NHS Board holds Special Board Meeting to discuss new Benbecula to Stornoway PSO Contract

The recent awarding of the new Public Service Obligation (PSO) contract for the Stornoway/Benbecula route could 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).

NHS Western Isles Board members will hear, at a Special Board meeting on Thursday July 11 (10am – 12noon), the concerning impact of the new PSO route, since Comhairle nan Eilean Siar awarded the contract to Hebridean Air Services in April.

NHS Western Isles is extremely concerned that 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.

NHS Western Isles is already aware of major logistical issues relating to the new service, in terms of a change to days of operation and a significant reduction in capacity, but is also extremely concerned about the disturbing issues being experienced on an ongoing and frequent basis by individuals attending healthcare appointments, and problems in relation to the lack of disabled access.

A report set to go before Board members will highlight that NHS Western Isles was not involved or consulted with regard to the pre-tender specification development, issuing the tender invitation, assessing, or awarding the Benbecula to Stornoway contract. It is the understanding of NHS Western Isles that, as part of the tender specification for the PSO procurement, the Comhairle took the decision not to score the proposed aircraft capacity.

In addition, NHS Western Isles understands that the procurement documentation did not state the overall passenger numbers to be provided and that the procurement documentation did not provide any up to date detail of the numbers that had typically used the service to attend a medical appointment or used the service to attend, as a medical professional, clinics or appointments.

The new contract provides 24-seat capacity return a week over three days, compared to the previous capacity of 96-98 over two days.  In relation to NHS staff and passengers travelling for health appointments alone, numbers over the past five years have averaged 25 (one way) a week, with some more recent data showing higher requirements of 33 seats per week. This does not take into account additional wider passenger requirements in terms of members of the public who wish to use the service.

As a result, whilst the number of days of flights has increased from two to three per week, there has been a considerable reduction in capacity. This has had a direct impact on individuals not being able to travel by air to scheduled healthcare appointments or for procedures.

In terms of the challenges and impact on visiting services to the Western Isles, NHS Western Isles Board members will hear about the current and predicted impact on services.

NHS Western Isles and the wider population are heavily dependent on clinical services provided by visiting clinicians from other NHS Boards, particularly NHS Highland.

Raigmore clinicians have provided a visiting service via a contract for at least 15 years. The visiting capacity helps to provide annual activity of 24,510 outpatient appointments, 1,287 theatre procedures and 1,033 endoscopy procedures. Of those, 7,528 procedures or appointments are provided by NHS Highland consultants – 28 per cent of activity.

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 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).

With regard to OUaB, 1,673 clinics are provided by NHS Western Isles clinicians and 689 by visiting clinicians from NHS Highland. The provision under the previous PSO included flights running two days a week (Tuesday and Thursday), linking Inverness and Benbecula.

The change in flights schedule to Monday, Tuesday and Friday will not allow many of the current services to continue. The majority of clinicians travel as day returns and this time is built into job plans, and overnight stays are not possible to arrange. The loss of a flight on Thursdays as part of the new Hebridean Air Services contract, greatly affects Western Isles clinicians’ ability to travel to Uist and Barra to provide in-person clinics.

The responsibility for the public transport network sits with local authorities and/or Transport Scotland. NHS Boards in Scotland are not funded or expected to manage public transport infrastructure under the National Health Services (Scotland) Act 1978 and are not authorised to fund transportation (with the exception of the provisions under Highlands and Islands Travel Scheme for the reimbursement of certain travel and escort expenses).

Despite this, NHS Western Isles continues to incur significant expenditure as a result of the new contract, to ensure the safety of patients who have been left stranded as a result of regular cancellation of flights under the new system. NHS Western Isles is extremely concerned about the current unreliability of the service. There have been numerous cancellations since mid-June – every Monday and Friday flight has been cancelled, either one of the legs or both (at the point that the Board paper was drafted), and Benbecula did not have an air service at all between 25 June and July 5. Cancellations have been for a variety of reasons, including weather, technical and non-technical issues

Alternative forms of transport (i.e. ferry and car) are not ideal or possible for some patients, such as stoma patients or some chemotherapy patients, and in any case, ferries are often at full capacity.

NHS Board members will discuss a range of impacts, recommendations and mitigations for the NHS – although clearly, the contract itself is a matter for Comhairle nan Eilean Siar.

Recommendations before Board members will include working with Caledonian MacBrayne to block book vehicle spaces; continue 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

Members of the public are welcome to attend the meeting to hear discussions. A link can be obtained by emailing michelle.mcphail@nhs.scot