Here are the letters to the editor for the edition released September 24, 2015. If you would like to share your views you can e-mail us at firstname.lastname@example.org or write to us at Stornoway Gazette, 10 Francis Street, Stornoway, HS1 2XE.
Out of Hours Medical Service
In statements made by me and accurately reported by your publication last week, I said that I was tired of obfuscations and spin by those at executive level in NHS Western Isles.
I was therefore not in the least surprised by the perfect demonstration of these in the response to my comments and reported in the same article. I would thus like to respond as follows:
While confidently asserting that I was wrong, the Boards spokesperson goes on to agree with me in regard to the provision of out of hours care in North Harris from 2004 until October 2014.
There was indeed a doctor available in Harris in this period, though the statement by the medical director in the same publication, but in a different article on page 7, states “The NHS 24 system has been in place in North Harris (and elsewhere in the Western Isles) since 2004” suggests that nothing has changed recently.
The North Harris practice did not opt out of providing an on call service until 2014, unlike the Lewis practices. To state otherwise gives a false impression.
In the case of an expected death it is true that it is normally the unscheduled care nurse that attends, but only a medical doctor can certify the death in Scotland. Until the certificate is signed, funeral arrangements cannot be made.
There is of course more to it, but once again the comment by the (unnamed) Health Board spokesperson implies that a doctor would not be required.
Once again, while asserting that I was wrong, not only did the spokesperson agree that I was right about the absence of an out of hours doctor for a 24 hour period in summer, but added that this had also happened previously in December 2014.
The most interesting element of this (apart from a clear problem with communication and media handling) is the list of doctors quoted as being available during the out of hours periods. “On both occasions the on call GP was substituted by another doctor working out of the Western Isles Hospital”.
There are only two possible explanations for this; either the doctors were already GPs and therefore available for out of hours care, in which case the periods mentioned could have been covered by a GP with a doctor in training drafted in to work in the hospital.
If however the doctors referred to were hospital doctors in training including GP trainees, this would constitute a breach of the regulations covering their training, and the availability of a GP for advice, presumably by phone, changes nothing.
No doubt the Dean of Postgraduate medicine would take a dim view of this, indeed one of the very reasons for introducing the successful system in Lewis prior to October 2014, was a fear that the Western Isles Hospital would have its status as a training hospital cancelled if the trainees were being utilised in a capacity not specified in their training.
Certainly there are consultants on call, but they are not contracted to provide initial assessment. They attend only when a patient has been seen by a doctor and referred for emergency care and would never be used to provide unscheduled care in any other sense.
Implied in the statement from the Health Board is that I have been discourteous to the highly skilled multi-disciplinary team providing out of hours care both in the community and in the hospital by drawing attention to the Health Boards failure to improve out of hours care. Nothing could be further from the truth.
I hold all those with whom I worked for years in the highest esteem and I believe that they know that. It’s a shame that those with the experience to introduce further improvements were not consulted, as required by NHS Scotland, when the changes in October 2014 were being introduced-had they been the Health Board would not find itself in this mess. This in fact is discourteous in the extreme.
Although I did not deal with the following in any depth, I believe that a statistician or health analyst would have some interesting light to shed on the proper use of medical resources if asked to consider that the only GP available for out of hours care in the most recent period mentioned above was located in Barra.
This translates into the placement of 1 doctor for 1,264 people, while no such person was available for the 20,473 people in Lewis and Harris.
The people of Barra have the same rights as every other person in the Western Isles and the comment above should in no way be construed as a suggestion that they are less important.
The question raised is about the balance of probability and health economics. It is interesting to note that the GP in Barra that day is Stornoway based.
I believe that if the people of the Western Isles are given the correct information to make an informed decision, including the difficulties being experienced by all Health Boards, and then consulted as opposed to being informed, they will feel included and valued, even when the final decisions do not meet with their approval.
The days of “the doctor knows best” have been confined to the dustbin of history alongside the use of leeches as a cure all. Care must be person centred. I am not and never have been a Luddite – I fully support the ethos and aims of the NHS and have repeatedly demonstrated that during the 29 years I spent providing emergency care in the Western Isles.
Isle of Lewis
Out of hours medical service
What Agnes Munro said about the missing GP’s (Gazette September 17) is truly abysmal!
I know that locum GP’s from as far away as Northern Ireland, provide weekend cover at Uist and Barra Hospital!
In my own case, I had an MRI scan on my spine, I was told by the consultant that the bottom five joints of the spine were “shot” (my own expression) that there was nothing he could do, and he referred me to the pain clinic.
Lovely , I thought, more pills , but at least I might walk properly again.
Wrong, there is no pain clinic in the Western Isles, simple as that, so the poor pestered GP’s at Loch Maddy are doing there best to find pain blocking pills that enable me to walk!
Name and address supplied
Our of Hours medical service
The concerns I expressed in a previous letter to the Stornoway Gazette about the out of hours care system in North Harris have been heightened by reading about the experience of Angus Macleod from Stockinish, and the timely comments from Agnes Munro who has contributed so much to the out of hours service in the Western Isles.
Having worked in The Lewis Hospital in the late sixties during my surgical training before becoming a consultant surgeon in Glasgow, and as a GP carrying out locum work in remote rural practices, and the out of hours calls for my wife who was a GP, I would be most concerned if I and my family lived there and depended on the present arrangements.
I suspect that most doctors of my generation would feel likewise, and can only speculate on how the dedicated and committed general practitioners on Lewis and Harris with whom I worked fifty years ago would regard the situation today.
Sadly, I acknowledge that these problems are replicated throughout rural Scotland, and specifically, the West Highland Free Press has highlighted similar deficiencies and horror services for those living in North Skye. Recognising that the practice of medicine has changed significantly since I qualified, and our way of life likewise transformed beyond all recognition,
I find it hard to understand why today’s doctors don’t appear to accept that medicine is a way of life as indeed are many other occupations.
It is a privilege to serve a community, and no matter how demanding, the rewards from working in areas such as the Western Isles, where in general local people go out of their way not to trouble the doctor or nurse, are immeasurable.
I am only too aware of all the problems confronting health boards in providing out of hours services since the ill fated “new” GP contract of 2003 and with the UK’s slavish adherence to the EWTD.
There is an understandable reluctance on the part of doctors to commit their private concerns to paper, but I hope that Dr McKellar would acknowledge that the current arrangements with NHS 24 can only be regarded as a “second best” compromise which inevitably must raise doubts as to whether the current system is “safe” and “reliable”.
While clearly not every patient requiring out of hours help needs to be visited by a GP (ideally their “family” doctor) in their own home, the opportunities for medical error increase with every measure which results in the patient being seen at a different location, by someone less qualified than a doctor, and above all when the sole contact is by phone. This after all is a fundamental tenet of medical practice with which many readers of this paper will no doubt agree.
John Sinclair. FRCSE.
More than 140 media bodies, campaign groups and others have written to the Prime Minister expressing ‘serious concern’ at the government’s approach to the Freedom of Information (FOI) Act.
And the editorial board of Johnston Press, the publishers of The Stornoway Gazette, are among these groups.
They are worried a new commission might turn back the clock on the public’s right to know how government operates and how public money is spent.
The Freedom of Information Act 2000 (and a Scottish Act from 2002) gave the public and journalists the right to ask questions about local authorities, the NHS, government departments, the police and many others – and they have to answer.
But the act has not been without its critics and on July 17 the Government announced a Commission on Freedom of Information.
Publishers like Johnston Press are concerned the commission is made up of politicians who are critical of the act and people who are subject to it, who are likely to restrict its remit.
There is also concern at government plans to introduce fees for tribunal appeals when someone disagrees with a ruling by the Information Commissioner. These are currently free of charge.
The letter from publishers and campaign groups has been co-ordinated by the Campaign for Freedom of Information, a lobbying group which campaigned for several decades to have the act passed as law.
The letter says the commission’s “purpose is to consider new restrictions to the Act”.
It points out that the Commission’s five members include two former home secretaries, a former permanent secretary and the chair of a body subject to the FOI Act.
A government perspective on the Act’s operation “will be well represented on the Commission itself” the letter says.
Among the commission members are: Former Home Secretary Jack Straw, who has said the FOI act “provides too great a level of disclosure”. When in government, Mr Straw called for information about government policy formulation to be automatically withheld, regardless of any public interest in its disclosure. Mr Straw called for charges to be introduced for FOI requests and said it should be significantly easier to refuse requests on cost grounds.
Dame Patricia Hodgson, chair of the communications regulator Ofcom. In 2012 Ofcom said “there is no doubt” the FOI Act had a “chilling effect”, discouraging the proper recording of information by public authorities. Ofcom has called for it to be made easier for authorities to refuse requests on cost grounds.
The letter says: “An independent Commission is expected to reach its views based on the evidence presented to it rather than the pre-existing views of its members.
“Indeed, in appointing members to such a body we would expect the government to expressly avoid those who appear to have already reached and expressed firm views. It has done the opposite.
“The government does not appear to intend the commission to carry out an independent and open minded inquiry. Such a review cannot provide a proper basis for significant changes to the FOI Act.”
Jeremy Clifford, chairman of Johnston Press editorial board said: “Johnston Press editors and journalists have used the FOI act consistently over the past decade to inform readers on many, many issues that directly affect them.
“We are deeply concerned at any plans to restrict the act and urge David Cameron to consider the membership of this commission and its remit.”
The letter also expresses concern at government proposals to introduce fees for tribunal appeals against the Information Commissioner’s FOI decisions, currently free.
Government proposals would require requesters to pay £100 for an appeal based on written submissions and £600 for one involving an oral hearing.
The letter says the introduction of fees for Employment Tribunal appeals has led to a drastic decrease in the number of cases brought and says a similar effect on the number of FOI appeals is likely.
The organisations say “We regard the FOI Act as a vital mechanism of accountability which has transformed the public’s rights to information and substantially improved the scrutiny of public authorities. We would deplore any attempt to weaken it.”