This article appears as part of the Inside the NHS newsletter.
"Worst fears coming true": that was the sentiment of campaigners earlier this week in the wake of one tragic death and another near miss in the north of Skye, where a lack of round-the-clock emergency medical provision has been a running sore in relations between NHS Highland and the local community for at least a decade.
What happened?
Deputy First Minister Kate Forbes – whose constituency includes Skye – said "enough is enough" on Monday as she criticised ongoing delays in implementing six-year-old recommendations to healthcare services in Portree.
She has called for an investigation following the death on Saturday of a woman who took ill at the Skye Live music festival in Portree.
The event – attended by some 1000 people – was held on Friday, Saturday, and Sunday, but at weekends and bank holidays urgent care is available "by appointment only" at Portree hospital, and only between the hours of 8.30am and 7.30pm.
An ambulance was dispatched to the festival site in Portree shortly before midnight with help also coming from an off-duty advanced nurse practitioner who was on-site and a doctor dispatched from the Broadford Hospital A&E department 25 miles away.
The woman was pronounced dead at the scene, but Ms Forbes said she is "hugely concerned by reports that during a medical emergency, access to Portree hospital was limited for vital life-saving equipment".
Around the same time as this tragedy was unfolding, another young woman – local teacher Eilidh Beaton – was suffering a life-threatening anaphylactic shock at a pub just 200 metres from Portree hospital.
According to the P&J she had to administer five EPI pens in a bid to stay alive as her throat began to close up while she waited nearly an hour for an ambulance to take her to Broadford.
First aid was sought from the RNLI instead while her boyfriend took to throwing stones at the windows of Portree hospital in a desperate bid to get in and find an oxygen mask because there was no one there to let him in.
Ritchie Review
It wasn't supposed to be this way. Exactly six years ago, in May 2018, an independent external review carried out by Sir Lewis Ritchie – a professor of general practice at Aberdeen University – described out of hours (OOH) services in Skye, Lochalsh and South West Ross (SLSWR) as "not sufficiently sustainable, nor equitable".
North Skye was particularly badly affected. At that time, inpatient bed numbers in Portree had been cut from 12 in 2009 to four and there was a fear that closure loomed.
While Broadford in the south operated 24/7, the Portree hospital – with its minor injuries unit – was officially open from 8am to 11pm. However, Prof Ritchie noted in his report that – at that time – it was still "normal practice for the small numbers who present directly to Portree Hospital seeking urgent help between 2300-0800, to be allowed access and for assistance to be offered".
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Nonetheless, the report made clear that proposals then on the table to centralise all urgent and emergency care services to Broadford were "neither sufficiently accessible nor equitable, for all the population served" and that the "proposed closure of OOH services at Portree Hospital overnight is disadvantageous to the people of north Skye, with its larger population, socioeconomic and geographic hinterland, growing tourist numbers, travel costs burden and volume of service requirement".
He made a series of recommendations, most importantly that "out-of-hours urgent care access at Portree Hospital should be provided 24/7 – there should be no closure of Portree Hospital in the out-of-hours period".
Six years on, campaigners say the situation is actually worse than it was with a "sporadic" out-of-hours service since Covid and a hospital that is "unstaffed during open hours".
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By April 2024, urgent care and minor injuries cover was supposed to be in place at Portree seven days a week from 8am to 8.30pm, according to an action plan set out in June 2023 by NHS Highland's deputy medical director, Dr Claire Copeland.
While that doesn't quite meet the Ritchie Review recommendations, it would be an improvement on the current situation.
Why that hasn't been achieved is something on which ministers, including Ms Forbes, will be seeking answers.
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