Clinical Strategy - a review

I got a copy of this document issued by the Health Board, and read it last night. It is available on the web, and I recommend that the public read it carefully. I'm not hugely knowledgeable about this area, so I hope other with more knowledge will also contribute to the consultation.

My impression of the document was actually very positive, as it is very clear that the intention of the Board is a serious attempt to resolve the financial issues that are the root cause of the whole problem. Finance is driving all of this, make no mistake. We are repeatedly told that the current position is untenable and structural changes must be made to recover the deficit.

I question that view. The Board must adopt that approach, as they are being told the financial parameters in which they must work by the Executive. But to try to claw back the accumulated deficit means that today's and tomorrow's services are being affected by decisions of the past (discredited) regime. We should expect our elected politicians to reject this notion, and fight for a decent level of funding.

Given that restriction and presumption by the Board, the document clearly sets out how they intend to achieve their aims, and I must applaud the Board for the clarity of their vision and the obvious sincerity in their aims. I don't agree with everything they say, but then that is why it is a consultation document.

Much is made of the relative cost of service delivery in the Western Isles compared to the rest of Scotland. Yes, but. Of course our costs are higher as population is sparser and unit costs will be higher. If we start down that route for all our public services then we are in trouble.

The attempt to build the "Hubs" i.e. the hospitals in Uist and Barra into community facilities is commendable, and it makes sense to house community services in as few locations as possible. However, it also means the loss of some key services, and I suspect that Uist and Barra will be up in arms.

It is also clear that Western Isles Hospital will lose some of the specialities, with these being dealt with in Raigmore, as we move to the "Rural General Hospital" model.

Will this balance the budget?: probably, eventually
Will this improve treatment for the patients?: probably not
Will it mean more travel for patients?: undoubtedly
Is it A Good Thing?: on balance I think not

Despite the inevitable jargon, the repetition of charts and some clauses, and the clear desire of the Board to do the right thing, they key element is that they are constrained by the historic budget deficit and the need to recover from that. If we are prepared to accept this constraint, we will get the Health Service that the budget and Civil Servants dictates. If that constraint is removed, we will get the Heath Service we deserve.