One of the fundamental tenets of the NHS is an equitable access to services for all, as close to home as we can possibly provide.
Outside the central belt we have a vast and sparsely populated land that is a unique part of what makes Scotland a magical place to call home. As doctors in Scotland's health service this makes for a significant geographical challenge and this is no more keenly felt than in our Island populations.
When I first moved to Aberdeen from London I must confess to having little awareness of the Shetland Isles. They were an otherworldly place from the car atlases of my childhood.
Yet when I took up my consultant post in paediatric orthopaedics in Aberdeen I quickly found I had more than a few patients from these far flung rocks. For a year or two I would welcome these folks into my clinic vaguely wondering why they looked harassed and frazzled.
The light bulb moment for me came when a child arrived grumpy after a rough crossing on the overnight ferry with parents equally distressed by the burden of special equipment they had to cart along with them. All this for 10 minutes with me before facing another equally difficult journey back home. My 10 minute consultation was a three day event for these islanders! 'This is crazy' I thought 'I should go to them!'
So now, four times a year, I find myself on a rubber band plane skipping the white tops to land at Sumburgh. The runway juts out into the sea and anyone who's been will know the relief of that little tin can screeching to a halt before we hit the brine.
The taxi ride to Lerwick which crosses the runway (!) takes in some truly beautiful scenery. My trips to Shetland however are not an opportunity to wander the sandy beaches, I have clinics full of patients to see over the next two days.
Challenges of a rural hospital
Gilbert Bain Hospital is my destination it provides secondary care to the people of Shetland and it does this exceptionally well. It faces all the challenges of a remote and rural setting with the added potential of near complete isolation in truly bad weather.
As a visiting specialist I have nothing but admiration for the dedication and skill of the consultants based here, providing care across a broad range of patient needs that would challenge the competencies of us city dwelling counterparts.
There is an intrinsic vulnerability here though. Highly skilled generalist consultants do not grow on proverbial trees and since there are so few in place to start with, any vacancy is a very significant burden on the remaining staff. Excellent succession planning is key.
One of the great benefits of visiting over the years - beyond patient convenience - is the enhanced multidisciplinary working that has developed. Getting to know the operating theatre team here has enabled me to undertake operating lists on my visits - not the most complex surgeries but nevertheless enabling folk to have specialist day case surgery here instead of overnight trips to Aberdeen. It is satisfying to cut patient journey time as well as saving NHS resources and it goes a long way to help me face my daughters back in Aberdeen who struggle to understand why their Dad should go away to see patients.
Haste ye back
In Shetland the balance of visiting specialists with local care to Island communities is a good one and I'm really very proud to be part of the integrated service that our island folk receive from the NHS in Scotland.
I have to remember though that my trips only take me to the Shetland mainland. Some patients still have a journey to see me there but perhaps there is a fair compromise in this. A clinic on Unst or Yell is not on my agenda…yet!
Simon Barker is the chair of BMA Scotland's consultant committee and a paediatric orthopaedic surgeon working in Aberdeen.
Great blog, and a great service!
What about the rest of the time? 8 days a year they get a local service. Are video consultations part of your routine offering? If not they should be! And blaming it on infrastructure is just a lazy excuse...