Q - Transport remains an issue; there are not enough ambulances and more were needed for bad weather and when Berriedale was closed.
A - The recently set up Maternity Review group were tasked with finding methods to alleviate the pressure on the ambulance service. This has now included additional £400k investment announced recently. This will take some time to complete recruitment but some immediate additional capacity has been put in place.
Nobody made their way to Raigmore without police and medical advice during bad weather. 4x4 and increased patient transport were other possibilities. Where road journeys were not possible, fixed wing aircraft, helicopter, coastguard and neonatal air transfer was available. These facilities have always been in place and these are challenges which we overcome across many parts of Highland.
The local Caithness Maternity and Gynecology Group (CMAG) are also looking at ongoing actions to address any issues relating to transport.
Q - Why not fly a paediatrician up to CGH?
A – When an issue emerges the relevant clinical resources are considered and the most appropriate response deployed. We could fly up a paedatrician, however, there are not the facilities, equipment and wider specialist staff on site to treat the patient. For babies, the neonatal transfer team would be utilised to provide assistance and support safe transfer. Until the team responds the immediate assessment, stabilization and treatment would get underway by relevant local clinicians with support on VC from a paedatrician.
Q - A family member was unable to visit his wife and child due to an infection outbreak at a hospital elsewhere.
A - Whilst unfortunate, patient safety is always the priority. This could happen anywhere.
Q - Are all mums to go to Raigmore or is it just high risk pregnancies?
A - It is just high risk pregnancies. It is hoped that there will more opportunities give birth locally but it will be based on clinical risk.
Q - Rumours abound locally. Would the baby at the centre of the report have survived if she had been born somewhere else?
A- Yes.
Q - If facts were known then opinion might be different.
A - We have done a lot of briefings and been to meetings to explain why the changes were required on grounds of safety.
Q - A family member made several trips to Raigmore over a period of days whilst partner was in labour. It is unaffordable for many.
A - Currently under the Highlands and Islands Travel Scheme expenses are reimbursed and two night’s accommodation is paid up front. However, cases are also looked at individually. We are developing more accommodation on the Raigmore site and we have paid upfront costs should hotel accommodation required. NHS Highland is undertaking a review of current issues. We have to come up with a policy that is reasonable and equitable across all patient groups and for all parts of Highland and Argyll & Bute
Q - What about people on Orkney; do they have to travel?
A – Yes, to Aberdeen. We are in contact with Orkney, Shetland and Western isles to agree a common approach and things like travel and accommodation.
Q - Are facilities being monitored in Raigmore to see if they are safe? Why can't we get the facilities up here?
A – Yes all units are monitored and we have safe services in place. Outside of Raigmore there are not enough births to have the staffing, equipment and training levels to the standard required and the service would remain unsafe.
The very low volume of cases has never justified there being a paediatric department in Caithness General Hospital. The low numbers would make it impossible to maintain appropriate levels of skills and expertise and therefore it would not be possible to maintain a quality safe service. The clinical evidence shows that survival of babies is better in larger neonatal units (level 3 units) compared to smaller units such as Caithness General.
Q - How do the midwives feel? What support are they going to get? Are they being blamed?
A - The midwives have a range of opinions as expected. All are highly trained and will receive further support to increase confidence during the changes. Senior midwives from other CMUs are working with them. Raigmore consultants and specialist staff are available for advice and lead consultant obstetrician has been appointed to oversee the ‘Hub’ and ‘Spoke arrangements. The staff is getting on with their job in a professional manner and keen to see the Unit thrive.
Some midwives do feel that under the spotlight and the constant negativity and misinformation is not helping.
Q - Have had recent stay in hospital and staff angry and overworked.
A - Hospitals are busier than ever and of course some of our struggles with recruitment do put a big onus on those in post. Services are also changing and that brings worries and uncertainty. There will no doubt be some mixed views in a large workforce but we have systems in place to support staff and encourage them to raise concerns.
Q - There is a shortage of hospital beds across the country but wards are being closed in Wick.
A - Sometimes hospitals face short term challenges with patient numbers. You are more likely to be admitted to hospital the closer you are to a hospital. Moreover the evidence shows you really should not be in a hospital unless you require that level of care. There are risks of infection, falls and very likely to lose independence.
The more hospital beds you have the more likely you will fill them and given some of the risks that is not a sound strategy. Getting the right number of beds is key but a large part of that is determined around community services are in place; ability to provide care at home and so on, Caithness is in unique position of having three hospitals in the county. If all out money is tied up in buildings there is less money and therefore staff that can be invested in community services. People say they want to be looked after in their own home but all of our money is tied up in expensive hospitals.
For instance costs per week to look after someone in Caithness General Hospital are £4,200, and in a Community Hospital it is £2,500. To look after the equivalent in the community via Care at Home is £200. The key point is it neither makes sense from a care point of view or cost to be looked after in a setting with higher level care than is required.
Q - We all understand change is necessary but report states that population is falling but it's actually rising due to increased investment in county. People won't move here if no facilities.
A - Changes to services have been happening all across NHSH but at a slower pace in Caithness so the need for change is more apparent here. Our experience based on many conversations that in fact we don’t believe that some people do agree in the need for change and don’t accept that there are some fundamental problems.
What the report actually says is the female population aged 15-44 years has fallen by 13% in just over a decade. And they are projected to fall by 23% by 2026. It also states that parts of Caithness are living in deprivation. Mothers and babies in deprived areas are more likely to require specialist care which cannot be provided locally.
People will rightly consider what local services are available. We also know this from our own research into recruitment. Issues such as education and health, the cost of housing, job opportunities for partners, crime rates, feel of community spirit and scenery are also considerations.
We are committed to providing safe local services. By far the vast majority of care that people access is their Primary Care Services. People also want to be reassured about access to A& E services and maternity care. Most people in other areas understand that access to specialist care is increasingly likely to be in bigger centre because the outcomes are better whether it is for maternity care or cardiology
Q - Is this the start of the closure of CGH?
A - Absolutely not but it does have to change including to put in a more sustainable clinical model that is not reliant in locums