Hansard

I am grateful for the opportunity to provide an update to members on NHS capital projects, specifically on the current position and next steps for the Monklands replacement project.

I begin by being absolutely clear: the Government will deliver a new Monklands hospital. That commitment has not changed and it will not change. However, having carefully considered the full business case that was submitted by NHS Lanarkshire, I cannot approve it in its current form within our current financial landscape. That is not a decision that I have taken lightly. The case for replacing Monklands is well established. The current hospital estate is ageing, it presents ongoing operational challenges and it constrains the delivery of modern models of care. Staff have worked in difficult conditions for many years and they deserve better. Patients deserve better.

There have been active campaigns by members across the chamber to represent the views of constituents in Lanarkshire, including by my colleagues Neil Gray and Fulton MacGregor. I fully appreciate the strength of feeling on the need for a new Monklands hospital. However, it is also my responsibility to ensure that major investment decisions are affordable, deliverable and aligned with the future direction of our health and care system. The proposal that is before us has an estimated cost of around £2.1 billion and would represent an unprecedented concentration of capital investment in a single health project. For context, it would cost an estimated £5 million per bed to deliver and would exceed the cost of delivering Scotland’s largest hospital, the Queen Elizabeth university hospital, and the new HMP Glasgow. Proceeding in that cost envelope would significantly limit our ability to invest in services and infrastructure across the wider NHS. I have carefully weighed the opportunity cost against our objective on improving public services.

The current proposal also raises important questions about value for money. It is significantly more expensive than comparable programmes. Investment of that scale must be fully justified before it can be approved. Just as importantly, the current design is heavily reliant on large acute hospital provision. That is not the direction in which our health service is moving. Across Scotland, we are shifting towards delivering more care closer to home, strengthening community services, making better use of digital technology and ensuring that hospitals are focused on those who need specialist and complex care. To proceed with the current proposal would risk locking us into a model that does not represent the best use of public investment in the years ahead. Finally, the project is approaching a point where continued design development would lead to further cost escalation and reduce our ability to consider alternatives. It is therefore essential that we act now.

Today, I am announcing that we will undertake a formal reset of the Monklands replacement programme. It is a reset and not a stop. It will involve pausing progression of the current design and commissioning a comprehensive redesign, which will be led jointly by the Government, NHS Lanarkshire and partners across the west of Scotland. It is not delay for its own sake and we are not stepping back from our commitment. The new design will take a whole-system approach, bringing together acute care, community services, diagnostics and digital provision in an integrated model. Importantly, the work will take place at pace from the summer and will be focused on designing a modern hospital with a more efficient footprint.

I recognise that the announcement will raise concerns locally, and I will address those directly. First, we remain fully committed to building a new hospital at Monklands. Secondly, this is not about downgrading services; it is about delivering the right service in the right place. Core services, including accident and emergency, will be retained. Thirdly, I recognise the challenges that staff and patients in the current hospital face, and I can announce today that we will invest in addressing immediate infrastructure risks, including known issues that affect patient experience. That will ensure that safe, high-quality care continues while the replacement programme is taken forward.

I pay tribute to the staff at Monklands for their dedication, patience and professionalism. They have been waiting a long time for a new facility, and the project team has worked hard to progress this important project. I am committed to working closely with NHS Lanarkshire to move the project forward at pace.

I am committed to ensuring that the new Monklands hospital plays a core role in designing how we deliver services in the future. That means ensuring that Monklands acts as the blueprint for how we deliver better services in the community, building on the work that is being taken forward by our subnational planning partnership. For example, I am open to the prospect of Monklands not only being an acute hospital but delivering specialist services for communities across the central belt and west Scotland. Alongside the reset of the Monklands programme, we will use this opportunity to rebalance investment across the wider system. The scale of the original proposal would have concentrated a significant proportion of our capital budget in a single project. By taking a different approach, in addition to investing in services that serve the people of Lanarkshire, we can invest more broadly.

Central to that will be investment in community health hubs, which will bring together services such as general practice, community nursing, mental healthcare, diagnostics and out-patient services in modern facilities closer to home. The hubs will make it easier for patients to access co-ordinated care in a single place, reducing the need to travel to hospital. We have set out the first phase of investment in the hubs in Port Glasgow, Cowdenbeath and Lochgelly, and East Calder. We will use those projects to deliver a standardised model for further centres, including in Hamilton, Cumbernauld, Edinburgh, Ayr, Kincardine, Inverness, East Dunbartonshire and Glasgow. For patients, that will mean quicker access, earlier intervention and more care delivered in the community. For the wider system, it will reduce pressure on acute hospitals, allowing focus on those who need specialist care most.

I can announce today that, as part of the programme, specifically for Lanarkshire, we will begin with a new general practitioner walk-in facility in Lanark—transforming an old shop front and a retail park in the town centre into a GP walk-in centre. We will also deliver a new walk-in GP service in Shotts.

By rebalancing our investment, it is my intention that we will deliver on other NHS capital projects that are priorities for communities across our country. For example, if further investment is required to ensure that the Baird hospital and ANCHOR—Aberdeen and north centre for haematology, oncology and radiotherapy—project in Aberdeen can be delivered safely, ministers will consider that carefully.

Under the reset approach, we will move at pace to complete the redesign over the next year and bring forward revised options by the middle of 2027. Subject to ministerial decisions, the design will then progress, with an ambition to begin construction in 2028. We will set clear milestones, including completion of the redesign, agreement of the final scheme and the start of construction. We will ensure demonstrable progress during this parliamentary session.

This is a difficult decision, but it is the right one. I want to reiterate three key points: we will build a new Monklands hospital; we will do so as part of a wider transformation of care across Lanarkshire and the west of Scotland; and we will ensure that the investment meets the standards that are required for managing public money by delivering the best possible outcomes for patients, staff and the people of Scotland.

I commit that the Government will work as quickly as possible with NHS Lanarkshire to ensure that there is a redesign that is affordable and, crucially, that reassures the local community that vital services will not be lost or downgraded.

I am happy to answer any questions that members have. I will also reach out directly to offer a meeting to any local MSPs who have further issues that they wish to discuss.