Former A&E manager hits out at service

Agnes Munro wants people to start asking the board the right questions, she says.
Agnes Munro wants people to start asking the board the right questions, she says.

The former Accident and Emergency manager for Western Isles Hospital has hit out at NHS Western Isles Out of Hours service. She claims the current system shows a lack of regard for residents of the isles.

Recently retired Agnes Munro was A & E manager for 15 years and has over 40 years’ service in nursing to her name, 29 of which were in A&E in NHS Western Isles.

However, she has decided - in her own words - ‘to put her head above the parapet’ to help residents ask the right questions of the health board.

“I’m raising my head above the parapet in the hope it gives current staff the confidence to try and resolve the many issues they feel unable to grapple with” she said. “An example is the increase in bullying behaviour which was highlighted in the latest staff survey.

“I would also like members of the public to start asking more probing questions. It is hard to know how to respond to a one-sided view if you are not given all the information you require to make a balanced judgement.”

Mrs Munro claimed that there was a 24-hour period over a weekend earlier this summer during which there was no GP covering out of hours for Lewis and North Harris.

The locum GP based in Barra agreed to handle any concerns arising in Lewis and North Harris. The NHS WI Medical Director confirmed this at a public annual review meeting on Monday, but declared that this was an entirely acceptable contingency plan.

Mrs Munro finds this unacceptable.

“To have not a single out of hours GP available in the whole of Lewis and North Harris on a weekend in the height of summer when the population is at its highest shows scant regard for the residents of the isles. If nothing else it is, undeniably, an appalling use of available resources,” she continued.

“From memory I cannot recall a single hour since 2004 when a GP was not available, let alone 24.

“What would have happened had there been an expected death? What use would a GP be so far away in Barra had a death occurred in Lewis or North Harris?

“Legally a doctor is the only person who can certify a death and there can be no delegation to anyone. Imagine the added pain and anguish of those who have lost a loved one all because there is no-one available to do the necessary legal paperwork.

“Until the legal requirements are completed, the remains may not be washed and arrangements for wakes and funerals cannot begin.

“I asked this question at the recent Health Board annual review and got no satisfactory response. Although a death does not constitute an emergency, it is without question one of the requirements of an out of hours service.”

In addition to her 29-years’ service at Western Isles Hospital, Mrs Munro has been heavily involved with many of the out of hours services both prior to, and following, the implementation of the successful system which existed until October 2014.

Indeed this contributed to the accolade of her being declared the Scottish NHS Manager of the year in 2008.

Mrs Munro said: “I know what I’m talking about. I first proposed the idea of an emergency nurse practitioner in 1997 and from 2000 was responsible for the development of this service, which became reality in 2003. From 2003 I was part of a multi-disciplinary group tasked with the planning, implementation and ongoing review of the NHS24 service locally.

“In 2004 I chaired a multi-disciplinary group tasked to review the way forward for the out of hours service in the Western Isles and reported the groups findings to the board in January 2005.

“As such I can justifiably claim to know more about the out of hours service from 2003 until my retirement in December 2014 than any of the current executive officers charged with current decision making.”

The Medical Director for the Western Isles, Dr Angus McKellar, insists the current system is ‘safe’ and ‘reliable’ while he also states NHS 24 has been running successfully in Harris, and all areas, for more than a decade.

However, Mrs Munro says this doesn’t paint an accurate picture.

“While it is true that since 2004 people in Harris have had to use the NHS 24 number in order to contact the GP, it was only in late 2014 that the North Harris practice withdrew from its commitment to providing out of hours care.

“Co-incidentally, no doubt, this was following the appointment of its principal partner to the post of Medical Director for NHS Western Isles some months previously.

“I decided I had to speak out after reading all the reports on the meetings in Harris and hearing the obfuscations and ‘spin’ being presented at the public annual review meeting and contained in the NHS Western Isles Self-assessment document presented at the meeting.

“It is claimed the system is working better than ever before but it clearly is not. There are many more questions to be asked about the out of hours service in particular, and other elements of the stewardship of our local health services by those at Executive level.

“As ever the ongoing respect, admiration and appreciation of those delivering care is undiminished and I must stress that they are doing a fantastic job despite the many obstacles placed before them.”

NHS Western Isles have vigooursouly defended their policies with a statement provided to the Gazette.

They wrote: “Contrary to claims made by Agnes Munro at the Annual Review of NHSWI, North Harris Medical Practice opted out of direct GP Out of Hours provision in 2004. From that time onwards, all Out of Hours calls have been directed via NHS24. North Harris Medical Practice GPs continued to provide on-site cover on behalf of NHSWI until October 2014

“NHSWI has, at all times, a team of health care professionals involved in providing OOH care. This is not confined to General Practitioners and it would be discourteous to the other highly skilled members of the Out of Hours team – doctors, nurses, paramedics and others - to assume that out of hours care must only be provided by a GP. The feedback from patients about the care and attention given to them by the OOH team members has been uniformly excellent, and in particular that provided by the Community Unscheduled Care nurses.

“In the case of an expected death, the team member attending would indeed normally be an Unscheduled Care Nurse.

“In terms of doctors who are available during the unscheduled care period in Lewis and Harris, these include GPs, a consultant physician, surgeon, orthopaedic surgeon, anaesthetist, obstetrician, psychiatrist and a childrens’ on call doctor.

“These doctors are part of a team which, as mentioned elsewhere, includes paramedics, community unscheduled care nurses, emergency nurse practitioners, clinical specialist nurses and a support team of many other individuals, all of whom are on call through the unscheduled care period. “NHSWI has contingency arrangements in place to ensure that should any member of the team be unavailable for duty, safe and effective patient care can still be provided. There have been two periods in the last year when contingency arrangements have had to be put in place. One of them for an out of hours shift in December 2014 and one for an out of hours shift in June 2015. On both occasions the on call GP was substituted by another doctor working out of the Western Isles Hospital.

“On both occasions the doctor in the Western Isles Hospital was backed up by an NHSWI GP who was available to give advice and direction, and by the entire Out of Hours team, as outlined above. These arrangements were safe and effective.”