Report by MICHAEL RUSSELL with photographs by WILLIE URQUHART
Over 40 concerned locals attended a special meeting of Raasay Community Council this week to discuss the lack of 24-hour medical cover on the island.
For the last three months Raasay has been without evening and weekend community nurse cover, with NHS Highland claiming that they have not been able to attract anyone suitable to the job.
However, in response to a comment from the audience at Monday’s meeting, Kate Earnshaw, the NHS district manager for Skye and Lochalsh, said: “There will not be a resident nurse on this island 24/7.” She also said that the recruitment of a permanent part-time nurse is “not our preferred solutiion”.
Tracy Ligema, area manager for the west, said locals were being sought who would be trained to acquire a certain level of medical expertise and who would be paid to deliver it.
In response, community council member Rebecca Mackay said: “I am perturbed that you are asking people in the community to train up to do these jobs. We are entitled to the same level of care as everywhere else. It seems to me that you are reneging on your responsibilities by asking people to do this. “The NHS are putting lives at risk by not conceding the need for a resident nurse on the island — so what is there to talk about?”
Ms Ligema added: “There is a recruitment problem. We find it really difficult to recruit staff. That’s our problem. It is hard to get staff like Margaret Ferguson [the former nurse] to live and work in communities. People are simply not willing to do that any more. We are losing nurses from all over the Highlands. They don’t want to live and work where they will lose their skills and where there is an on-call element. This is the reality of what we are dealing with.”
There were also criticisms of the way in which NHS Highland have advertised the job on Raasay. Their job description makes it sound as if it is “difficult to live here”.
Mrs Earnshaw also admitted that the payment of an offshore allowance for living on Raasay was not included in the advert.
Adverts are compiled to a standard that is used across the health authority, she said. But this “one size fits all approach” is clearly unsuitable for somewhere like Raasay, a member of the audience said.
It was agreed that local residents will be able to feed their ideas into a new advert and that this can be accomplished via email ahead of another meeting planned for 27th October.
Need for a new model
Both Mrs Earnshaw and Ms Ligema kept stressing the need for a new model of health cover that is sustainable in the long term.
“Activity levels on Raasay are very low for staff coming over here,” said Mrs Earnshaw. “There is not the activity to keep their skills maintained.” She also stressed the introduction in April of next year of the “revalidation” process that requires nurses to undertake a minimum of 450 hours of practice over three years.
Mrs Earnshaw said this had been introduced since NHS Highland last advertised for the post of a resident nurse on Raasay.
Audience member Anne Gillies highlighted the growing overspend at Raigmore Hospital in Inverness as the reason for saving money on the periphery.
“Five years ago there was a £600,000 overspend in Raigmore; last year it was £9.6 million,” she said. “Underpsending in other areas has been used to plug that gap. NHS Highland are creating compensatory underspends to break even.”
Finance Director Nick Kenton recently explained that the “majority of saving was long-term post vacancies”, Ms Gillies said.
She added: “Recurring savings can be classified so they can be removed from the budget. Savings in outlying areas going into black hole of Raigmore through a deliberate policy of holding posts vacant.”
Ms Ligema responded: “We absolutely do not have underspends. There are certainly no vacancies being held in this patch. “
Any vacancies that are being held will be in bigger teams in the Inner Moray Firth and Raigmore itself, not in the small teams in remote areas. You can’t cut there because you will be left with nothing.”
Agenda for Change
No extra salary can be given for a nurse working on Raasay because of the Agenda for Change national framework, said Ms Ligema. However, NHS Highland can offer a one-off payment to help with relocation, she said, though they cannot pay rent or a mortgage.
One person said: “If you are tied into Agenda for Change that seems to be a huge impediment to flexibility, which is what you need in remote areas.”
Mrs Earnshaw said there was an “element of truth” in that. “But we can write our own job descriptions,” she added.
“We have spoken to one nurse who is looking to move to the island,” said Mrs Earnshaw. “She has acute experience but very little community experience. She is not on bank so can’t use her and she is currently employed elsewhere.”
In response to calls for agency nurses to provide cover in the interim, Mrs Earnshaw was emphatic. “I am not getting an agency nurse. I don’t have a budget for that and they would not have the appropriate qualifications.
“I would have to go to the highest authority to get authorisation for an agency nurse. I have a budget for Raasay but not for agency nurses.”
This drew an immediate response from one audience member: “If I pop my clogs tonight can I have on my gravestone there was no money in the budget?”