NHS annual review highlights areas for improvement

NHS Shetland is performing well but needs to improve dental and mental health services as well as the appointments system at Lerwick Health Centre, a public meeting was told.

According to chairman of NHS Shetland board Ian Kinniburgh, speaking at the public annual review last night, the board intends to build on its strengths, including good patient and professional interaction, which he described as “really good patient-centred care”, and do as well as possible within ever-tighter budgets.

The board has a statutory duty to break even every year, and has to try to ensure health “equality” in the most remote areas of Shetland.

It is also having to cope with the prospect of an ageing population and, in parallel with that, an ageing workforce.

Mr Kinniburgh said it will be increasingly important to make the best use of shared resources, including with NHS Grampian, and “partner agencies” in Shetland.

Chief executive Ralph Roberts said that recruitment and retention of medical staff was increasingly difficult, with its “professional isolation” and “small teams”.

This “challenge” has for years been particularly evident in dental services, but a new strategy had been agreed this year with more emphasis on recruitment, including for dental hygienists.

All mental health services, from those for children to those for older people with dementia, are to be examined in a forthcoming visit from Mental Health Scotland’s clinical lead.

A question from the floor raised the issue of a place of safety for patients in a crisis – the two single rooms in the Gilbert Bain Hospital’s ward three were not deemed suitable. Mr Roberts said the policy was to provide care as close to home as possible, but people with “complex needs” would be safer in a specialist centre on the mainland.

Director of clinical services Simon Bokor-Ingram, who is also interim director of community care, acknowledged: “We could do something better, in a quieter environment or even out of the hospital.” But meanwhile, he said the Gilbert Bain rooms were suitable, and the staff, although not trained in mental health, were “very good generalists, well capable of holding people in a place of safety”.

Mr Kinniburgh said the board was conscious of the shortcomings in mental health provision, calling it a “live issue”.

The possibility of a hospice for Lerwick was also raised. Mr Bokor-Ingram said that most people wanted to die in their own home or at least be cared for as close to home as possible – this could be in a local care centre. If they had to come into hospital for their last few days, he would regard that as a “failure” of the care system.

He did not dismiss the idea of a hospice, but suggested it might be something to be done “voluntarily”.

The on-going problem of getting appointments at Lerwick Health Centre will again be considered when the data gathered from the 909 responses to a survey carried out be patient Harold Massie is analysed.

Mr Massie thanked everyone who contributed, calling the interest “overwhelming”. He said that 600 of the responses came up with “very sensible suggestions.”

The forthcoming appointment of a consultant gynaecologist and obstetrician should ease pressure at the health centre, as currently doctors are frequently called away to provide maternity cover at the Gilbert Bain Hospital.