VIEW ON NHS: Highland healthcare in a precarious position
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Angus MacDonald is a member of Highland Council for the Fort William and Ardnamurchan ward and Liberal Democrat candidate for the new Inverness, Skye and West Ross-shire Westminster constituency. He offers his view on the problems facing the NHS and care sector and what can be done to improve things:
The health care sector in the Highlands suffers from inflationary pressures especially in medicines and staff costs, an ageing population and a lack of younger healthcare professionals in more rural areas while at the same time seeing a considerable increase in the overall population of Inverness.
These issues combined require a significant increase in funding for our healthcare sector in the Highlands. Not only is there a massive budget gap in annual running costs but major investment is required to replace or upgrade hospitals and care homes.
My points do not reflect any unhappiness with people in the health and care sector in the Highlands, my travels around care homes and hospitals has demonstrated to me again how lucky we are to have professionals of the quality we have.
The Highland Health and Social Care Partnership (HHSCP) finance report as of August 30 confirmed that there remains a budget gap of £98m for the year 23/24. Cuts of £29.5m have been proposed. No funding source has been identified for the residual gap of £68.7m.
All the way through the report the difficulty of hiring and retaining staff is repeated. There is a single line on costs which really stands out, locum and agency staffing in the four months to end July was £22.6m.
Highland councillors recently received the Strategic Plan on adult services. The scale of the challenges makes harrowing reading.
Largely due to staffing issues, seven care homes have closed permanently and temporarily since March 2022 in Cromarty, Grantown, Portree, Ullapool, Stontian, Mallaig and Invergordon with a combined loss of 161 beds. A major care home company has exited from their three Highland care homes, with Moss Park, their largeish Fort William care home up for sale. In April of this year HHSCP took over an independent sector care home in Newtonmore.
To generalise, independently owned care homes are losing money, the regulator Care Inspectorate Scotland has introduced new facility upgrade requirements for licencing which are frankly unaffordable. Unless an independent care home gets relicensed it cannot be sold as a care home, a major reason for care homes being closed.
We all want our parents in care homes near where we live. A local doctor tells me Lochaber has half the care beds it needs. Anecdotally care home residents from Skye are being sent to care homes in Nairn and Ault Bay.
Care home staff get paid less than staff in hospitality businesses, no wonder hiring is difficult. In terms of carer payment rates, they vary between providers, but the minimum of £10.90 per hour applies, though the First Minister in his ‘Programme for Government’ announced an inflation matching increase of 10 per cent to £12, it is not clear from when, and in any case remains uncompetitive with the hospitality sector.
A care home manager told me that her staff resign, sign up with an agency for the care provider who then pays three times the amount to get that same staff member back.
We read of the importance of care at home, but the report said there was a reduction in "available commissioned services" of 1300 hours per week.
If we don’t have enough care/respite capacity then we get delayed discharges in the hospitals with appalling consequences. That is exactly what we are seeing in the latest Performance and Quality Report.
According to Alex Neil, a former SNP health minister, a week in an acute hospital bed costs £4500, whereas a care home costs £700 and care at home £350 for the same period. Clearly having a hospital bed taken up due to no care home space is financial madness, not to mention the impact on hospital waiting lists etc.
Likewise, if care home staff were paid, say £15 per hour, then there would be less staff turnover and the massive agency bill reduced. Possibly a self funding pay increase?
Our hospitals are in need of enormous help from NHS Scotland/Scottish Government.
For hospital visits, we have a commitment that "95 per cent will be seen within four hours", but in NHS Highland it is only 78.5 per cent. As at end of May there are 13,355 people on the NHS Highland waiting list for appointments. Almost 5000 of these for psychiatry consultations. Mental health is a major problem, and the suicide rate per head of population in the Highlands is above the rest of Scotland.
The percentage of people waiting for three weeks or longer from the referral date for a drug and alcohol appointment is 53.5 per cent, twice as long a wait as the Scottish average of 25 per cent.
As at August 16 there were 181 delayed discharges, the highest level of delayed discharges in seven years, patients taking up a hospital bed whilst waiting for a care home place. The HHSCP report includes the line "hospital flow has undoubtedly been impacted by care home closures".
Fort William’s Belford hospital replacement has now been bumped twice with the hope that funding will be allocated in 2028…..it was originally scheduled for the year 2000. Caithness Hospital is going through an outline business case for redesign, Broadford Hospital is seriously understaffed and Portree Hospital remains open, but only just
The chief executive of NHS Highland wrote: "With regards to Raigmore, we absolutely recognise the age of the facility and that for the longer term these facilities are not sustainable as they stand".
We all know of the shortage of dentists in Scotland, in the Highlands it is more acute. We know that the dentists in Kyle of Lochalsh, Loch Carron and Ullapool have closed recently. In Fort William, a member of the public tells me he has been waiting a year for an appointment. In the chief officer's report of March 1 it was reported that "no practices within NHS Highland are accepting new adult patients". Only half of Scots have seen a dentist within the last two years. "Conveniently" the Scottish Government have just cut funding from the recommended two visits per year to one.
What can be done to get the dentists we need? The NHS needs to react to the evidence given at the Skills for Health and Social Care consultation, continue dialogue with the British Dental Association, increase the Remote Areas Allowance that has been frozen for 17 years and ensure that the expenses element of remuneration for dental practices keeps up with inflation.
Scottish universities allocate too few places to Scots for dentists and doctor education, as English and overseas students are far more lucrative. Scottish medics are far more likely to want to work here.
To summarise, Highlanders are seriously unhappy about our health sector, everyone will know people who cannot get a dentist appointment, are waiting for a hospital operation or mental health consultation, have a friend or family in a care home far too far away from their loved ones or just need to see a GP.
We need the Highlands to have a health sector like we used to have, and to do that we need the funding required to pay the staff properly, equip them with staff accommodation, and ensure we have the care homes and hospitals fit for the next 25 years and beyond.
Us Highlanders seem to accept our lot with little complaint. We need large numbers to petition the health minister Michael Matheson to fully fund NHS Highland sufficiently well to do its job and avoid massive cuts on an already limping service.