By Michael Alexander

NHS FIFE was last night accused of “losing the plot” following its decision, in principle, to support health service cuts aimed at keeping Fife hospitals within cash limits.

Mid Scotland and Fife SNP MSP Tricia Marwick slated the proposals designed to save around £4 million from primary and acute care, describing it as a “black day for Fife.”

She was particularly concerned at proposals to do away with 37 Fife nursing posts by retirement or resignation, criticised proposals to continue the use of locum and agency staff as “a waste of money” and noted that no management posts were included in the proposed cuts.

Independent Fife councillor, and former Fife Health Board member, Andrew Rodger, expressed similar concern, calling on the NHS Fife chairman and chief executive to “go now before they cause any more damage to the health service.”

But NHS Fife, albeit not unanimously, defended its stance, pointing to the “huge savings” that can be made through this rationalisation process.

The health authority said its budget was heading for an estimated £6 million overspend and that cuts in services would probably have to be made before the end of the financial year. It was confident that levels of care would be unaffected.

Mrs Marwick told The Courier, “Fife Health Board is in crisis. They have completely lost the plot if they are even considering cutting 34 ward-based and three non-ward based nursing jobs and community health services.

“I will be writing today to Malcolm Chisholm, the health minister, because I had an undertaking from him that Fife’s financial problems would not be solved at the expense of patient care. Clearly that is happening here. It is appalling. It’s a black day for Fife.”

Councillor Rodger, who walked out of the public gallery in disgust half way through yesterday’s meeting, said, “This is absolutely terrible. At a time when Jack McConnell is saying we need more nurses and should be tackling waiting times, this goes completely against it.”

At yesterday’s NHS Fife board meeting at Springfield House, near Cupar, members were presented with separate papers outlining a range of approaches aimed at reducing NHS Fife expenditure to bring it into line with available funds.

A report by Dr Frances Elliot, interim chief executive of Fife Primary Care, set out a number of cost reduction proposals and the associated risks ensuring that relevant information was publicly available to the board before difficult decisions were made. The primary care division had already delivered £943,000 of cost reductions with no material impact on clinical activity.

John Wilson, acting chief executive of Fife Acute Hospitals, reported that £2.9 million savings had already been made in the acute division with a further £250,000 got by reducing the use of bank and agency staff. New approaches over both divisions were to be discussed with managers and staff representatives.

The primary care division management plan outlined proposals designed to save £1 million, primarily through the loss of 37 nursing posts as well as several other posts including cuts in speech and language therapy, occupational therapy, podiatry, physiotherapy and dietetics.

The paper did not specify individual posts but stressed that no staff would lose their jobs as such. Instead, posts would be “freed up” through retirement or resignation.

The acute hospitals division management plan, meanwhile, outlined proposals designed to save £3 million. It did not go into detail about its proposals but generally proposed the speeding up of the Right for Fife process with more centrally-based services.

The changes should be possible because services in the community now allow people to stay longer in their homes and delayed discharge numbers keep falling, so the need for hospital beds would reduce.

However, during a long and at times heated debate that dominated yesterday’s close to four-hour meeting, it soon became clear there was a split within NHS Fife ranks, with NHS Fife’s employee director Simon Fevre and non-executive member Jim Mudie expressing strong feelings over the way the proposals were being put forward, and at least one other member saying they felt the proposals were “haphazard”.

They felt there had been inadequate consultation with staff to date and refused to move the proposals as they stood.

Mr Fevre said, “I have significant concerns. This sends out a very negative message to staff. It does nothing to show that we value them. I am disappointed we have to go down this road.”

Mr Mudie argued that rationalisation did not save money. It merely saw the same cash being spent in a different way. He said if there were fewer posts available then there would be fewer opportunities for nurses in future.

He said it was important staff were involved in discussions before the proposals went any further. He warned Dr Elliot she was “making a big rod for her back to be broken” if staff were not kept fully involved.

But Dr Elliot challenged the objectors to explain what they would do instead. She said, “If you’ve got any ideas I’d love to hear them!”

She was supported by chief executive George Brechin, who said the board was having to take a strategic approach.

They were committed to getting the maximum quality care out of the money available but, having been “squeezed and squeezed and squeezed again”, they were now having to go back and look at what other savings could be made.

He said the cost reductions of just under £4 million already in place this year need to be set against the extra £25.3 million being spent in 2003/2004.

Acknowledging these were always going to be difficult decisions, chairman Esther Roberton said, “We have to respond to needs on a limited budget.”

With the exception of Messrs Mudie and Fevre, the board overwhelmingly agreed the range of approaches which will now be taken forward for further discussion.

Last night Councillor Joyce Smith of Methilhill, who has just returned home after three weeks in the rehabilitation ward at Cameron Hospital, Windygates, praised the treatment she had received and said it would be a “disaster” if they cut back on nurses.

She said, “How the trust can do away with nurses is beyond me. They should be appealing for more cash to employ more nurses. A lot of primary care work is for the elderly who need a lot more help than patients in some of the other hospitals.”