NHS SHETLAND chief executive Ralph Roberts has defended the health board’s plans to close Gilbert Bain Hospital’s Ronas Ward as the “most efficient” way of cutting spending while minimising the impact on services.
He also revealed that the health board wants to undertake a study over the next year into the size of the hospital to explore how the isles’ service should look amid a time of “significant financial challenge”.
Roberts told Shetland News that the eventual closure of Ronas Ward would save around £500,000 a year, and claimed it was also something NHS Shetland should be considering irrespective of financial challenges which see the health board seeking to cut costs by around £4 million a year.
It was confirmed last year that the ward, which contains six beds and is used for patient rehabilitation and recuperation, could shut as efforts to ultimately give more patients treatment in their own homes or in care centres are stepped up.
The issue is due to be the subject of a report going before a meeting of the integration joint board (IJB), a shared forum between the NHS and Shetland Islands Council, next Wednesday (25 January).
Question-mark over £500,000 savings
In September the IJB unanimously deferred any decision and called for further information. With things at a “delicate stage”, one source said it was vital to ensure rehab patients can be properly cared for outwith the hospital before going ahead with shutting Ronas Ward.
Another questioned how easy it would be to save half a million pounds when Ronas staff would initially have to be redeployed within the health service. The factor of upcoming SIC elections in May could also affect the timing of any closure – with some council candidates likely to stand on a platform of trying to prevent it from being shut.
More widely in the UK – and particularly in England – there has been a crisis with numerous NHS hospitals facing a crippling shortage of beds, but Roberts said the situation was quite different in Shetland.
The GBH never had more than two-thirds of its 50 beds full over the Christmas period, with occupancy at times as low as 20 per cent – leading to some questions as to why Ronas should shut its doors when there are a number of empty beds in the hospital’s other two acute wards.
Roberts conceded that if money was “no object” then there would be a case for keeping some of the rehabilitation facilities in the hospital.
He added that on nearly every day last year, patients in Ronas Ward could have been accommodated in one of the other two wards if necessary.
Best option for patients
The primary aim of the proposal, however, is to ensure more patients are cared for outside of hospital, he said, while the make-up of the standalone rehab ward means that it needs at least two staff present at all times despite its low number of patients.
“The first thing is that we should be doing what is right for patients, and I think caring for patients in the community is better,” the chief executive said.
“The second thing is that if we have to find savings – and we will have to, there’s no question about that – you then have to ask where is the best place to find those. If you can find them in a way that actually potentially improves the service, or at the very least doesn’t make the service less good, then that surely is the place that you should go first.
“The reality is that we should be wanting to do it regardless of the finances, because it supports the shift into the community. But it is not an unreasonable suggestion that if money was no object, then there is an argument for having some facility in the hospital where you could do some longer term rehab for some patients.”
Roberts argued that removing beds from the hospital’s other wards instead of closing Ronas Ward would still leave staffing levels at the same level.
The chief executive expects the issue will continue to be discussed with the integration joint board, which expressed concerns over how patients in outlying areas will be affected and subsequently caused the proposals to be delayed, over the coming months.
Roberts admitted that the health board will need to keep monitoring the number of beds in the hospital.
Hospital’s size to be reviewed
He said there are plans to review the size of the GBH to ensure NHS Shetland can make a strong case for its services, with public sector austerity looking set to keep on biting.
Roberts added that the “honest truth” was that Shetland only has a hospital the size of the GBH because of its island location.
“One of things that we’ve said we do need to do, and want to do, is do a piece of work in the next year that really looks at what do we think the long-term size and model for an acute hospital in Shetland should be,” he said.
“If you had a population of 22,000 people and it wasn’t in Shetland on an island 200 miles off the mainland, and it had a hospital the size of the Gilbert Bain, you don’t need a hospital like that to provide care for 22,000 people.
“But we have it, because [of] where we are, and because we have to do acute care and we have to care for people before they go to a bigger hospital, and we want to maintain care locally.
“So we have to ensure we have a really good argument for what is the best way of providing that in the long term. I don’t think it will be very different from what we have now. Whether the two acute wards will have 44 beds, 42 or 40, I think that’s almost less of an issue – it’s about what the facility is that you need to provide medical care and surgical care.”