Thank you very much. We are here because NHS Highland is proposing to close both hospitals on Skye and to replace them with a single central hospital. That is a major service change that has been approved by the Cabinet Secretary for Health, Wellbeing and Sport, and we are here to ask for your help in getting that approval reversed.
I think you have all been issued with maps—is that correct? They are there to help illustrate our argument. If you look at the first map, you will see that the area is divided into three by the dotted lines. There is north Skye and Raasay, south Skye and Lochalsh, and south-west Ross. The majority of the population in Skye and Lochalsh live north and west of that line. That is more than 7,600 residents. If we add students, workers and visitors, that can easily double the daily population to more than 15,000. Those are significant figures in the west Highlands and Islands. They might not sound very big to people from the central belt, but Fort William has only around 10,000 residents and Oban has fewer than 9,000, so 7,600 permanent residents and 15,000 people through the day is a lot of people.
Portree is by far the largest settlement in the area, Broadford is about half the size and everywhere else is smaller again. The squiggly line between Portree and Broadford shows the line of the road. The geography of the island means that very few people live along that road, so there are two very distinct areas: north and south.
There are currently two community hospitals—one in Portree and one in Broadford—that serve the whole of Skye and Lochalsh. The geography of the mainland means that the communities in south-west Ross tend to use Dingwall and Inverness hospitals. Typically, only 1 per cent of admissions to the Skye hospitals come from south-west Ross. NHS Highland is proposing to close both the existing hospitals and to build a new one in Broadford. Portree will be left with nothing but a day clinic.
The second map on the sheet shows the area overlaid on to the central belt to give you a better idea of the distances that are involved in getting to and from the proposed new hospital. Portree to Broadford takes the same time as driving from Falkirk to Uddingston and, for people in the far north and west of Skye, the journey to Broadford is like driving from Kirkcaldy to Uddingston. They are significant distances.
The coloured circles on the first map show that almost everyone in north Skye lives more than 30 minutes away from Broadford by car, and about a quarter of those live more than an hour away. Those travel times assume immediate access to a car in favourable weather conditions, with no tourist traffic; they are the best times that you can make. Public transport between north Skye and Broadford is almost non-existent.
Therefore, centralising hospital services in Broadford means that the majority of the population will find it much harder to use them. Getting to and from hospital for admissions, discharges and visiting will be much more difficult and the certainty of getting medical attention out of hours by turning up at Portree hospital will disappear, leaving people to choose between the lottery of the ambulance service—which has response times of up to 70 minutes—or driving the extra 30 minutes or more to Broadford. Again, that assumes access to a car, which is not the case for a lot of people.
Every part of north Skye features on the Scottish index of multiple deprivation. That accounts for about 10 per cent of the population. Two data zones have deprivation rates of 15 per cent or more. Many of those people are elderly or have chronic health conditions that prevent them from earning, which means that few of them have cars.
Bus services are sparse or non-existent, and taxi services, for the distances involved, are just outrageously expensive, so people rely on the good will of friends and neighbours to get to and from Portree for hospital admissions and discharges, and to visit their sick relatives. Comparatively few people in north Skye routinely make the journey to Broadford, so there are far fewer opportunities to get a lift to and from Broadford hospital. That means that the closure of Portree hospital will exacerbate the effects of the inverse care law: those with the greatest health needs will have the worst access to health services.
One of the seven project investment objectives of NHS Highland’s redesign is to
“Improve Access to Services and Care”.
The proposed actions will do the exact opposite for more than half the population of Skye and Lochalsh. The disjunction between what the redesign is supposed to deliver and what is actually going to happen is alarming, but it is just one example of NHS Highland’s astonishing lack of rigour in the management of the project.
You would expect that the decision on a major service change would be underpinned by hard evidence. You would expect to see numbers showing the current services, how they are used and the current gaps in provision. You would expect to see forecasts showing how the proposed changes will contribute to the objectives of the project. In this case, there is no hard evidence of any sort—no before-and-after numbers—to support the proposals. There are no comparative metrics whatsoever.
Indeed, the only evidence of data gathering that we can find is an informal request, made at very short notice, to NHS statisticians in November 2013. An email from one of the number crunchers is very disturbing. She says that the timescale for information gathering
“is incredibly tight ... and leaves no time for thorough checking or validation and interpretation of the analysis ... there will also be gaps in the information and I have concerns about decisions being made on the basis of quite limited information. This seems a high profile and important piece of work but with an oddly short timescale for information gathering”.
One of her colleagues echoed her concerns in two subsequent emails and, after that, the bulk of the data request was abandoned. The only data that were used in the local options appraisal and the public consultation document were some raw numbers about populations and drive times, which are presented in a map format that is really quite misleading.
The report that was approved by the cabinet secretary a year later had references to more raw numbers—things such as current patient activity, bed occupancy and income deprivation—but that is all dumb data. There are no projections, no before-and-after analysis and no numerical evidence of the potential consequences of the proposals.
This major service change has been decided without any measurable assessment of how it will affect clinical outcomes, access to services or the health of our communities. Despite the glaring lack of evidence in support of the proposals, they are being spun by NHS Highland as being wholly positive. Misrepresentation is endemic in everything that it puts out. Words such as “modernisation”, “upgrade” and “improvement” are used again and again, despite the obvious downgrading of access to services for the majority of the population.
The public consultation documents refer throughout to “Portree Hospital” being the spoke to the new hub in Broadford. Nowhere do they admit that the proposed spoke is not a hospital at all but merely a clinic. There are no beds, so it is not a hospital.
The report that recommends the proposals to the cabinet secretary emphasises the results of a survey showing 1,900 people in support. Nowhere is it acknowledged that the survey is an unscientific, self-selecting sample of opinion that was not subjected to any independent audit. The options appraisal information in the report implies that the proposals have statistical validity when, in reality, there was no attempt at systematic gathering and analysis of evidence.
Most bizarrely of all, NHS Highland has repeatedly refused to admit that Portree hospital has been providing out-of-hours accident and emergency triage and treatment since 2004, and has repeatedly failed to acknowledge the value of those services to the communities of north Skye.
We think that the cabinet secretary has been misled by NHS Highland into believing that the proposed redesign will improve our health services. When it comes to access to services, the evidence presented on the maps clearly shows that, for more than half the population, that is clearly not the case. That is the obvious flaw. What else is NHS Highland getting wrong? We do not know and we need to find out.
The cabinet secretary has also been misled into believing that the people of north Skye are broadly in favour of the changes. Our petition, which has more than 4,900 signatures, suggests that the opposite is true. That number of signatures is the equivalent of 65 per cent of the population of north-west Skye. That is like 300,000 people in Edinburgh putting their names to a petition.
We want to be clear that we are not campaigning for the status quo. We recognise that the way that healthcare is delivered has to change, but we have to get it right. If we do not get it right and we allow the current proposals to go ahead, the communities in north Skye are going to suffer and health inequality will increase. The campaign is about not just our health services but the future health of our communities.
The petition asks for the establishment of an independent scrutiny panel. We want it to do what NHS Highland has failed to do—to define our medical, health and social care needs, to define the minimum acceptable levels of access to services and to recommend how local services should be delivered. First, however, we need the cabinet secretary to reverse her approval of the major service change. We need her to recognise that there is a lack of evidence in support of NHS Highland’s claims that the changes will improve and upgrade services. So far, she has refused to acknowledge that NHS Highland may be guilty of misleading her or that its proposals might be flawed. We are asking for your help to get her to change her mind.