Isles health care is “in breach of human rights”

He was speaking during a lengthy discussion at last week’s Transport and Infrastructure Committee. It followed a presentation by HITRANS partnership manager, Neil Macrae, who is leading a working group set up to examine links between health and transport in the islands.

While the study was prompted by concerns about the air service capacity between Benbecula and Stornoway, it became clear that it has widened into many other areas of concern, large and small.

Councillor Steele cited examples of patients having to cancel appointments on the mainland because they could not afford the accommodation costs involved, sometimes running into thousands of pounds.

“That is putting people’s lives at risk”, he said, and is therefore in breach of their human right to health care access. He added that the problem is “very specific to Uist and Barra” because so few specialist services are available within a day’s travelling distance.

The question of why patients are routinely sent first to Stornoway before being referred to mainland hospitals was raised by South Uist councillor, Iain Macleod. He asked if any consideration had been given to switching hospital referrals direct to Glasgow.

Mr Macrae said the Health Board had ruled this out due to the complexity of existing contracts and also because waiting lists are longer on the mainland. However, Councillor Angus MacCormack, who resigned from the Health Board, described this as “a load of puff – there is no reason why they should not go straight to Glasgow”.

Barra councillor Kenneth Maclean said research showed that health outcomes are affected by the stress of travel and being away from home. “It is clear that we should not be forcing people into these long, arduous journeys of three or four days to Stornoway when a day could get them there and back to Benbecula or Glasgow”.

Councillor Mustapha Hocine, North Uist, quoted a case in which an expectant mother had to spend two weeks in Stornoway at peak tourist season and faced an accommodation bill of £3000, against an allowance of £55 a night. He added: “Giving birth is a basic human right.”

“You can’t give birth in Uist (and) not everyone from Uist can afford £3000 to give birth”.

He suggested that, with co-ordination, packages could be put together which covered everything from the point of referral, including transport and accommodation. “It is very expensive to be ill in Uist”, said Councillor Hocine.

Another aspect which provoked discussion was the lack of co-ordination in patient travel which results in multiple taxi hires between airport and hospital or, in the case of ferry journeys, fares running into hundreds of pounds between Leverburgh and Stornoway.

Councillor Iain Macaulay questioned why there could not be a “door to door service” with patients in Uist collected from their homes and travelling as a group by minibus to hospital in Stornoway.

In his presentation, Mr Macrae said that patients travelled off the islands last year for 54 different specialisms with nine of these accounting for 75 per cent of the travel. This led Councillor Donald Crichton to suggest that the best solution would be “to bring these nine specialisms to the people – that should be the starting point in this”.

Another area of discussion was the dilution of funding for escort travel when patients need to be accompanied. Councillor Hocine said he knew of cases where patients had not taken up their appointments because they were refused escort travel, thereby damaging their health outcomes.

He said the system had previously been based on GPs, certifying the need for an escort. However, the Health Board had centralised decision-making and since then there have been continuing problems with the refusal of escort travel.

Councillor MacCormack recalled that when he joined the Health Board, escort decisions were made by GPs but then the Scottish Government set a budget for the Health Board to operate within. “Some mandarin in Stornoway now decides they don’t need an escort,” he said.

Councillor Norman Macdonald suggested that the Highlands and Islands report by the Scottish Human Rights Commission “is potentially an angle we can use in articulating the additional resource that is needed”. Calling for a co-ordinated approach, Councillor Macdonald said: “There seems to be an invisible barrier between the Health Board and ourselves”.

On the inter-island air service, Mr Macrae said it had been identified that “there is usually spare capacity on the Benbecula-Stornoway flight but that is not always obvious to the Health Board”. A solution to this lack of communication is being sought.

There was a general welcome for the fact that these issues were being given an airing – described by Comhairle leader, Paul Steele, as “long overdue”. The working party was set up by Health Secretary Neil Gray following a meeting in Uist in August.

However, the working party is due to produce its final report by mid-December and it is clear that very few of the questions raised will have been answered by then.

Mr Macrae ended on an optimistic note: “By all working together, we could find ways that things could be done better”.