John Speech on Island Health Boards

On Thursday (6th October) John spoke in a member’s debate, held by Liam McArthur MSP, on the importance of Island Health Boards

“I, too, thank Liam McArthur for bringing this very important debate to the chamber. The motion talks about distinct communities, and my colleague Rhoda Grant talked about changing the mindset. If members were to read the “Scottish Government Urban Rural Classification”—if they had nothing better to do—they would see that there are various classifications, all of which are fixated on centres of population. The classification of “remote rural” is somewhere

“with a drive time of over 30 minutes to a settlement of 10,000 or more”.

That is challenging, because we are talking about communities that might be classed as being beyond “very remote rural” because they are significantly impeded by geography.

The motion also talks about a one-size-fits-all approach not working, and I agree with that, although there are some exceptions that members have previously alluded to—for example, standards of care and terms and conditions for staff, which should be protected however the administrative arrangements are configured. Nevertheless, there are challenges associated with that, too. In the previous session, I wrote to the Cabinet Secretary for Health and Sport about the challenges that are faced in delivery of training to people in social care on Orkney’s small islands. Of course, there is an assessment of needs, but there must be a practical approach to how that is delivered that bears in mind—quite literally—time and tide. I have no doubt that such approaches are best determined locally.

Island communities require different solutions and although impact assessments inform a lot of our decision making in this building, it is hard to change mindsets—it is a two-way thing: urban-rural, rural-urban—and I do not think that there is a clear understanding of some of the practical implications. The solutions come from communities. For example, I commend the new and innovative model of care on the small islands in the NHS Highland area. Called the nuka model of health and care services, it was created and is managed and owned by Alaskan native people, and it has enabled the islands of Eigg and Muck to come up with their own solutions to problems as well as delivering jobs there.

Another phrase in the motion—“inevitably requires additional resources”—is important because, as has been said, there are additional travel costs and other costs associated with travel. When Highlands and Islands Enterprise had the budget for training, it took cognisance of the actual costs. However, when Skills Development Scotland took over that budget, it moved to one-size-fits-all delivery of training per capita, which has impacted desperately on some of the small providers; indeed, Argyll Training went out of business just last Friday. All decisions are best made locally and on an informed basis.

A colleague mentioned NHS Highland. I can stand at the north end of that board’s catchment area and look over to Liam McArthur’s constituency in Orkney and I can stand at the southern end and look over to Glasgow. It is a ridiculous size—it covers an area the size of Belgium and Wales, with Argyll and Bute added on. It is not the model that we should be looking at, and it is certainly not the one that I am promoting.

Integration of health and social care is a factor, too, but I do not know whether that factor has prompted some of the Scottish Government’s proposals. My party and I suggest that there should be more rather than fewer local management decisions. There is no doubt that collaboration will continue, but not every health board could or should have every specialism.

As we have heard from Mr McArthur, the scanner in Orkney has made a difference. Telehealth and the information technology infrastructure that underpins it are important.

The NHS is a shared resource and a valued public service and it should be managed locally. For the good folk of Orkney, that should be from within the islands by NHS Orkney.”


You can watch John’s speech here: