Health funding crisis – crucial projects on hold

NHSWI had identified a list of “high priority” and higher cost works, totalling £4.5m, but has received a grant of just £1.29m from the Scottish Government.

Addressing last week’s board meeting of NHS Western Isles, Director of Finance, Debbie Bozkurt, said: “In the last eight or nine years, the capital allocation has only gone up about 5 per-cent, but actually, construction inflation has gone up about 30 per-cent. So the money we’re getting now does less than it did six or seven years ago.”

Following the Scottish Government’s decision to “pause” the replacement of the St Brendan’s hospital building and GP surgery, a report before last week’s board meeting confirmed that the existing facilities have been reviewed and this identified that the heating systems, electrical wiring and water systems require upgrading “in the very near future”, with costs for the work estimated at £1m, and with total project costs expected to be “significantly higher”.

Included on the list of works not progressing at the Western Isles Hospital is the replacement of the air flow cleansing canopy in one operating theatre, which NHSWI documents confirm is “showing signs of failure”.

Should it break down, the report says, the operating theatre would be “unusable”, impacting on waiting times for elective orthopaedic procedures and requiring transfer of emergencies off island.

Also sidelined is the acquisition of automated medicine cabinets in Stornoway which would allow for more timely discharge of patients, and would also reduce the requirement for pharmacists to attend out of hours.

Staffing shortages in pharmacy are, the NHS report states, “proving difficult to resolve” and a requirement for out of hours working is “unappealing to potential applicants and costly when reliant on agency locums”.

The initial investment for the cabinets has been costed at £300k which, the report states, is “unaffordable in this financial year”.

Refurbishment of Medical Ward 2 at Western Isles Hospital is considered high priority as there is currently only one shower available for its 29 beds.

The NHS report states that this project has not yet been costed, “however, the extent of the works required means it is unaffordable in this financial year”.

Radiology Equipment in the X-ray rooms at Uist and Barra Hospital and Western Isles Hospital has also been identified as need replacement at an estimated cost of £650k, along with the Bone Density (Dexa) scanner at WIH, at an estimated cost of £120k, but that will not happen without additional funding.

The works that will progress this year, having being identified as having the “highest risk ratings”, include the redesign of the A&E department at Western Isles Hospital.

The report before the meeting stated that the layout of the emergency department at WIH does not allow for the treatment of more than one critical patient at a time, with additional space in the hospital having to be found during major incidents.

This has been identified as “a significant risk” that can be mitigated by redesigning A&E, and ‘a suitable scheme’ has been identified. It is expected that the work will be undertaken in this financial year at an estimated cost of £643k.

Debbie Bozkurt confirmed that NHSWI is awaiting a return of tenders for the works, and said: “At the moment the A&E dept is not suitable for major incidents, as we found out when there was a major incident on a trawler recently. And with the cruise ships in, and the big buses going around, you know, it feels like we’re a ticking time bomb, and we must get that sorted.”

Also progressing as a highest risk priority is a major upgrade of NHS digital IT infrastructure, at a cost £311k, a replacement of the 15 year old colposcopy couch and monitor in Gynaecology (50k) with the current equipment having intermittent faults which are “impacting on patient care” and replacement of the 30-year-old Ophthalmology Keratometer and A-scanner equipment at a cost of £28k.

This is deemed essential for NHSWI, which carries out an average of 250 cataract procedures a year.

A replacement ECG machine in Uist and Barra Hospital has also been purchased at a cost of £9k.

Vital Signs monitoring equipment, used in cases of serious trauma at WIH, both within A&E and during intra-hospital transfer, and required ‘to mitigate risk and improve patient safety,’ has been purchased at a cost of £66k, and £20k has been spent on the replacement of unreliable ovens, deemed ‘beyond repair’ at WIH kitchens at a cost of £20k.

The MRI scanner planned for WIH is not included in the budgets, as it is the subject of separate funding from the Scottish Government.

Debbie Bozkurt said the lack of capital budget was not only affecting major items, but was affecting the rolling programme of smaller works, too.

She said: “There are small rolling programs, like the community beds, community OT, the beds in the hospital, these sort of things where you had a rolling program that spent £20–£30k a year for each category. They have to be put on hold, which is not not great. They will have to wait their turn.”

A spokesperson for the Scottish Government said: “Due to significant increases in construction costs due to inflation, and a lower than expected capital grant from the UK Government, a capital review is currently underway.

“Alongside this, we are working with all health boards to develop a whole-system infrastructure plan which reflects on the needs for the whole of Scotland.”

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