NHS Board agrees to become an alternative provider for An Cotan Childcare Centre 

Western Isles NHS Board has today (Wednesday) agreed to become an alternative provider for An Cotan Childcare Centre, whilst recognising the risks that are associated with this decision. 

At the Board meeting today, members had a significant discussion on the risks and benefits of becoming an alternative provider of An Cotan Childcare Centre, and the decision to proceed is based on mitigating a number of risks, including meeting Care Commission registration requirements, establishing contractual agreements with the University of the Highlands and Islands (UHI) in terms of premises, and securing a registered manager.  

The need to explore a salary sacrifice scheme for NHS staff using the nursery was also agreed. 

Members discussed in detail the impact that closure of the nursery would have on NHS staff, and the risk that health staff may not be able to fulfil their employment contracts as a result of a lack of childcare. They also discussed the wider risks to the sustainability of the Western Isles should An Cotan Childcare Centre close and the impact on recruitment to the islands if there was an additional unmet need for childcare. 

Discussions on the risks of becoming an alternative provider included the risk of being able to ensure the nursery is able to break-even and also the ability to recruit staff to the nursery. Members were also concerned that nursery fees should remain affordable for those using the nursery, though there was a recognition that there would need to be an increase in fees to help avoid an unsustainable overspend.  

Members overwhelmingly voted in favour of becoming an alternative provider, but agreed that there is a need to look at short, medium and long term plans and to consider wider local childcare issues as a matter of urgency with Community Planning Partners. 

Western Isles Health Board Chair, Gillian McCannon, said: “This was not an easy decision for the Board today. However, in terms of the sustainability of the Western Isles as a whole and our ability as a health and social care system to be able to recruit and retain staff, there really was no other option than to become an alternative provider, as a lack of intervention would result in imminent closure of the facility. There is a clear unmet need for childcare in the Lewis and Harris area and the loss of a nursery such as An Cotan would have such a detrimental impact that we must do all we can to ensure it continues to be available to the population.  

“Our senior teams now have a great deal of work to take forward to ensure all the requirements are in place to ensure that we can take over the nursery as quickly and as smoothly as possible. We are well aware that running a childcare provision is a complicated business, and not one which is our primary role as an NHS Board. However, we hope to continue to have the support of our partners including Comhairle nan Eilean Siar and the University of the Highlands and Islands, to ensure the continuation of An Cotan and then to also consider and try to address the wider issue of childcare needs across the Western Isles.” 

Chief Executive, Gordon Jamieson, said: “The sustainable provision of accessible nursery childcare provision is mission critical to our ability to attract, recruit and retain Health and Social Care staff. Loss of the current An Cotan provision would have an immediate and longer term impact on our ability to recruit and retain staff to the Western Isles and immediately on service and sustainability.  

“It is for these reasons that the Board has considered that, despite the clear risks involved, it is the right thing to do for our staff, our services and our population.”   

Background (Notes for Editors)

An Cotan Childcare Centre is run by the University of the Highlands and Islands (UHI) and provided childcare for children aged 0-5 for more than 20 years (0-3 only since January 2023).  The UHI Board has recently made the decision to close the nursery. 

Over the last 12 months the nursery has been operationally challenged due to financial pressures, staff turnover and high rates of staff absence.  Comhairle nan Eilean Siar has provided support through the provision of staff which has allowed the facility to remain open but at a reduced capacity and service offer.   

UHI has increasingly subsidised the nursery over the time they have run it, but financial pressures and increasing losses have meant that they are unable to continue, and the UHI Board has agreed to closure.  The initial timescale for closure was end of April and that was extended until the end of May.  There is potential to delay closure for a further short time but that would be weeks rather than months. 

NHS Western Isles declared an interest in becoming an alternative provider for the nursery in March and has been in discussion with UHI and Comhairle nan Eilean Siar to share information and explore potential options for continuing the provision.  There is no material interest from private providers. 

It is likely that if the nursery closes, there are staff currently using it, who have been to date, unable to find an alternative.  It is clear that some of those staff, despite our family friendly and flexible working support, would not be able to fulfil their contract with NHSWI, if they are unable to secure alternative childcare provision, and this could potentially impact on service provision 

Comhairle nursery provision has been extended but there remains limited provision, in particular for the babies and younger children that would meet the needs of working parents. 

Like many employers, NHS Western Isles has experienced increased challenges in attracting and retaining staff since the COVID-19 pandemic and the Western Isles is facing a continued reduction in workforce. This is already greatly affecting the Health and Social Care system’s ability to fill posts and provide the level of services the Islands need. The workforce situation, without intervention, will worsen considerably and rapidly in the next few years. The steady population decline, which is the single biggest risk facing the sustainability of Health and Social Care services,  in addition will result in a year-on-year reduction in the available workforce to nurse, care for, and attend to the most vulnerable of people, whose numbers are increasing year on year.  

Survey 

NHS Western Isles issued a survey to all NHS Western Isles staff and to the wider public on Wednesday 24 May 2023. The survey closed on Monday 29 May. The aim of the survey was to gather information on the unmet demand for childcare in Lewis and Harris.  

Those with unmet need (or those who would have an unmet need if An Cotan Childcare Centre was to close) and anyone who is likely to require nursery provision in the next 0-5 years was encouraged to complete the survey.  

In total, 202 people responded to the survey. A total of 83 respondents identified themselves as healthcare staff, with a further 15 identifying themselves as carers or social care/social work staff.  

The main demand for childcare was for the 0-3 year age group (179 respondents) with a less, but still significant, demand for the 3-5 year childcare (56 respondents).