Meeting of the Parliament 21 May 2014
As the Scottish Government’s mental health strategy states, mental illness is one of the greatest health challenges that we face. However, with appropriate and good-quality treatment and support, people can cope, learn to manage their condition and make a full recovery. Government policy is—rightly—geared towards shifting the balance of care from institutional settings to more community-based provision, where treatment is delivered at home or in the community. All the major stakeholders are signed up to that policy—or at least we thought that they were.
In the past week, following a freedom of information request that my colleague John Pentland submitted 18 months ago and a ruling by the Scottish Information Commissioner that ordered the release of the papers involved, we have established that one of the key players who is supposed to be driving the policy is not signed up to it at all—or at least he was not signed up to it when he thought that it would have an impact on his constituency. That player is the Cabinet Secretary for Health and Wellbeing—the man in charge of the policy.
As far back as 2006, NHS Lanarkshire identified a need to change how it delivers mental health services. Years of consultation, planning and work with clinicians, staff, patients and voluntary organisations followed, and a consensus emerged that a two-site plan—with acute beds located at Hairmyres hospital and a much-needed intensive psychiatric care unit at Wishaw general hospital, complemented by community-based provision—was the best way forward to deliver much-improved services.
That plan was to help waiting time targets to be achieved, reduce admissions of young people to non-age-specific in-patient beds, extend child and adolescent mental health services provision beyond the age of 16, address the Mental Welfare Commission for Scotland’s critique of NHS Lanarkshire being the only mainland board without a dedicated intensive psychiatric care unit and provide a safer and more sustainable medical rota to deliver care. That was approved by the then cabinet secretary, Nicola Sturgeon, and by Lanarkshire Links—the leading mental health organisation in the area—and its members.
Following the Cabinet reshuffle on 5 September 2012, Alex Neil replaced Nicola Sturgeon as the cabinet secretary. He acted immediately and, on 15 September, he advised civil servants that he was reviewing the NHS Lanarkshire proposals and that a final decision would be taken soon.
On 18 September, the then head of NHS Scotland, Derek Feeley, advised Catriona Borland, director for health and workforce planning, that Alex Neil was
“minded to review the decision on Lanarkshire’s mental health proposal.”
On 26 September at 9.43 am, Alex Neil’s private secretary advised civil servants:
“Mr Neil is clear in his view that acute mental health facilities should be retained in both Wishaw and Monklands. The Cabinet Secretary has asked that you seek agreement from NHS Lanarkshire to reconfigure their plans accordingly.”
In other words, he scrapped the proposals that had been endorsed by the stakeholders and his predecessor Nicola Sturgeon.
Later that day, in a reply to Richard Lyle MSP in the chamber, the cabinet secretary said:
“I believe that”
NHS Lanarkshire
“is revising its original proposal for the mental health unit at Monklands with a view to retaining an acute mental health facility at the hospital.”—[Official Report, 26 September 2012; c 11895.]
Of course he believed that the board was reviewing its proposal, because he had instructed it to do so.
However, the plot thickens. It has now been revealed that, at 9.44 that day, several hours before the cabinet secretary answered Richard Lyle’s question, Ian Ross, the chief executive of NHS Lanarkshire, advised him:
“there is no alternative option which can deliver the same benefits within the funding. Any changes to this plan would need to be explained to the key stakeholders including service users and carers who are fully supportive of the proposed developments.”
Only later that day, after all that involvement, did the cabinet secretary decide to take a step back because, as he said,
“there could be a perception of a conflict of interest.”
There was not a perception of a conflict of interest: there was a conflict of interest. Alex Neil had already made a decision that ran contrary to the policy that he was in charge of promoting.
Let us review the evidence and charges against the cabinet secretary. When Nicola Sturgeon was in post, he initially asked her to delay any decision until after the council elections and then until after his holiday, thus putting the needs of mental health patients behind his party and personal interests.
He reversed the decision that Nicola Sturgeon had endorsed to go with the consensus on how to improve services—a decision that NHS Lanarkshire’s chief executive said would result in a
“less than optimal service for patients who might be cared for there.”
He ordered the retention of facilities known to be riddled with asbestos. He worked against the interests of the people of Lanarkshire by pretending to be their saviour when, all along, the clinical evidence was clear that the proposed changes were in the best interest of patients.
He actively opposed his own Government’s policy of shifting the balance of care—the very policy that he was in charge of. He breached the ministerial code by failing to recognise the conflict of interest between his ministerial role of promoting Government policy and his constituency interest and stood back only after he had decided to reverse his predecessor’s decision.
Crucially for members, he misled Parliament by stating that he “believed” that NHS Lanarkshire was reviewing a decision when, as we now know, he had already taken the decision.
I take no pleasure in moving the motion. We have been forced into this position by the cabinet secretary and the First Minister who, in the last week, have singularly failed to come up with—or even try to come up with—a credible answer to the charges that are laid before them.
I say to the other parties that this Parliament has a duty to demand integrity in our political system. The dogs in the street know what Alex Neil has been up to. He has been caught holding the smoking gun, and the First Minister and his deputy know it. We believe that he has misled his constituents and we believe that he has misled this Parliament. For those reasons, we have proposed a vote of no confidence in Alex Neil.
I move,
That the Parliament has no confidence in the Cabinet Secretary for Health and Wellbeing as a result of his failure to disclose his involvement in the decision to reverse the planned closure of mental health services at Monklands Hospital.
15:40