven Hospital to maintain the highest possible level of local access. The hospital will continue to provide inpatient operations and procedures, and outpatient services including kidney dialysis, cardiac investigation and day surgery.
"The GP out-of-hours service and the Minor Injuries Unit, which is open from 9.00 am to 9.00 pm - 7 days a week, will continue to operate from the hospital to provide a wide range of services for patients who require to see a doctor or nurse after normal working hours."
Briefings were issued to staff on Friday, 1st September 2006 and a follow-up meeting for staff will be held in the Vale of Leven Hospital on Wednesday 6th September 2006.
A public meeting has been organised to give local patients, community groups and other key stakeholders the opportunity to hear more about these developments and the proposed next steps in more detail. The meeting is open to everyone, however, anyone wishing to attend should register in advance by telephoning 0141 201 4908 during office hours. This will help ensure we can cater effectively for demand and meet any special requirements that individuals may have.
The meeting will take place on
Date:Thursday 21st September 2006
Strathclyde Homes Stadium