The health service in Shetland passed its yearly government examination with flying colours this week, earning congratulations from Scotland’s health secretary Nicola Sturgeon for “doing all the right things”.
Ms Sturgeon, the deputy First Minister, used video-conferencing to publicly question five health board employees and board chairman Ian Kinniburgh for one-and-a-half hours on Wednesday.
She was refreshingly upbeat about the £45 million-a-year organisation’s performance in 2009/10, despite the trickle of negative stories in the Shetland press relating to isolated cases of poor service and professional misconduct.
Summing up her impressions, she said she was “very pleased indeed” with NHS Shetland’s record for 2009/10. “It has worked hard to reduce waiting times and hospital infection rates and its health improvement figures on smoking cessation … are among the best in Scotland. All those involved should be congratulated.”
She was conducting the last annual review ahead of the cuts set to be unleashed on Scotland’s public services by the UK government. With the extent of those cutbacks not to be revealed until next week Ms Sturgeon only issued a general warning of “tough decisions ahead”, although the Scottish government has pledged to shield the health service.
While all NHS boards face “difficult times” she said the work Shetland had already done “puts it in a good position to face up to the challenges ahead”.
She confirmed there was no plan to save money by merging NHS Shetland with NHS Grampian, which the island board has been developing a much closer relationship with over the past two years.
A real criticism she did hear earlier in the day during a private session with patient representatives involved the continuing saga of patients in Lerwick and Bressay being unable to get doctors’ appointments at the Lerwick Health Centre. Mr Kinniburgh responded that the board had put extra resources and management into the practice to try to resolve the problems but he acknowledged that it was “certainly not at the desired end point yet”.
Director of clinical services Simon Bokor-Ingram agreed that the waiting time of around 20 days for routine appointments was “totally unacceptable”. It has now been brought down to an almost same-day appointment system, he told the minister, but now there are complaints that the system is inflexible and actually prevents people booking appointments more than one day ahead. The matter is to be looked into with some urgency.
Ms Sturgeon also picked up on the waiting lists in Shetland for adults to see a dentist, which continue to be long, particularly in Lerwick. According to Mr Kinniburgh the board will decide by the end of next March whether the business case stacks up for a new four-chair dental surgery. A central decontamination unit for all dentist practices in Shetland has also recently been approved.
Ms Sturgeon was addressing the Brevik House gathering from a meeting room in Edinburgh because she could not fit in a visit to Lerwick. She apologised for not being able to officially open the new Montfield support unit.
The annual review of the Shetland NHS Board is the only occasion the public gets to witness the body being scrutinised by its government paymaster. Although the BBC and The Shetland Times did attend only 10 other people were interested enough to sit on the public benches, most of them NHS employees. Others included council convener Sandy Cluness and an octogenarian veteran of hundreds of public meetings and ministerial visits, Jimmy Wiseman.
Only one person took up the offer to pose a question with Barrie Jehu actually wishing just to praise the board for extending its suicide prevention training to more people and groups than it is required to do.
According to the minister’s letter to public visitors, the intention during the session is to avoid slipping into impenetrable medical and administrative jargon, or what she dubbed “management speak”. But much of what was said during the session fell squarely into that category including bewildering talk of obligate networks, the e-KSF trajectory, HEAT targets and root cause analysis.
Among the issues of more significance to the layman was the tackling of hospital-acquired infections where Shetland is setting a shining example in good cleanliness. The rate of C Diff infection in patients over 65 and staphylococcus aureus bacteria (including MRSA) has fallen to zero since June this year.
Ms Sturgeon has made the fight against these superbugs her top priority, tripling expenditure on national prevention efforts, so she found the board’s record “very encouraging indeed”.
NHS Shetland has also been working towards cutting waiting times by keeping more patients in Shetland for operations and procedures rather than them having to wait in a queue to get treated in Aberdeen.
Mr Bokor-Ingram said the three consultant surgeons in Shetland were working with the board with a view to carrying out even more procedures which are “safe and right to do here in Shetland”, also making use of the skills of GPs with special interests.
Ms Sturgeon said she wanted to stress how impressive the waiting time performance was for an island board which has to rely on another health board to help meet its targets.
As well as succeeding in balancing its books again last year the board had a range of other successes which earned it brownie points, which included having:
• the lowest number of smokers in Scotland at 18 per cent with the aim of having 237 more quitters by March next year;
• all people with suspected cancer starting treatment within 62 days;
• nobody left waiting in a hospital for admission to a care home or to be cared for at home;
• one of the highest rates of older people with complex care needs being able to get care at home (42.8 per cent compared with the Scottish average of 32 per cent);
• the highest rate of breastfed babies in Scotland at 37.9 per cent;
• a reduction in deaths from coronary heart disease among people under 75 by 46.5 per cent since 1999.
Areas where the board has fallen down include the lowest number of attempts to persuade patients to cut down their drinking – the so-called alcohol brief interventions – of which only 157 were managed in Shetland during 2009/10 compared with 669 in Orkney and 786 in the Western Isles, according to government figures.
Mr Kinniburgh said there had now been 208 ABIs and the target for March 2011 was to complete 622.
Public health director Dr Sarah Taylor said ABIs were now done as a matter of routine at the accident and emergency department and in maternity with the Lerwick GP practice and others joining in after training had been carried out.
This week’s annual board review was the last one for outgoing chief executive Sandra Laurenson who retires at Christmas after 10 years in the post. Ms Sturgeon took the time to pay tribute, thanking her for an enormous contribution to the development of the NHS in Shetland. “I know you are going to be sorely missed,” she said.
Afterwards Mr Kinniburgh said he was delighted with the minister’s commendation for the board’s work. “It was clearly a very positive annual review and it reflects very well on all the hard work by all the staff over the year so it is difficult to be anything other than pleased with an appraisal like that.”