John Thurso MP

Maternity Unit Poses Wider Questions About NHS Management

Local MP John Thurso, speaking on the occasion of the Closing Dinner of the Annual Surgical Meeting at the Portland Arms, Lybster on Thursday 9th September, called for a full review of NHS Highland in the wake of the "catalogue of mismanagement that has surrounded NHS Highland's approach to the Maternity Unit at Wick General Hospital".

Focussing on the delivery of medical services in remote areas, the MP said:

"The contract between the state and the citizen is straightforward: we pay our taxes in return for services. Certainly we who live in the North accept that we have many advantages not enjoyed by urban dwellers and some disadvantages. However, the basic services of education, social services and particularly health must be available to all just as we all pay tax irrespective of where we live. The state has a duty to provide these services and cannot escape that duty.

"This does not mean that every facet of medicine must be available everywhere. Clearly the many great advances in modern medicine mean that there are many procedures requiring high degrees of specialist skill that should be delivered at centres of excellence - brain surgery and complex heart surgery are obvious examples. But, at the other end of the spectrum, we have developed procedures which when delivered locally, greatly enhance the quality of life of our citizens. A perfect example of this is the provision of kidney dialysis in the new unit at Caithness General Hospital which has transformed the lives of those in the North who previously had to travel to Inverness. I believe that the provision of Maternity services falls clearly into this latter category, and from the comments I have received that is the overwhelming view of the citizens of the North and of all their elected representatives, of all parties and at every level. Why then does the will of the people not prevail?"

"The answer lies in the way in which health is now managed in this country and in particular in the Highlands. Once below cabinet level, health provision has been divorced from political responsibility through the creation of Trusts. The link between local democracy and health provision was severed in the 1980s. At that time, the North had its own health trust which was well run, financially sound, and, very importantly, supervised by a board resident in the community it served. This link was broken when that Trust was absorbed by the creation of the Highland Health Board and its two operating Trusts, Primary and Acute. Last year these amalgamated to become NHS Highland."

"The link with local communities has been lost and needs to be restored."

"I do not criticise any individual on the Board, in management or in service provision of NHS Highland. What I do criticise is the almost accidental creation of a behemoth that simply cannot serve local needs by its very nature. It is the very nature of the size and complexity of the structure that creates muddled management".

"As a non-governmental public body the Board is subject to appointment by Nolan principles. I have no reason to suppose that all the members did not pass that test. But Nolan not only requires individuals to be fit for purpose but that a Board as a whole be fit for purpose. Surely proper geographic representation should be included in that test? Yet no lay member of the board resides outwith the greater Inverness area. I believe this deficiency renders the board non-compliant with Nolan".

"The manner in which the subject of the provision of maternity services in Caithness has been handled cannot under any circumstances be described as good management. It began with a letter from clinicians that was not properly addressed, has proceeded through a review that was clearly flawed ignoring as it did the vital issue of ambulance transport, and now appears to be being driven to conclusions that no-one wants or accepts accompanied by, to say the least, curious management practice in relation to locums. In my judgement this catalogue of mismanagement that has surrounded NHS Highland's approach to the Maternity Unit at Wick General Hospital can only be rectified by a full review of NHS Highland itself, which I would hope would lead to proper recognition of local responsibility for local service provision by the re-establishment of more local Trusts, able to respond without the conflict of other priorities to local needs. It is a measure of the failure of the current system that it forces the Health Board to choose areas and priorities and forces Highlander into conflict with Highlander".

"The campaign to maintain Caithness's Maternity Unit will continue, and I hope succeed. But this issue is a symptom, not the disease. The disease is a bureaucracy that is structurally incapable of delivery and it is that which needs to be treated by the Scottish Executive Health Minister".

The Viking Surgical Club is a group of surgeons working in remote and rural hospitals in Scotland, Northern Ireland and Scandinavia who meet annually to exchange experiences and discuss issues of common interest (2001 Iceland, 2002 Oban, 2003 Kirkwall). 40 surgeons attended this year's annual conference in Caithness.