CMO responds to healthcare concerns

AN OVERSUBSCRIBED visiting optician, paediatric care and bowel cancer screening, are just a few of subjects about health care in the Falklands raised as a result of election debates and discussions between election candidates and voters.

As such Penguin News invited the Chief Medical Officer Dr Becky  Edwards to respond to some of the specific concerns.

Asked what the position was with the optician's visits she explained: “Normally our optician visits twice a year.  Unfortunately her last scheduled visit had to be cancelled because of travel problems between Ascension Island, St Helena and us here in the Falklands.  

“This means the visit which is about to take place is oversubscribed and so we have prioritised those patients who have a medical reason for needing their sight monitored.  We will fit in as many routine eye tests as possible, but some people will need to wait for the next visit which will be arranged as soon as possible.”

Paediatric Care
A number of voters expressed concern about what they viewed as the lack of paediatric care in the Islands but Dr Edwards said it was, “not possible to have all medical specialities represented on the Falklands and this includes paediatric care.  It is also important to mention that the field of paediatric medicine is huge in itself, ranging from neonatology and SCBU care, to community paediatrics, or specialised fields like paediatric cardiology, gastroenterology or paediatric psychiatric care to name but a few.”

She said the hospital had to refer patients for treatment overseas, “when they need something we cannot provide here.  This might be because of expertise, facilities, equipment, or the urgency of the case.”
She said even without considering the expense, there was no chance of being able to recruit a suitably qualified person to work in the Falklands. There would not be enough patients for any doctor to maintain their specialist skills and competencies, and they would risk their professional registration if they could not demonstrate sufficient use of their skills all the time said Dr Edwards.

 She said: “Having a visiting specialist programme means we are benefitting from the skills those specialist doctors practice elsewhere.  We have on occasion brought a specialist doctor or other health professional to the Island for a specific patient, and when that happens we make the best use of their time by asking them to see other appropriate patients and provide training for our staff.  We have had paediatricians visit us in the past, and hope to again in the future.  Children who need specialist advice and guidance are referred overseas where they can see the whole remit of sub-specialists involved in complete paediatric care.”

However she emphasised there was room to grow and develop in terms of formalising links with specialist groups in the UK/NHS.  

“Currently our visiting specialist programme runs on links we have forged and developed over the years.  

Telemedicine is used throughout the UK - even between hospitals within cities, not just in remote settings - and it would be useful if we could explore the feasibility of using this technology here.”
Bowel cancer screening
Bowel cancer screening methods had been updated in the Falklands she noted.

In previous years, KEMH undertook one-off screening scopes on people aged 56 years to screen for colon cancer. For various operational issues, this screening programme ceased about 8-9 years ago.  Dr Edwards explained: “However, we have moved to implement new medical best practices which recognise that Faecal Occult Blood (FOB) screening for bowel cancer is appropriate for most individuals. The more invasive colonoscopy testing is used where abnormalities are observed, or for those who are at higher risk due to their own, or their family’s medical history.  This screening protocol is widely followed in the UK and is well established, with good evidence behind it.” 

She emphasised that FOB screening was offered to all patients, between the ages of 50 and 75 years and had been in place at KEMH since 2014.  

She said: “We are about to roll out another batch of FOB screening within the next few months and would encourage all those patients who receive a pack to send the samples back.

“It is important to note that Islanders who have been identified as higher risk or who screen positive in the FOB tests, do receive all appropriate care including regular colonoscopy as medically indicated.Dr Oscar Varas, a consultant gastroenterologist and endoscopist, who many people will have met, visits us four times a year to provide our scoping service, and Mr Cheema is available to scope people in an emergency.”
Asked if it was correct that the spend on locums was10 times what was budgeted she said: “The information you have is incomplete.  At the beginning of each financial year we are given a modest budget for locums.  This is not intended to cover the full cost of paying for locums, it is a ‘top up’ that recognises the cost of locums is higher than the cost of directly employing someone. 
“When we pay a bill for a locum we use the allocated salary for the vacancy, plus some of the locum budget. Our finance system does not allow us to pay an invoice from the salary budget code, so we transfer the salary element into the locum budget code and pay the bill from there.

“If we look at the total spend on salary  and locums for the year we can see it is very close to the original budget, but the spend appears on different budget lines to the original budget and therefore give the appearance of a large locum overspend.”

She said overall there was a relatively small additional spend on locums - less than 9% at the end of the financial year.  

“This reflects the fact that we sometimes use locums to cover long term sickness or maternity leave which cannot be covered by other staff. This additional spend is funded from elsewhere in the Health and Social Services budget and no extra money is requested from Treasury.”

She added that it was also important to note that the term ‘locum’ is not just used in this context in relation to doctors.  

“For our budget we refer to all temporary or short term staff as locums, and not all of these people are employed through agencies.  The ‘locums’ referred to here include doctors, nurses, midwives, physiotherapists, pharmacy staff, radiology staff, social services staff, and even cleaners.  For example, there are currently no locum doctors working at the KEMH, as all  the doctors here at the moment are on local contracts, some long-term, some short term.  There are, however, other locum staff.”