Service has to change, says senior consultant
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THE future of out-of-hours surgery at Caithness General should be decided “over the next few months,” according to a senior consultant at the hospital.
John Macleod, a 52-year-old consultant anaesthetist who also runs the Highland chronic pain unit, says whatever the outcome, the way the service is provided has to change.
Having three consultants based at Wick is unsustainable in the long term, he said.
“The status quo is not an option,” he said.
NHS Highland is finding it difficult to recruit consultants to posts in places such as Wick, partly because of the one-in-three on-call rota system. As a result, it is having to look at different ways to attract the staff to the north and is considering recruiting on a Highland-wide basis.
Dr Macleod supports that proposal and thinks it will deliver a better, safer and more sustainable service for the public. He also points out that more planned operations would be undertaken at Wick.
“We absolutely must have a hospital here that provides high-quality care. People in Caithness deserve that but how we do that is a work in progress,” he said.
When the Wick hospital is fully staffed, it has 12 consultants – a fraction of the number at big city hospitals. As a result, losing two or three key people can lead to problems and that is why changes are required.
Dr Macleod said it is “less likely rather than more likely” there will be round-the-clock cover provided at Caithness General by Wick-based surgeons in future. He said very little surgery is done at the hospital out-of-hours.
Instead, he thinks emergency doctors trained for the task will be recruited to deal with out-of-hours problems.
“Having experienced staff on call 24/7 with back-up would be my preference,” said Dr Macleod, who believes Highland-wide recruitment would make posts more, not less attractive.
Working at a number of hospitals, including the bigger ones such as Raigmore, will retain the doctors’ skills and help with their professional development. They can, he said, feel isolated based in a remote and rural location.
To illustrate the recruitment problems, he pointed out that a consultant physician post was advertised in the British Medical Journal in December and there was not a single applicant by the closing date.
“We are re-advertising it but are not optimistic about getting a response,” said Dr Macleod, who accepts uncertainty over what is happening at the hospital is affecting morale.
“It is unsettling for staff when you undertake major changes. You have to take the staff and the public with you.
“I think things are moving in the right direction regarding the staff but it will be a significant challenge to take the public with us. There is a difference between the public perception and the professional reality,” he said.
Dr Macleod claims the changes will result in an improved service for local people. “I genuinely believe the quality of care will be better not worse,.” he said.
Concern has been expressed about the adverse impact the changes could have on efforts to attract companies and staff to the area in the wake of the rundown at Dounreay. However, Dr Macleod does not subscribe to that view and claims the new set-up should improve the service.
He also rejects claims the changes are being driven by the NHS Highland deficit. “I don’t believe that. The overspend is due to the costs of providing locum cover. We are spending a fortune on that. It is not money well spent,” he saidstated.
He does not know when a decision will be made on the future of the surgical cover at Caithness General but expects it will happen “over the next few months”.
Criticism has been levelled at NHS Highland over its handling of the plans. “Perhaps it was badly handled but part of that is down to people like me who did not communicate particularly effectively,” he added.
The health authority also has also been accused of not having a strategy in place and just reacting to events but that argument is rejected by the consultant.
“Delivering healthcare over a wide geographic area is a challenge but this is about how we better manage care here,” said Dr Macleod, who has been working at Caithness General for 13 years.
He comes from Stornoway and worked in Birmingham before moving north. Dr Macleod is married to Sandra – a school nurse – and lives in Wick. The couple have three grown-up sons.
“I am very happy here and have no plans to leave. I have put a lot of effort into my work and developing the Highland chronic pain service. I am committed to that,” he said.
