Knapdale Ward psychiatrist who challenged plan to close "lifeline" dementia unit says she was "bullied out of job"

"It's inhumane," Dr Calder told the Herald on Sunday. "In the context of what a health service should do, which is to prioritise the needs of the most vulnerable, this is just is so wrong."

Argyll and Bute Health and Social Care Partnership (HSCP) is due to make a final decision on March 25 and is expected to approve the closure of the ward. It has proposed a community-based enhanced dementia service instead.

Dr Calder, a locum consultant psychiatrist, was the clinical lead for the ward from August 2018 until July 2019 when her contract - due to expire in September 2019 - was terminated prematurely.

She said this occurred three weeks after she wrote to NHS Highland challenging management proposals to close the ward and questioning the "deeply flawed" review process.

In a letter to the chair and chief executive of NHS Highland dated July 8 2019, and now shared with the Herald on Sunday, Dr Calder said she was raising concerns as a whistleblower and described a "recurrent theme of medical opinion being ignored, marginalised and undermined".

She was critical of "managerial neglect which has greatly affected the morale of staff" and questioned why the ward had been closed to admissions for more than a year when referrals for dementia continued to come from GPs, indicating demand for the service.

Although she acknowledged that there were difficulties attracting enough staff, Dr Calder stressed that three applicants had applied for advertised posts only for those posts to be frozen before interviews could take place.

She said she and other key clinicians had been excluded from the July 4 meeting where the decision was made to close the ward, and noted that the Sturrock Report into bullying in NHS Highland had made specific recommendations that management practices within Argyll and Bute needed to be reviewed.

She added: "In my view the internal process has been faulty, key staff have been ignored, there has been no consultation with patients' relatives and the wider public, let alone the community teams who will have to 'pick up the pieces' of acutely unwell patients in the community."

Dr Calder told the Herald on Sunday that, following her letter to the health board, a series of relatively minor complaints against her were used as an "excuse to get rid of me".

These included claims she had missed meetings which she says she had never been told about, criticism that she took too long with patients, and claims she had insulted patients including calling one of them fat - something Dr Calder strongly denies.

Dr Calder, who continues to work as a locum consultant within NHS Scotland, said: "I wasn't given any opportunity to respond to the complaints against me - I was just told that they weren't renewing my contract."

She also wrote to Health Secretary Jeane Freeman on March 1 stating that she had been "bullied by staff at Argyll and Bute HSCP and by management of the HSCP and NHS Highland Board", adding that she knew of other Knapdale staff who "fear for their posts if they were to speak their minds".

The Herald on Sunday has also spoken to a retired nurse who says she was removed from her post at Knapdale after proposing that the ward should be retained.

The nurse, who has held senior positions in mental health nursing in Scotland but asked not to be named, said she had been chairing a Short Life Working Group examining options for dementia care when she was suddenly replaced in March 2019.

She said: "I didn't feel victimised. I was conscious that I was a bank nurse, that this wasn't a [permanent] post.

"But I did feel I had more to offer, and it felt that the direction I was taking things - proposing the retention of Knapdale and the different options that would enable us to do so - wasn't what they wanted.

"The person who took over from me was very much in favour of the closure of the ward."

Argyll and Bute already has the oldest population in Scotland and the number of people aged 75 and over is projected to increase by 30% by 2026.

However, it has also experienced the sharpest drop in care home places for the elderly.

Belinda Braithwaite, a former nurse whose late husband Richard was cared for in the Knapdale Ward from 2011 until his death, aged 69, in September 2014, said it had been "lifeline".

She said: "I benefitted massively from being able to visit him every single day. I took him his lunch and got to spend time with him. If he'd have been in Glasgow it would have been maybe once or twice a week.

"To be absolutely clear, the best place for people with dementia to be is at home and many thousands of carers manage that as long as the can with support from respite and day care provision.

"Something like Knapdale is for what they call 'stressed and distressed behaviours' such as delusions, hallucinations and aggressive behaviour, and less than 1% of people with dementia will need that. But for those that do it is an absolutely precious resource.

"By the time Richard was cared for on Knapdale the only thing he could do for himself was to scratch his nose. He couldn't turn over, he needed to be changed and washed, fed and given drinks."

As a mechanical engineer, Mr Braithwaite had set up his own company which invented the specialist tools responsible for making the first exploratory borehole between the UK and French sides of the Channel Tunnel.

In 2004, however, he was diagnosed with Lewy Body Dementia (LBD), a rare form of the disease which accounts for fewer than 5% of cases.

It is characterised by hallucinations, tremors, stiff muscles, sleepwalking, confusion, memory loss, speech problems, and deterioration of regulatory functions such as pulse, digestion, seating and blood pressure.

Mrs Braithwaite is among those - including Knapdale staff and medics, local councillors and the Unison trade union - pushing for the ward to be retained and improved.

They want it to continue to provide specialist dementia inpatient beds, as well as a day centre and emergency respite beds to accommodate patients temporarily if, for instance, they carers are unwell.

Mrs Braithwaite says provision on Argyll and Bute should at least match Shetland, Orkney and the Western Isles.

Despite comparable population sizes, Mid-Argyll, Kintyre and the islands (Islay and Jura) has only four nursing homes and care centres offering any respite beds, compared to eight in the Western Isles, 12 in Orkney and 16 on Shetland.

Day care provision is non-existent in Mid-Argyll, Kintyre and the islands, but Shetland has eight sites offering day care, four in Orkney and two in the Western Isles.

"How much longer might I have been able to manage before I got totally burned out if Richard had been able to go for day care a couple of days a week?," said Mrs Braithwaite. "Or if there had been emergency respite so that if I had the flu or gastroenteritis or something I could use that facility.

"But Argyll has got absolutely no day care provision whatsoever."

The HSCP argues that Knapdale is too mid-Argyll centric for those on the islands and not a "homely environment".

However the most recent inspection report by the Mental Welfare Commission (MWC) for Scotland found it was "clean and bright, and has good natural light, and a garden space which provides a safe and easily accessible area for patients and visitors".

It also praised the quality of clinical care provided.

The HSCP argue that the shift to a community-based enhanced dementia service is in line with the recommendations of the independent report into specialist dementia care carried out by Alzheimer Scotland for the Scottish Government.

However, Dougie Philand, a former psychiatric nurse with more than 37 years’ experience who is now an independent councillor for Mid Argyll, takes issue with this idea.

He points out that that same report also noted that there will be “a small proportion of people who will require specialist dementia hospital care and treatment” because they experience “very severe and persistent psychological distress and behaviours that would be too challenging to be managed in mainstream settings”.

“I'm all for enhanced dementia care in the community,” said Mr Philand. “But you need specialist inpatient care alongside it.

"If patients are being sent miles away to Glasgow I just think it's inhumane.”

Mr Philand also says it is “deeply concerning” in light of the Sturrock report’s findings that the closure could proceed without a proper investigation into Ms Calder’s claim she was bullied as a whistleblower.

“The whole thing [ward closure] has been a fait accompli," he said.

A spokesman for Argyll and Bute HSCP said: “We recently carried out a comprehensive consultation into the proposed model of care for dementia services in Argyll and Bute.

"An update on the consultation and the proposed next steps will be presented to our Integration Joint Board at its meeting on the March 25.”