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NHS struggles to keep up with demand

NHS Shetland chief executive Ralph Roberts.

SHETLAND has the highest rate of GP vacancies in Scotland at almost 18 per cent, according to a new report on the financial health of the NHS in the country.

NHS Shetland has also the highest rates of nursing and midwifery vacancies among health board at over eight per cent, a report by public finances watchdog Audit Scotland revealed.

The local health board is further struggling to identify long-term savings with 60 per cent savings in 2015/16 having been one-offs that cannot be repeated in future years.

Other findings were:

  • 47 per cent of the health board’s properties are over 50 years old;
  • NHS Shetland failed to meet the three-week target for drug and alcohol treatment;
  • NHS Shetland was one of only three boards that met the target for discharging all patients within 14 days of their treatment being completed, the so-called bed blocking;
  • NHS Shetland is unable to locate more than four per cent of its assets included in its physical asset register.

In her report NHS in Scotland 2016, published on Thursday, auditor general Caroline Gardner acknowledged that a combination of increasing cost, staffing pressures and unprecedented saving targets is making life difficult for health boards.

And although NHS funding has increased in real terms, spending is not keeping pace with rising costs and the needs of a growing and ageing population, she said.

“Major challenges lie ahead for the NHS in Scotland. There are growing pressures on health boards which are struggling to juggle service delivery and progressing major reform whilst also managing considerable financial challenges.”

In a detailed response to the finding, NHS Shetland chief executive Ralph Roberts said he welcomed the 48-page report as it “clearly sets out some of the challenges facing the health service in Scotland, particularly in relation to recruitment & retention, funding and the inevitable increased demand from a growing and ageing population.”

Roberts said the national difficulties for GP recruitment were well known and NHS Shetland was continuing to actively promote the isles as a good place to live and work in as a GP.

“Alongside our recruitment drives we are looking at how we can use the skills of the wider team to address GP vacancies.

“The expansion of the Advanced Nurse Practitioner model in the Lerwick Health Centre has been successful and has allowed service delivery to be maintained and we are looking at how this might be used in other areas of Shetland,” he said.

Roberts continued by saying it was increasingly difficult to identify savings without making “sustained change” to the way the health board was delivering its services.

“We are working hard to identify ongoing efficiencies and are committed to doing this, wherever possible, in a way that minimises the impact on patients, for example by reducing the need for patients to travel to the mainland for hospital appointments or reducing medicines waste,” he said.

“However other changes will result in us providing services that are different from those currently provided.”

NHS Shetland said the high number of properties being older than 50 years was due to the age of its largest property, the Gilbert Bain Hospital.

“The majority of our primary care facilities are much newer and with the relocation of Scalloway we now have relatively new or refurbished health centres across Shetland,” Roberts said.

“We have been actively working on our backlog maintenance and expect this figure to reduce significantly in the next year.”

He added that the health board accepted the recommendations made by the auditor in relation to being unable to locate four per cent of the organisation’s assets.

“The work done by our auditors indicated, that particularly in relation to assets that had been purchased over ten years ago we had not been as effective as we might in recording these on our asset register,” he said.

“This was not the case with newer assets. As a result of these recommendations we have reviewed our recording system and this is being updated.

“While we were unable to formally evidence through our register where a small number of assets were, we are confident that these had in fact either been replaced, upgraded or appropriately disposed of after they were no longer required.”