Official Report 1167KB pdf
The next item of business is a statement by Neil Gray on improving care on the Isle of Skye. The cabinet secretary will take questions on the issues raised by his statement afterwards, so there should be no interruptions or interventions.
14:53
As part of my summer tour, I travelled to Skye and visited Broadford and Portree hospitals as well as Home Farm care home. I went to hear directly from the public in Skye about the challenges in providing urgent care services, and to see how we can work together to address them. I was proud to meet dedicated staff, including nurses, advanced nurse practitioners, doctors and paramedics, local community groups and the co-chairs of Sir Lewis Ritchie’s steering group, alongside the Deputy First Minister in her constituency capacity.
Let me provide some important context. In February 2018, Sir Lewis Ritchie, a respected academic general practitioner, was asked by the chair of NHS Highland to carry out a review of urgent care services in Skye, Lochalsh and south-west Ross. That review came after a period of serious staffing challenges, most acutely in Portree, which led to a breakdown in resilient out-of-hours care provision. It recommended essential improvements for sustainable 24/7 urgent care and in-patient services at Portree hospital in tandem with the services provided at Broadford hospital. The review also emphasised the excellent care that is provided to the public by clinical, social and support care staff.
During his expert group’s review process, Sir Lewis talked to and listened to many, including the public who receive services and the staff who are working tirelessly to deliver them. My recent visit to Broadford and Portree was also about listening and learning. The people of Skye spoke out because they feared the loss of vital health services that they depend on. I am clear that recent incidents that have been highlighted in the media about difficulties accessing services are not acceptable, and I understand why the people of Skye have felt frustrated.
I take this opportunity to pay tribute to the dedication and commitment of the community representative groups in Skye who ensured that their voices were heard on those important issues. Throughout 2018, Sir Lewis met local communities and their representatives in Skye, Lochalsh and south-west Ross, and he also engaged with the leadership team at NHS Highland. From there, independent facilitators were appointed to drive forward a range of recommended changes. I am pleased to say that real, positive progress began to take shape. Importantly, every single one of Sir Lewis’s recommendations was accepted by NHS Highland.
However, as we know, the journey since then has not been without setbacks. The arrival of the Covid-19 pandemic brought severe operational challenges. Progress stalled and, in some areas, was even reversed as staff left their posts and NHS Highland struggled to recruit those who were needed to deliver a safe and sustainable service. Regrettably, that led to a further breakdown in trust between NHS Highland and the communities of Skye.
However, let me be clear: during my recent visit and through continued engagement with the board, I have been assured that NHS Highland is fully committed to rebuilding that relationship. NHS Highland will work hand in hand with the people of Skye to deliver a service that is safe, suitable and sustainable. I welcome that commitment and will ensure that the Scottish Government provides its full support to NHS Highland to enable the board to implement the service.
Portree hospital provides in-patient, out-patient and urgent care facilities and is a base for the Scottish Ambulance Service. Currently, the hospital has capacity for 12 in-patient beds, but utilisation of those beds can vary depending on patient need and availability of staff. The hospital is utilising up to eight beds while the board completes recruitment to all established vacancies. Agency staff are supporting the in-patient service in the short term until that is achieved. As for the site’s future, since the review’s initial report was published, NHS Highland has been clear that Portree hospital will remain open and will provide a range of key services.
I am clear that the local community’s voice must be central in any decisions that are taken and that that will be done through Sir Lewis Ritchie’s implementation steering group. For a number of years now, the group has been the vehicle for many members of the community to voice their concerns, communicate directly with the board and work collaboratively with it on important issues.
As a result of the implementation of Sir Lewis’s recommendations, significant improvements have been made to urgent care services in Skye. Urgent care at Portree hospital is provided 24/7 by an integrated team of clinical staff, which includes registered nursing staff, advanced nurse practitioners and paramedics. They can all assess patients and respond to a range of minor injuries.
Members might recall the tragic incident that took place at the Skye music festival in May 2024, when one person sadly lost their life and another person was unable to access urgent care support from clinical staff at Portree hospital. NHS Highland learned many important lessons following that event. A new service model was implemented in August of the same year, which enabled there to be access to 24/7 urgent care at Portree hospital.
NHS Highland has pursued a number of successful recruitment initiatives in partnership with the local community. It has considered meeting the accommodation needs of clinical staff and looked at developing training opportunities. I am pleased to say that that approach has led to successful appointments to all advanced nurse practitioner vacancies in Skye. All the new permanent staff will be in place by the end of this year. In addition, on 8 September, a new team lead for urgent care took up his post, which is a crucial appointment to support the service’s expertise and resilience. His role will span urgent care on the hospital sites at both Portree and Broadford, to ensure a seamless service and to develop the integrated model that NHS Highland aims to achieve.
NHS Highland continues to build the resilience of the service by investing in staff training and development, to ensure that the highest level of clinical expertise is available to Skye patients 24/7. Paramedics, ward nurses and advanced nurse practitioners are working together, as a multidisciplinary team across the hospital, to share knowledge and skills and optimise the quality of the care that they can give.
When I visited Skye, I stressed the importance of effective communication with the public about how to access urgent care. That is essential in order to build trust and confidence in the resilience and availability of the service. We know that NHS 24 plays a vital role in responding to patients as a first point of contact, and its staff are trained to direct patients to the right place to get help. NHS Highland continues to work in tandem with NHS 24 and the Scottish Ambulance Service to ensure that patients in Skye know how to access the healthcare that they need, when they need it.
In August, in collaboration with NHS Highland, NHS 24 and the Scottish Ambulance Service undertook a leaflet drop to approximately 6,000 households in Skye, to highlight the urgent care services that are on offer and explain how to access them. NHS Highland will continue to monitor the effectiveness of such campaigns and will work together with local community representatives to ensure that a consistent communication plan about the services is agreed and implemented.
Members—and you in particular, Presiding Officer—will be aware that I grew up in Orkney, and I know all too well that living and working in rural and island communities brings with it challenges. In Skye in particular there are concerns about the availability of affordable housing, which was the subject of one of the recommendations in Sir Lewis’s review. That is why the Scottish Government is making up to £25 million available to local authorities and registered social landlords to enable them to acquire suitable homes to support the needs of key workers, where required. Beyond that, the Scottish Government has established a number of other initiatives to support rural and island healthcare, including committing more than £3 million to progress the national centre for remote and rural health and care, which launched in October 2023. The centre is working with health boards and health and social care partnerships to ensure that we avoid a one-size-fits-all approach.
We also established the remote, rural and islands task and finish group to develop a sustainable model for delivery of healthcare for those communities and reflect the unique needs of those areas. That includes better use of digital tools, mobile services and local workforce solutions. That work is helping to shape a tiered framework for healthcare delivery, ensuring that care is provided as close to home as possible, while also improving access to specialist services when needed. Board chief executives will discuss that work in October. A programme of rural and island specific training sessions is also in development, with two pieces of work already in progress, which focus on dispensing practices and developing supervisory training hubs.
I understand the concerns that are shared by communities in Skye. I appreciate that it has been seven years since Sir Lewis Ritchie’s report, but it is right that NHS Highland has been given the time and the space to rebuild its workforce and to address the wider barriers that stand in the way of delivering sustainable services. However, I am also clear that we must see continued improvement. Any future decisions that are taken on the provision of services must be based on the right clinical evidence and take into consideration the impact on local accessibility and, importantly, equity.
It is my pledge that the Scottish Government will do all that it can to assist NHS Highland and to ensure that the voices of the people of Skye are well represented in decisions that are taken. Indeed, that is a wider pledge to all rural and island communities in Scotland. As an islander myself, I understand the challenges and I assure people in those areas that this is a Government that will continue to listen to them and learn from them.
The cabinet secretary will now take questions on the issues raised in his statement. I intend to allow around 20 minutes for those, after which we will need to move on to the next item of business. I encourage members who wish to ask a question to make sure that they have pressed their request-to-speak buttons.
I thank the cabinet secretary for advance sight of his statement, but it is a statement that should not have had to have been made. Last year, when apologising to Eilidh Beaton for the frightening experience that she had to endure, John Swinney said that it should never have been allowed to happen, that it was
“a matter of deep concern”
to the Government that Sir Lewis Ritchie’s recommendations had not been delivered and that Neil Gray had told NHS Highland the previous day that Portree community hospital should be returned to use as a 24/7 emergency facility
“at the earliest possible opportunity.”—[Official Report, 16 May 2024; c 10.]
However, here we are again, because that did not happen. There was a short period of improved service, but people were still turned or directed away from Portree hospital before NHS Highland finally admitted to SOS-NHS Skye campaigners in June that its model was not working.
We must all recognise that the people of north Skye have been badly served. Time and again, the Government and NHS Highland have not delivered what they promised, which is a sustainable 24-hour urgent care service at Portree that is accessible to local people.
In today’s statement, Neil Gray has largely passed the buck to NHS Highland, as the Scottish Government has repeatedly done. Will he accept that there is nothing in his statement that outlines action that the Scottish Government is taking specifically to improve the situation in north Skye? However, if he thinks that what he has announced today will work and will restore long-term sustainable 24-hour urgent care at Portree hospital, can he tell us when will that happen?
Local people do not want more empty promises; they want a proper, sustainable plan to deliver 24-hour urgent care at Portree, and they want a long-term vision for their hospital. Today, Neil Gray has said that things will improve. He said the same thing to campaigners last month. Their response was:
“That’s what NHS Highland said 7 years ago, and every year since.”
I had the opportunity to meet campaigners, and I heard their concerns very clearly. I can understand their frustrations, and, in my statement, I set out where those frustrations come from. As an islander, like Mr Halcro Johnston, I readily understand their perspective.
There were a number of inaccuracies in Mr Halcro Johnston’s question that I need to correct. First, NHS Highland has not said that the model is not working; it has said that it is challenging, which is different. He suggested that accessible 24-hour urgent care is not available, but that is not true—it is currently available, and I was able to see how that is working.
On the Scottish Government’s interventions, I have already set out in my statement the work that we are doing to support NHS Highland, which has allowed the board to move forward with recruitment work and with the model of change that came about in August.
In collaboration with NHS Highland, my commitment as cabinet secretary to the people of Skye is that the investments that are being made and the additional recruitment that has been undertaken will offer a 24/7 out-of-hour service on a sustainable basis.
Those steps have already been made, yet nothing has changed, and there is no new action outlined in today’s statement that gives confidence that there will be any change. The cabinet secretary himself admits that seven years is already far too long to wait, yet it will be at least eight years before the changes that he has talked about materialise—that is, if they materialise.
The posts have been filled before, only to have applicants pull out because they cannot find a home in Skye. The key workers housing fund has been available for three years, yet it has not been used in Portree, and it only has two years left to run. What has changed that will make these promises a reality? When will the people of north Skye have a health service that they can rely on? Is this just another pre-election promise with no hope of delivery?
The reason why I am here setting out the statement is that there was a request from parties in the Parliamentary Bureau for there to be a statement providing an update. The fundamental change happened last summer when the model that was deployed by NHS Highland was updated off the back of the tragic incidents that took place in Skye, also last summer. The Government has provided NHS Highland with support to undertake necessary recruitment, for example of advanced nurse practitioners; support the training that is taking place for all staff on the Portree site; and ensure the co-ordination that is being delivered by the new director for urgent care services, which will all help to ensure that the sustainable service that Rhoda Grant rightly asked for can be maintained.
The implementation of the Ritchie recommendations is badly needed, and I am glad to hear of progress, although I recognise that the time between now and the publication of the recommendations in 2018 has meant a loss of trust and continued frustration about services. Recruitment and retention of staff will be critical to ensuring that future work is successful. Will the cabinet secretary speak to how that will be prioritised and what the key barriers are to securing a full workforce?
I absolutely understand that issue and reflected in my statement on the frustrations and the time that it has taken to get to this point. Emma Roddick is absolutely right about recruitment. The recruitment processes are under way, and we expect the full staff complement to be in place by the end of the year.
What is not helping us in relation to recruitment is, as I have already set out, the housing situation—which we are investing in and supporting in communities around Skye and in other parts of rural and island Scotland—as well as the very restrictive migration situation that has been perpetrated by the Labour United Kingdom Government, in which we have seen a 77 per cent reduction in the number of health and care visas that have been offered over the past year.
I welcomed the Lewis Ritchie report in 2018, and I was delighted to play a part in some of the recommendations. One of the recommendations was that a fast-response vehicle and a paramedic should be based at Portree hospital. I think that the fast-response vehicle cost £100,000. In 2024, the fast-response vehicle was seen heading towards Fort William. Is it back? Is it manned? Will it be replaced in 2025, when its life is determined to be up?
I heard about the situation with regard to the rapid-response vehicle when I was meeting campaigners. I also heard about the positioning of the Ambulance Service at Portree and about how the Ambulance Service staff are helping as a multidisciplinary team to ensure that safe and sustainable services can be delivered on a continuing basis at Portree.
I am grateful to Edward Mountain for his collaboration in Sir Lewis Ritchie’s report, and I would be happy to write to him with more detail on his further questions.
I am proud that the Scottish Government’s 2025-26 budget, which Labour and the Tories did not vote for, provides increased investment of £133 million from 2024-25 for NHS Highland. How has that additional funding been, and how will it continue to be, used to support our island communities, such as the Isle of Skye?
In 2025-26, all boards received increased investment in their baseline funding, with NHS Highland receiving more than £940 million. As has been set out, that represented increased investment of £133 million from 2024-25, including additional funding to provide for prior pay deals, as well as a range of funding to support vital front-line services.
NHS Highland’s funding for 2025-26 will support delivery of commitments such as providing direct access to front-door frailty services at its acute site, improving community capacity and fully delivering the 2025-26 discharge without delay programme principles in all in-patient sites, ensuring timely discharge planning, the full use of multidisciplinary teams and the expansion of hospital at home services.
I thank the cabinet secretary for his statement. The Health, Social Care and Sport Committee had the opportunity to visit Skye in May 2024, which was an insightful visit, certainly for me as a rather parochial Glaswegian—it was my first visit to the island. The insights of the staff at Portree and at Broadford were instructive.
On that visit, some helpful suggestions were made. One that stuck out for me was that the abandoned old Broadford hospital buildings that were boarded up could be readily converted into accommodation for visiting clinicians, or even more permanent accommodation for people who are looking to develop careers on the island. The housing pressure still seems to be a structural challenge there. Therefore, although it is welcome that the practitioner vacancies have been filled, the longer-term need to preserve career pathways on the island is important.
Another key point was that the CT scanner at Broadford does not exist. Having a scanner there is an obvious way to reduce ambulance transfers to Raigmore. Could that matter be looked at?
All the matters that Mr Sweeney has raised are being looked at. I understand that the situation with regard to the former Broadford site is being looked at and progressed. That is part of the Government investment to give rural and island communities across Scotland opportunities to take forward innovative ways to provide key worker housing and support, to ensure that we continue to have sustainable island and rural communities.
I remind members that I am employed as a bank nurse by NHS Greater Glasgow and Clyde. The hospital at home service in Scotland has been welcomed by patients who receive hospital-level care in their own homes, and I am pleased that the Scottish Government has committed to expanding it. It is arguably most valuable in rural and island communities, where healthcare facilities might be far away. Will the cabinet secretary set out how patients in those communities are already benefiting and what more we can expect as the service grows?
Clare Haughey is absolutely right about the appreciation among patients and staff for the expansion of the hospital at home service, which has been supported this year by a share of £100 million as part of the 2025-26 budget to reduce waiting times and delayed discharges, thereby shifting the balance of care from acute to community. That funding will support boards with the additional up-front costs associated with the setting up of services and work is well under way to increase hospital at home provision to 2,000 beds by the end of 2026, making it Scotland’s biggest hospital and meaning that more people can receive hospital-level care in their own homes.
I have also commissioned Healthcare Improvement Scotland to support integration authorities to adapt hospital at home to rural and island communities. The social impact of hospital at home on those communities can be even greater than on typical urban areas, because it enables people to stay at home and in their own community and to avoid being transported outwith their community and away from family and friends.
Although out-of-hours hospital care is vital, most healthcare on Skye is delivered in the community. With GP recruitment and retention across the Highlands in a fragile state, will the Government take action to prevent community services following the same path as Portree hospital by committing to a whole-system approach that will support rural workforce retention, improve access to training and career progression and ensure sustainable primary care for rural communities?
First, I am confident in the service that is being provided at Portree hospital, but we are currently in discussion with the British Medical Association and the Royal College of General Practitioners about future funding models to ensure that a sustainable general practice model comes forward and includes the recruitment of additional general practitioners in order to improve access.
As I set out in my statement, we have taken steps with rural and island medical provision to ensure that we have foresight on the issues and know what is required in rural and island communities. I have taken a number of steps, including with the Scottish graduate entry medicine programme—ScotGEM—to recruit more staff into rural and island communities.
Colleagues will remember that I raised this subject at First Minister’s question time when there was very nearly a tragic incident on the doorstep of Portree hospital last year. The cabinet secretary says that most of the recommendations made by the independent review have been met, but people on Skye still face the possibility of finding the doors of Portree hospital locked during a moment of crisis and some will still be forced into a two-hour round trip to Broadford. Given the tragic incidents of last year and the continued confusion around urgent care, when will people living on the north end of Skye be able to walk into Portree hospital without first having to phone NHS 24 and with the confidence that qualified staff will be there to treat them?
I am sure that Mr Cole-Hamilton recognises that urgent care services tend not to be drop-in services. He should also be aware that, following the situation last summer, there is now an intercom service at the door of that hospital and that patients will not be turned away.
However, in line with normal security provisions for staff, and as is evident elsewhere, the right process is for patients to contact NHS 24 in the first instance to ensure that their needs can be best met and that they are directed to the best services. That is what is in place in every other part of the country. I recognise the concerns that have been raised with me regarding NHS 24 and the knowledge that its staff have of the local system, and I have reflected back to it my experience as an islander. I understand that, which is why we have been working with NHS Highland and NHS 24 to ensure that the urgent out-of-hours care that is in place for every other part of the community is also provided on Skye.
The cabinet secretary referred to the national centre for remote and rural health and care, which was created to help reduce health inequalities and improve the delivery of healthcare services in rural communities. Will he provide an update on the work that is being carried out by that centre and on how that will continue to be supported beyond the end of phase 1 this month?
The national centre was established in 2023 and has four priorities: supporting and developing our rural and island healthcare workforce; building sustainable health and care services; sharing rural primary care knowledge and data; and reducing rural health inequalities. The work that has been completed so far includes a training network for rural primary care practices, funding for five paramedics to undertake the MSc in rural advanced practice, specific training for dispensing practices and a practitioner-led research award scheme. Funding is in place until April 2026 and NHS Education for Scotland is working closely with officials to establish a plan for the next phase of the centre.
I think that basic healthcare should be the same, regardless of the locality. Emergency care—whether that is accident and emergency care, care to deal with events such as strokes and heart attacks, or maternity care—is required with a level of urgency. Does the minister recognise that, as long as health boards are forced to centralise services to balance budgets, rural communities such as those in the Highlands and Islands will keep having local healthcare pulled away from them, which degrades care and puts lives at risk?
I know that Mr Whittle will not have wanted to do this, but he has conflated urgent care and emergency care. Today, we are talking about urgent care, particularly in the out-of-hours period, and accessibility to that in Portree, which has been maintained. As far as emergency care is concerned, there are very clear pathways to such care in place to support the communities in Skye, and that provision is on-going.
I remind members that, prior to entering Parliament, I was a clinical nurse educator in rural Dumfries and Galloway.
As the cabinet secretary mentioned, multidisciplinary teams can play a pivotal role in bridging gaps in care in rural and island communities. Can he provide any further information on the Government’s work to support implementation of such teams?
Emma Harper is absolutely right. We are committed to the development of multidisciplinary teams to help to ensure that people receive the right care at the right time, in general practice and in the community. This year, we are investing more than £190 million in the primary care improvement fund, and we are making strong progress in expanding the multidisciplinary team workforce.
As of March this year, there were more than 5,000 whole-time-equivalent staff in post, who support services including physiotherapy, pharmacotherapy and phlebotomy. That represents an increase of more than 170 whole-time equivalents since last year. Around 3,500 whole-time equivalents have been funded directly by our primary care improvement fund. On my summer tours, I witnessed the incredible flexibility of our rural workforce in ensuring continuity of care for people who require primary and urgent care services.
That concludes the statement. Before the next item of business, there will be a brief pause to allow front-bench members to change over.