To clarify, my operational responsibilities have been signed off by the IJB. Although it has not been delegated, the IJB agreed the executive leadership role that I was asked to take at the end of last year. That decision was made because it made sense for things to be local and because many of the activities that were being looked at already related to the wider local system.
I recognise all the comments that Mr Stewart quoted; I have heard them being made many times by many people. In Moray, there is a perception and a belief that that is the situation. However, there are alternative views, so we have to step back a bit to try to work out where the truth of the matter lies.
As I have said, from my experience in Dr Gray’s hospital, we hold our own on scheduled care. All such care takes place locally; a person would go to Aberdeen only if they had a severe issue that could not be dealt with in Moray. A small number of frail and elderly people have found themselves in Aberdeen, but they have gone there in very specific circumstances. We contain and deal with our people locally, which is a huge part of our business.
There have been very challenging experiences across the hospital in relation to aspects of women’s and children’s services. I see it as my daily job to look across at things as they are, what they have been and what we need for the future. The way in which services have operated, with the luxury of the staffing and other provision that we had historically, is very different from where we are now. We have talked about pensions and our ageing workforce, and we have looked at what has worked well. There have been changes from what we could configure and deliver in the past. People find it hard to get their head around that and to see why changes need to be made, because they have had a good service from Dr Gray’s, which has a dedicated and passionate staff. We see that from the fact that most people who work in Moray live in Moray, so there is another level of commitment in that regard.
The women’s and children’s services aspect has been extremely tricky and complex. The public’s perspective is that there is a move to try to remove Dr Gray’s from the system and that there is no investment and support for the hospital. I have spoken to many people who have that view, and I have been able to give a number of examples of investment. There has been no cap on overspends, and there have been quite significant overspends in trying to deliver a good service. Of course, the workforce challenge is probably the most prevalent one.
In the past year, we have received significant funding and additional leadership to support me in trying to address the situation at Dr Gray’s and in being clear about how we can run things in the future for the good of the local population and as part of the network.
We have worked through the paediatric challenge. We have worked with the community through a planning process, and we are now moving into an implementation phase. That work has gone very well.
NHS Grampian has approved extra funds for four additional paediatricians in the system. We are confident, because our offer is attractive and sits in the context of an on-call rota across the Grampian system, that we will have recruited individuals to those posts by February. We have an alternative model that has been consulted on and is now going ahead. Things have moved on well on the paediatric side.
However, maternity provision continues to be a huge challenge for us. We are not working in a static landscape: the regulations change, and staff availability varies as people move on. Over the past year, the resources that we thought we had could change within a week. We are currently trying to resolve challenges around the anaesthetics service, which is the backbone of a small acute care hospital. Without the right capacity in place, we would be unable to perform certain tasks in obstetrics, including consultant-led obstetrics. We are working actively on that as we speak. In addition, there is a question around the number of obstetricians that will be required, depending on the nature of services and the requirements for optimisation.
We have set up a board to oversee the transformation of services, which I chair along with Paul Bachoo, who is the medical director for acute services. We have met twice so far and have looked at all the data and the strategic needs assessment for adults, and we are working through how we can prioritise those vulnerable areas.
I have had significant investment from NHS Grampian to assist me in that work, and we have some really positive stories to tell. Last week, we recruited people to a number of posts in orthopaedics that we had previously struggled to fill. In addition, over the past six months, we have had significant external interest in other posts in the hospital and in the partnership, and we are now recruiting. However, I understand that actions speak louder than words and that, until people feel confident in the position of maternity services, we will continue to be challenged on whether we are committed to that area.