06.03.15 Caithness redesign reference group The following was sent to the Caithness Courier I read with interest the article in the Caithness Courier of 4 th March headed Members are being left in the dark over key meetings. I would like to point out that all Caithness community councils are represented on NHS Highland s Caithness redesign reference group. The situation is that The Highland Council has informed us that it cannot give us private contact details of community council office-bearers. NHS Highland has therefore had to rely on the council s ward manager to inform community councils of forthcoming meetings on our behalf. We are assured that this has happened for all the reference group s meetings, including the one held in the Pentland Hotel, Thurso, on 4 th March. Because of The Highland Council s policy on disclosure of community council contact details, community councils themselves have had to provide us with email addresses or telephone numbers; so far, only three of the 12 in Caithness have done so. NHS Highland is keen to secure the involvement of as many groups or individuals as possible in the redesign process. This work is critical to the county and to the wider Highland community and we feel it is important that everyone understands both the challenges and opportunities ahead. I would urge any person or organisation with a desire to get involved in the process to get in touch with me. Maimie Thompson, Head of PR and Engagement, NHS Highland 09.03.15 Caithness Courier - wanting some further details on indicative costs of the redesign in CGH and confirmation of Maternity Unit temporary location and options for permanent arrangements. Response Pam Garbe, Lead for CGH Redesign, spoke to the journalist and gave clarification on the maternity location explaining we were utilising the conf, seminar rooms and offices etc for maternity and utilising prime clinical space. Journalist was also invited to see the plans and have a walk round CGH. He was also asked him if it would be useful to include the redesign hospital draft options in one of their publications as it is difficult to visualise the proposed options. 19.03.15 Major upgrade proposed for hospital Press release will be in folder we can link up to this when it goes online. NHS Highland is working up plans for a multi-million revamp of Caithness General Hospital in Wick. The health board is currently costing a range of options as part of the business plan process that s a necessary part of such a large infrastructure project.
It hopes that, if it secures the estimated 5 million it needs for the project from the Scottish Government, work on upgrading the 74-bed rural general hospital will get under way next year and be completed within two years. 23.03.15 NOSN NHS Highland responses in red: I have received a copy of the ad NHS Highland placed for a locum consultant anaesthetist based at Caithness General hospital in Wick I notice it says the on-call rota will be one in three. I thought NHS Highland accepted that such a rota was one of the negative factors in attracting recruits to the north and yet it is now advertising a post with that rota system in place. We have advertised a one in three rota as we do not as yet have a new model, and need to maintain anaesthetic services whilst we explore new ways of working. But the rota is far from ideal. However we can t just change the model without going through due process and that is why we have been looking at the options with all concerned. We still have more work to do to shape and discuss possible options with local people. Why is that? Notice the ad also stresses the positives about the area which must help the cause. Any feedback to the ad yet? We have received one expression of interest over the weekend and a pack was emailed out this morning. Is there a closing date for applications? I can confirm the closing date for the Locum Anaesthetist - 1 year post, is 6 April 2015. Re substantive posts no interest in physicians post and no suitable candidate for anaesthetic - we are about to re-advertise for both. 31.03.15 North of Scotland Newspapers I was at a meeting of the Caithness District Partnership in Wick on Friday. When Bob Silverwood was giving an update in recruitment issues he mentioned difficulties at the Lochshell Dental Clinic near Wick. Failure to fill a post/posts has led to appointments being prioritised with emergencies, children and the frail elderly at the top of the queue. Appointments for other patients have been delayed as a result although the Scottish Government seems to have granted permission to recruit other dentists. The news was described as disappointing at the meeting. Can you confirm if that is the situation and how long has it been that way? Is NHS Highland hopeful of resolving the situation soon? How many staff are needed at the clinic to take it up to complement? A comment on the situation from the relevant person would be appreciated. Response Due to vacant dentists post within the Wick Public Dental Service Clinic it has become necessary to prioritise those patients: requiring emergency care; children requiring routine care; adult patients with additional needs for example the frail elderly and those with significant learning disabilities, mental health problems, etc.
This means that some adult patients will receive a letter in the coming weeks advising them that their recall appointments are being delayed while NHS Highland recruits to these vacancies. The first vacancy for a dentist arose in Lochshell on 8th December 2014 and the second vacancy on 16th March 2015. Both vacancies are to be advertised during the early part of April as NHS Highland this month received approval from the Chief Dental Officer (CDO) to recruit to both posts on a fixed-term basis. The CDO has also requested that NHS Highland ensures that progress is made to rebalance primary care dental services in the Wick area through the provision of opportunities for patients in Wick to register with a General Dental Practitioner: i.e. an independent contractor. This in turn will free up capacity within the Public Dental Service to focus on the provision of services for those patients with additional needs such as the dependant elderly and those with mental health or learning difficulties. NHS Highland has requested that the Scottish Government considers making available grant assistance under the Scottish Dental Access Initiative to incentivise General Dental Practitioners to set up NHS-committed practices in the area. Follow-up - Are you able to say what sort of delays those patients not being prioritised are likely to face? Response It is likely that they will face delays of up to two months but during that time should any patient experience a dental emergency then they will be prioritised. There are also two dental practices in Thurso that are accepting new patients for NHS registration and patients are free to contact these practices directly to transfer their registration if that would be more suitable for them. They are: Ormlie Hill Dental Clinic, Ormlie House, Thurso Dunbar Clinic, Dunbar Hospital, Ormlie Road,Thurso KW14 7DY KW14 7XE 01847 896777 01847 896580 North of Scotland Newspapers You told us last week that you had one expression of interest in an anaesthetist post at Caithness General. Is that still, the case? Response The person who had expressed interest has been deemed not to meet the criteria for the post and so the situation at present is that we have no live expressions of interest. 08.04.15 JOG (responses in red) - Following on from your comments about the Dunbar just wondered if you could clarify a couple of points. It was stated at the time of the last review that Dunbar would need investment to bring it up to standard. Are there any plans to do that? No I have been told the physio department at the hospital is still fenced off. Is that right? Yes Any plans for that building? No One member of the public told me he feared death by a thousand cuts at the Dunbar if no investment is made there. What would NHS Highland say to that? What has been cut? And on Caithness General been told staff morale has never been so bad. Anything the health authority can do to address that issue? Quote from Bob Silverwood - As mentioned last week we have not progressed any proposals for re-design of services around the
Dunbar facility. Any future plans or investments would be service-led to meet future requirements. In the meantime there has been significant investment in the Dunbar site. In fact we have spent more money in Dunbar in recent years than any other Community Hospital in Highland It is certainly the case that the staff in Caithness General have been working under particularly testing times with challenges around clinical staffing as well as operational pressures such as managing Norovirus outbreaks. On top of this, we are undergoing a period of necessary change to modernise the way we deliver some services and start the planning of the re-design of the hospital. While some staff members thrive in making changes others find it more difficult and rather unsettling. But they are all united in doing the best they can to improve the care and services they provide for patients and they understand that we can t stand still. The feed-back from Raigmore consultant s who have been providing week-end cover has been extremely complementary around the quality of the staff and their experience of services provided in Caithness General. This feed-back has been welcomed and well received. 09.04.15 John o Groat Journal Further to your response yesterday about investment on the Dunbar, an indication of how much has been invested over what timescale and for what would be useful. Response NHS Highland has spent the following on the Dunbar over the past five years: Electrical re-wiring 275k; new biomass boiler 240k; fire upgrading 50k, new fire alarm system 50k, new emergency lighting system 25k, upgrade of car parking area including resurfacing 150k, new dental unit 800k; total investment 1,590k. John o Groat Journal I heard least night that a senior charge nurse at the Bignold Ward in Caithness General Hospital has tendered his/her resignation. This person was due to retire next year and had been in post for less than a year. I was told the reason for the resignation was around the low morale that exists in the hospital. Can you confirm that and can I have a comment on the loss of another member of staff at the hospital? Response We cannot possibly comment on this. As for the issue of morale, I refer you to a comment we provided you yesterday. John O Groat Journal I hear that Caithness General is having to deal with MRSA cases. Is that right and if so, can you provide us with some details? What wards affected? How many patients involved? When first identified? How long is it expected to last? Response - No increase in MRSA cases at CGH. Patients that have previous positive results can and will continue to be admitted but they will be risk assessed accordingly. Follow up - Could you give me an indication of the number of people affected at present at CGH. Also what timescale are you referring to? Response There are currently no patients in CGH with an MRSA infection. Follow up - So when was there MRSA cases at Caithness General? I was told there was a problem there Response I think you have been misinformed. The last MRSA infection at CGH was in February 2013 - more than two years ago
15.04.15 NOSN I am contacting you regarding NHS Highland plans to recruit a consultant surgeon at Raigmore Hospital who would be expected to undertake work across the Highlands, including Caithness General Hospital. Caithness District Partnership chairman Bill Fernie told members of the Wick Community Council on Monday night that he had spoken to medical based professionals in the area who are saying that the idea will not work. He claims medical professionals in the far north have said with areas all across the UK competing to attract trained medical staff, the prospect of being constantly relocated to different hospitals across the Highlands will not receive any interest. He said medical professionals want to know that they will be permanently based at one hospital, rather than being shifted across a wide geographical area. I would like to ask if NHS Highland did receive any applications for the Highland wide vacancy based at Raigmore? If not is there plans to re-advertise the post again? Also, does NHS Highland think Mr Fernie has a point when he said job vacancies for Highland wide consultants who are constantly shifted around different hospitals is an unattractive prospect? Mr Fernie also said the only way to solve the staffing crisis is to reevaluate the recruitment process to make jobs in the Highlands more attractive to medical professionals. Does NHS Highland agree? Response Pauline Craw, NHS Highland rural general hospital manager, said: Interest in the future of Caithness General Hospital is understandable and to be welcomed. NHS Highland is about to embark on a major structural overhaul of the hospital s interior, we are carrying out a review of our services across Highland and we are reviewing surgical services across Highland. These reviews are necessary because it is clear that we need to change the way we are doing things, not least because of the well-documented difficulties we have had in recruiting and retaining consultants. We are working hard to improve our services but we are concerned that our attempts to do so may be undermined by what appears to be a constant stream of unwarranted negativity. We welcome contributions to the ongoing debate about the hospital but we are becoming increasingly concerned that undue negativity may not be helping our attempts to recruit consultants. You say that it has been suggested that jobs in the Highlands should be more attractive to medical professionals. We agree but we cannot believe that such comments contribute to that end. Dr Emma Watson, NHS Highland s director of medical education, added: As we have previously explained, the depleted number of consultants at Caithness General five out of 12 substantive consultants in post means that the situation at the hospital was extremely fragile. Despite our best efforts, the recruitment of consultants to Caithness General became so problematic that it was clear that we had to devise a new, sustainable model. What we have tried in the past simply has not worked as we would have wished and we believe our pan- Highland approach can only be more effective.
We believe and our clinicians have concurred that a pan-highland approach to consultant recruitment would offer us much more flexibility and would offer those who are recruited the opportunity better to develop their skills and careers as part of a wider team. This is further backed up by the large number of applicants we have received for the Clinical Development Fellows (junior doctor) posts who will be working in exactly this way, rotating between Raigmore and Caithness General Hospital. Dr Ron Coggins, general surgeon and clinical director for surgical services in Raigmore Hospital, said: I do not think this [the pan-highland strategy] is an unattractive proposition, and I disagree entirely with the views voiced locally. We have already successfully appointed two posts on this basis (one with verbal consent to the process, the other with specific detail in the job advert), both of which were Raigmore-funded posts and evidence of Raigmore's commitment to sustaining the Wick service. Regardless of whether the adverts are successful first time round (and we know from experience that they are not always), we all know that the model of care in Wick needs to change. The current model is without doubt unattractive to applicants, as has been demonstrated repeatedly, and I would stress: Surgical posts based wholly in Wick are not sustainable through issues with surgical training, as well as the long-term maintenance of skills and professional isolation. An inability to demonstrate appropriate maintenance of skills is a threat to revalidation, and arguably one of the biggest threats to ongoing surgical provision in Wick (and other rural hospitals). The evidence does not support a model that has consultant surgical staff on site 24/7. 05.05.15 North of Scotland Newspapers (responses in red) I have just seen a copy of Caithness General Hospital Your Questions Answered document and have some questions for you. It seems to rule out 24/7 surgical cover at Wick because of the low volume of emergency work. Is that a decision reached by NHS Highland and, if so, when was it reached? Is it the first time that has been stated publicly? No decision on this has been reached. The document merely sought to explain what the actual situation is as we develop options for the future. We will still have to do a formal options appraisal and consult on the options. The document also states that the health authority has moved to a contingency measure but we thought that had not been invoked. You will be aware that we had to bring in some changes when NHS Education for Scotland highlighted concerns around junior doctors. This is why we have consultant surgeon, physicians and other clinicians from Highland travelling to Caithness and providing care. It also mentions the plan to deliver significantly more elective surgery at Caithness General and have 24/7 anaesthetist cover. But what is the point in having that if there are no surgeons based at Wick 24/7. They would only be here during the day as I understand it. There will be surgeons based in Wick as well providing visiting service. Elective surgery is not carried out 24/7 theatre lists are planned and take place during in-hours. Anaesthetic cover is not provided solely for surgical patients, and out-of-hours cover is required for the other acute care that is provided at the hospital, such as medical and maternity.
NOSN (follow-up) Just to clarify: no decision has been reached about the future of 24/7 surgical cover at Wick although the document seems to suggest the low volume of emergency work does not require 24-availability of a consultant surgeon at Caithness General. The query about the 24/7 anaesthetist cover also needs clarifying. Why would you need such a provision if there would be no surgeons on site out-of-hours? When is a decision expected as the temporary solution regarding surgical cover runs out in June? Response The decision has not yet been made but all the work we have done so far indicates that there is not a need and that other models of care would make more sense. We are in the middle of another round of meetings with local people to explain the challenges and discuss the criteria they believe are important to agree the service model. As mentioned, anaesthetic cover is not provided solely for surgical patients. Anaesthetic cover is also required out of hours for the other acute care that is provided at the hospital, such as medical, maternity and A&E. What we have said is that the current arrangements to provide surgical cover are likely to run out in June but we will still need to sustain the service. This will depend on how the current round of recruitment goes. In parallel to these arrangements we are working through a process to identify possible future options and consult on these. 27.05.15 North of Scotland Newspapers Gill McVicar was at the Caithness and Sutherland Area Committee in Wick yesterday and met councillors in private before the public session. Is there anything you can divulge about the private element of the meeting? Response (provided by Gill McVicar) It was a private meeting and you may wish to ask the councillors if they wish to make a statement. What we can say is that we met members of the area committee to brief them on what has been happening with clinical staffing in Caithness General Hospital and to discuss ongoing and further engagement with the public on future models of care. It was a positive meeting and we hope to meet regularly with councillors as we progress. 01.06.15 North of Scotland Newspapers - Thank you for sending the NHS Highland Media Briefing for board meeting on June 2 2015. Reading through Page 3 Work progresses on changes throughout NHS Highland area a few paragraphs stuck out which I would like to ask to be clarified. In the third paragraph referring to Caithness General Hospital, it states However, a report to the board will explain that medical staffing challenges in terms of consultant and junior roles have led to a contingency plan being put in place. Can you confirm what the contingency plan at Caithness General Hospital is and also when it was implemented? The contingency is that Raigmore Consultants are rotating up to CGH every weekend, the Clinical director who is also a Rural Practitioner is working in the hospital overnight midweek, another Physician is spending three days every three weeks in CGH and there is increased Care of the Elderly Consultant input. Is it related to 24 surgeon cover or another area of medical provision at CGH? There are vacancies for Surgeons, Physicians, Anaesthetists, Obstetricians and Junior Drs. Also the report reads Out of 12 substantive posts, there are only four post holders and locums are being employed on a 14 hour, two week programme. Can you confirm the eight substantive posts which are unfilled at CGH and the four which are currently filled? 8 vacancies. Response (Maimie Thompson) Gill McVicar agreed to speak to the journalist. 04.06.15 North of Scotland Newspapers Wick councillor Bill Fernie has been in touch with us after making a Freedom of Information (FoI) request to NHS Highland about its recruitment process and details about the advertisement of each of its vacancies.
He claims that NHS Highland advertised three locum consultant and physician positions at Caithness General Hospital (CGH) between March and November 2014 which he said were only advertised once and believes the positions were not filled. He also said FoI information he has received indicates the positions were not re-advertised. He claims as a result of the information he has received, he does not think NHS Highland have tried as hard as they could to advertise these posts and fill positions at CGH particular in relation to consultants and physicians. I would like to ask NHS Highland if Mr Fernie is correct in saying NHS Highland has only made one advert for individual vacancies at CGH relating to consultants and physicians in a year? If Mr Fernie is correct or not, could NHS Highland explain what is NHS Highland s approach to vacancies which do not receive any applications? Do they re-advertise immediately or do they evaluate the need for the vacancy at the hospital if it drew little interest? Also Mr Fernie argues NHS Highland are not doing enough to advertise vacancies at CGH to fill positions such as consultants and physicians. Is this something CGH would agree with? Response (Jackie Sutherland, John Huband and Maimie Thompson) - Councillor Fernie was advised that the FoI request he tabled would have required research which would have cost far in excess of the ceiling of 600. However, to try to be helpful, we did send him data put together in response to a similar FoI request, which was made by you and to which we responded on 12 th January 2015. The central contention behind your enquiry yesterday did not ring true with me and we have now ascertained that our administrative processes are such that we did not trap all the data relating to advertisements when we drafted our FoI response. Clearly, it would not have been in our interest to report that we advertised vacancies less often than we actually did. However, checks have revealed that that is in fact what happened, and we can only apologise for that. The following response is based on information that has now been put together by our medical staffing manager and our head of employment services. We would refute the suggestion that NHS Highland are not doing enough to advertise vacancies. In the period from January 2014 to January 2015 we placed adverts as follows: On 26 th January 2014, for a locum consultant in obstetrics and gynaecology. This advert was placed on the SHOW (Scotland s Health on the Web) website, where we place all such job adverts. It attracted one enquiry but no applicants. This post was re-advertised on 5 th April 2014, both on SHOW and in the British Medical Journal. It had been decided that, although NHS Highland does not advertise all consultant vacancies in the BMJ, we would do so in future for all Caithness posts in view of our difficulties recruiting there. We had six enquiries and one applicant, and an appointment was made. On 14 th March 2014 for two consultant physicians, on SHOW and in the BMJ. We had one enquiry from someone who later withdrew interest. We subsequently made an appointment through a recruitment agency and re-advertised the other vacancy, again on SHOW and in the BMJ, on 16th November 2014 and again on 7th February this year. On 21 st June 2014 for a locum consultant surgeon, on SHOW and in the BMJ. There was only one applicant, who was not suitable for the post.
On 17 th January 2015, for a consultant anaesthetist, on SHOW and in the BMJ. We have had only one application, a doctor from overseas, and we are looking to interview the applicant. We also advertised on SHOW and in the BMJ for a rotational consultant surgeon. This has attracted two applicants, and it may be that both are appointed. It should be noted that advertising is not our sole means of seeking to appoint. We are in constant dialogue with specialist recruitment agencies, and were so in relation to all the vacancies mentioned above. We consider responses to advertisements on a case-by-case basis and do not have a general policy immediately to re-advertise if we fail to attract responses or to fill vacancies. However, you will note from the above that we have re-advertised. We also do what we have done in the case of Caithness General Hospital: think again. And with Caithness General we have concluded, on the basis of extensive past experience, that our record with recruiting and retaining surgeons there is such that the service model we operated was neither safe nor sustainable and that change was necessary. So yes, we have re-evaluated the position and have determined that a new model was essential. In addition to the above, we have recently advertised for Clinical Development Fellows (four job offers to be issued this week, with the intention of basing two posts at a time at Caithness General) and six emergency doctors (interviews pending). We are also about to advertise for a rotational physician (a doctor; job description being written), a nurse practitioner (job description pending), a physician s assistant (advert being finalised). Furthermore, we recently adopted a new tactic, of seeking to attract physicians in the Netherlands. We placed an advertisement in a leading Dutch newspaper which drew attention to vacancies in a wide range of specialties including oncology, radiology, rheumatology, anaesthetics and psychiatry, as well as general medicine and general practice. The advert attracted eight responses, and we are hopeful of making appointments though it is too early to give further details at this stage.