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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 –
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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?
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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.
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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.
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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…
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The public’s
view is clear – don’t change the current services unless you are
improving them.
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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.
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There are basic
structural problems in the NHS in Scotland. These problems stem from the
shortage of Doctors and Consultants.
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Unless urgent
action is taken to increase the number of Doctors and Consultants being
trained in Scotland every rural hospital is under threat.
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