news focus

More penguins than people, and joint-working that would be the envy of many a manager on the UK mainland. But the 'goldfish bowl' community of the Falklands brings its own problems. Mark Gould reports

When British armed forces began to scale down their presence in the Falkland Islands, invasion by Argentina followed, and the rest - the war of 1982 - is, as they say, history.

Happily, the recent withdrawal of defence medical services from the islands and the creation of a health service has been handled without incident, according to Norman McGregor-Edwards, the man who runs the new Falkland Islands health service.

Mr McGregor-Edwards' last job was general manager of Glasgow Central primary care trust, where he helped provide services for 600,000 people.His journey home was through one of the most deprived areas in Europe. Now his 20-minute walk from the King Edward Memorial Hospital in the capital, Stanley, takes him past sea lions sunbathing on a jetty.

As general manager of FIHS, he is responsible for the health and social care of a mainly rural population of around 2,500, spread over two islands, together the size of Wales. In 1999, the over-stretched and under-resourced defence medical service announced it would pull out of the Falklands.

The islands' government placed an advertisement in HSJ asking trusts to submit bids to provide theatre services. Mr McGregor-Edwards said that, despite lengthy talks with several trusts, a satisfactory deal could not be struck. As a result, surgeons and anaesthetists are provided by London-based agency the Locum Group.

'This is working quite well, but we are continually looking at how we relate to UK hospitals.We have a good relationship with Southampton trust and with hospitals in Oxford, and we always want to look at new ways we can help them and they can help us, ' Mr McGregor-Edwards said.

The departure of the military has left several loose ends. With FIHS providing medical care for the Falklands garrison, the Ministry of Defence initially agreed to pay 20 per cent of the running costs.

'The long-term financial implications of that deal for both sides are still not clear, so it might be that we need some fine tuning.'

With such a tiny resident population, Mr McGregor-Edwards says the surgical unit is never as busy as UK units, despite visits from 35,000 cruise passengers and squid fishing fleets from Spain, Japan, South Korea and Russia each year.

'For that reason, it is not possible to keep a full team of two surgeons and two anaesthetists occupied, so we have a rotation system of three or four months.'

The four GPs on the island provide care at the hospital and assist midwives with the birth of around 30 Falklands babies a year. Given the location of the Falklands - 8,000 miles from the UK and 1,000 miles from the nearest centre of excellence in Uruguay - staff need to be of the highest calibre.

'We have to have highly qualified staff who can cope with any situation - and they do not come cheap.

We also provide the same staffing levels for theatres as the MoD, but as our staff is civilian they want good working hours, weekends off and other perks.'

Wool has been the mainstay of the Falklands economy, but a dramatic fall in value since the mid1990s has magnified the problems of a remote rural community - high levels of alcohol and tobacco consumption, depression, loneliness and marital problems.

Strategy documents on alcohol and tobacco are expected soon, along with a dental plan, as Mr McGregor-Edwards says dental health on the islands is 'very bad'.

But he says tackling health and social problems is helped because the Falklands 'are exactly where the UK would like to be in terms of joined-up services'.

'If there is a problem that is medical, social or at the primary care interface, they are all included within my department and within a common budget.

That is very useful.'

But he says the 'goldfish bowl' nature of the islands raises problems of confidentiality 'because everybody knows everyone else, or is in some way distantly related.'

It means it is not possible to remain anonymous, as is so easy in a big city: 'You can't afford to have a long-term spat here, ' he says.

Islanders do not like what they read in UK newspapers about hospital trolley waits and NHS reforms. 'When I came here, they said: 'do not you come here with your fancy UK NHS changes'.'

Despite the warning, Mr McGregor-Edwards has introduced changes to cut GP waiting time and he has brought in a system to give people from the Camp (anywhere outside Stanley) priority, and is soon to introduce an over-the-counter pharmacy service.

'We also want to increase the accountability of the health service to local people: we are trying to include, and get feedback from, as many people as possible.

'A new complaints procedure has gone down well. We have actually had an increased number of comments and suggestions, rather than complaints.'

However, some elements of Falklands life just do not translate into NHS speak: 'We have discovered there is a Read code (codes to identify ailments and treatments) for sea urchin spine injury, but not one for sea-lion bite.'

Here and there: Norman McGregor-Edwards'

CV

1972: BA English literature and language

1972 1972-90: Career in RAF general management

1993: Open University MBA

1993: Practice manager and fund manager, Valley Medical Group, Sheffield

1994: Various managerial jobs, Greater Glasgow health board

1999-2000: General manager, Glasgow Central primary care trust

January 2001: General manager, Falklands Islands health service