In order to answer your question, I will have to refer to both Edinburgh-wide and larger national issues but I will do my best to stick to the brief!
My main concern with health delivery in Edinburgh is the ongoing rollout of combined health and social care services. I, along with the Scottish Liberal Democrats, understand the need for this process. In general, the population is getting older and this means more long-term, chronic illness. The practice of relying upon long hospital stays has become increasingly difficult. In response to this challenge, there has been various pilot schemes set up across Scotland. Known as Hospital-at-Home, the purpose is to keep the patient in their own home for as long as possible while under the same level of medical care they would receive while in hospital. This means that the GPs, hospital doctors, nurses and pharmacists would come to them.
Hospital-at-Home has several advantages. First of all, the patient is able to maintain a higher life quality and level of independence than if they were staying in hospital. It amazed me when I learned how quickly people forget even basic things like washing up and making a cup of tea when they have been in hospital after a long stay. While in the person's home, changes in social care needs can also be quickly identified by the visiting health professional and packages tailored appropriately. What is most important is when the person does need to go into hospital, the visit can be planned and a bed made ready. The most costly manner of hospital admission is through the A&E system, which are unplanned, meaning that there can be long and costly delays while a bed and staffing is found.
From reports that I have received, the integration of health and social care in Edinburgh is not going well. There was supposed to be extra budget set up for Hospital-at-Home but the money was not provided. Instead staff was transferred from ward duties and based in Liberton Hospital, resulting in the closure of a physiotherapy gym. The hospital staff were not replaced.
Unlike other Hospital-at-Home schemes in Scotland (i.e. Fife), there is no provision for pharmaceutical services to be part of the home visit scheme here in Edinburgh. Fife found that it is far more efficient to include pharmacists as patients' drug needs can be monitored and, if necessary, changed thus avoiding unnecessary crisis situations. In Edinburgh it seems that frequently a patient has to return to hospital before an effective review can take place. This can result in the postponement of planned surgery, delays in admission and bed-blocking down the line.
It seems that the care side of the package is not being effectively handled either. Agency staff are not being used (deemed too expensive) and there are problems in both recruitment of new staff and retaining existing personnel. Neither staff nor patients like the 15 minute visit but these still happen, resulting in poor service and sometimes leaving patients flustered and upset. People can pay the difference to ensure better care but only if they can afford it, leaving the poorest with a take-it-or-leave-it service.
Add to all this the planned closure of Liberton Hospital, due for early 2017, resulting in the loss of vital rehabilitation services. Astley Ainsley hospital had its orthopaedic recover services moved to Liberton in 2015, so with the closure of Liberton it looks like that Edinburgh would lose this as well. Astley Ainsley itself is due to be remodelled as a care village but there is no clear timetable as to when this will take place. In the meantime Gylemuir to the west of the city is being used as an interim rehabilitation venue but people have to pay the current national care home rate to use it. The 60 beds announced by health minister as being new were in fact already in use.
One has to remember that this situation is taking place against the background of long-term and continued cuts made by the SNP Scottish government. Once inflation and capital spending has been accounted for, Audit Scotland found that in real terms health spending in Scotland since 2008/09 has decreased by 0.7%. While the SNP claim they are spending record amounts on the NHS, they are not matching the ring-fenced amounts made for NHS England by the Westminster government, although the budget we receive reflects this protected spending.
If Scottish Liberal Democrats are part of the next Scottish government, we will seek to address three areas of Scotland's NHS:
- Increase spending on mental health services, especially for young and adolescence age group. We will also see that there are 24/7 mental health facilities in all 30 of the nation's A&E units and in every one of Scotland's police divisions
- Address the increasing need for GPs across Scotland. From 2009 to 2013, the SNP government only managed to create 35 new GP positions across Scotland. By 2020, the Royal College of GPs predict a shortfall of 740 positions. Although the Scottish government announced the creation of 400 new training places, of the 315 of these that have been advertised, only 237 positions have actually been filled.
- The integration of health and social care involves the creation of 31 new care boards overseeing £8 billion of NHS and social care resources. In March 2015, Audit Scotland’s report on progress towards the integration of health and social care found: “a lack of national leadership and clear planning is preventing the wider change urgently needed if Scotland’s health and social care services are to adapt to increasing pressures”.
It is to this latter point that the problems with Edinburgh's integration of health and social care lies.
So to answer your question:
The first thing I would certainly do as an MSP is to postpone the closure of Liberton Hospital, at least until the problems of Edinburgh's Hospital-at-Home and social care deliver have been suitably addressed. Following the Fife example, I want to see pharmacy services included as part of Hospital-at-Home. Only after those services are running properly can we review the hospital bed situation across the city.
I would also seek to get the Astley Ainsley remodelling into a care village underway. It cannot be allowed to continue in it's current state of limbo and, with our aging population, it will certainly be needed.
Later this week I am meeting with a local GP who is also a representative of the British Medical Association. I will listen very carefully to what is said and how we can improve GP services across the city and what can be done to improve frontline mental health services city-wide.
In order to see an improvement in the state of our local health and care services, I hope I have convinced you that both the Scottish Liberal Democrats are aware of the challenges that we face and have the resolution to tackle them. If so, please support us in the upcoming election by casting both votes for Scottish Liberal Democrats.