Out-of-hours Hospital Services (Skye)

First Minister’s Question Time – in the Scottish Parliament at on 16 May 2024.

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Photo of Douglas Ross Douglas Ross Conservative

On Saturday, a woman tragically died at a music festival on Skye. At the same festival, 27-year-old Eilidh Beaton nearly lost her life when no ambulances were available. Eilidh told The Press and Journal:

“I was coming in and out of consciousness. My airways were shutting down.”

She said:

“I could not breathe”

and

“At one point I thought if I don’t get oxygen I will not be here tomorrow.”

When we spoke with Eilidh last night, she said:

“We were 200 yards from Portree Hospital. A local coastguard offered to carry me to the hospital but were told there was no point because it was closed—so I would just be left lying outside.”

One life has been lost and another was very nearly lost. Does John Swinney accept that that should never have been allowed to happen?

Photo of John Swinney John Swinney Scottish National Party

I agree with Mr Ross that that should never have happened. I express my sincere condolences to the family of the individual who lost their life and I say to Eilidh directly that I am sorry for the terrifying experience that she had on Saturday night.

As Mr Ross will be aware, Portree community hospital is not currently operating as a 24/7 emergency facility. Some years ago, Sir Lewis Ritchie recommended that it should be, and it is a matter of deep concern to the Government that that has not happened. The health secretary spoke with the leadership of NHS Highland yesterday to make it clear that we want that to happen at the earliest possible opportunity.

I want to say something to the ambulance crews and other individuals who supported Eilidh. The Portree ambulance was away from Portree at the time, so ambulances came to Portree from Dunvegan and from Kyle, which, as Mr Ross will know, involves quite a travel time. The ambulances got there as quickly as possible. The individuals who supported Eilidh, including Royal National Lifeboat Institution volunteers and others, have the admiration and appreciation of the Government for the steps that they took to support an individual in our society.

Photo of Douglas Ross Douglas Ross Conservative

We all have admiration for those who stepped in to help, but it should never have got to that stage. John Swinney says that he has deep concern that the recommendations of the report by Sir Lewis Ritchie have not been implemented. It is far worse than that. The report is from more than a few years ago; it was published in May 2018—six years ago.

The report was an independent external review of out-of-hours health services in Skye, Lochalsh and the surrounding area. The very first recommendation of the review from May 2018 said:

“Out-of-hours urgent care access at Portree Hospital should be provided 24/7”.

It also said:

“there should be no closure of Portree Hospital in the out-of-hours period”.

The report went on to say:

“The Scottish Ambulance Service ... should increase its paramedical staff ... capacity and capability in”

the region.

When we spoke to her last night, Eilidh said:

“The report has been on the table for 6 years saying we need 24 hour urgent care. They keep making these promises but delivering no action, making the same excuses.”

Those are her words, First Minister. Why, in the past six years, have the recommendations of the independent report not been implemented?

Photo of John Swinney John Swinney Scottish National Party

I understand the genuine concern that Mr Ross is expressing to Parliament today, and I take that very seriously. Mr Ross is correct that the report came out in 2018, but I point out that there has been a three-year period since then in which 24-hour emergency care arrangements were provided at Portree community hospital; however, they were not able to be sustained because of workforce challenges in the locality. I accept that that is not good enough, which is why the health secretary has spoken to NHS Highland to insist that those arrangements should be put in place.

There is of course a challenge in relation to some workforce issues, because of staff availability and issues in connection with housing availability. I say to Mr Ross that ambulance cover is available in Dunvegan, Portree, Kyle and, of course, at Broadford hospital. However, I do not in any way want to say that that is good enough.

Sir Lewis Ritchie’s recommendations must be implemented, and the health secretary has made that point directly and clearly to NHS Highland. It is a matter of fact that there was a three-year period in which those recommendations were in force, but they have not been able to be sustained because of workforce challenges.

Photo of Douglas Ross Douglas Ross Conservative

I know that the First Minister is treating the issue sensitively, as I think we all are, but that is no comfort to Eilidh, who thought that her airway was closing. She thought that, if she did not get oxygen, she might not see the next day. She will take absolutely zero comfort from the fact that, in three of the past six years, there was 24/7 care, because when there was a major event in Skye, it was not available.

The First Minister says that the Government will implement the recommendations of the report. Why are we hearing that from him and the health secretary now, and not when the report was published six years ago?

Six years ago, the local MSP for the area, Kate Forbes, said that the situation was “utterly unacceptable” and that the out-of-hours closure was

“another step in the wrong direction”.

This week, the Deputy First Minister said:

“Enough is enough. It has been six years, and the timescales for delivering the recommendations keep shifting.”

That was the Deputy First Minister saying that, and she added:

“there must be accountability”.

We agree, but it is the Scottish National Party Government, in which she serves, that needs to be accountable. Kate Forbes was the Cabinet Secretary for Finance and the Economy for years, and she is now the Deputy First Minister, which is the second-most powerful position in the Government. Where was the will to act before now?

It is not more empty words that are needed—it is action. Why does it take tragic events, such as the ones that we witnessed in Skye on Saturday, for the Government to finally step up and deliver?

Photo of John Swinney John Swinney Scottish National Party

I am trying to be as helpful as I can on the question, but it is a matter of fact that Sir Lewis Ritchie’s recommendations were implemented for a three-year period, although they have not been sustained.

I accept that that is not good enough. That is what the Government is addressing. That is why, in the past 48 hours, the health secretary has met directly with the leadership of NHS Highland. He has also met Kate Forbes, who is the Deputy First Minister and MSP for Skye, Lochaber and Badenoch. All those conversations are taking place to ensure that Sir Lewis Ritchie’s recommendations are implemented, and that they are implemented in short order.

I give Mr Ross the assurance that the health secretary and I, as First Minister, will make sure that the issue is progressed. It should not have taken tragedy to get to this point, but I assure Parliament that the issue has the attention of ministers to ensure that it is addressed promptly.

Photo of Douglas Ross Douglas Ross Conservative

Skye’s health services were once again shown to be deficient at the weekend. Just last Friday, my colleague Jamie Halcro Johnston met campaigners in Portree, before those events happened, because local people and visitors were worried about the situation. They are still worried, and they are right to be worried, because we are getting comforting words but no sign of action.

The action should have happened in 2018. It is as simple as that. We do not ask for independent external reviews and then say that their recommendations are implemented every now and then. The recommended changes were required in 2018, and they have been required for the entire six-year period since then—not just for three years.

The crisis across healthcare in rural Scotland is a concern to people up and down the country. As this incident has shown, there are black spots across Scotland where urgent treatment is often unavailable. There are sometimes no ambulances if people live in the wrong place. There is a postcode lottery for emergency care. This crisis is costing lives and putting people at risk. What action will John Swinney take today to ensure that everyone in Scotland, regardless of where they live, has the same access to the urgent healthcare that they need?

Photo of John Swinney John Swinney Scottish National Party

I reiterate to Mr Ross that the recommendations were implemented but were found to be unsustainable. They were implemented for a three-year period; I have accepted that that is not good enough and that the issue must be addressed, which is exactly what the health secretary is doing.

It is important that I put on record the emergency care that is available in Skye. There is an advanced nurse practitioner-led, non-emergency, appointments-based out-of-hours service in Portree hospital, which is available by appointment on Saturdays, Sundays and bank holidays from 8.30 in the morning to 7.30 pm.

There is an accident and emergency at Broadford hospital, which is 30 minutes south of Portree. In addition to that provision, the Scottish Ambulance Service has four double-crewed ambulances that cover Skye, which are based in Broadford, Portree, Dunvegan and Kyle.

There is, however, a necessity for Sir Lewis Ritchie’s recommendations to be implemented. That is exactly what the health secretary has insisted will be undertaken with NHS Highland, and that is what will happen. We will update Parliament about the improvements that are delivered.