Chamber and committees

Deputy First Minister submission of 20 December 2021

PE1915/A - Reinstate Caithness County Council and Caithness NHS Board

The Scottish Government is committed to the principle of subsidiarity – that decisions are taken at the right level, and as close as possible to those most affected. The governance of our communities and the ability of these communities to shape their own future is vital. The difficult experience of COVID demonstrates that many results can be achieved at the local level.

The ongoing joint Local Governance Review with COSLA aims to strengthen local democracy by considering how power should be shared between national and local government, and with our communities. Programme for Government 2021-22 confirms that we will conclude the review and introduce a Local Democracy Bill within this parliament.

As part of the review process, we published Democracy Matters material which outlines how ambitious new democratic decision-making structures and processes could work in Scotland’s towns, villages and neighbourhoods. These new arrangements would offer local communities the option of taking responsibility for different elements of a potentially wide-range of public services and associated budgets, including existing health and council functions.

The Democracy Matters material also includes many of the questions which will need to be answered if these ambitious new arrangements are to meet people’s aspirations to improve outcomes for all, tackle inequalities, and enhance human rights. We are not asking people to respond to these questions now. Rather, we will work with COSLA in order to take forward a further phase of nationwide community engagement.

The timing of this engagement will be in part dependent on the extent of the pressures created by the ongoing public health emergency. It is vital that we hear as many voices as possible in discussions about the future of local democracy in Scotland. A Highland perspective will be vital, and we look forward to working with local public sector partners, community councils and community groups to understand how alternative governance arrangements might work in different geographies, including Caithness.

In response to the specific call in the petition for a separate NHS Board for Caithness, as the Scottish Government takes forward work to create a National Care Service we will also review the number, structure and regulation of Health Boards and other related delivery services, to remove unwarranted duplication of functions and make best use of the public purse.  However, the analysis of the National Care Service consultation, which ended on 2 November, is on-going, and there are currently no plans to bring about any changes to the structure of NHS Boards.  As the Committee will appreciate, NHS Boards continue to operate under a state of emergency as a result of the Covid-19 pandemic; the priority therefore continues to be on operational resilience and the safe, effective remobilisation of services, in line with the NHS Recovery Plan.

NHS Highland have been providing statutory services locally for over 20 years, having replaced the Caithness and Sutherland Health Trust.  Over those years, local services have been reshaped as medicine, health and technology have evolved.  Indeed, it is for individual NHS Boards to review, plan and deliver services to their local population, consistent with national frameworks and policies; and I have set out below some of the work NHS Highland advise they are doing in relation to the delivery of high quality, safe and sustainable services in Caithness.  I hope this is helpful.

The Board are clear that they are actively investing in health and social care services in Caithness.  At its November meeting, the Board of NHS Highland approved the Initial Agreement for the Caithness Re-design (the former Cabinet Secretary for Health and Sport Jeanne Freeman approved NHS Highland’s proposals for the re-design of health and social care services in Caithness on 2 May 2019).  As part of a national pilot in association with the Scottish Futures Trust, the redesign will see the development of a new local care model, aimed at shifting the balance of care.  As part of that approach, NHS Highland will focus on strengthening their workforce locally: for example, developing new and innovative posts such as a Frailty Practitioner and enhancing the community response overnight to ensure people can remain at home for their care, where appropriate.  In terms of facilities, NHS Highland advise they are investing in health and care services in Caithness with: the recent opening of an improved Community Midwifery Unit, the development of proposals for two new Community Hubs (in Wick and Thurso) and the refurbishment of Caithness General Hospital. The new hubs will replace the community hospitals in Wick (Town & County) and Thurso (Dunbar) and the residential care homes in Wick (Pulteney House) and Thurso (Bayview House). Day Services currently provided in Wick and Thurso will also be included in the Hubs and they will form a base for the community integrated teams (Community Nursing, Allied Health Professionals, Adult Social Care, Care at Home). 

In relation to the specific points raised in the petition on palliative care and maternity, NHS Highland advise that, while Caithness does not and has not had specific hospice facilities, the teams locally work very closely with the Highland Hospice located in Inverness.  The Board are clear that there have been no closures of palliative care beds locally; rather, there has been a strengthening of services locally.  The community teams (community nurses, care at home and Macmillan Nurses) support the care homes and families locally to allow patients to die in the place of their choice. NHS Highland advise that they are currently working with the Highland Hospice to further develop end of life care, together with enhanced training and development of care staff providing a 24/7 service to patients in their own home.

Changes to the provision of maternal and neonatal services at Caithness General were introduced in November 2016 following NHS Highland Board consideration of the evidence set out in the Caithness Maternity and Neonatal Services - A Public Health Review.  Following consideration of the report, the Board endorsed the recommendation that the consultant-led obstetric unit in the Caithness General Hospital should be reconfigured as a midwife led Community Maternity Unit (CMU).  It is important to note that this was not a planned service change, but one taken on the grounds of safety, which is clearly of paramount concern.  The Board’s considerations in this respect were reviewed and endorsed by the Scottish Government’s Chief Medical Officer at the time.

Further recent changes to the medical model at Caithness General Hospital to ensure operational resilience include the establishment of rotational consultants for both Raigmore Hospital and Caithness General Hospital for both medical and surgical services, as well as the development of the Rural Practitioner post.  This has led to a fundamental, positive change in the service from one substantive physician in post to eight.  The Board note that this has allowed the Deanery to support more junior doctor placements and medical students; and the service is now seen as an exemplar for Rural General Hospitals.  The Board recognises that there is a need to prevent unnecessary patient travel and will continue to develop and fully support digital access options, such as Near Me, to ensure as many people can be seen locally as possible.