‘Serious’ financial challenge for health service

NHS Shetland will have to make considerable financial savings over the coming years, and staff will be expected to “do things differently”, a meeting of the health board heard this week.

Every staff vacancy will now be scrutinised by an executive management team to see if the post is necessary. NHS Shetland board chairman Ian Kinniburgh said this would “impose a degree of discipline, replacements have to be justified”.

This would start immediately, he said, and added: “We must become more efficient and we need staff to understand the importance of working with management to help us protect patient services.”

Mr Kinniburgh said the health board (as all health boards in Scotland) was required to make three per cent savings every year, but was allowed to keep the money to “reinvest”, for example, in prescribing costs. Budgets are fixed for the next two years but in the year 2017/18 the health board will make one and a half per cent savings which will be applied across the board, with the other one and a half per cent “targeted” at specific areas.

Chief executive Ralph Roberts said NHS’s financial position was “as serious as it has been in my time”, that is, in the last five years since he took up his post in Shetland.

NHS Shetland finance chief Colin Marsland said the board was £439,000 overspent by June this year, and the financial position was “challenging”.

Two of the areas of expense, he said, were prescribing and locum costs. A meeting of the council’s social services committee heard on Monday that Shetland’s prescribing was above the Scottish average, but generic drugs were used whenever possible.

Regarding locums, Mr Marsland said that as the Yell GP was moving to Bixter, this could result in employing a locum in Yell while recruitment takes place. Additionally there was one full-time GP vacancy at Lerwick Health Centre, he said.

Mr Marsland added that it cost NHS Shetland £2 million a year flying people to and from Aberdeen, and he hoped as many services as possible could be delivered in Shetland.

Mr Kinniburgh said that although the use of locums was an issue, Shetland would shortly become the only health board in Scotland when all consultant posts were filled, obviating the need for locums. This will happen in October when the new consultant obstetrician/gynaecologist is installed.

However, Mr Kinninburgh said that regarding NHS finances, it was “ever more difficult to keep up” but he was confident the local service would find a way to work through the problems.

He said: “It’s beginning to get to the stage when we won’t necessarily be able to deliver the full range of services we do now, we’ll have to look at doing things differently.” He added that the health board “managed well within its resources”.
A small board like Shetland would find it more difficult to absorb extra costs such as in prescribing, he said, but steps would be

taken to tackle medicine waste and [excess] repeat prescribing. The financial situation would be increasingly difficult as 50 per cent of the budget would be ringfenced by the Integrated Joint Board (IJB), the new body that will sit between the council and health board.