Response to Uist services publications

NHS Western Isles has compiled a detailed response to inaccurate and misleading information recently published with regard to services in Uist.  

Our commitment to maintaining, modernising and developing clinical services is clear, even looking only at the last 3 years, with services enhanced clearly by the level of investment over and above the baseline service budget (see below). 

NHS Western Isles disagrees entirely with any suggestion that there is some kind of ongoing degradation of services at Ospadal Uibhist agus Bharraigh (Uist and Barra Hospital) or in Uist generally. 

The steady depopulation is of ongoing significant concern to NHS Western Isles and something we have monitored, reported and taken steps in terms of recruitment, flexible working and key worker housing to address. 

Whilst NHS Scotland is committed to ensuring that the population has equity in terms of access to health services, it is not realistic or appropriate to expect all services to be available in every community. All Health Boards across Scotland have main population centres, and more remote or island areas. The services available in each area are driven by national standards, safety, efficiency, and effectiveness. More specialist services and facilities are greater in number in the higher population areas. More local services reflect what can be safely and effectively sustained.  

Daliburgh Hospital in South Uist which provided long term care was closed in 2001. 

Lochmaddy Hospital in North Uist which provided GP led care also closed in 2001. 

An option appraisal for hospital services reached the conclusion that a new build hospital in Benbecula, close to the airport, Ospadal Uibhist agus Bharraigh, was the preferred option.  

The new Ospadal Uibhist agus Bharraigh opened in 2001. 

Surgical Services and Anaesthesia  

The Scottish Board of the Royal College of Anaesthetists, at the request of the Scottish Government Support Team in Western Isles, carried out a review of Anaesthetic services in both Ospadal Uibhist agus Bharraigh and Western Isles Hospital in Stornoway in 2000. 

At the time, a selected caseload of approximately 30-40 patients in Uist per year was undergoing elective surgery and anaesthesia. 

A surgeon, anaesthetist, and operating department practitioner travelled to Uist from Stornoway over a 2-day period. 

One of the General Practitioners at that time had a special interest in surgery and two other GPs had anaesthetic qualifications.  (Two now retired, and the third continuing employment with NHS Western Isles.)

The review found that it was difficult to justify the small volume of practice carried out by the GP anaesthetist without direct local Consultant supervision in terms of contemporary national standards or on clinical governance grounds.  The recommendation was that emergency anaesthesia should not be carried out in Ospadal Uibhist agus Bharraigh.

In an attempt to maintain skills for two GP anaesthetists, it was recommended that they continue to participate in the elective anaesthesia for minor cases. 

From a clinical perspective, the absence of laboratory, High Dependency, blood transfusion, and the possibility of post operative complication developing within a remote community hospital mitigated against elective, general anaesthetic surgery continuing. 

The out of hours commitment for both GPs in terms of resuscitation, stabilisation and transfer of patients, plus other aspects of acute medical care was found to be too onerous to be sustainable in the long term.  It was clear that rising standards of quality, practice, safety and governance would impact on any question of sustainability of surgical services. 

‘Loss of the theatre and anaesthetic machine’

Elective surgery, as described, was stopped on governance and safety grounds around 15 years ago. 

It is correct to say that our Gynaecology Consultants did carry out laparoscopic surgery at Ospadal Uibhist agus Bharraigh.  As there are no staff or clinical support services to safely and effectively support surgery unexpectedly progressing from laparoscopic to open surgery, this was again discontinued on safety and clinical risk grounds. 

Obstetrician Gynaecologists deliver outpatient clinics in Ospadal Uibhist agus Bharraigh from Tuesday to Thursday every second month.  This is a change from the previous two days a month and was necessary due to the change in air flights, and on call commitments for two consultants.  

There has never been a High Dependency facility, full laboratory service or blood product preparation service within Ospadal Uibhist agus Bharraigh. 

In 2019 the NHS Board and Integration Joint Board, following full consultation with both, approved the development of a new dental hub in Ospadal Uibhist agus Bharraigh, which opened in July 2024.  

This hub will provide a better, more accessible environment for those who are less able, and improve wider multi-disciplinary team working. Currently we have an acute challenge in terms of recruitment, and we have an active process underway. 

The full capital programme included the development of a new resuscitation/stabilisation room as part of the ward area.  The work is now complete and this purpose-built area, includes a portable ventilator for respiratory support pre-transfer.  There are no substantive anaesthetists based in Ospadal Uibhist agus Bharraigh so the reference to the ‘loss’ of an anaesthetic machine is somewhat irrelevant in the context of current service provision. 

Midwifery 

Between 1993 and 2025 the Uist birth rate fell from 70 to 23 per year, this decline has been steady and continuous.  Two thirds of deliveries take place in mainland units, mainly Glasgow, the remaining third in Western Isles Hospital. 

All pregnancies are risk assessed to protect mother and baby and achieve the best outcome. 

Midwifery services employ one full time Midwife to cover North and South Uist and Benbecula. This is considered proportionate to the caseload of pregnant women in that area, 1:20 (approximately). The recommendation for The Best Start 5-year Midwifery Programme is that each Midwife should not have a caseload of more that 1:35. 

During periods of Midwife absence in Uist, the Midwife is replaced by a fellow colleague from Barra or Lewis. 

If a woman requests a home birth in Uist, NHS Western Isles will accommodate this with extra staff being deployed from Lewis or Barra. 

To clarify, since 2005, there was never a 24-hour Midwifery service. On-call Midwives were available if needed out of hours. GP support is also available.  

Midwifery on-call has not been available for the past 7 years. If a Midwife is required for advice this can be sought from the Lewis Midwives, but the local Uist Midwife can be activated if available and if there is a clinical need. 

There has been one Midwifery unplanned call out/out of hours for the past 4 years, which resulted in a very positive outcome. 

Women are given information to make an informed choice as to where they want to deliver their baby. Almost all women from Uist choose to deliver off island. This is thought to be primarily due to the absence of Obstetric and Neonatal expertise available in their areas should anything unexpected arise in labour or post-delivery, even for low-risk women. Time frames to get airlifted off for emergency situations can be quite variable and daunting for most families. 

If the Midwife on Uist is utilised out of hours, she has the ability to readjust her schedule and workload to accommodate rest and downtime following the call-out. 

Ospadal Uibhist agus Bharraigh has none of the following: 

• Consultant Obstetrics/Gynaecological staff  
• Anaesthetist 
• Epidural service 
• High Dependency Unit 
• Elective or emergency caesarean section capability.  
• Blood transfusion service 

Radiology 

The Radiology service in Uist and Barra Hospital has not been a 24-hour service for 20 years. 

The Radiographer employed in Ospadal Uibhist agus Bharraigh provides an on-call service between 9am and 9pm daily. 

In the event of a major trauma, the Radiographer would be called in to attend, as would other staff. 

Patients who require CT scanning as a result of trauma would need transferred by air to Western Isles Hospital or a mainland centre. 

Recruitment of Radiologists to ultrasound posts is extremely challenging for NHS Western Isles. 

At present NHS Western Isles has two very experienced part time Sonographers, and one full time, who provide a visiting service to Ospadal Uibhist agus Bharraigh two days per fortnight. 

We are also about to complete the accredited training programme for a Midwife Sonographer who provides a visiting service to Ospadal Uibhist agus Bharraigh on a 3-4 week basis to do growth, dating, anomaly, and early pregnancy scans on a monthly basis.

There has never been a Radiologist based at Ospadal Uibhist agus Bharraigh. A Radiologist is available for advice at Western Isles Hospital on a 24/7 basis. 

Dental Services 

As described, a new four surgery Dental hub opened in July 2024, providing a modern, well equipped, suitable environment. 

Orthodontic service clinics have been operating out of one of our other areas, the Linaclete Dental Clinic, and will re-locate to the new hub. 

It is fair to say that our dental services generally are continuing to recover post pandemic and remain a priority area for the Health Board. 

Endoscopy 

Carrying out scopes in Ospadal Uibhist agus Bharraigh as a visiting service has been an important part of our service provision.  Changes to Infection Prevention and Control decontamination requirements brought about the cessation of scope activity in March 2020 in order that we could undertake further work to comply with the new decontamination requirements. 

A new endoscopy washer, scope stack and reverse osmosis plant have been purchased and installed to comply with the new requirements.  In relation to the new equipment, staff required training in Bristol, England, to operate effectively.  The training was delayed due to a post covid backlog.  However, all staff have, through this sole provider, completed the necessary training.  Latterly we have been addressing a water quality issue which delayed re-commencement. The completed equipment installation now requires external validation which is in hand and it is anticipated that scopes will resume. 

We have a specific Surgeon who is employed to carry out scopes in Ospadal Uibhist agus Bharraigh. This individual also undertakes minor surgical procedures, and a surgical outpatient clinic when he attends, there are no plans to alter this. 

Orthopaedics 

The Orthopaedic in-patient surgery is provided at Western Isles Hospital Stornoway. We have 2 local Orthopaedic surgeons and one visiting Orthopaedic Consultant.  The Western Isles Hospital local consultants, as well as inpatient care, elective and trauma surgery, work a 1:2 on call. 

Hip, knee, shoulder, and recently wrist replacements are all carried out within Western Isles Hospital Stornoway.  The primary governance reasons being the need for laboratories, blood transfusion, high dependency care, the management of any potential post operative complications, and consultant leadership of care. 

Orthopaedic outpatient appointments 

Our well-established Extended Scope Physiotherapist carries out an assessment orthopaedic clinic once a month for 3 days in Uist and will treat and, or make appropriate onward referrals. 

Orthopaedic surgeons are currently increasing the use of ‘Near Me’ clinics by necessity as a direct result of the lack of flights to and from Benbecula. 

‘Near Me’ clinics are currently once per month with the Physiotherapist and Consultant taking part. Feedback in terms of learning and support has been extremely positive. 

In the event of a patient requiring a cast, this is carried out by the on-site medical staff or a Band 6 Nurse with orthopaedic experience.  Complicated trauma and trauma requiring emergency surgery has always been transferred to Western Isles Hospital Stornoway or a mainland centre. 

Blood Transfusion 

Whilst there are no laboratories in Uist and Barra Hospital, point of care testing is used. 

The hospital carries a stock of ‘O’ negative blood for urgent transfusion. 

Planned blood transfusion does take place as required. 

Mental Health 

Our Mental Health (MH) services have benefited from significant increased Scottish Government investment for psychological therapies and CAMHs across the Western Isles. 

Community Psychiatric Nurse (CPN) numbers on Uist has doubled in terms of funded posts and the service now has 4 funded CPN posts for Uist and Barra and 1 funded mental health worker post for Barra. The Barra MH worker is currently training to become a mental health nurse and is due to qualify towards the end of 2026. 

The CAMHs service has 2 mental health workers (1.6 wte) based in Benbecula with the service supported by visiting CAMHs nurses from Lewis on a needs-led basis to support Children and Young People (CYP)  in crisis, CYP receiving care and treatment for a mental health condition and CYP requiring assessment and support for ADHD. The CAMHs Occupational Therapist will also visit the Uists.   

It is fair to say that recruitment efforts to get to full establishment have been, and remain, challenging.

Adult and CAMHs psychology support is also available. Adult and CAMHs psychology provide a hybrid service (face to face and digital) to the Western Isles with the CAMHs service currently having a post based in Uist who also provides a service to Lewis and Harris. 

Our consultant psychiatrists, of which we have two locum staff who work a 1:2 on call, have historically been able to travel to provide adult and old age psychiatry clinics in Uist on a monthly basis for adults and old age. Clinics to Barra would be on a two monthly basis. 

This service is now under review as changes in relation to air travel as a result of the new Stornoway/Benbecula PSO are potentially preventing ongoing delivery.  In the interim the ‘Near Me’ clinic option has been increased. Other challenges include weather difficulties and flight cancellations, consultant sickness and consultant annual leave which require backfill services via the ‘Near Me’ service to be offered. This is in line with the Scottish Government’s care in the digital age delivery plan aim to improve access to treatment and digital assessment and follow has been successful during COVID and since.    

There is also a part-time CAMHs consultant post who provides a hybrid service to the Western Isles. CAMHs is a nurse-led service but access to the consultant is based on a needs-led basis rather than a geographical based basis. The average face to face clinics held in Uist for 2025 was three. The post has recently become vacant and we have increased the hours attached to the part-time post and we hope to have a new consultant in CAMHs in place by March. 

Community Out of Hours 

GP Out of Hours 

The national change of the General Medical Service Contract 2018, changed the arrangement between the Practices and the Out of Hours service.  This changed from an ‘opt-out’ service, to an ‘opt-in’ service and a practice-based decision.  In Uist, the local practices were unable to continue with the Out of Hours service and therefore did not opt-in, however, a number of local GPs remain engaged with the service, providing paid second on-call cover on weekends/public holidays and during times of service pressures. Ongoing provision of out of hours urgent care rests with the Health Board. 

The use of Locums in the out of hours service has been very successful for the Uists. Since 2021, NHSWI has attracted locums who enjoy working and living in the Uists who return on a very regular basis, some working annually two weeks on/off and for blocks of time during peak periods, summer season and festive holidays. The locums are committed to supporting the wider healthcare system in Uist and the Western Isles, supporting the daytime GP practice work for the independent practices and service pressures elsewhere in the Western Isles. The locums that continue to work with us, have a wealth of experience due to working in parts of Scotland in the out of hours service and Community Hospitals mainly Orkney, Shetland and NHS Highland. The clinicians who work with us are experienced in remote and rural practice and can respond effectively to clinical need.  

The clinicians in general practice also support the wider system daytime, providing immediate and first response care acting as a point of contact/response for the Scottish Ambulance Service.  This is not based on goodwill but is a funded national enhanced service within the GMS contract.  

The developments of the primary care improvement programme, have allowed the Urgent Care service to launch in the Uists.  This is currently a daytime operated service between the hours 8am and 9pm –7 days a week.  The workforce operates at advanced practice level, supporting patients in the community on behalf of the practices daytime and home visits for the out of hours until 9pm.   

NHS Western Isles commenced working towards launching the Community Glaucoma service in 2025. This service is available for patients of Uist via the Community Optician Service in 2026.  Patients will be discharged from secondary care when appropriate to do so and supported by the community optician service which will work closely with Ophthalmology colleagues to support the needs of the patients in Uist.  

The current activity in terms of urgent/unscheduled care calls out of hours is 1 per day, 6 or 7 per week. 

Additional on-call staff based in Uist who are currently available include: 

• Community Psychiatric Nursing 
• Scottish Ambulance Service Paramedics 
• Community Nursing 
• Chemotherapy 
• Training for Emergencies 
• Transport 

One of our most recent developments has been the transition of Benbecula Medical Practice from being independent to becoming a 2C practice, led and managed by the Health Board.  GPs and other clinical and support staff provide the full range of General Medical Services, Our of Hours Unscheduled Care and Inpatient care at Ospadal Uibhist agus Bharraigh. 

Chemotherapy 

Our aim is to provide care, and or services, as close to people’s homes or in their community. 

The administration of Systemic Anti-Cancer Therapy is complex and the clinical governance and risk management arrangements for these medicines have to be consistent with best practice as detailed in the Scottish Government Guidance for the safe delivery of systemic anti-cancer therapy CEL 30 (2012), Revised 2023.  

Where possible, chemotherapy will be administered locally, but with advances in drugs, the number of treatments has risen, and patients across the Western Isles may have to travel to Specialist Centres as appropriate. NHS Western Isles now administers double the amount of chemotherapy since 2018, and this continues to increase.   

The evolution of chemotherapy has developed to treatments that can be taken orally, and this is demonstrated in the increasing numbers of patients who do receive chemotherapy across Uist and Barra.   

These drugs require careful monitoring and the Macmillan Team provides a clinic in Ospadal Uibhist agus Bharraigh in conjunction with the Western Isles Hospital Chemotherapy Team (via Near Me) weekly to review all patients due chemotherapy. This is to ensure they are well enough to receive their treatment and /or travel. 

The Macmillan Cancer and Palliative Care Service has increased its resource locally for Uist & Barra with an establishment of three Full Time members of staff (Band 7, Band 6 and Band 3). The service has been developed to a Single Point of Contact for people with cancer as part of the Scottish Government Cancer Strategy key aims. Changes to travel options have meant that cancer patients who do have to travel are now facing longer more complex and convoluted travel arrangements than they have experienced before requiring additional support to facilitate their travel arrangements.  The Macmillan service operates across the Western Isles seven days a week providing advice and support including access to a Macmillan Nurse at weekends and Public Holidays.  

There are suggestions at various points in the recent publication issued about ‘de-skilling’ of staff. 

Our objective is always to ensure that all of our staff are confident, competent, and comfortable in the performance of their duties and care. 

Training for Emergencies 

All staff are able to access training.  As a Board we have invested heavily in the Clinical Skills Team – both staff and equipment.  All forms of life support training are available, Basic Life Support (BLS), Advanced Life Support (ALS), European trauma course and BASICS for GPs. 

The NHS Scotland medical skills training bus visits at least once a year – most recently in 2025.  Training on offer and delivered included obstetric, mental health and Emergency Medical Retrieval Scenarios. 

Transport 

The single biggest ongoing current risk to a range of services provided in Uist is the recent PSO, Stornoway to Benbecula contract (1st April 2024), which was awarded by Comhairle nan Eilean Siar. 

Western Isles NHS Board was not consulted or involved in specification preparation, letting, or awarding the PSO contract which was undertaken by CnES. 

We are working daily to mitigate, within our powers, and governance parameters, the impact for individuals, recognising the very significant difficulties that members of the public and patient experience in terms of travel to health.