How well is NHS Highland faring compared to other parts of Scotland and what are the biggest worries for its patients and staff?

Contrary to the perception of remote and rural areas, Highland tends to perform better than the national average on several key waiting times measures.

Patients who were admitted to hospital for an inpatient or day case procedure between July and September last year had typically waited 135 days, compared a median wait of 166 day across Scotland as a whole or 205 day in Greater Glasgow and Clyde (GGC) - the country's largest health board.


Its elective activity - the number of planned operations being carried out - was almost back to pre-pandemic levels by November last year, thanks in part to the launch of its five-theatre National Treatment Centre in Inverness last summer.

In contrast, NHS Scotland as a whole still lags 13% behind its 2019 turnover.

Patients diagnosed with cancer in Highland are also slightly more likely to start treatment within 62 days of their initial referral for tests: 76% compared to 72% Scotland-wide, and 66% in GGC (although all are well short of the 95% target).

Highland currently has access to six CT scanners for a patient population of 320,860 people - slightly more per head than GGC, which has 19 CT scanners for 1.2 million patients.

This is only part of the story, however.

The rural geography of Highland means patients tend to face much longer journeys for treatment, and often have to be referred out of area for more specialist care.

This is reflected in the fact that Highland has roughly one acute bed for every 507 residents compared to one per 299 in GGC, which accepts a large number of referrals from other health board regions.

In both areas, occupancy is running around 90% - higher than the 85% threshold recommended for patient safety and infection control.

The biggest challenge for Highland lies in recruitment and retention, with some services particularly fragile when staff leave.

The departure last year of a specialist colorectal oncology consultant from Raigmore hospital resulted in dozens of bowel cancer patients being forced to travel to Aberdeen, Edinburgh or Dundee for chemotherapy after attempts to recruit a replacement - even on a locum basis - failed.

More recently, blood cancer patients from Argyll and Bute have faced journeying to Glasgow for treatment after NHS GGC reneged on a previous arrangement whereby a consultant haematologist had visited patients in the region once a month.

Previous research by BMA Scotland found that consultant vacancy rates were higher in Highland than any other mainland region, and roughly three times higher than they are in the Central Belt.

NHS Highland has spent £19.5 million so far in 2023/24 on locum medical cover.

Smaller hospitals such as Lorn & Islands in Oban and the New Craigs psychiatric hospital in Inverness have become extremely reliant on locums.

The Herald reported last year that Lorn & Islands had been left with just one permanent consultant physician after a string of experienced clinicians quit or retired, with Dr Gordon Caldwell - the hospital's former clinical lead - blaming "dysfunctional" management for the exodus.

Back in September 2018, it was the Herald which broke news of the Highland bullying scandal after whistleblowing doctors went public to voice concerns over a "culture of fear and intimidation" said to emanate from the "very top of the organisation".

Yet more than five years on, with £2.8 million paid out in compensation as part of a "healing process", trade union Unison says it has seen no discernible reduction in the number of bullying complaints its Highland reps are handling.

Speaking in December, Dawn Macdonald - Unison's Highland healthcare branch secretary - said the problem "is not going away".

Beyond workload and workplace culture NHS Highland faces recruitment obstacles beyond its control, from the lack of available or affordable accommodation - particularly in places such as Skye or Caithness - and the deterrent effect of the region's persistent transport problems.

An unreliable ferry network and constant landslips on the Rest and Be Thankful are hardly enticing.

The region is also battling some of worst - and worsening - GP shortages.

By April 2023, a quarter of GP surgeries in the 'North Highland' (Caithness and Sutherland) region were being directly run by the health board after GP partners handed back their contracts.

So-called '2C' practices are both more expensive to run and more reliant on salaried and locum doctors, providing less continuity of care for patients.

Anger continues to run deep over the implementation of the 2018 Scottish GP contract - an agreement struck between the Scottish Government and BMA Scotland, but opposed by doctors in Highland - which allocated substantial extra sums to Central Belt-based GPs while those in rural areas received little or no uplift in funding for their practices.

It also paved the way to the transfer of vaccinations from GP surgeries to health boards, something which Highland GPs repeatedly warned was unsuitable for a remote and rural region.

Highland now has the lowest MMR coverage for five-year-olds of all the mainland boards - at 84.5% - and an internal report from NHS Highland, leaked last year, revealed concerns over "significant challenges" in delivery of immunisations.