Impact of new air service on patients, public and sustainability of the islands discussed by NHS Board members

“Patients are at the heart of what we are here for, and it is painful to see what has happened and the impact on them, in terms of this service.”

This was one of the points made by NHS Western Isles Board Chair, Gillian McCannon, at a special meeting of Western Isles Health Board today (Thursday) to discuss the impact of the new Benbecula to Stornoway Public Service Obligation (PSO).

NHS Western Isles Board members discussed how the new Benbecula to Stornoway PSO contract has impacted patients and those travelling for health appointments, as well as the ability of the local NHS to provide certain clinics and services.

There was significant praise throughout the meeting for NHS Western Isles and NHS Highland staff who had gone to great lengths above and beyond the call of duty in an attempt to address and mitigate the impact of changes. The Board Chair, Mrs McCannon, acknowledged that the issue has challenged healthcare staff ‘in ways that I have never before seen’. 

The awarding of the new Public Service Obligation (PSO) contract for the Stornoway/Benbecula route from April 2024 by Comhairle nan Eilean Siar could nevertheless lead to both a reduction in visiting services clinics to the Western Isles as well as a loss of outpatient clinics specifically in Ospadal Uibhist agus Bharraigh (OUaB).

The Board agreed a number of mitigations and recommendations – however members were clear that, despite every effort, there will be increased disruption and inconvenience for patients and those travelling for health appointments as a result of the new service. 

NHS Western Isles Director of Finance and Procurement, Debbie Bozkurt, told Board members how the new service will affect both access to health for the public, and the ability of NHS Western Isles to provide safe and effective services as close to home as possible for the residents of the Western Isles.

She also pointed out that, whilst NHS Boards in Scotland are not funded or expected to manage public transport infrastructure under the National Health Services (Scotland) Act 1978, the NHS does significantly contribute indirectly to the service in terms of passenger tickets of £3.5million to £4million annually. 

Ms Bozkurt stated that NHS Western Isles did not expect to be directly involved in the pre-tender specification development, however there was an expectation that the NHS would have been consulted as a stakeholder, so that requirements in terms of timetabling and capacity could be understood, to potentially avoid an impact on health services for the local community. The NHS had, however, not been consulted.  

Non-Executive Director, Paul MacAskill, suggested that such decisions should consider the risk of ‘collateral damage’ to other bodies. 

Mr MacAskill said that he was particularly concerned about individuals who will need to access services over the winter months and the impact this change will have on travel arrangements and experiences at that time. 

He added that he always looks at the individual experiencing the impact of change and he knows that every effort has been made by NHS staff to provide the best possible services to patients in the circumstances.

As a result of the new contract, whilst the number of days of flights has increased from two to three per week, there has been a considerable reduction in capacity from 96 – 98 seats over two days to 24-seat capacity return a week over three days. This has had a direct impact on individuals not being able to travel by air to scheduled healthcare appointments or for procedures.

The days of delivery of these services are linked to NHS Highland Consultants’ Job Plans/contracts, theatre days, and other commitments the consultants may have in remote and rural areas of NHS Highland.  It is not possible to simply adjust days, or increase the days needed for travel, as such adjustment is likely to impact the consultants’ obligations in relation to their own Board area. NHS Western Isles cannot divert patients to NHS Greater Glasgow and Clyde as no specific Visiting Service contract is in place and NHS Greater Glasgow and Clyde is at capacity in terms of its own patient numbers and demand. 

NHS Western Isles Chief Executive, Gordon Jamieson explained: “The transport infrastructure is extremely important to provide our communities with access to health. The consequences of this change are clear for those trying to access healthcare, but we will do all we can within our operating parameters to reduce that impact. It is clear however that we will not be able to remove or resolve all the problems that have risen.

“There is no doubt that waiting times are at high risk of becoming longer. The issue is that waiting times in the Outer Hebrides, relative to most other NHS Board areas, have been very short, and what we might see is considerable lengthening here of waits in some specialties.”

He added: “We would like to thank members of the public for working with us. It’s a really difficult time for them and their families. We would also thank clinical and non- clinical staff for the huge effort in trying to find solutions for those experiencing difficulties or challenges.”

Professor Annetta Smith, Non-Executive Director, stated that she recognised that staff were going above and beyond in terms of ensuring access to services for patients, with consultants taking extra time to travel to provide services and having to take more time away from home, often with additional overnight stays. She added that what staff had done to support members of the public travelling for health appointments was ‘extraordinary’.

Mr Jamieson said that he was ‘humbled and impressed’ by NHS Highland consultants.

Mr Jamieson pointed out that there is a limit to how long consultant staff can be away from base. In terms of their day-to-day workload, appointments and on-call commitments. 

“Their commitment to come here and work around challenges and put themselves at a level of additional time away, speaks for itself,” he said. “They have gone as far as they possibly can. However, the risk we face is that any further reduction or changes will compound these issues beyond the redress of resolution.”

Mrs McCannon, pointed out that the issue had ‘challenged us in ways that I have never seen staff challenged’ and she was particularly concerned about people who have been left stranded as a result of ongoing and frequent cancellations.

She added: “It pains us seeing people having to travel in ways that they would not normally have to travel. It has tested every single individual around this table in how to manage this one particular issue. Patients are at the heart of what we are here for and it is painful to see what has happened and the impact on them, in terms of this service. I commend everyone who has been trying to provide workarounds for patients – they have gone above and beyond.”

Additional concerns expressed by Board members with regard to the new contract included the requirements in terms of the Equality Act, with Professor Annetta Smith referring to the lack of disabled access on the aircraft providing the service. “People who are disabled are quite significantly affected,” she stated.

Whilst the impact of the new service on healthcare and patients was the main focus of discussions, Board members also expressed concern about the impact of the changes on the sustainability of the Western Isles. 

Non-Executive Director, Ms Julia Higginbottom, expressed concerns about the impact of the new service on depopulation and ‘quality of life’ for islanders.

Non-Executive Director, Paul MacAskill, added: “Inter-island services are key for our survival as communities. It’s important these are maintained. We have seen the impact that this change has on people. It’s important to have an integrated transportation approach, where links to the mainland and back to the islands are interconnected and joined up in a cohesive way.”

NHS Western Isles suspects that, as a direct consequence of the new Benbecula to Stornoway PSO, Loganair is set to withdraw the 7am flight from Inverness to Stornoway from August. This is the flight that clinical staff used to travel to Stornoway to provide visiting services. It also used to connect to and from Inverness to Benbecula, as it was a direct flight, but no longer does so under the new contract.

If morning flights are not provided after August 1, then up to 40 per cent of the activity delivered by visiting consultants at Western Isles Hospital in Stornoway is at risk (more than 3,000 procedures or outpatient clinic appointments).

Mr Jamieson pointed out: “If this flight does not continue post-August, there will be significant additional implications.

“We will strive to provide as much safe and effective care as we can in the Outer Hebrides. However, to do that care here, there needs to be an optimal and reliable transport system. It is a mission critical service.

“Looking to the winter, I am more than anxious about what any additional impact may be. The winter will be a challenging period. Our staff want to do their best for every patient, and they find it a real struggle when anything stops them from doing that. I can only apologise to people for any inconvenience, distress and disappointment that they have had. We are doing everything we possibly can to mitigate that in terms of our own operating parameters.”

Board members agreed to a range of recommendations, including working with Caledonian MacBrayne to block book vehicle spaces; continuing discussions with Loganair to discuss the early morning flight from Inverness; to undertake an assessment of all clinics to consider where remote clinics can be provided; and to continue to work with NHS Highland on any reasonable changes that could be made to safeguard services. 

The full Board papers are available at: www.wihb.scot.nhs.uk/about-us/meet-the-board/board-papers