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ACTIONS to address the region’s bed-based intermediate care needs were agreed at today’s meeting of Dumfries and Galloway Integration Joint Board (IJB). 

Members agreed a flexible model for some beds in settings such as care homes, along with proposals to work with communities on plans for how facilities, such as cottage hospitals, will play a role in meeting health and social care needs in the future. 

IJB chairman Andy McFarlane said: “As we plan for the future, it is very clear that we face a massive challenge in meeting the increasingly complex needs of our population. 

“Continuing with the existing approach to bed-based care which sits between the two acute hospitals and people are able to manage independently in their own home is not going to work. 

“We know we have to adapt, and make strategic use of all our available resources in order to provide the treatment and care our population will require over the next 15 to 20 years. 

“I’m very pleased, therefore, that the report which came to the IJB today provides us with the best way forward, working together with our communities to develop an approach that best meets their needs.” 

The Right Care, Right Place report results from extensive community engagement earlier in the year which was then followed by 12 weeks of formal public consultation in the summer focused on four areas: 

• The findings of the Right Care, Right Place: Intermediate Care engagement programme earlier in the year 
  
   
• A description of how intermediate care is delivered, and the forecast of what will be required in future  

• The proposal to introduce a flexible approach to intermediate care, to allow bed capacity to be allocated to different roles depending on demand 
    
• Ideas on how intermediate care should be delivered in each local area, over three timescales – 1-2 years, 5 years and 10-15 years  

Director of Strategic Planning and Transformation David Rowland said: “We’re extremely grateful to everyone who took part in Right Care, Right Place. 

“During the consultation we heard a strong and clear message from people across the region that they want to see bed-based palliative and end of life care delivered within their local communities as a matter of priority and that we also need to make provision for local step-up and step-down care.   

“The approach agreed at IJB today means we can start implementing a flexible approach to bed usage.  

“We will now be working closely with local care home owners to support them to expand capacity to deliver bed-based intermediate care within local communities. 

“We will also now be looking to build on the conversations we have had throughout this year and will be sitting down with local communities to start planning how we make best use of our wider facilities to meet their health and social care needs in the medium and longer-term.  

“As always, we need to undertake this work with our communities with a mutual appreciation and recognition that we don’t have boundless resources, and that within Dumfries and Galloway, as nationally, we face major challenges in areas such as finance and recruiting to vacant posts.  

“As the Right Care, Right Place consultation set out, we believe that key to meeting this increasing and increasingly complex need is flexibility – both in the way our care provider organisations are structured and positioned to deliver care, and also in the way that our populations adapt to ensure that finite resources are employed as effectively as possible, and that we all work to support each other as members of our communities.” 

CONSULTATION on the future of Maternity Services in Wigtownshire is set to begin, after two options were presented to Dumfries and Galloway Health and Social Care IJB today. 

However, seeking to clarify expectations, the IJB notes that neither of the two options means birthing facilities will be available to all expectant mothers in the area – instead exploring birthing options for the low risk pregnant population in the Wigtownshire area. 

Chairman of the IJB Andy McFarlane said: “It’s well reported that hospital-based birthing services in Wigtownshire were halted in 2018 as a result of shortfalls in the number of qualified midwives required to ensure the safety of mothers and their babies. 

“As a Board, we have recognised strong feelings on this issue, particularly around the current travelling required for many births, and a local desire to establish a way forward.  

“Earlier this year, under two independent chairs and a national midwifery expert, engagement took place with people in the community and with staff in order to gain information to help shape potential options for the future of services. 

“Several options were developed by the independent chairs following engagement with stakeholders, and these went through a scoring process. 

“At the end of that scoring, two front-running options for births in the area were tied – the current arrangement which provides only for low-risk home births and a second option which would include pre-planned births at Galloway Community Hospital, again only for the same relatively small number of low-risk births.  

“While conscious that this was an independently chaired service review, it is important to recognise that this was a local service review which should include contributions and views from professional NHS staff. By doing so, it was noted that both option 1 and 2 scored the same on the day, with option 2 narrowly preferred by the independent chairs when the local professional scores were excluded.” 

The report by the independent chairs, NHS Ayrshire and Arran Medical Director Crawford McGuffie and NHS Ayrshire and Arran Executive Nurse Director Jennifer Wilson, came to the Transformation sub-committee of the IJB on August 10 2023. 

Mr McFarlane said: “The two options were discussed at that committee. Feeling there was a lack of a decisive outcome, and with no proposals or options having yet been taken out for the public to consider, a recommendation was agreed that two options be taken out for formal consultation. 

“This proposal was agreed at the meeting of the IJB on Wednesday 27 September, with a view that these possible options should go out to consultation so that the perspectives people offer in response can help inform and shape the ultimate decision making. 

“For the avoidance of doubt, and contrary to some reporting, neither of these options would represent a full birthing service in Wigtownshire. High risk births have always been advised to deliver in the Dumfries and Galloway Royal Infirmary and this would remain the advice. 

“The second option is for pre-planned births in hospital which are assessed as being low-risk – and the last statistics for Wigtownshire showed that this was 23 per cent of all pregnancies in the area. 

“We’ll be looking to move to consultation as quickly as possible, and expecting this process to provide everyone with full information and understanding about both these options, and their implications – with details to be published in due course. 

“The IJB does not have a preferred outcome here, and we are keen that consultation takes place so that everyone within the community can help shape a model for childbirth that will serve Wigtownshire for years to come.” 

A REPORT on the future of maternity services in Wigtownshire was considered on Thursday by a sub-committee of the region’s Integration Joint Board.

Head of Midwifery Laura Boyce said: “I’m very pleased that the report has been presented to this sub-committee of the IJB setting out options for the future of maternity services in Wigtownshire.

“I’d like to express my sincere thanks to the two independent chairs, NHS Ayrshire and Arran Medical Director Crawford McGuffie and NHS Ayrshire and Arran Executive Nurse Director Jennifer Wilson, and for the support provided by professional midwifery expert Angela Cunningham.”

The local service review of maternity services in Wigtownshire was launched on January 18 under independent expert chairs, seeking views from stakeholders to help inform approaches.

On Thursday, Dumfries and Galloway Integration Joint Board’s (IJB) Transformation and Innovation/Futures Committee met with the purpose of considering and discussing the findings in the report and the next steps in moving towards a sustainable approach – to be taken on through the full IJB.

The report set out the work which had taken place to review maternity services and engage with the voice of our local communities, families who had experience of maternity services in Wigtownshire, as well as wider staff groups.

This review was undertaken in the context of the temporary suspension of low-risk, intrapartum maternity services at Galloway Community Hospital which came into effect in 2018 due to staffing pressures.

Option one represents the birthing service currently available in Wigtownshire. It would comprise continued care provision from Community Maternity Hub (Oak Tree Family Centre) and support for home births, but with no provision for intrapartum care within Galloway Community Hospital.

Option two would comprise the continued care delivery from Community Maternity Hub (Oak Tree Family Centre), with the addition of a planned, on call birthing option for low risk births from Clenoch Birth Centre within Galloway Community Hospital.

Under either option, there would be no midwives routinely based at Galloway Community Hospital for wider aspects of care.

Both options achieved the same score of 78 in the scoring process, inclusive of NHS Dumfries and Galloway professional leads who participated in the process. Option two was the preferred option of the professional experts independent to NHS Dumfries and Galloway, with a score of 80.

The report also noted the resource implications for resuming births on a planned, low-risk basis at the Clenoch Birth Centre, at an associated cost of about £103,000.

Contrary to some media reporting, the report was very clear that option 2 would only be for planned, low-risk labour and birth and would not be suitable for all births in the Wigtownshire area.

In the most recent data for Wigtownshire, 23% of all pregnancies were assessed as low-risk. Risk assessment throughout pregnancy and birth is undertaken following nationally recognised standards.

There is a need to highlight that, other than for location, the service provided under the option for planned, low-risk births in the Clenoch Birth Centre would be the same as the regionwide home birth service currently provided for expectant mothers in Wigtownshire.

On Thursday, the Dumfries and Galloway Integration Joint Board’s (IJB) Transformation and Innovation/Futures Committee decided to recommend to the full IJB meeting of September 27 that the two options are taken out to public consultation.