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Fears NHS Highland’s £112 million deficit could see vascular surgery cut

By Scott Maclennan

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Fears NHS Highland may cut vascular surgery amid ‘significant’ risk from £112 million deficit.
Fears NHS Highland may cut vascular surgery amid ‘significant’ risk from £112 million deficit.

The staggering financial pressures faced by NHS Highland appear to have prompted the health board to consider cutting vascular surgery – that could be a stunning blow to healthcare in the region.

Fergus Ewing revealed that a whistleblower contacted him concerned about the potential development which the Inverness and Nairn SNP MSP said is likely to “threaten the availability of safe provision of other acute services such as trauma”.

The health board pointed to the dependence on locums saying a “more sustainable solution will be needed” before adding “a minimum population of 800,000” is needed for a viable vascular service.

About 320,000 people live in the NHS Highland area which includes Argyll and Bute.

Fears about the future of the vascular surgery service in the Highlands come as NHS Highland lays bare the almost insurmountable financial challenge of delivering healthcare in the region.

The currently projected unadjusted funding shortfall for the next two financial years stands at £168 million. Despite additional funding from the Scottish Government the deficit this financial year is expected to be £55.8 million at worst – £39 million at best.

But the situation for 2024/25 budget is expected to be even worse. Without additional cash, the board believes it is faced with a £112.5 million shortfall while extra government money is capped at £28.4 million, leaving a financial gap of £84 million.

In a report to be discussed at tomorrow’s NHS Highland board meeting, director of finance Heledd Cooper warned “there is a significant risk that NHS Highland cannot deliver the required financial position for 2024/2025”.

She added that only “limited assurance can be provided that NHS Highland can deliver the level of cost reductions required” – that is the second lowest available to the board so it is clear why there is an “ongoing discussion” with the government.

One of the main areas of concern is the cost and funding of adult social care. That does not appear to have been helped by Highland Council unilaterally voting to cut the amount it pays the health board for the service.

Mr Ewing said: “News was provided to me by a whistleblower that the NHS Highland management are believed to be planning to cease provision of non-diagnostic vascular services, commencing from April.

“If that is true, then it is extremely worrying and obviously I am seeking full details from the management. I appreciate that the loss of just a few consultants in Raigmore can threaten the safe provision of services.

“Indeed, this is a long-standing systemic problem that has faced the provision of acute services in the Highlands for as long as I can remember.

“If emergency vascular surgery is not available, there are worries that this will in turn threaten the availability of safe provision of other acute services such as trauma.

"We need to use new policy measures to attract more experienced clinicians to Inverness. The use of bonds to require young clinicians to work in the rural parts of the country: the use of signing on fees as in dentistry, and other measures need to be considered urgently by the Scottish Government.

“I made a speech recently and wrote to Neil Gray, the health secretary, recommending the use of bonds, which other nations use to secure mandatory service in rural parts of their countries.

“But in the short term NHS Highland must explain what further actions they will take to avert this severe blow for health in the HIghlands. I shall seek to raise this issue at First Minister’s Questions this week.”

A spokeswoman for NHS Highland said: “There are national shortages of some medical specialisms, including in vascular surgery. NHS Highland's vascular service has relied on locum cover for the past year and a more sustainable solution will be needed.

“The provision of vascular surgery across Scotland is currently being considered at regional and national level, in order to ensure the best possible outcomes for patients. UK recommendation is that a minimum population of 800,000 is considered necessary for a viable vascular service.”

She added: "NHS Highland expects to end this financial year with a deficit of no more than £55.8 million. In the coming financial year, 2024-25, we require to deliver £84.091 million of cost improvements and reductions.

“This is because increases in costs are not matched by the funding available. The board will discuss plans to meet this target at the meeting on March 26."

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