'He has listened to us' – Caithness health campaigners heartened by response from health secretary Humza Yousaf
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Scotland's health secretary Humza Yousaf has given renewed hope to Caithness campaigners that more services can be provided locally – potentially leading to a reduction in the number of patients having to travel back and forth to Inverness.
Mr Yousaf held a meeting with Caithness Health Action Team (CHAT) in Wick in August and this week he sent a detailed follow-up letter to the group touching on a range of healthcare issues.
CHAT welcomed the letter, noting that it contained a number of positives, and said: "He has obviously listened to us."
The consultant-led maternity unit at Caithness General Hospital in Wick was downgraded in 2016 to a midwife-led facility and most women in the far north now give birth at Raigmore.
Mr Yousaf wrote: "After listening to the concerns discussed, I asked my officials to contact NHS Highland to follow up on specific points raised during our meeting.
"We have requested information about local service provision and work under way or planned to provide more services locally in Caithness (particularly maternity) and any other initiatives that might reduce the requirement to travel."
The health secretary stressed that NHS Highland is "committed to delivering local services to local communities where possible and practicable", adding: "Key reviews of services include workforce planning for midwifery, considering additional services which may be provided by midwives."
He pointed out that the health board is also carrying out a review of outpatient department services.
Mr Yousaf noted that NHS Highland is working closely with NHS Orkney "to provide additional gynaecology outpatient and theatre sessions to the women of Caithness".
He wrote: "NHS Highland has committed to work proactively with CHAT to listen and respond to concerns raised with a view to continuing to develop services that meet the needs of the people of Caithness.
"I would like to assure you the Scottish Government is supporting rural, remote and island communities to address the unique health and social care challenges they face, including recruitment and retention, access and transport."
CHAT chairman Ron Gunn said: “We would like to thank him for accepting our invitation and listening to our concerns. We now have a document to work from.
“There are positives in it, trying to get local services back. He has obviously listened to us with our concerns."
In his letter Mr Yousaf mentioned the provision of bili-blankets for jaundiced newborns.
“They used to have them in Caithness General," Mr Gunn said. "When it was highlighted by CHAT he was very keen to get it back again.”
“Also trying to reduce the number of outpatients having to travel down to Raigmore, which is great news to us. There are still over 6000 a year from Caithness alone having to go up and down the road, which is roughly 25 to 27 a day based on the number of days on which appointments are available.
“We are very interested in working with NHS Orkney on the gynaecology side of things because that is a real problem for women here.
“It could be that they might put surgeons over here, I really don't know. That's just the initial reading of it. At least they're speaking to each other and working together to try and resolve a problem.
“He has obviously highlighted the fact that there should be better engagement and relationships with the likes of CHAT and the North Highland Women’s Wellbeing Hub. That's good news to us.
"He says that NHS Highland has committed to work with us proactively, to listen and respond to our concerns, so that can only be an improvement for patients in Caithness.
“Campaign groups quite often get forgotten about at that kind of level. He has obviously brought that to the front, that it's important to have these campaign groups.
“With the Best Start North review, we would like more information about what happens there.
“But it's encouraging to hear a lot of what he is saying – that the Scottish Government is committed to remote and rural health and social care.
“Time will tell if anything actually improves, We'll have to wait and see. But I think overall we're delighted with his letter.”
At the meeting with CHAT in August at Wick's Norseman Hotel, Mr Yousaf was given a first-hand account of the impact on families caused by the downgrading of Caithness maternity services by a young local mother who attended with her baby. The woman broke down as she spoke about the worry and stress of having to travel to Inverness to give birth.
Mr Gunn said: "We would like to thank the young mother who came along with her baby to relate her experiences to Mr Yousaf.
"She gave a very personal insight into her situation. Having her there really got the message over."
Full text of letter to Caithness Health Action Team from Humza Yousaf, Scotland's cabinet secretary for health and social care, dated October 4:
Apologies for the delay in responding to you. I would like to thank you again for giving me the opportunity to meet with representatives from CHAT and local people when I travelled to Caithness on 15 August 2022. I was pleased to discuss maternity service provision and the wider health concerns you raised.
After listening to the concerns discussed, I asked my officials to contact NHS Highland to follow up on specific points raised during our meeting.
We have requested information about local service provision and work under way or planned to provide more services locally in Caithness (particularly maternity) and any other initiatives that might reduce the requirement to travel. NHS Highland has informed they are committed to delivering local services to local communities where possible and practicable. Key reviews of services include workforce planning for midwifery, considering additional services which may be provided by midwives, for example:
- Care of women with hyperemesis gravidarum [excessive nausea and vomiting experienced by some women in pregnancy]
- Pre-assessment for elective caesarean section
- Management of neonatal jaundice in the community
The workforce review is due for completion in October 2022. Some of the above may only progress when recruitment to current vacancies is secured.
NHS Highland is also carrying out a review of the outpatient department services, by speciality, to establish the number of patients travelling outwith the area. A short-life working group is being established to review the current service and data to explore potential options to reduce the number of patients travelling to Raigmore Hospital.
Additionally, the board updated they are currently working closely with NHS Orkney through a new proposed service level agreement, to provide additional gynaecology outpatient and theatre sessions to the women of Caithness.
I had noted that the engagement and relationship between the board and action groups could be improved, and for that purpose have asked NHS Highland for assurance on how communications and visibility of activity could be provided to the campaigners as part of any plans to strengthen relationships.
NHS Highland updated they are committed to working closely with all communities and service users. Following the appointment of a new deputy chief officer for acute services in September 2021, with leadership responsibility for Caithness General Hospital, there has been a strategy to forge closer and more formalised links with CHAT and North Highland Women’s Wellbeing Hub. There is now a formalised face-to-face NHS Highland / CHAT meeting scheduled every two months with senior members of NHS Highland in attendance.
NHS Highland has committed to work proactively with CHAT to listen and respond to concerns raised with a view to continuing to develop services that meet the needs of the people of Caithness.
In addition to the above, and regarding plans to be able to provide bili-blankets for home use for jaundiced newborns, NHS Highland has consulted with NHS board areas which provide management of neonatal jaundice in the community to explore how to provide this service in NHS Highland. This work will be progressed jointly with midwives, advanced neonatal nurse practitioners and paediatricians. NHS Highland is committed to reducing unnecessary travel for newborn babies and their families.
With regard to the Best Start North review process being involved on the issues raised regarding maternity service provision, and as you may know, that consultation was facilitated by the Digital Health and Care Innovation Centre on behalf of the board chief executives for the north region. This is a NHS board-led review that was commissioned by NHS Grampian, Highland and the island boards. At the moment, we are establishing the current position on this matter and looking for further information on where this work has restarted.
Finally, I would like to assure you the Scottish Government is supporting rural, remote and island communities to address the unique health and social care challenges they face, including recruitment and retention, access and transport.
The Scottish Government is committed to the development of a National Centre for Remote and Rural Health and Social Care. NHS Education for Scotland (NES) has been commissioned to write a business plan for the National Centre’s development. As a national health board, NES is well positioned to harness its resources to ensure that the National Centre is pan-Scotland in its approach. The National Centre will promote excellence to ensure that remote and rural health services are world leading. It will likely do so in accordance with the Four Pillars: Recruitment and Retention, Ideal Practice and Evaluation, Training and Education, and Research and Innovation.
I hope you find this information helpful and I would like to reiterate that the Scottish Government recognises the challenges facing remote and rural health boards and works to ensure services are developed in a sustainable, flexible and innovative way recognising local population needs and geographic challenges.
