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Survey: mental health services are falling short

THREE in four islanders believe that Shetland’s mental health services are inadequate, according to a survey run by local MSP Tavish Scott.

More than 900 people responded to Scott’s survey, which also highlighted concerns on GP and dentistry services and the experience people have when travelling south for treatment.

Seventy three per cent of respondents felt mental health provision was inadequate. The Liberal Democrat MSP said it reinforced his belief that mental health ought to receive “the same urgency and importance as physical health”.

He said one idea was to ensure a mental health professional is available in A&E departments and he intends to consult on whether that would be appropriate for the Gilbert Bain Hospital.

Scott said the system was “broadly speaking” working when people are able to access care, though there appeared to be some cases where patients were sent to Cornhill and not given a long-term solution to their problems.

But he said suicide statistics for Shetland were “deeply disturbing” and he intends to approach NHS Shetland to discuss “how to ensure the best possible access to mental health services for all those who need it”.

MSP Tavish Scott: survey has highlighted islanders' concerns in various parts of the health service.

The survey painted a mixed picture on GP appointments. The introduction of nurse practitioners at Lerwick Health Centre has resulted in a genuine improvement, but Scott said that town folk were still “waiting a long time” when they needed to see a GP.

He said Hillswick doctor Susan Bowie had made the point that, while 90 per cent of the NHS workload was shouldered by doctors and nurses, they account for only eight per cent of its budget.

The majority are able to see a GP within a week, and 52 per cent rated the service as either “good” or “very good”, with only 20 per cent saying it was “bad” or “very bad”.

But 37 per cent felt GP services had worsened in the past five years, while only 25 per cent felt things had improved.

Scott said feedback recognised the “hard work of our GPs”, but recruiting doctors to the islands remains “a difficulty and a challenge”.

“We need to be able to provide lots of good reasons to live and work here,” he said. “If we ask doctors in Yell to be on call all the time, it’s not surprising that we’re struggling to recruit.”

He said almost a third of doctors trained in Scottish medical schools “leave the country the minute they finish their training”. He believes there is an “unanswerable case” that GP graduates should be made to commit to working in Scotland for five years.

On dentistry, people say they are waiting between two and six months for a routine appointment – while some wait five to seven years to be registered with a dentist.

Forty six per cent rated dental services on the whole as “bad” or “very bad”, compared to only 27 per cent who felt it was “good” or “very good”.

NHS Shetland chief executive Ralph Roberts says the findings are no surprise, and the health board is already working on ways of improving dentistry and mental health services.

The MSP said many people were “very disappointed” at not being able to get swift access to dental care. Regular check-ups are “not happening as often as they should” and that is having a negative effect on islanders’ dental health, he said.

Those travelling to the Scottish mainland for treatment are generally satisfied – with 64 per cent describing their experience as either “good” or “very good” and only 15 per cent rating it either “bad” or “very bad”.

Scott said he hoped more could be done to ensure consultations are conducted over the phone or videoconferencing to save on patient travel.

Last year NHS Shetland spent £2 million on patient travel using Loganair, and the MSP said the salary cost of employing specialist staff based in Shetland could be “more than offset” by the reduction in air and ferry fares to send people south.

Speaking more generally, Scott said he still felt the health board was being short-changed to the tune of £900,000 a year under a national funding formula – a point not accepted by NHS Shetland chairman Ian Kinniburgh.

The MSP said healthcare professionals were “subjected to the bureaucratic paper chase of a target-driven culture” and “the command-and-control structure that flows from Edinburgh appears to me to be counterproductive at the moment”.

NHS Shetland chief executive Ralph Roberts said the health board welcomed “all feedback, whether good or not, because it is only by listening that we can improve what we do”.

“I am pleased that the survey has had a large number of responses which just shows how important the health service is to the local community,” he said. “It is also good to hear the positive comments about the commitment and professionalism of our staff, which is fully deserved.

“I am pleased that the main issues identified in the survey are areas we are already working to improve. We have, for example, already invested in new staff to work within the mental health service, there is a new dental practice due to open later in the year in Lerwick and – as your readers will be aware – we have introduced advanced nurse practitioners into Lerwick Health Centre.”

Roberts continued: “However we are not complacent and the respondents are also right to have recognised that difficulties with recruitment is a key concern for us. We therefore have to do everything we can to make ourselves and [our] community as attractive a place as possible to live and work.”

He said bringing trainees to Shetland had an important role to play in resolving recruitment difficulties. Those who have experienced working in rural healthcare jobs are “more likely to come back and work” once qualified.

Roberts agreed that more could be done to reduce patient travel, such as the recent appointment of a Shetland-based gynaecologist, though some specialists are “less comfortable” operating in remote parts of the country.

While any health board wants more money to spend, Roberts said the health board did not share Scott’s interpretation of the funding figures.

He said NHS Shetland believed that “we are getting our share as calculated by the formula”, to within one per cent of its “target share” of national NHS resources.

“We need to continue to argue to make sure the formula appropriately reflects what we think is the additional cost of health services in somewhere like Shetland,” he added.