This paper reconsiders the redesign of health and social care services in
Skye, Lochalsh and South West Ross which was first mooted in 2008. This
redesign had at its heart the building of a new hospital in Broadford and the
centralization of community hospital beds in Broadford along with key related
services such as a centralized A and E. The redesign was based on an options
appraisal process which did not include the so-called social costs of such a
change.

When NHS boards plan a centralised model in the main population centre there
is little need to consider such costs. The redesign in SLSWR, however,
centralised hospital provision away from the main population centre, a unique
experiment for an area with a unique socio demographic, and such social costs were
not factored into the modelling despite there being a mandatory requirement so
to do. There have already been many problems arising from this centralisation
model, particulary concerning access to urgent care with the North Skye
community now being at a crucial juncture with respect to the way ahead. It is
therefore a timely point at which to revisit the crucial issue of social costs,
which is what we do in a prelimianry basis in this paper. If the extant
patient safety issues that have been a recurring feature of the health care
service in North Skye are to be adressed then it is imperative that Scottish
Government ensure that NHSH’s statutory obligations with respect to the
calculation of social costs are now fullfilled. Until this is done the provision
of health and social care in North Skye will continue to lurch from one crisis
to the next and patient safety will be com