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£133m extra NHS Highland cash won’t help Caithness maternity situation





Hopes that maternity services in Caithness might get a boost when the Scottish Government announced an extra £133 million funding for NHS Highland have been dashed.

In fact, the health board said the settlement was less generous that might first be assumed because £90 million would immediately be used up by pay settlements agreed by the Scottish Government.

CHAT chairman Ron Gunn is one of three key speakers in the session entitled 'How’s Your Rural Health?' to be hosted by Scottish Rural Action. Picture: Alan Hendry
CHAT chairman Ron Gunn is one of three key speakers in the session entitled 'How’s Your Rural Health?' to be hosted by Scottish Rural Action. Picture: Alan Hendry

That still leaves £43 million, but NHS Highland has been notoriously unsuccessful at keeping within budget and frequently had to seek brokerage – essentially a government bailout at the turn of the financial year.

In Caithness, the health board confirmed it would not use any of the additional funding to reinstate consultant-led maternity care in the far north – something campaigners have been pressing for.

Instead, NHS Highland said: “Safety and quality are at the forefront of all of our service planning, and we provide as many gynaecology and maternity procedures as is safe to do so in Caithness General Hospital.”

Far north MP Jamie Stone said: "I find it astonishing that the Highland health board still seems to be doggedly sticking to their argument that a great number of far north babies should continue to be born in Inverness. It is extremely disappointing to see no assurance that capital will be ringfenced for the hiring of consultants for Caithness General.”

The issue of the distances expectant mothers and gynaecological patients have to travel in the Highlands has damaged both the local health board’s reputation and that of NHS Scotland and the government.

The consultant-led maternity unit at Caithness General Hospital was downgraded in 2016 and the vast majority of local women now give birth in Inverness. Picture: Alan Hendry
The consultant-led maternity unit at Caithness General Hospital was downgraded in 2016 and the vast majority of local women now give birth in Inverness. Picture: Alan Hendry

For years officials have pleaded that it was “safer” in complex cases to move pregnant women to Raigmore.

Each year, 14,000 people must travel beyond Caithness to access health care – that is 55 per cent of the population of the county.

The last month or so has seen a flurry of fresh activity over the issue, largely prompted by a report by the Scottish Human Rights Commission that labelled the distances mothers have to travel “barbaric”.

Then the Caithness Health Action Team (CHAT) sent a submission to the UN Committee on Economic, Social and Cultural Rights in Switzerland arguing on behalf of women from the far north.

The submission claimed that they “are denied their basic human rights in relation to fair, equitable, adequate and accessible healthcare” because so many have to travel to Inverness to give birth.

The Lib Dems Scottish leader Alex Cole-Hamilton raised the issue at Holyrood.
The Lib Dems Scottish leader Alex Cole-Hamilton raised the issue at Holyrood.

Ron Gunn, chairman of CHAT and a Thurso and Northwest Caithness councillor, welcomed the extra NHS Highland funding but questioned why so many cases are considered high-risk.

He said: “Over the years since the downgrading in 2016, around 1600 Caithness mums have given birth, only around 60 have given birth in the CMU [community midwife unit at Caithness General] . I find it difficult to understand how the remaining 1540 were either high risk or complex births.

“A few years ago the CMU in Wick was refurbished and fully equipped and I understand recruitment to the midwifery team is going well. We have always said that our CMU is a great facility with a dedicated team, all mothers that have given birth there have had a great experience.

“A substantial amount of money was spent on the CMU but it shows that spending money on the facilities alone does not improve the birthrate. The problem is the model NHS Highland use. If they were to adopt the ‘Orkney Model’ (midwife led with consultant backup) we would see the local birth rate dramatically increase.

“The recently published Scottish Human Rights Commission report confirms the feedback we get, that many patients, including expectant mothers, do not have good experiences having to go to Raigmore.”

The issue was also raised in the Scottish Parliament by Liberal Democrat leader Alex Cole-Hamilton who called on First Minister John Swinney to take action on the issue.

The First Minister said that it was not a matter of investment but safety, claiming “the Caithness situation is slightly different because it is informed by assessments of patient safety about the volume of maternity cases that can be dealt with in Caithness.”

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In another issue that may yet impact mothers in the far north, the maternity unit at Raigmore was also due for a major upgrade to accommodate demand not just from the health board area but overspill due to pressures at Dr Gray’s Hospital in Elgin.

But the £9 million expansion was halted in January 2024 when the development did not appear on the 2021-22 to 2025-26 Infrastructure Investment Plan which “identified the priority health capital projects for funding”.

NHS Highland has confirmed that “no funding has been provided for specific capital investment other than the development of the Belford business case”, which was announced in the budget.

An NHS Highland spokesman said: “The draft budget was announced on December 4 and the NHS Highland board are in the early process of establishing our first draft of the financial plan to be submitted to the Scottish Government by January 27, with the final plan due on March 17.

“However, much of the budget announcement relates to committed staff pay uplifts (£90m) and future pay uplifts, leaving a small amount to offset annual inflationary pressures and growth.

“Safety and quality are at the forefront of all of our service planning, and we provide as many gynaecology and maternity procedures as is safe to do so in Caithness General Hospital.

“There are regular consultant clinics in Caithness and we have successfully increased the midwifery team there.

“High risk or complex cases continue to come to our District General Hospital in Inverness – this is the same for all our remote and rural areas in the Highland region.

“We plan our theatre lists to support travel for those travelling longer distances and accommodation and expenses are also provided.

“Capital is provided on an annual formulary basis and is committed to back-log maintenance, equipment and digital infrastructure and costs. No funding has been provided for specific capital investment other than the development of the Belford business case.”


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