Healthcare rights ‘wilfully denied to people in Caithness’
The right to fair and accessible healthcare is “being wilfully denied to people in Caithness”, it has been alleged.
Caithness Health Action Team (CHAT) insists there is “overwhelming evidence” to back up that claim and says it will no longer be “fobbed off” with excuses.
It argues that forcing the vast majority of expectant mothers to travel to Inverness to have their babies has been a deliberately retrogressive step and “is no longer defensible”.
Vice-chairman Iain Gregory spoke out after a United Nations committee reported on a series of concerns put forward by the group.
The UN response has prompted CHAT to repeat its invitation to Scotland’s First Minister John Swinney and health secretary Neil Gray to visit Caithness “to see the situation for themselves”.
The UN Committee on Economic, Social and Cultural Rights, based in Geneva, Switzerland, received a detailed submission from CHAT last December followed by a verbal presentation by Mr Gregory in February.
Committee members were told that mums-to-be from Caithness are being denied their rights through “a policy of centralisation, retrogression and reduction of services”.
CHAT argued that many other patients are also “denied their rights to accessible and adequate facilities” by being asked to travel long distances for appointments and treatment.
The group’s submission to the UN came after a major report by the Scottish Human Rights Commission (SHRC) found that mothers in Caithness and Sutherland felt “unsafe” and “terrified” about going to Raigmore to have their babies.
The consultant-led maternity unit at Caithness General Hospital was downgraded in 2016 to a midwife-led facility and the vast majority of local women now give birth in Inverness.
In a section on “Right to physical and mental health”, the UN report says: “The committee expresses concern about the inadequate funding for the health sector, the long waiting times for medical appointments, procedures and operations, the shortages of medical staff and equipment and the barriers to access to healthcare for the most disadvantaged and those living in remote areas.”
Later, in a section on “Right to sexual and reproductive health”, it states: “The committee is concerned about... disparities in access to sexual and reproductive health services and information, which adversely affect women and girls from disadvantaged groups and in peripheral and remote areas.”
The committee recommends that the UK government, along with the devolved governments, “adequately equip facilities for antenatal, perinatal and postnatal care, particularly in rural areas” and “strengthen measures to ensure the accessibility and availability of appropriate, good-quality sexual and reproductive healthcare services and information... for all women and adolescent girls, particularly those living in rural or remote areas”.
The committee calls for its recommendations to be “implemented effectively… including at the local authority level”.
Mr Gregory said: “Registering CHAT as a non-governmental organisation with the UN, and subsequently preparing our submission and presenting our report in person to the committee, involved a lot of work. But we believe that the response by the United Nations, allied to the damning findings of the SHRC report, along with the local evidence amassed by us over the years, means that no longer will it be possible for us to be effectively ‘fobbed off’ with the usual excuses.
“The facts are simple. Until 2016 the vast majority of women in Caithness were able to have their babies in the county. That is no longer the case, and this situation arises from undeniably a deliberate retrogressive decision, one which politicians have been at pains to defend, but which is no longer defensible.
“Similarly, all patients, whether they are women who are forced to travel for vital healthcare, or indeed anyone who must access services, are entitled to adequate, accessible and equitable healthcare.
“This is not optional. It is a basic human right, and we consider that, on the basis of the overwhelming evidence available, it is a human right which is being wilfully denied to people in Caithness, and indeed in other areas distant from centralised facilities – so, in our case, Inverness, or even further away.
“CHAT has called upon both the First Minister, John Swinney, and the health secretary, Neil Gray, to visit Caithness to see the situation for themselves, and we take this opportunity to repeat the invitations.
“We note with interest that the First Minister recently visited Orkney, and that a post on the Highland Council Facebook page reports that Mr Gray travelled to Highland Council HQ to discuss ‘innovative approaches to health and social care’.
“What a shame that neither of them came to Caithness to meet with CHAT. I think it is fair to say that ‘innovative approaches’ in the county would involve acting – and acting rapidly – on the findings of the SHRC report, and the recommendations of the United Nations.”
Speaking to the committee in February, Mr Gregory asked: “Is it acceptable that women about to deliver their babies should, in a First World country, in the 21st century, be forced to travel well over 100 miles, in all weather conditions, at all hours of the day and night, in pain and distress, with risk and danger occasioned to them and to their unborn babies, because the authorities have pursued a policy of centralisation, retrogression and reduction of services?
“I submit that it cannot be, and we ask the committee to uphold our submission and to make the appropriate recommendations to the state to restore accessible maternity care – and other health services – to Caithness.”
He and Maria Aitken, the CHAT secretary, had met with the author of the SHRC report, Dr Luis F Yanes. Dr Yanes advised them that they could present a submission to the UN committee and he provided guidance on how to do so.
NHS Highland stressed that it provides “as many gynaecology and maternity procedures as is safe to do so in Caithness General Hospital” and that safety and quality are at the forefront of service planning.
Responding to CHAT’s comments in light of the report from the UN Committee on Economic, Social and Cultural Rights, a spokesperson for the Inverness-based health board said: “We acknowledge the importance of working with and hearing from people living in our communities.
“We appreciate the unique challenges that are faced by people in remote, rural and island areas and in providing safe and effective services as close to home as possible.
“We are a listening and learning organisation and will consider feedback alongside our continued community engagement as we work together to plan our services for the future.
“Safety and quality are at the forefront of all of our service planning, and we provide as many gynaecology and maternity procedures as is safe to do so in Caithness General Hospital. There are regular consultant clinics in Caithness, and we have successfully increased the midwifery team there.
“High-risk or complex cases continue to come to our district general hospital in Inverness – this is the same for all our remote and rural areas in the Highland region. We plan our theatre lists to support travel for those travelling longer distances and accommodation and expenses are also provided.
“We meet with the community groups regularly in Caithness, including CHAT, which is always a positive opportunity to discuss how we can work more closely together on some future pieces of work.
“We value local community groups bringing ideas, concerns and suggestions forward and as a team we work to achieve improvement.”
A Scottish Government spokesperson said: “NHS Highland took the decision to move to a midwife-led unit at Caithness General Hospital based on patient safety.
“This means that women can choose to give birth with the support of a midwife, either at home or in the midwife-led unit. However, if there are any risks to mother or baby, they are advised to give birth at Raigmore’s consultant-led unit which has access to specialist care.
“To minimise the need for women to travel, NHS Highland provides weekly obstetric-run antenatal clinics and scanning services in Caithness. NHS Highland also helps with travel and accommodation costs for those who need to travel for care.”