The challenge of providing maternity care across the Highlands is one that has troubled the health board for many years.
The problems that Moray faces have thrust the issue back into the spotlight, and it is vital that the care of pregnant Highland women is addressed as a top priority.
The biggest question, of course, is how Raigmore Hospital copes with the Moray redesign, which, it is predicted, will result in (at least) an additional 500 mothers needing maternity care. This is on top of the existing 2,000, including those 170-odd who travel down from Caithness due to the lack of facilities there.
Apparently, the option for NHS Highland to refuse to take on these extra Moray mothers remains, but, realistically, the government has already decided on the outcome.
My recent visit to the Raigmore maternity unit showed a facility that was creaking under pressure, struggling with staffing, and coping with over 20 years of under-investment. Without doubt, the determination of the maternity team makes the facility work, but narrow corridors, low ceilings and cramped rooms are neither good for those who work there nor for those giving birth.
Everyone deserves better, which is why the £5 million promised by the central government is enticing. It is interesting that both Highland and Grampian health boards have been offered the same sum, which seems odd unless it is to ensure neither feels left out.
Help has been promised – but will it be enough?
During my visit, I was shown exciting but uncosted architectural sketches of the proposed improvements. These will be expensive, take time to deliver and cause severe disruption to the existing maternity unit as they are carried out.
The knock-on effect is that parts of the maternity unit will be forced to relocate as the new facilities are built, which, in turn, will mean beds lost from other wards. Mothers will likely also be much further away from the obstetric theatre for emergencies, and from the special care baby unit.
Tomorrow I am visiting the maternity unit at Raigmore. The question is; can we cope if we are also providing cover for Moray mums @KeepMUMMoray
— Edward Mountain (@1edmountain) April 19, 2022
There are other issues that will need to be addressed, such as the length of time Raigmore will have to look after these additional mums, where they will find the extra staff that will be required and, indeed, who will pay for them. Not to mention the additional ambulance cover that will be required to move patients to and from Moray, or the accommodation that will need to be provided for the families that come with them.
When have you known any government to accept a business case without reducing the requested funding?
Whilst I know that these later two points are on the board’s radar, they were not fully considered when the Caithness maternity cover was downgraded, which was a mistake.
All these issues will have cost implications and, to be fair, the government have said that they will help. Of course, the costs will only be approved if they are part of an accepted business case submitted by NHS Highland this summer.
But, I have to ask, when have you known any government to accept a business case without reducing the requested funding?
Jeopardising the safety of women
As the board looks at delivering on the instructions of the health secretary to help look after Moray mums, they should not be blinded by the additional investment that is being offered.
They will need the support of their maternity staff, some of whom wrote to an open letter to Humza Yousaf in December 2021 voicing their concerns. Those concerns need to be addressed if this idea is to work. Recent correspondence and calls I have received suggest that these concerns remain.
This issue cannot continue to be kicked into the long grass, as it has been for so long.
What is clear to me is that, whilst the existing maternity team can rise to the challenge, it is not fair to ask them to do so without giving them the correct tools.
It is also very clear that, until we have the facilities and resources in place, there is a real chance that we will let down and potentially jeopardise the safety of both the existing and additional mums we are trying to help.
NHS Highland can’t do everything
For those reasons alone I cannot, at this time, support Moray mums coming to Raigmore. I could change my mind when everything is in place to receive them, including new accommodation, additional staffing and additional funding.
Raigmore is already bursting at the seams, with huge waiting lists in key surgical areas. Simply displacing these patients to accommodate others is not the way forward.
What I fear the most is that the government will force the health board to compromise in order to secure the investment in maternity in the Highlands that has been lacking for the last 20 years.
Simply put, NHS Highland cannot do everything. They need to be able to address their own shortcomings in maternity care before they attempt to help NHS Grampian address theirs.
Edward Mountain is a Scottish Conservative politician and has been MSP for the Highlands and Islands region since 2016