Wester Ross, Strathpeffer & Lochalsh Joint Community Councils

Notes of Meeting held in Kinlochewe Village Hall, 26th March 2009

Chair: Richard Munday, (Shieldaig Community Council)
Present: Shieldaig CC; Marybank CC; Coigach CC; Lochbroom CC; Torridon & Kinlochewe CC; Applecross CC; Wester Lochewe CC; Garve & District CC; Dornie & District CC; Lochcarron CC; Gairloch CC; Aultbea CC. Cllr Biz Campbell; Cllr Richard Greene; Cllr Audrey Sinclair; Cllr Jean Urquhart; Cllr David Alston (Black Isle Ward);

Apologies: Glenelg & Arnisdale CC; Lochalsh CC; Loch Duich CC; Plockton CC; Stromeferry & Achmore CC.

Officials in attendance: Robbie Bain (Highland Council, Ward Manager); Mary Gibson (SNH).

Introduction: Richard Munday welcomed everyone to the meeting and explained the background to the meeting.
Highland Council Budget for 2009/10 and expenditure prospects for the longer term.

David Alston, Highland Councillor in the Black Isle Ward and Budget Leader for the Council gave an overview of the current situation regarding public sector finance.

He noted that there had been strong growth in public sector funding between 2000 and 2008 but that budgets would be “flat” from 2010/11 with a real prospect that the public sector would face a period of very tight budget settlements and possible cuts in budgets for the next 10 or so years as the Government recouped the money spent during the recession.

This would also be at a time when there would be considerable other pressures such as the need to invest in methods to reduce Carbon-dependence.

However, it should be remembered that the public sector would still be spending considerable sums in Highland every year (Highland Council about £3,000 per person; NHS about £2,000 per person and other agencies about £1,000 per person).

There will need to be changes in the way that The Council and other agencies work.

There will need to be better joined-up working between departments.

Sustainable solutions may need to be found with communities taking control of service delivery.
Communities will need to consider their own priorities across services although there will be limits to what variation in standards would be acceptable.

In The Council, hard questions will need to be asked, since it may not be possible to make cuts at the edges of services and instead The Council may have to stop doing some things completely, leaving a gap that might be filled by communities themselves.

Discussion commenced with issues of winter maintenance on the road system.

The Council had already spent £5.2m on winter maintenance this year and spend on this would probably be about £0.5m over budget at the year end.

While £350k had been removed from the winter maintenance budget as a result of a series of milder winters, it was noted that spend this year was still higher than previous budget levels.

It was suggested that the Council owned more assets than it had the finances to adequately maintain and that to bring this into balance, some rationalisation would be needed.

Discussion on communities taking control of service provision highlighted the example of the Howard Doris Centre which had significant benefits beyond Lochcarron.

The recent community needs assessment in Shieldaig was given as an example of how useful it is for a community to identify the resources and skills that are present within it.

The issue of school closures was raised and while it was acknowledged that there was existing protection for rural primary schools there was concern that when schools become too small, issues can arise in terms of education quality and children’s social development.

Affordable Housing was seen as one of the keys to keeping small communities alive, but even where affordable housing was present, there was often little opportunity for residents to move out of this and free it up for younger families. There was concern about the loss of young people who couldn’t find affordable accommodation which was particularly galling given the number of second-homes that lay empty for much of the year. There was a shortage of available land for building but local landowners might be reluctant to give up land unless they were sure the houses would be made available - and stay available - to local people.

Scottish Water. Robbie Bain presented on Scottish Water’s behalf, using information contained in an email from Joanna Peebles. It was noted that Scottish Water was in the process of making a considerable level of investment in Ward, with a total of nearly £42m worth of capital investment either completed or in the immediate programme:

Achnasheen - £307k upgrade of water production plant - completed autumn 2008

Aultbea - £204k upgrade of water production plant - started autumn '08 complete now

Badcaul - £3M new Water Treatment Works

Kinlochewe - £519k upgrade of drinking water supply - complete spring '08

Kishorn - £5M Wastewater Treatment works - due to be constructed this year once planning permission and land negotiations are complete.

Loch Ewe - £15M at Aultbea and Mellon Charles is making progress. A treatment works and sewer system are being installed to remove private discharges of raw and poorly treated sewage into the shellfish waters of Loch Ewe.

Loch Maree - £10M Regional Drinking Water supply - planning applications have been submitted.

Poolewe £745k upgrade Wastewater Treatment Works - due or completion this year.

Sheildaig - £212k upgrade disinfection system has just been completed.

Ullapool - £7M project to provide clearer, fresher drinking water. New water from boreholes at Inverbroom was recently put in to supply. A new treatment works is due for completion in the spring of 2010.

The level of investment in the Ward was welcomed, however concerns remained about the quality of some of the older pipework and while it was noted that there was a rolling programme of pipe replacement on-going, in the meantime some communities were facing repeated bursts and disruption as piece-meal emergency repairs were carried out. Concerns were raised about communication through the service centre, although there was general praise for the front-line staff and the speed of response to emergencies.

Post Buses. There was a brief discussion on the current situation regarding the withdrawal of post buses from three routes in the Ward. It was made clear that the Royal Mail response that the withdrawal of service had come about as a result of discussion with The Council was completely without foundation.

It was suggested that the only way forward was to mount a political campaign to expose Royal Mail’s approach on this matter to closer public scrutiny.

Out of Hours Group. Liz Pritchard presented the Group’s 6th Progress Report, covering the period May 2008 to March 4th 2009.

The full report is appended to this minute.

The Group asks for continued support for its work; for help in spreading the information to the community and for consideration to be given to a dedicated meeting which would allow greater discussion of the OOH Group’s work.

Future Arrangement for Ward Forums and Joint Community Council Meeting.
This item was left over for discussion at a future ward forum.

Wester Ross Community CouncilsOut-of-Hours Group Progress Report (6)
Our previous Progress Reports were issued on March 29th, 2006, January 16th, & March 26th 2007, January 31st, 2008 and May 18th, 2008.

This report follows on from them and covers the period from May 2008 – March 14th, 2009. After Nicola Sturgeon, MSP, Cabinet Secretary for Health and Wellbeing visited Wester Ross in May 2008 the Group was very encouraged to receive letters of appreciation for arranging the visit from Ms. Sturgeon and others.

In order to continue its work beyond May 2008 the initial task for the Group was to secure funding to enable the Group to continue its work towards achieving the safe and sustainable OOH care provision which will meet the needs of our communities in Wester Ross.

It is pleased to report that it has received additional funding from Wester Ross Community Councils and match funding from Highland Council Ward members’ discretionary budget. Shieldaig CC continues to administer the OOH Group account.

In addition Mid-Highland CHP is now covering the cost of hire of various meeting venues.
Results of the OOH Group’s survey into Community use of NHS 24 to access OOH medical care have now been assessed by NHS 24, NHS Highland, Scottish Ambulance Service and Wester Ross GPs, their comments have been sent to Nicola Sturgeon MSP and circulated as appropriate, ensuring that patient confidentiality was maintained, to Wester Ross Community Councils and service providers.

Since the new funding has been in place the Group has met four times. Cllr Isabelle Campbell, who is a committee member of the Mid-Highland CHP (Community Health Partnership), attended two meetings.

Ullapool Practice area is now represented by Mairi MacKenzie. On January 27th, 2008 Tracy Ligema, NHS H OOH Operational and Development Manager and Alison Phimister, Mid-Highland CHP Ross and Cromarty and West Ness Locality Manager attended and explained the proposals for future delivery of OOH care in Wester Ross. After discussion at its meeting on February 17th the Group asked for these to be set out formally Tracy Ligema responded as follows.

(The underlined statements were our understanding of the verbal information given at the meeting on January 27th.)

OOH Group: NHS H budgets have been reconfigured so that Wester Ross current OOH service will remain for the foreseeable future.

NHS H: I can confirm that the NHS Highland OOH budget has been devolved to CHPs from1 April 2008. The allocation of budgets was made using the Scottish Allocation Formula which takes into account factors such as rurality and deprivation. At locality level within CHPs this method of allocation has resulted in some areas having a bigger budget than was previously the case. The Ross, Cromarty and West Ness locality is one which has benefited in this way.

The result of this is that the Ross, Cromarty and West Ness locality OOH budget is no longer ‘overspent’, however it should be noted that a disproportionately large share of the budget is being used to deliver Wester Ross OOH services.

The change in budget allocation does mean that there is not an immediate pressure to re-configure OOH services in Wester Ross although at the meeting of 27 January 2009 we did discuss the need to consider the OOH budget as part of the total budget available to provide health care in Wester Ross and that the CHP would wish to engage with the community to consider how best to distribute the available funding.

In order to ensure that other essential services are provided, it may be that at some future time the current OOH configuration may need to be reviewed.

OOH Group: Current provision of GPs will remain the same.
NHS H: Current OOH provision will remain the same, subject to the potential for future budgetary considerations outlined at 1. above.
OOH Group: Only use locum GPs who will be local to Highland and not agency GPs.
NHS H: During the meeting it was highlighted that NHS Highland is currently able to fill OOH rotas with local (Highland based) GPs rather than agency locums.
This was a statement of the current situation and cannot be guaranteed indefinitely. NHS Highland always endeavours to use locally based GPs and always attempts to fill rotas in this way first.

If, however, shifts remain vacant and cannot be filled from within Highland then there will be a need to use agency locums in order to provide continuity of cover.

OOH Group: Current service is within the revised budget and meets all NHS H markers.
NHS H: I can confirm that the current OOH configuration is being delivered within the current budget, however please refer to 1. above.

In respect of the performance of the service I can confirm that current service delivery meets the key performance indicators which were proposed to the NHS Highland Board as part of the OOH Framework in February 2009.

OOH Group: Integrated working with Scottish Ambulance Service.
NHS H: In respect of integrated working with Scottish Ambulance Service, you will be aware of the collaborative approach which underpins the expected outputs of the Remote & Rural Implementation Group’s Emergency Response and Transport Workstream.

In line with this, there is opportunity for joint working between NHS Highland and SAS to develop multi-disciplinary extended primary care teams.

At the strategic level I can confirm that a Joint Organisational Forum is now in place which is being led by Elaine Mead and Shirley Rodgers.

OOH Group: Current temporary contract with Wester Ross GPs will be formalised.
NHS H: The current GP contract is already a formal contract which is permanent. However, for flexibility on all sides, it is a rolling contract which does not therefore require formal annual review.

OOH Group: The proposals regarding introduction of a Community Advisory Committee.
NHS H: At the meeting we discussed the potential implementation of a Community Advisory Committee (CAC). I can confirm that a proposal for CAC implementation will be taken to the Mid Highland CHP Management Team shortly.

As discussed, the CAC is intended to provide a forum which will allow ongoing constructive engagement between the CHP/Locality and the community in respect of a range of service delivery considerations.

The Group has discussed the possibility of producing an Information Leaflet to explain clearly “How to use the OOH Medical Service”, which could be distributed throughout Wester Ross.

Calum Campbell, Area Service Manager with Scottish Ambulance Service (SAS) attended the meeting on February 17th at which current local concerns including staffing levels and allocation, GPs’ availability to respond to Emergency Calls, shortage of local volunteers for Ambulance Car Service and the launch of the Torridon Medical Practice area First Responders Scheme were discussed.

The problem of single-manning is being addressed because SAS has received additional funding which has enabled it to employ additional staff in Gairloch, Lochcarron and Ullapool. It is also advertising again in order to meet any staffing shortfall.

The group has used opportunities for wider representation of the needs and challenges of very remote and rural areas.

A member of our group is now participating as a patient representative with the Scottish Centre for Telehealth (SCT) and attends meetings of NoSPG (North of Scotland Planning Group) whose members come from remote, rural and island Health Boards, NHS 24 and SAS The Group was invited to comment on the NoSPG Draft Standards paper.

At the meeting on March 13th the Group considered the potential of increased use of Telehealth, Telemedicine and Telecare. We look forward to the benefit from TeleHealth if Broadband infrastructure is in place in all areas of Wester Ross.

This Group has achieved, on behalf of the Wester Ross communities, an undertaking that the current OOH service will be maintained for the foreseeable future. However, members of the Group are of the opinion that there is a need to meet on a regular basis to monitor OOH and wider health service provision in Wester Ross.

It seeks the Wester Ross Community Councils’ support to carry forward this role and suggests that it is used to maintain the valuable contacts established with all health service providers.
March 26th, 2009