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Caithness News Bulletins August 2004

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North Action Group Maternity Services Campaign On Caithness.org  

13 August 04
Caithness Minister Bill Wallace Hits Out At Current Shambles Over Maternity
“NHS Highland prompt action in dismissing unsatisfactory staff is to be welcomed. However, the current shambles over the Maternity services shouldn’t be allowed to be an excuse for down-grading the Unit at Caithness General. The public are clear about the type of Health Service they want. The Government, to their credit, have invested much new money into the NHS.  In the light of that it is unthinkable that the service for the future should be less than in previous years.  If NHS Highland cannot staff the unit because of shortage of Consultants they should not kid us on that what they are suggesting is an improvement on the present service.  They should tell the government that unless they train more Doctors and Consultants they cannot provide an acceptable level of service throughout the area.  Otherwise we will continue to see the decline of services in rural areas.
Caithness Maternity Unit should not be seen in isolation from the national picture which indicates that we are starting to see the melt-down of rural hospitals.”

Bill Wallace, Caithness presbytery

4 August 04
Closure of Wick Maternity Unit Would Be ‘tip of iceberg’ Claims Caithness Presbytery

‘All rural hospitals would be under threat.’

Members of Caithness Presbytery, the largest membership organisation in Caithness, are extremely concerned about the future of maternity services at Caithness General Hospital.

A report written by the Reverend Bill Wallace,  Minister of Pulteneytown and Thrumster Church, Wick says that the so called public ‘consultations’ held by successive Health Service management groups have one thing in common. They have shown that there is, in fact, no need to consult the public – there is a near unanimous view in the community that the retention of a Consultant led maternity service is the only acceptable option. The public’s opinion is clear and emphatic – only change the present service provision if you can provide something better. The public are unconvinced that any of the alternative proposals currently under discussion by NHS Highland are in any way better than what is already in place.

The reasons for this have been well rehearsed. The round journey of over 200 miles to Raigmore, Inverness…… the poor road system….the main artery (the A9) has been completely closed for several hours  on a number of occasions this year already after serious accidents….the added problems of weather complicating that system (fog ruling out air travel and fog / snow/ ice making road travel very difficult)….. the unpredictability of pregnancy making sudden emergencies a real problem…… the social complications of mother and baby being so far from father and family, perhaps for a considerable period - not forgetting ‘false-starts’ etc….Does Raigmore have facilities to cope with mothers-to-be who are recommended to be in Hospital a week before the delivery date?

The knock –on effects are considerable and have scarcely been considered. Indeed we find failure by the Health Authorities to address them a dereliction of responsibility. At both Health Board and Government level there seems to be an unwillingness to face the fact the unless major changes take place in the next few years we will see the closure of most rural hospitals sooner than we dare contemplate.  The working hours directive has only increased the problem. But the problem was looming long before the directive’s implementation. If NHS Highland are unable to continue with a consultant led service in Caithness there should be no doubt that this is but the tip of the ice-berg and heralds the demise of most rural hospitals in Scotland.

The report goes on to say that there are at least three major issues –

  • I) As long as  the ‘experts’ who advise and, in effect decide, how our hospitals should run are the leaders of large, high-tech. Units, we will never have a viable strategy for the whole country. The Professor Calders of this world rightly seek to have every possible piece of advanced machinery in their units and at their finger-tips. They love their ‘centres of excellence’ and rightly so. But in the real world that is not possible in every part of the country – the cost would be prohibitive. The real questions are ‘Is the high-tech option really necessary in most cases of child-birth?’ and ‘Is it better to have a capable person or a special machine in the locality?’ And is there any possibility of having all the latest technology even in Raigmore?

  • 2. The shortage of specialists in Scotland is acute. (167 at present – over half of these for more than six months) If there is a national shortage of Consultants should they not be spread evenly throughout the country? But there is a further question. Do we have the right type of Consultants to meet the needs of the people of Scotland? Sir David Carter is reported to have suggested that we need ‘General Specialists’ in order to meet the needs of our scattered rural communities. There is clearly a need, particularly in light of the working hours directive, to have ‘specialists’ who cover a range on interests e.g. obstetrics, gynaecology and also paediatrics. In other words a specialist who, amongst other things, covers ‘early years’. There must also be scope for encouraging GPs to have a special  area of interest. The medical profession is notorious for its ‘demarcation’ of specialised areas which get increasingly narrow with the years. The advance of knowledge, in one sense has caused this but if it means that large parts of the country do not have ready access to ‘specialist’ care we have clearly lost sight of the need for a National Health Service.

  • 3. The knock-on effect of closing the Consultant-led maternity unit in Wick is considerable. There will be less work for anaesthetists bringing into question the viability of the surgical unit.

  • 4. There is currently a shortage of doctors and an acute shortage is looming. The BMA has recently high-lighted the effect of the current proportion of women being recruited. We need more women Doctors but it does not take an Einstein to see that the number of years they will work as Doctors will, on average, be significantly less than their male counter-parts. Not only will there be considerable difficulty recruiting rural GPs but there will also be a shortage of hospital doctors. Unless the Government take immediate steps either to increase the number of Doctors being trained or ‘ration’ the available Doctors across the country there is little hope of a genuine National Health Service being provided in the future. The suggestion of some politicians that we should recruit third world Doctors displays an unwillingness to face the depth of the crisis and also a lack of morality in that  these countries need their doctors even more than we do.

Unless our Health planners take long term strategic decisions most rural hospitals in Scotland will, in the not-too-distant future, either close or be little more than community nursing homes. If NHS Highland is unable or unwilling to continue to provide the health care service to this community that is currently provided it will not only herald a major decline in community resources in Caithness but, because of the underlying structural problems, should be seen as the tip of an ice-berg which will eventually see the down-grading of every rural hospital in the land.

In conclusion…

  1. The public’s view is clear – don’t change the current services unless you are improving them.

  2. There is no point in further public ‘consultations’ – the vast majority of the public in Caithness want a Consultant –led Maternity Service in the county.

  3. There are basic structural problems in the NHS in Scotland. These problems stem from the shortage of Doctors and Consultants.

  4. Unless urgent action is taken to increase the number of Doctors and Consultants being trained in Scotland every rural hospital is under threat.