Human rights group questions NHS Highland over Caithness and Sutherland women’s healthcare
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NHS Highland is facing questions over the centralisation of women’s healthcare and the impact it is having on the human rights of patients in the far north.
Issues ranging from lengthy journeys on the A9 to the quality of gynaecological provision were highlighted by the Scottish Human Rights Commission (SHRC) following concerns from women in Caithness and Sutherland.
In a letter to NHS Highland chief executive Pam Dudek, the commission's chairman, Ian Duddy, pointed out that "the right to health is an internationally recognised right to which the UK has committed to comply".
He also said the SHRC wanted to ensure that the delivery of health services in the Highlands "takes a human rights-based approach".
Mr Duddy's intervention comes after representatives of the North Highland Women’s Wellbeing Hub met Scotland's health secretary Humza Yousaf during his visit to Wick in August.
Hub chairperson Kirsteen Campbell said she looked forward to seeing the health board's response.
In his letter to Mrs Dudek, dated October 31, Mr Duddy explained that the SHRC is Scotland’s national human rights institution "with a statutory duty to promote and protect human rights in Scotland, including the right to the highest attainable standard of health".
He wrote: "The commission has received reports from individuals in Caithness and Sutherland who are concerned about the centralisation of women’s healthcare, in particular gynaecological services, leading to lengthy road trips to Inverness, sometimes involving overnight stays. In addition, some individuals have questioned the quality of gynaecological care that they have received at Raigmore Hospital.
"The right to health is an internationally recognised right to which the UK has committed to comply with by adhering itself to the International Covenant on Economic, Social and Cultural Rights and the European Social Charter.
"Under human rights standards, for health services and policies to be considered adequate they need to be accessible. This implies that they need to be both physically and financially accessible."
Mr Duddy went on: "In addition to the accessibility requirements, for services to be considered adequate under human rights terms, they need to be of good quality. In particular, this means that services need to be medically and scientifically appropriate, ensuring skilled medical personnel are available.
"I understand that there are significant financial constraints on public services in Scotland and that there is a balance to be struck between local access and centralised provision. However, given the concerns expressed by some women in accessing healthcare in Caithness and Sutherland, the commission would like to hear your views on how the accessibility criteria as a component of the right to health is impacted by centralised provision.
"In particular, can you advise whether a human rights-based analysis has been carried out to determine the impact on women in these regions?"
Mrs Campbell said yesterday: "Since 2016, when the decision was made to change Caithness General Hospital to a community midwife-led unit, it just has not sat well with me. I attended the board meeting that day and spoke for women's health.
"The decision was made on the safety of babies, which I absolutely agree had to change – it was not safe. Nothing was answered then or to this day around concerns of emergency situations and no local cover.
"I have checked back the NHS Highland board meeting minutes and there’s no talk about gynaecology or women's health. It’s reckless and dangerous, and a miracle we haven’t lost a woman.
"I was introduced to Clare MacGillivray from Making Rights Real earlier this year. She pulled up three human rights areas of concern before we met the cabinet secretary in August. Then she introduced us to Ian Duddy, who has been working with the hub.
"We welcome Ian’s letter and look forward to seeing NHS Highland's response."
Full text of letter from Ian Duddy, chairman of the Scottish Human Rights Commission, to Pam Dudek, chief executive of NHS Highland, dated October 31:
WOMEN’S HEALTHCARE IN THE HIGHLANDS
Dear Ms Dudek
The Scottish Human Rights Commission (SHRC) is Scotland’s national human rights institution with a statutory duty to promote and protect human rights in Scotland, including the right to the highest attainable standard of health.
The commission has received reports from individuals in Caithness and Sutherland who are concerned about the centralisation of women’s healthcare, in particular gynaecological services, leading to lengthy road trips to Inverness, sometimes involving overnight stays. In addition, some individuals have questioned the quality of gynaecological care that they have received at Raigmore Hospital.
The right to health is an internationally recognised right to which the UK has committed to comply with by adhering itself to the International Covenant on Economic, Social and Cultural Rights and the European Social Charter. Under human rights standards, for health services and policies to be considered adequate they need to be accessible. This implies that they need to be both physically and financially accessible. In particular:
- Physically accessible requires for services to be within safe physical reach for all sections of the population, especially vulnerable or marginalised groups, such as women, ethnic minorities, children and young people, older persons, and persons with disabilities, among others.
- Financially accessible requires for health services to be affordable for all. This includes ensuring that everyone, and particularly those most vulnerable, do not incur unaffordable expenses in order to access medical services, such as through the payment of fees, accommodation, and transport.
In addition to the accessibility requirements, for services to be considered adequate under human rights terms, they need to be of good quality. In particular, this means that services need to be medically and scientifically appropriate, ensuring skilled medical personnel are available.
I understand that there are significant financial constraints on public services in Scotland and that there is a balance to be struck between local access and centralised provision. However, given the concerns expressed by some women in accessing healthcare in Caithness and Sutherland, the commission would like to hear your views on how the accessibility criteria as a component of the right to health is impacted by centralised provision. In particular, can you advise whether a human rights-based analysis has been carried out to determine the impact on women in these regions?
For example, we are interested in understanding the impact on women whose pregnancies are low-risk and their ability to access adequate services locally. We are also interested in the situation of high-risk patients and whether it is appropriate that they be expected to travel to Raigmore Hospital for treatment. Are you able to share data on the still birth rate in the region and whether that has significantly improved with the centralisation of service? I would be grateful for any information or data that you are able to share.
The commission wishes to engage constructively with you in order to provide support through guidance and/or capacity building to ensure that the provision of health services in the Highlands takes a human rights-based approach.
Ian Duddy
Chair, Scottish Human Rights Commission
The letter is copied to Scotland's health secretary Humza Yousaf.
