National Care Service will have ‘neutral impact’ on councils’ finances



SCOTLAND’S Social Care minister has insisted that the new National Care Service (NCS) will have a “neutral impact” on councils’ finances.

In a letter to Holyrood’s Public Administration Committee, Kevin Stewart told MSPs the planned reform was still “at a relatively early stage” and that the government was “taking the time to undertake meaningful co-design work” with local authorities and patients and families. 

Health Secretary Humza Yousaf introduced the National Care Service (Scotland) Bill in June promising to “end the ‘postcode lottery’ of care.”

The legislation – which is currently making its way through Holyrood –  will see the government set up ‘care boards’ directly accountable to the Scottish Ministers who will take on functions and staff that are currently managed and run by local authorities and health boards.

Nicola Sturgeon has described it as the most significant reform to public services since the creation of the NHS.

Criticism of the Bill has been mounting, with MSPs, councils, unions and organisations and carer’s charities urging the government to pause or think again.

Audit Scotland has raised serious concerns about the financial memorandum accompanying the legislation. They warned that ministers had underestimated “the margin of uncertainty” in their cost estimates, which have ranged from £650m to £1.3bn. 

According to the public spending watchdog, the potential for additional cost is “significant”

They have warned that pensions, VAT changes, changes to capital investment costs and health board transition costs could lead to the overall budget skyrocketing.

In his letter to the committee, Mr Stewart responded to a series of questions following his appearance in front of him earlier this month.

On tax implications, the minister said external advisors believed the care boards could “potentially fall under Section 33 or Section 41 of the VAT Act 1994”.

If they are the former, that means the boards could recover all VAT costs associated with both taxable business and non-business activities. 

If they are Section 41 they can “claim a refund of VAT incurred on some services but not all.”

Currently, the integrated boards responsible for delivering adult community health and social care services, have a “broadly neutral” VAT accounting arrangement with HMRC. 

Before that deal was negotiated with the treasury, the VAT cost was estimated to be circa £32m.

However, in his letter, the Minister told the committee: “As this was for adult health and social care functions only, the worst-case VAT cost impact associated with the creation of the NCS would likely be in excess of this estimate.”

Mr Stewart added that “further work will therefore need to be undertaken to refine this estimate.”

He also said ministers were “looking to achieve a fiscally neutral VAT position” with HMRC. 

On IT costs, Mr Stewart said the government were looking to create  a “nationally consistent integrated and accessible electronic social care and health record.” 

While “early discovery work has started” on what is needed for this record, the cost had not been included in the financial memorandum. He said this would “be subject to a formal, dedicated business case.” 

The committee also asked Mr Stewart to expand further on his claim that the NCS would mean “no detriment to local government finances.” 

In his letter, Mr Stewart said: “We recognise that in establishing a NCS, including any transfer of accountabilities (and associated financial resources from local authorities), we need to take into consideration the impact on local authorities’ ability to resource and deliver other important public services.

“The nature of the impact on local government from the establishment of the NCS will depend on the details of the transfer of functions to Scottish Ministers, and on local decisions about how services are to be provided.

“We will continue to work closely with local government to understand current costs and financial impact of any detailed options being considered following co-design.”

Mr Stewart said the government would publish a Programme Business Case, in early 2023, which would share detail on costs, and “the strategic, economic, and commercial value of this reform, as well as a plan for its effective management.”

He added: “It is important to note, that the NCS Programme is at a relatively early stage in terms of delivery. The Scottish Government is committed to getting this reform right for everyone.

“That means taking the time to undertake meaningful co-design work, with the people who use and deliver health and social care services; the organisations which represent them; and our delivery partners.

“The business case for NCS delivery will have to evolve alongside our understanding of the needs of people receiving and working in social care, which will grow as a result of our evidence gathering and co-design work. 

“The Programme Business Case will set out key decision points and how these key decisions will be made in a robust, evidence-based way, is subject to proper scrutiny; and how these decisions will be made in a way which delivers the best value for the people of Scotland.” 

He said this could mean “the delivery of more detailed business cases throughout the lifetime of the NCS Programme, to support future decisions.”

Earlier today, Robert Kilgour, the chief executive of Renaissance Care, which operates fifteen care homes throughout Scotland, warned the new NCS “won’t necessarily improve care.”

He told the Press and Journal: “I fear it’s a political marketing exercise. It’s a further land grab for central control.”

The businessman – who also founded the anti-independence Scottish Business UK group – said the SNP government were “not prepared to engage with key stakeholders in a meaningful way.”

He added: “In principle I’m supportive. But you’ve got so many different groups against the way the government is ploughing on.”





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Nicola Sturgeon has ‘absolute confidence’ in Humza Yousaf



NICOLA Sturgeon has accused opposition parties of “political game playing” over the state of Scotland’s NHS. 

The First Minister insisted she had “absolute confidence” in Health Secretary Humza Yousaf.

Last week Labour branded him “the worst health secretary since devolution,” blaming him for unprecedented waits in A&E and record vacancies of critical NHS staff. 

The beleaguered minister’s week only got worse when Scotland’s nurses voted to strike for the first time in the Royal College of Nursing’s 106-year-history. 

Scottish Ambulance Service workers have now confirmed that they too will stage a 26-hour strike later this month over pay.

Visiting a school on Monday, the First Minister told the PA: “I have absolute confidence in Humza Yousaf.”

“Anybody who thinks the challenges – the very real challenges – our National Health Service is facing now is down to who the Health Secretary is, probably doesn’t understand the nature of those challenges,” she added.

The First Minister said that the NHS was performing “better in many respects” than the health service in England and Wales. 

“I think what we need to see from the opposition is a bit less political game-playing over the NHS and a real focus on the very real and very hard challenges that our National Health Service is facing.

“That is what I am bringing to bear and that is what Humza Yousaf is bringing to bear.”

On strikes, the First Minister said there was “political will” to come back with a higher pay offer, but the government simply did not have the money. 

“The management of the health service is absolutely the responsibility of the Scottish Government, but our ability to put more resources into the health service depends on decisions taken by the UK Government which determines the overall size of our budget,” she said.

“We can see from the higher pay increase that NHS workers are being offered in Scotland compared to England and Wales, that political will is there in Scotland – what is holding us back is a lack of funding, and that can only come now from the UK Government.”





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Jeane Freeman: ‘Substituting argument for insult takes us nowhere’



My first meeting with Jeane Freeman – at a Burns Supper in Glasgow in 2005 – didn’t begin well. The right-wing newspaper for which I then worked had carried a story the previous week with the heading “Jack McConnell’s Lesbian Love Triangle”. Freeman and her partner were both senior civil servants in Scotland’s Labour administration and the paper felt they were thus fair game for taking at a tilt at a lefty government.

The days when such a heading would have been considered acceptable by any media outlet have long since gone but it remains to Freeman’s eternal credit that she felt able to forgive, if not forget. Yet, traces of some wretched, old habits remain in Scottish public life.

Freeman says: “Look, when you stand for election and accept the responsibilities that come with ministerial office you accept that you’ll be scrutinised and criticised and that some of it will be unfair. And, to be honest, I’d been given a fairly easy ride when I was Secretary for Social Security. People liked what we were doing and the way we were going about it, mainly by seeking broad consensus beyond party lines to future-proof it from any subsequent interference.

“But the health brief was a different matter entirely. Intellectually, you kind of sense that it’s coming down the pipe, but nothing really prepares you for the reality of it. No matter what and no matter who, the health job is one of the hardest jobs in any government. It’s only right that it’s scrutinised and analysed much more closely, but what isn’t right is when it gets personal and you get objectified.”

Long before she’d become a government advisor, Freeman had gained a formidable track record in delivering ground-breaking social initiatives. She was founder and CEO of Apex Scotland, a remarkable organisation which, for 30 years, has worked with people with criminal convictions, enabling them to gain the skills and training to gain employment and break damaging patterns of behaviour. Later she would become a founding member of the Women for Independence group which brought many women who had previously been disengaged into political activism.

None of this though, spared her from a slew of infantile comment about her appearance. She says: “Making disparaging remarks about my looks as an indicator of whether I can be a good health secretary, or not, is outrageous. And women do get it much more than men. None of my male predecessors could ever have been mistaken for George Clooney, but no one ever commented on their looks or appearance.

“They are substituting argument and debate for insult and it takes us nowhere. And, yes, it hurts and it hurts those who love you. At times I thought of my great nieces and great nephew who are super-proud of their auntie and I’m thinking, ‘they’re going to think politics is horrible and I don’t want them to think that. I want them to be politically engaged.

“Young people so need to be engaged perhaps more now than at any other time. But they’re looking at their auntie who’s getting pelters for the lines in her face and the size of her bum and what she’s wearing: it’s preposterous. And they must be thinking, ‘well, I’m not doing that’. So, there’s a real democratic issue in this. Women’s voices need to be heard. That’s fundamental. 

“Elected politics is all about the voter handing you their power in trust for a set period of time, so you need them to be engaged enough to decide whether it’s you they’re going to hand that power to. But if that world looks like a cesspit then why would they bother? And that’s frighteningly dangerous because it leaves the field open to extremists and darker forces.”

And, while she was gratified about how opposition politicians and the press conducted themselves during the pandemic, some tribal instincts were still at play. Perhaps the most egregious example came when the political commentator, Angela Haggerty – a single mum of a new-born baby who was shielding during the pandemic – took to Twitter to highlight some concerns about food-delivery provision. Freeman took up her case, but mainly as a means to ironing out wrinkles in the system for others in similar situations.

Her intervention led to Ruth Davidson, then the Scottish Tory leader, making cheap publicity from mocking the situation, suggesting that Freeman had only acted because Haggerty was a well-known supporter of independence.

“That situation was deliberately misunderstood.

“Some people put a spin on it for nefarious reasons. I didn’t know Angela, aside from her being a shielding, new, single mother, living alone and cut off. Many others were in the same situation. It was important for me to get the message to them that I was listening and would do what I could to address any issues.”

Freeman stepped away from frontline politics last year to take up a part-time post at Glasgow University as Ambassador for Community Engagement, Public Health and Innovation for the College of Medical, Veterinary and Life Sciences. This has inspired a series of Future Shock seminars considering how civic Scotland can arm itself and become more resilient to future global health and economic crises.

Last month she interviewed Anthony Fauci, the globally renowned US scientist and immunologist whose thankless job it was to convince Donald Trump, the world’s most famous Covid-denier, that the pandemic was real.

“Doctor Fauci said something that resonated powerfully with me about learning lessons from global shocks,” says Freeman. “He said, ‘At the start of March 2020 we didn’t believe there could be asymptomatic transmission from Covid because no other virus has ever done that. All the evidence pointed to this. But by the end of March it was a case of, hell – this one’s different. What we had said at the beginning of March was correct based on what we knew and what we said at the end of March was also right based on what we knew. Science is a self-correcting process.’”

The Future Shock series could yet provide the key to dealing with the catastrophes to come by future-proofing services and policies in the present. It also seeks to explore the tension that inevitably occurs when emergency powers butt up against personal rights and freedoms. “History tells us,” says Freeman “that civic freedoms, once lost, can be very difficult to reinstate.

“One positive outcome happened, of necessity, during the first year of Covid. We didn’t have time for 42 committees having 42 meetings to decide something and so decision-making was devolved to the front line… and it worked. I said to our health boards: ‘You have committees that haven’t operated in the last year and nothing bad happened, so why would you set them back up again? If you’ve devolved decision-making to the consultants, to the janitors, to the procurement specialists, to the nursing staff and it worked then let’s keep it. Why wouldn’t you?

“It means these front-line specialists immediately feel more fulfilled and valued. And they really know what they’re doing: they don’t take risks; they’re always looking for value for money; and their focus is always on the patient. What more do you want or need?

“We need to devolve decision-making in health much more. Government’s job is to enable. No health secretary can tell a super-clever cardiologist, or a really good head of housekeeping, how to do their jobs.

“Our job is to ensure there’s the right training and the right numbers of people coming through in the right skill-sets and specialisms. People are thus valued and the local structure enables them and doesn’t hold them back. And, as medicine constantly evolves, there’s another question: do we really need as many health boards as we currently have in a country of five million people?”

She recounts the tale of the young Scottish student blogger, John the Travelling Tabby, whose coronavirus tracker across the UK produced a remarkably accurate and sharp picture of the evolving pandemic.

“I checked in with his blog every day just in case he’d spotted any anomalies Public Health Scotland might have missed. He was my go-to. He was fantastic. Nicola met him and I messaged him privately to thank him. He’s a wee star and, to my knowledge, he was never wrong.”

Freeman adds: “Not only was he really good at crunching the numbers, he was great at communicating them to people who aren’t good at numbers. That is the essence of public service.”





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Jeane Freeman: ‘Substituting argument for insult takes us nowhere’



My first meeting with Jeane Freeman – at a Burns Supper in Glasgow in 2005 – didn’t begin well. The right-wing newspaper for which I then worked had carried a story the previous week with the heading “Jack McConnell’s Lesbian Love Triangle”. Freeman and her partner were both senior civil servants in Scotland’s Labour administration and the paper felt they were thus fair game for taking at a tilt at a lefty government.

The days when such a heading would have been considered acceptable by any media outlet have long since gone but it remains to Freeman’s eternal credit that she felt able to forgive, if not forget. Yet, traces of some wretched, old habits remain in Scottish public life.

Freeman says: “Look, when you stand for election and accept the responsibilities that come with ministerial office you accept that you’ll be scrutinised and criticised and that some of it will be unfair. And, to be honest, I’d been given a fairly easy ride when I was Secretary for Social Security. People liked what we were doing and the way we were going about it, mainly by seeking broad consensus beyond party lines to future-proof it from any subsequent interference.

“But the health brief was a different matter entirely. Intellectually, you kind of sense that it’s coming down the pipe, but nothing really prepares you for the reality of it. No matter what and no matter who, the health job is one of the hardest jobs in any government. It’s only right that it’s scrutinised and analysed much more closely, but what isn’t right is when it gets personal and you get objectified.”

Long before she’d become a government advisor, Freeman had gained a formidable track record in delivering ground-breaking social initiatives. She was founder and CEO of Apex Scotland, a remarkable organisation which, for 30 years, has worked with people with criminal convictions, enabling them to gain the skills and training to gain employment and break damaging patterns of behaviour. Later she would become a founding member of the Women for Independence group which brought many women who had previously been disengaged into political activism.

None of this though, spared her from a slew of infantile comment about her appearance. She says: “Making disparaging remarks about my looks as an indicator of whether I can be a good health secretary, or not, is outrageous. And women do get it much more than men. None of my male predecessors could ever have been mistaken for George Clooney, but no one ever commented on their looks or appearance.

“They are substituting argument and debate for insult and it takes us nowhere. And, yes, it hurts and it hurts those who love you. At times I thought of my great nieces and great nephew who are super-proud of their auntie and I’m thinking, ‘they’re going to think politics is horrible and I don’t want them to think that. I want them to be politically engaged.

“Young people so need to be engaged perhaps more now than at any other time. But they’re looking at their auntie who’s getting pelters for the lines in her face and the size of her bum and what she’s wearing: it’s preposterous. And they must be thinking, ‘well, I’m not doing that’. So, there’s a real democratic issue in this. Women’s voices need to be heard. That’s fundamental. 

“Elected politics is all about the voter handing you their power in trust for a set period of time, so you need them to be engaged enough to decide whether it’s you they’re going to hand that power to. But if that world looks like a cesspit then why would they bother? And that’s frighteningly dangerous because it leaves the field open to extremists and darker forces.”

And, while she was gratified about how opposition politicians and the press conducted themselves during the pandemic, some tribal instincts were still at play. Perhaps the most egregious example came when the political commentator, Angela Haggerty – a single mum of a new-born baby who was shielding during the pandemic – took to Twitter to highlight some concerns about food-delivery provision. Freeman took up her case, but mainly as a means to ironing out wrinkles in the system for others in similar situations.

Her intervention led to Ruth Davidson, then the Scottish Tory leader, making cheap publicity from mocking the situation, suggesting that Freeman had only acted because Haggerty was a well-known supporter of independence.

“That situation was deliberately misunderstood.

“Some people put a spin on it for nefarious reasons. I didn’t know Angela, aside from her being a shielding, new, single mother, living alone and cut off. Many others were in the same situation. It was important for me to get the message to them that I was listening and would do what I could to address any issues.”

Freeman stepped away from frontline politics last year to take up a part-time post at Glasgow University as Ambassador for Community Engagement, Public Health and Innovation for the College of Medical, Veterinary and Life Sciences. This has inspired a series of Future Shock seminars considering how civic Scotland can arm itself and become more resilient to future global health and economic crises.

Last month she interviewed Anthony Fauci, the globally renowned US scientist and immunologist whose thankless job it was to convince Donald Trump, the world’s most famous Covid-denier, that the pandemic was real.

“Doctor Fauci said something that resonated powerfully with me about learning lessons from global shocks,” says Freeman. “He said, ‘At the start of March 2020 we didn’t believe there could be asymptomatic transmission from Covid because no other virus has ever done that. All the evidence pointed to this. But by the end of March it was a case of, hell – this one’s different. What we had said at the beginning of March was correct based on what we knew and what we said at the end of March was also right based on what we knew. Science is a self-correcting process.’”

The Future Shock series could yet provide the key to dealing with the catastrophes to come by future-proofing services and policies in the present. It also seeks to explore the tension that inevitably occurs when emergency powers butt up against personal rights and freedoms. “History tells us,” says Freeman “that civic freedoms, once lost, can be very difficult to reinstate.

“One positive outcome happened, of necessity, during the first year of Covid. We didn’t have time for 42 committees having 42 meetings to decide something and so decision-making was devolved to the front line… and it worked. I said to our health boards: ‘You have committees that haven’t operated in the last year and nothing bad happened, so why would you set them back up again? If you’ve devolved decision-making to the consultants, to the janitors, to the procurement specialists, to the nursing staff and it worked then let’s keep it. Why wouldn’t you?

“It means these front-line specialists immediately feel more fulfilled and valued. And they really know what they’re doing: they don’t take risks; they’re always looking for value for money; and their focus is always on the patient. What more do you want or need?

“We need to devolve decision-making in health much more. Government’s job is to enable. No health secretary can tell a super-clever cardiologist, or a really good head of housekeeping, how to do their jobs.

“Our job is to ensure there’s the right training and the right numbers of people coming through in the right skill-sets and specialisms. People are thus valued and the local structure enables them and doesn’t hold them back. And, as medicine constantly evolves, there’s another question: do we really need as many health boards as we currently have in a country of five million people?”

She recounts the tale of the young Scottish student blogger, John the Travelling Tabby, whose coronavirus tracker across the UK produced a remarkably accurate and sharp picture of the evolving pandemic.

“I checked in with his blog every day just in case he’d spotted any anomalies Public Health Scotland might have missed. He was my go-to. He was fantastic. Nicola met him and I messaged him privately to thank him. He’s a wee star and, to my knowledge, he was never wrong.”

Freeman adds: “Not only was he really good at crunching the numbers, he was great at communicating them to people who aren’t good at numbers. That is the essence of public service.”





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Wedding venue unveiled by Ayrshire spa hotel The Gailes

A SCOTTISH spa hotel has unveiled a new luxury wedding suite following a £250,000 makeover.

The Gailes Hotel & Spa near Irvine, part of family-run operator SimpsInns, has transformed its Lagavulin suite and rooftop conservatory into what it describes as “one of the most stylish and contemporary wedding venues on the Ayrshire coast”>

The Lagavulin suite has the flexibility to host smaller weddings, as well as gatherings for up to 250 guests, including civil and religious ceremonies.

READ MORE: Brexit home truths undeniable but not to Tories: Ian McConnell

The makeover was managed by interior designer 3 Design Scotland, and includes new soft furnishings and lighting, as well as a new purpose-built outdoor wedding pavilion in the hotel’s private gardens, the rooftop conservatory and a garden terrace with sweeping views over the countryside and beyond to the Isle of Arran.

READ MORE: CalMac lifeline ferry services storm must not end in privatisation

SimpsInns, which owns and operates a portfolio of hotels, restaurants, bars and leisure activities around Ayrshire, supports around 280 jobs. It has recently invested over £3 million across its portfolio of venues around the Ayrshire coast to “enhance quality and the overall visitor experience”, including at The Waterside Hotel at West Kilbride and the Old Loans Inn near Troon, as well as the Gailes Hotel & Spa.

Malcolm Simpson, director of SimpsInns, said: “We’re extremely proud to be enhancing our reputation as one of Ayrshire’s most popular and established wedding venues. We’re committed to exceeding our guests’ expectations and are regularly investing in our hotel and leisure facilities.”

The 42-bedroom Gailes, which also has a nine-hole golf course, is also home to the Si! Spa, which offers more than 50 personalised treatments, day spa packages and overnight spa breaks, as well as special packages for weddings and honeymoons. It has a thermal suite with vitality pool, sauna, and steam room and outdoor hydropool.

45 per cent of Scotland’s wealth held by 10 per cent of households



Nearly half of Scotland’s wealth is held by 10 per cent of households, a new report has found. 

It also showed that living standards in Scotland have seen an “unprecedented stagnation” since 2010 which has had a negative impact on the population’s health

The Health Inequalities in Scotland report, by the Fraser of Allander Institute at the University of Strathclyde, explores trends in Scotland since 1999 in the key factors that influence health.

It revealed 45% of the country’s wealth was held by a tenth of households – with health being closely linked to financial security. Economic factors such as the quality of housing and the local environment, education, and employment were all cited as having an impact on health. 

Typical weekly earnings in Scotland were found to be around £80 per week below what they would have been had long-running trends before 2010 continued.

David Eiser, deputy director at Fraser of Allander Institute and author of the report, said the health of a population is shaped by “social and economic circumstances”.

He said: “Scotland’s economy, like the UK’s, has been characterised by high levels of inequality for many decades. Since 2010, the economy has also been characterised by stagnating earnings growth and flatlining living standards.

“The similarities between Scotland’s economic and health trends are striking.

“Stagnation of improvement in incomes and living standards has coincided with a slowing of improvement on some health outcomes, including life expectancy and healthy life expectancy, and an increasing prevalence of mental health issues.

“The links between the economy and health are complex and work both ways.

“We’ve seen this in the context of Covid (where socio-economic circumstances influenced vulnerability to the disease), and the current cost-of-living crisis – which has the potential to affect health in a number of ways.”

The work has been funded by the Health Foundation working with Scottish research partners and an expert advisory group.

David Finch, assistant director at the Health Foundation, said: “Today’s report represents a comprehensive attempt to map and assess trends in a wide range of the socioeconomic determinants of health in Scotland including incomes and poverty, wealth and debt, employment and education, housing and more.

“Across these areas the message is clear. Inequalities are high, and progress has slowed. Addressing socioeconomic inequalities and improving living standards will be key to making meaningful progress towards improving the health of Scotland.”

READ MORE: Scottish economy’s downturn deepens – Royal Bank PMI survey

READ MORE: Rishi Sunak says taxes must rise to satisfy markets ahead of autumn statement





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SNP rural hospital pledge not met and ‘threatening lives’


A pledge by the first SNP government to ensure all six rural hospitals in Scotland are staffed by three general surgeons “at a minimum” has not been met and may be threatening lives, a doctor has claimed.

A report in 2007 made a commitment that patients should only have to travel for specialised services that cannot be provided locally and Scotland’s six rural hospitals should have a minimum of three surgeons.

Stuart Fergusson, a Rural Surgical Fellow at Aberdeen Royal Infirmary says only two; Balfour Hospital in Orkney and the Gilbert Bain Hospital in Shetland are currently operating at this level.

Mr Fergusson made the headlines in 2016 because he was the only junior doctor in Scotland preparing for a career in a rural hospital. 

The University of Glasgow graduate opted for a broad range of clinical placements rather than specialising in one part of the body to ensure he could work in remote areas. After his fellowship ends in 2023 he will transfer to Shetland.

He raised his concerns about staff shortages at the recent Viking Surgeons Association conference in Skye, which gathers healthcare workers from across the UK and the Nordic countries who have an interest in rural surgical practice. 

The Belford Hospital (Fort William), Caithness General Hospital (Wick), Lorn & Islands Hospital (Oban) and the Western Isles Hospital all, currently have fewer than three permanent general surgery consultants. 

“The Scottish Government is not currently fulfilling their commitment to the provision of surgical services in rural general hospitals,” said Mr Ferguson.

“Rural surgeons face unique challenges in providing a broad range of services in comparatively isolated environments. 

HeraldScotland:

“It is not possible to staff a small rural unit with every kind of specialist, so generalist surgeons have to widen their practice and often perform many different types of operation in small numbers. 

“Many studies have described how rural practice requires a certain kind of ‘clinical courage’, where practitioners operate beyond familiar comfort zones in order to meet needs locally.

He added: “The capability to provide major elective (planned) surgery has been significantly eroded in some rural surgical units and I am concerned that this loss of expertise will also impact on the ability of rural hospitals to provide life-saving emergency surgery when required.”

READ MORE: Former GP’s ‘utter dismay’ as new rural hospital faces a further delay 

NHS Highland said three new surgeons had recently been appointed to the Belford Hospital, who are due to start in the New Year which will take the complement to four.

David Sedgwick, former head surgeon at the Lochaber hospital says the medical profession “has to bear some of the responsibility” for staff shortages.

“It is maybe the case that medical and surgical advisers are drawn mainly from the city centre type of practise and will advise accordingly,”  he said.

HeraldScotland:

“The ability of people from remote and rural areas to access routine general surgical and medical services will be compromised if there aren’t general surgeons.

“Someone with acute abdominal pain, possibly appendicitis, may have to travel four hours to see a surgeon.”

He said there is “real interest” from trainee doctors and said it was encouraging to see fifteen trainees at the recent rural surgery conference.

“That’s the most we’ve seen but they need to see a pathway to a consultant post that will be supported,” said Mr Sedgwick.

“There’s been an expansion in the number of consultant posts but not a proportional expansion in the number of training posts and the encouragement to consider remote and rural surgery as a career.

READ MORE: Doctor warns new cancer centres could increase patient journeys

“Quite a lot of the trainers don’t have experience of it and I think would find it quite daunting.”

Mr Sedgwick, who is retired and is now involved in training, said he would encourage any medical student to consider rural work.

He said: “You have to a certain extent a degree of autonomy, you have a breadth of procedures that you can do.
“My main area was colorectal but I did quite a lot of care of patients with urological problems, with trauma and paediatric care and that gives a really interesting workload.

“It’s a great place to live, all the rural hospital [areas] have good primary and secondary schools.

“Culturally, it’s interesting – all our kids played musical instruments and you can work in collaboration with the super-specialists.

“For me, it was in Inverness and Glasgow and I had great support from the guys there.”

A Scottish Government spokeswoman said:“The staffing issues faced by rural and island health boards were a central point of discussions during the Health Secretary’s visits across the county over the summer and we will continue to work closely with remote, rural and island boards where we know recruitment and retention challenges can be particularly acute.

“NHS Scotland staffing remains at historically high levels, up 2% on permanent staff the same time last year.

“This comes as part of 10 consecutive years of increases in staffing across our NHS. Consultants in NHS Scotland are the best paid in the UK with a basic salary at the top of scale of over £121,000. 

“Boards have the power to offer various working patterns and flexibilities to attract candidates and are required to set out clearly in their workforce plans how they will continue to ensure safe and sustainable numbers of staff.”

 





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SNP rural hospital pledge not met and ‘threatening lives’


A pledge by the first SNP government to ensure all six rural hospitals in Scotland are staffed by three general surgeons “at a minimum” has not been met and may be threatening lives, a doctor has claimed.

A report in 2007 made a commitment that patients should only have to travel for specialised services that cannot be provided locally and Scotland’s six rural hospitals should have a minimum of three surgeons.

Stuart Fergusson, a Rural Surgical Fellow at Aberdeen Royal Infirmary says only two; Balfour Hospital in Orkney and the Gilbert Bain Hospital in Shetland are currently operating at this level.

Mr Fergusson made the headlines in 2016 because he was the only junior doctor in Scotland preparing for a career in a rural hospital. 

The University of Glasgow graduate opted for a broad range of clinical placements rather than specialising in one part of the body to ensure he could work in remote areas. After his fellowship ends in 2023 he will transfer to Shetland.

He raised his concerns about staff shortages at the recent Viking Surgeons Association conference in Skye, which gathers healthcare workers from across the UK and the Nordic countries who have an interest in rural surgical practice. 

The Belford Hospital (Fort William), Caithness General Hospital (Wick), Lorn & Islands Hospital (Oban) and the Western Isles Hospital all, currently have fewer than three permanent general surgery consultants. 

“The Scottish Government is not currently fulfilling their commitment to the provision of surgical services in rural general hospitals,” said Mr Ferguson.

“Rural surgeons face unique challenges in providing a broad range of services in comparatively isolated environments. 

HeraldScotland:

“It is not possible to staff a small rural unit with every kind of specialist, so generalist surgeons have to widen their practice and often perform many different types of operation in small numbers. 

“Many studies have described how rural practice requires a certain kind of ‘clinical courage’, where practitioners operate beyond familiar comfort zones in order to meet needs locally.

He added: “The capability to provide major elective (planned) surgery has been significantly eroded in some rural surgical units and I am concerned that this loss of expertise will also impact on the ability of rural hospitals to provide life-saving emergency surgery when required.”

READ MORE: Former GP’s ‘utter dismay’ as new rural hospital faces a further delay 

NHS Highland said three new surgeons had recently been appointed to the Belford Hospital, who are due to start in the New Year which will take the complement to four.

David Sedgwick, former head surgeon at the Lochaber hospital says the medical profession “has to bear some of the responsibility” for staff shortages.

“It is maybe the case that medical and surgical advisers are drawn mainly from the city centre type of practise and will advise accordingly,”  he said.

HeraldScotland:

“The ability of people from remote and rural areas to access routine general surgical and medical services will be compromised if there aren’t general surgeons.

“Someone with acute abdominal pain, possibly appendicitis, may have to travel four hours to see a surgeon.”

He said there is “real interest” from trainee doctors and said it was encouraging to see fifteen trainees at the recent rural surgery conference.

“That’s the most we’ve seen but they need to see a pathway to a consultant post that will be supported,” said Mr Sedgwick.

“There’s been an expansion in the number of consultant posts but not a proportional expansion in the number of training posts and the encouragement to consider remote and rural surgery as a career.

READ MORE: Doctor warns new cancer centres could increase patient journeys

“Quite a lot of the trainers don’t have experience of it and I think would find it quite daunting.”

Mr Sedgwick, who is retired and is now involved in training, said he would encourage any medical student to consider rural work.

He said: “You have to a certain extent a degree of autonomy, you have a breadth of procedures that you can do.
“My main area was colorectal but I did quite a lot of care of patients with urological problems, with trauma and paediatric care and that gives a really interesting workload.

“It’s a great place to live, all the rural hospital [areas] have good primary and secondary schools.

“Culturally, it’s interesting – all our kids played musical instruments and you can work in collaboration with the super-specialists.

“For me, it was in Inverness and Glasgow and I had great support from the guys there.”





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UK’s skewed priorities are destroying our health service


I WORKED in the NHS for 30 years; I am a passionate supporter of it and unfortunately due to factors beyond my control I currently have to rely on it for what is to me urgently required but not readily available treatment.

There is no doubt that the gradual decline of the NHS I witnessed during my working life has accelerated and the system is “fire-fighting” to the detriment of both staff and patients. This situation applies both to the availability of treatment within the hospital sector and at a GP level.

I would have thought that in a relatively wealthy country with an established democratic system of governance the least that the electorate could expect would be that they would be kept fed and healthy. Not so here.

It cannot be beyond the wit of someone with specific knowledge and a pen and paper to calculate how many medical personnel we need to train annually to staff the NHS. We don’t do that as it’s cheaper to rely on some distant country training nurses and doctors in the hope they will want to come to the UK rather than treat patients in the Philippines or India. Conversely, it can’t be impossible to provide our own graduates currently employed in the NHS with a working environment and salaries that make them want to stay here and not emigrate. The NHS is understaffed and under-funded as a matter of choice and the culprit is Westminster. The NHS is the largest employer in the UK and more than half of the annual budget goes on staff wages so in terms of the general economy the more staff the merrier.

So why is the NHS underfunded when medical treatment in the private sector is relatively easy to access? It is as usual a matter of priorities. Last year as the NHS deteriorated the number of UK billionaires increased by 28 to 177 and Westminster paid three times as much in interest payments on the National Debt than was spent on all the NHS sectors in Scotland. It’s mind over matter, they don’t mind and we don’t matter.
David J Crawford, Glasgow

• HUMZA Yousaf took to Twitter to say that he will “spend every waking moment working with unions to avoid a strike this winter”. Unfortunately for us, Mr Yousaf is asleep at the wheel of our NHS.

He claims that there is no money to fund a pay rise and wants the UK Government to use its “moral obligation” and help fund pay deals for NHS staff while his boss, the First Minister, is promising £5 million in climate reparations at COP27.

Perhaps instead of trying to convince unions that they shouldn’t strike, he should have a word with Nicola Sturgeon and make clear her priorities are skewed.
Jane Lax, Aberlour

No hope from Tories or Labour

IT is obvious to anyone who follows UK news that the poorer-performing NHS in England or Wales is not politicised to anything like the extent it is in Scotland. The BBC reported the latest A&E waiting times in England as the worst-ever at 69.3% but for comparison purposes this falls to 54.8% of patients seen within four hours in type 1 A&E 24-hour emergency departments, which is the closest equivalent to similar A&E departments in Scotland that currently stand at 63.1%. In Wales the numbers on NHS waiting lists are almost 50% higher than in Scotland.

The average nurse’s salary in Scotland is currently £36,641 compared to £33,384 in England yet the Scottish Government is offering a much better pay award at 7% on average, with more than 11% for the lowest bands, compared to the average 4.75 % in England in Wales.

It takes some nerve for the Tories to attempt to blame the SNP for the UK-wide strikes particularly when Scotland has a fixed budget and Labour Welsh ministers have also pointed out the limitations of the devolution settlement to deal with rampant UK inflation made worse by Tory policies.

Those who believe in the NHS will not be encouraged by Sir Keir Starmer’s views on foreign workers and no return to freedom of movement or in shadow health minister Wes Streeting, who last week called Jeremy Corbyn “senile”, and wants to move from the 20th century funding model of the NHS while saying a Labour government can’t spend more money on it.
Mary Thomas, Edinburgh

Pathetic response from Swinney

AT First Minister’s Questions, John Swinney followed that well-trodden path prepared by Nicola Sturgeon when defending their position by stating that it’s worse in England (“Ross calls for Yousaf’s head but health secretary doesn’t seem too bothered”, The Herald, November 11). Not only is this standard response becoming tediously boring, it is as pathetic as the Old Firm fans shouting about who was worse in Europe and ignoring the fact that both teams were appallingly bad.

There is a strange part of the Scottish psyche that gets more pleasure out of England getting beat at team sports than their own team winning. Sadly it has transcended to Holyrood.
Duncan Sooman, Milngavie

• THE opposition in Scotland are experts at shooting themselves in the foot as evidenced again in the latest First Minister’s Questions. Douglas Ross called for Health Secretary Humza Yousaf to be fired on the grounds of NHS waiting times in Scotland. However, we need to recognise Scotland has the best-performing NHS in the UK and pays the best rate of pay for NHS employees in the UK. So will Mr Ross be consistent with his call on waiting times, and call for the other health secretaries in the UK to be fired?
Catriona C Clark, Falkirk

Gunboat diplomacy days are over

STRUAN Stevenson thinks the West should overthrow the regime in Iran (“The West must now focus on regime change in Iran”, The Herald, November 9). They have, of course, done this before. In 1953, the UK and US toppled the government of Mohammad Mossadegh; they were acting at the behest of the Anglo-Persian Oil Company (now BP), who objected to the nationalisation of the Iranian oil industry.

The British and Americans restored the tyrannical Shah to power. He lived in opulence and lavished enormous sums on vanity projects, while his people struggled to afford the basics of life. Eventually, disparate Iranian groups came together and drove the Shah from power in 1979. It’s tragic that the power vacuum was filled by the clerics.

There are other and more recent examples of the West blundering in to depose a government that it didn’t like the look of, as if we had an imperial right to decide another nation’s governance. There have been extreme cases when it might be justified: Cambodia under the Khmer Rouge and Uganda under Idi Amin spring to mind. But those brutal regimes were overthrown by neighbouring states who understood what they were doing. Mr Stevenson might not like it, but western gunboat diplomacy has had its day.
Doug Maughan, Dunblane

CalMac up to the challenge

I ENJOYED reading Ian McConnell’s Friday column (“Storm over Scotland’s vital ferry services must not end in break-up or privatisation”, The Herald, November 11). It was a clear-sighted view of the strategic issues facing the service, and an antidote against some of the more inaccurate claims consistently being made.

The issue is a significant reduction in fares which led to accelerating demand and a strain on capacity, as investment in new vessels has been delayed. The biggest operational challenge we face is not reliability, it is a shortfall in capacity. Every major vessel is fully deployed to the full extent of the working day, and there is no capacity for additional sailings to cover for peak demand periods or technical failures. No commercial ferry company would deploy all of their assets all of the time, as this simply leads to burn-out.

The increase in demand, 20-35% over five years depending on the route, is a tremendous success story for island economic sustainability, but one which is now increasingly difficult to manage. We have hauliers, islanders, tourists, and commercials all trying to access a limited car deck capacity. In the past, islanders had the flexibility to travel when they wanted, but increasingly they must plan ahead, which is difficult when you are going about your day-to-day business. Several years ago, when a sailing was disrupted, we could move passengers onto the next sailing. However, we are finding now that the next sailings are fully booked making it far more difficult to manage disruptions.

While the next year or two will remain challenging we now have six large vessels and 10 small vessels on order or being planned which will make a real difference for our communities.

We are modern, open and professional, with a diverse and deep maritime experience. We are happy to talk to anyone about the real facts of the service, and how it can be improved.
Robbie Drummond, Chief Executive, CalMac


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