Health cost-cutting strategy revealed

These include “negotiating hard with agencies” over the cost of locum staff which have doubled since 2018. A report by finance director Debbie Bozkurt says an agreement with Templars Agency “has saved us £20-30k per month on individual locums”

However, the “crippling” cost of psychiatric consultants is highlighted with pay for agency staff “upwards of £140 per hour plus VAT”. The Board is now seeking advice from the Mental Health Commission to find if it is legally obliged to provide “24/7 on call psychiatric cover”.

Savings through non-filling of posts are “fortuitous” as they are “due to the inability to recruit in a timely manner due to shortage of available workforce, not because a decision has been taken to hold posts”.

Another area in which reductions are sought is GP services in Uist and Barra where “there is an identified pressure of £506k for both managing the community hospital in Barra and for the GP out of hours service”.

The report adds: “An option paper has been drawn up and we are hoping to put in place a cost neutral solution if recruitment is possible. Recruitment has been difficult, and the Board has had to use locum GPs at a sizable cost” .

Accommodation costs for locums in Uist and Barra are described as “unsustainable” as the board “have not been able yet to secure long term leases as in the other Islands. The cost of accommodation is equating to three-quarters of the cost of a substantive post”.

Regarding locum GP cover on Barra, where the Board took over the service in September following a long-running dispute with the local GP, the report says “we cannot (yet) estimate the cost of this financially”.

Rather than savings, increased costs due to agency staff are described across a range of services: “The highest increasing risk the islands face is population decline and decreasing available workforce…

“The population changes will result in a year-on-year reduction in the available workforce to nurse, care and attend to the most vulnerable of people whose numbers are increasing year on year. The Health and Social Care Partnership is already feeling the effect of the changes in demography with high levels of vacancies in social care and nursing”.

Wider pressures are also threatening the drive to make savings. The report states: “The Board is dependent on the ability of other Boards to provide services. Potential above standard inflation may cause an overspend within this service. The risk is estimated at £500k and is rated as high”.

Ms Bozkurt also told the meeting: “The biggest worry we can’t do anything about is the inflational uplifts. Predominantly we run our buildings on oil”. She estimated the increased energy costs in the year at £400-500,000.

Chief executive, Gordon Jamieson, said that “non-clinical” costs would be prioritised for cuts in order to protect front-line services.