Health / Day surgery upgrade moves step closer

Lerwick's Gilbert Bain Hospital.

PLANS to extend and enhance the day surgery unit at Gilbert Bain Hospital in Lerwick have moved a step forward after an outline business case for the £1.3 million project was approved.

Members of the NHS Shetland board met on Tuesday morning where they gave their backing for taking the proposal forward.


Capital funding from the Scottish Government has already been agreed in principle for the works, and the outline business case will now be submitted to the national Capital Investment Group for the money to be released.

A full business case is now expected to come before the board later this year.

The project would create more capacity for day surgery and other day care interventions at the hospital.

This in turn would reduce NHS Shetland’s reliance on inpatient beds and overnight hospital admissions.

The business case said that it would also “increase our ability to repatriate services to Shetland and reduce unnecessary patient travel”.


There is a target to avoid £170,000 in patient travel costs as part of the initial clinical care that could be delivered locally if the unit was improved – reducing NHS Shetland’s carbon footprint at the same time.

The development could also increase the ability for the Gilbert Bain to take in patients from NHS Grampian and NHS Orkney to improve waiting times.

Board members were warned that not progressing the project further would limit the ability to deliver NHS Shetland’s drive to “shift the balance of care” into the community.

They were also told that modern facilities form part of the overall recruitment package in a field already struggling with attracting and retaining staff.


The outline business case said that since 2014 NHS Shetland has reduced outpatient activity by 18 per cent, and increased day surgical activity by nearly one third at the same time.

The number of video consultations has risen from 600 in 2016 to over 2,000 in 2018, significantly decreasing the number of patients who need to travel south for appointments.

The day surgical unit is operating at or near to bedded capacity, and this is leading to patients being admitted to in-patient wards unnecessarily.

Director of nursing and acute services Kathleen Carolan said at Tuesday’s meeting that the proposal first came in front of the NHS Shetland board in August last year.

The commitment in principle of capital funding was then provided in November.

Reflecting on the positives that could come from the refurbishment, Carolan said there was “overwhelming evidence” that shorter stays in hospitals – particularly for elderly people – leads to better outcomes.

She said the current set-up has restrictions, including a lack of space for confidential discussions.

“Gender and age segregation is really difficult,” Carolan added.

Finance director Colin Marsland confirmed following a question from area partnership forum chairman Ian Sandliands that the £1.3 million in capital funding would not need to be paid back.


Interim chief executive Simon Bokor-Ingram, however, said that the year-on-year revenue cost to the health board would be £90,000.

“That’s the true cost that we will pay,” he said.

Head of estates and facilities Lawson Bisset said that if approved the project would be undertaken in phases.

Bokor-Ingram also noted that if more patients were being discharged earlier then there could be short term pressures on services in the community.

“But actually we will not be following them up in the longer term,” he said.

Sandilands also questioned whether there would be plans to run the upgraded unit beyond the usual Monday to Friday, 9am to 5pm hours.

Carolan confirmed that it is anticipated to operate as it is at the moment, although she said there was flexibility as “the staff work around the demand on the unit”.

“The initial aim is to improve access,” she noted.

Concluding Tuesday’s meeting, health board chairman Gary Robinson said: “I think this is a necessary step in the process and hopefully a step in the right direction”