Like all good tales, the OOH (Out-of-Hours) saga appears to have reached its climax. The Integration Joint Board (IJB) of the Fife Health and Social Care Partnership (FHSCP) accepted a proposal to maintain an OOH service in St Andrews community hospital. This has been the culmination of a year’s battle, but what really happened and who saved the service?
OOH care is that provided outside the normal surgery open hours 8.00-18.00. If you have an urgent medical issue which does not warrant 999, calling NHS 24 (Scotland) or NHS 111 will put you through to a nurse adviser. You may be given advice, referred to a clinician, or in serious cases be referred to hospital. This is provided by the Fife Primary Care trust.
In April last year, primary care emergency services at St Andrews, Queen Margaret, and Glenrothes hospitals were suspended due to staffing shortages. Instead, patients would be referred to Victoria hospital in Kirkcaldy. Principal Sally Mapstone expressed concern in an open letter noting that “The alternative to the MIU (Minor Injuries Unit), Kirkcaldy’s Victoria Hospital, is simply inaccessible for most students faced with an emergency at night”.
Healthcare commissioning is a complex beast with NHS Scotland employing 160,000 people while wielding an annual budget of £12.2 billion. Integration Joint Boards were established by the Scottish government and serve a similar role to Clinical Commissioning Groups in England. Commissioning services and delineating funding in order to provide holistic care. The FHSCP insisted the contingency plan was temporary while they attempted to recruit and re-instate the service. However, a proposal emerged to cease the OOH service in St Andrews entirely. The three-month trial of suspended services became extended until January and then till August of this year.
Local and Student Resistance
The imminent threat to services gave impetus for a response. The collective issue mobilized students and locals alike. Director of Wellbeing, Nicholas Farrer, headed up the student effort with the Students’ Association President Paloma Paige. Despite the complexity of the task, work began in earnest.
Mr Farrer wrote a motion to the JC seeking a mandate before arranging a group of volunteers to petition, make presentations, and leaflets were distributed on planned routes. With the help of Ms Paige, and the Rector’s Committee testimonials about people’s experience with the OOH were gathered. At the same time, posts were made on the Union social media while the student body were emailed with links to the petition, and details regarding the consultations and public meetings. Physical consultation forms were also distributed.
In October the consultation period ended; however, this did not signal an end to the campaign. Mr Farrer and Ms Paige joined a wider community body, the OOH group which was composed of the community council, councillors such as Linda Holt and Jane Ann, Will Rennie, Dr Chris Lusk of the University and some local GPs. Dr Angela Anderson was made Chair. Ms Paige organised a room booking in the Union and was essential in liaising between the OOH Group and SA.
Mr Farrer organised a protest at the NHS Fife annual review at Victoria Hospital in Kirkcaldy. The action was a complex organizational task requiring two coaches to be haggled, sign-ups to monitor numbers, risk assessment, press coordination (as seen in the Couriers reportage), and ordered materials to make signs. Ms Paige filed to the IJB to do a deputation, where a small group take part in a formal process, here the meeting, on behalf of a larger group. This was a split deputation with the Anstruther and St Andrews Community Councils.
Back on the political front, Liberal Democrat MSP Willie Rennie pressured Health Secretary Jeane Freeman to admit that progress would be watched more closely. In December, the IJB recommended that plans should be organised for an OOH in North East Fife.
Participation Request meetings between the Royal Burgh of St Andrews Community Council began with Mr Farrer attending. Later they attended options workshops as community representatives with Dr Lusk, Dr Anderson, and Penelope Fraser. These would be presented to the IJB with Paloma and Nick writing a motion to the Students’ Representative Council to give them the mandate to endorse the option; a press release endorsed this motion. Ultimately, the proposal was accepted by the IBJ; however, Glenrothes OOH was not spared as it was deemed unsustainable.
This victory came at the end of a protracted campaign involving the exhaustive efforts of many. In their Facebook post, the sabbaticals were keen to thank Dr Chris Lusk for helping extend the consultation time, Dr Angela Anderson, chair of the OOH group, Penelope Fraser, vice-chair of The Royal Burgh of St Andrews Community Council and chair of their Health and Wellbeing Subcommittee, and all Councillors and MSPs. The efforts of Association President Paloma Paige, and Director of Wellbeing Nick Farrer were incredibly significant.