Chamber
Plenary, 05 Jun 2008
05 Jun 2008 · S3 · Plenary
Item of business
Remote and Rural Health Care
I welcome the temperate and considered speech that my colleague on the Health and Sport Committee, Ross Finnie, has just made.
The foreword to "Delivering for Remote and Rural Healthcare" mentions the objectives of delivering
"a strategy for sustainable healthcare in remote and rural Scotland"
and
"workforce planning arrangements to support the remote and rural agenda."
The report contains a diagram that shows the relationships between district general hospitals, community hospitals and extended community care teams. I want to explore those with reference to an area that I know well—the Scottish Borders—against the area's background of an ageing population and the demands of that, a lack of public transport, long distances and the often historic existing facilities. Areas elsewhere in rural Scotland have a similar background.
We should all welcome a strategy that is not a straitjacket. We know that the cabinet secretary's approach must have built-in flexibility to reflect the topographical differences between, say, the island communities, the Highland mainland, the Scottish Borders and other parts of the south of Scotland. There are remote places and isolated farmhouses in the valleys of the Borders, but the Borders also contain many historic communities, such as Jedburgh, Selkirk and Peebles, which have a culture of proud autonomy. It is to be regretted that, in the face of fierce local opposition, the previous Labour-Liberal Administration supported the closure of the community hospitals in Jedburgh and Coldstream, but effective, efficient and modernised community hospitals, such as Hawick community hospital and Hay Lodge hospital in Peebles, remain.
Hay Lodge hospital is currently at war with the health board over a proposed reduction in the number of long-term beds—I will address that matter shortly. I have met the cabinet secretary, the board and the GP practice at Hay Lodge hospital, and it seems to me that, although on paper there is excess bed provision seasonally across the Borders as a whole and the board may be able to make staff savings—particularly agency savings; all members know that agencies are costly—by not servicing beds, there is no spare capacity at Hay Lodge hospital. I understand the logic behind the board's thinking that there will be economic savings through discharging an elderly Peebles patient to, say, Hawick community hospital, but the patient's family, the community and I do not think that doing so would be in that person's medical, psychological or social interest when they could be placed locally, within reach of their family and friends in Peebles, and not have to use public transport, which is, as I have said, poor in the area. NHS Borders is, of course, responsible for making 2 per cent savings across its budget and balancing its books—indeed, I think that it did so for the first time in the previous financial year—but I ask the cabinet secretary to keep a watching brief on the problem, which may be replicated elsewhere. I know that she will do so.
Page 18 of the report contains commitments. It states:
"CHPs should review their Community Hospitals to determine which, if any, should be enhanced".
The responsibilities at bullet points 5, 6 and 7 would be affected if long-term stay beds at Hay Lodge hospital closed. Palliative care, out-patient treatment and so on would be affected.
On NRAC, it has been said that the previous Administration established the independent committee, but that does not mean that members of that Administration or anyone else must follow it slavishly. That is the key point. Obviously, concern exists that rural boards may be losing out. The cabinet secretary has given an assurance that no board will lose out and that measures will be phased in, and in attending to the Liberal Democrat amendment she agreed to keep things under review and to set up a standing committee. That is the way forward. If we fight such wars in the local press, we may stir up more problems—[Interruption.] I am trying to be straight. If we fight such wars in the local press, we may stir up more problems than may or may not exist. The way forward is through cool heads considering the matter. Indeed, the report says that the report itself should be considered against the background of the NRAC review, which predated it. We have sets of information that need to be assessed together.
The foreword to "Delivering for Remote and Rural Healthcare" mentions the objectives of delivering
"a strategy for sustainable healthcare in remote and rural Scotland"
and
"workforce planning arrangements to support the remote and rural agenda."
The report contains a diagram that shows the relationships between district general hospitals, community hospitals and extended community care teams. I want to explore those with reference to an area that I know well—the Scottish Borders—against the area's background of an ageing population and the demands of that, a lack of public transport, long distances and the often historic existing facilities. Areas elsewhere in rural Scotland have a similar background.
We should all welcome a strategy that is not a straitjacket. We know that the cabinet secretary's approach must have built-in flexibility to reflect the topographical differences between, say, the island communities, the Highland mainland, the Scottish Borders and other parts of the south of Scotland. There are remote places and isolated farmhouses in the valleys of the Borders, but the Borders also contain many historic communities, such as Jedburgh, Selkirk and Peebles, which have a culture of proud autonomy. It is to be regretted that, in the face of fierce local opposition, the previous Labour-Liberal Administration supported the closure of the community hospitals in Jedburgh and Coldstream, but effective, efficient and modernised community hospitals, such as Hawick community hospital and Hay Lodge hospital in Peebles, remain.
Hay Lodge hospital is currently at war with the health board over a proposed reduction in the number of long-term beds—I will address that matter shortly. I have met the cabinet secretary, the board and the GP practice at Hay Lodge hospital, and it seems to me that, although on paper there is excess bed provision seasonally across the Borders as a whole and the board may be able to make staff savings—particularly agency savings; all members know that agencies are costly—by not servicing beds, there is no spare capacity at Hay Lodge hospital. I understand the logic behind the board's thinking that there will be economic savings through discharging an elderly Peebles patient to, say, Hawick community hospital, but the patient's family, the community and I do not think that doing so would be in that person's medical, psychological or social interest when they could be placed locally, within reach of their family and friends in Peebles, and not have to use public transport, which is, as I have said, poor in the area. NHS Borders is, of course, responsible for making 2 per cent savings across its budget and balancing its books—indeed, I think that it did so for the first time in the previous financial year—but I ask the cabinet secretary to keep a watching brief on the problem, which may be replicated elsewhere. I know that she will do so.
Page 18 of the report contains commitments. It states:
"CHPs should review their Community Hospitals to determine which, if any, should be enhanced".
The responsibilities at bullet points 5, 6 and 7 would be affected if long-term stay beds at Hay Lodge hospital closed. Palliative care, out-patient treatment and so on would be affected.
On NRAC, it has been said that the previous Administration established the independent committee, but that does not mean that members of that Administration or anyone else must follow it slavishly. That is the key point. Obviously, concern exists that rural boards may be losing out. The cabinet secretary has given an assurance that no board will lose out and that measures will be phased in, and in attending to the Liberal Democrat amendment she agreed to keep things under review and to set up a standing committee. That is the way forward. If we fight such wars in the local press, we may stir up more problems—[Interruption.] I am trying to be straight. If we fight such wars in the local press, we may stir up more problems than may or may not exist. The way forward is through cool heads considering the matter. Indeed, the report says that the report itself should be considered against the background of the NRAC review, which predated it. We have sets of information that need to be assessed together.
In the same item of business
The Presiding Officer (Alex Fergusson):
NPA
Good morning. The first item of business is a debate on motion S3M-2056, in the name of Nicola Sturgeon, on remote and rural health care. I remind members th...
The Deputy First Minister and Cabinet Secretary for Health and Wellbeing (Nicola Sturgeon):
SNP
I am happy to open yet another health debate. I suspect that there are members here this morning who have not been home since last night's member's business ...
Jeremy Purvis (Tweeddale, Ettrick and Lauderdale) (LD):
LD
I have heard that mantra on many occasions. It is, however, disingenuous. Although the baseline grant has not been affected for this year, boards such as Bor...
Nicola Sturgeon:
SNP
Jeremy Purvis came in right on cue when I was talking about irresponsible members. What I said is not a mantra; it happens to be the truth. No health board w...
Rhoda Grant (Highlands and Islands) (Lab):
Lab
Will the cabinet secretary take an intervention?
Nicola Sturgeon:
SNP
No—I have to move on and discuss the Liberal Democrat amendment. The amendment is sensible, because a funding formula should not be static. It should be kept...
Margaret Curran (Glasgow Baillieston) (Lab):
Lab
On what I hope is a consensual note, I begin by saying that Labour feels that this is certainly a welcome debate on an important issue. Health care in remote...
Nicola Sturgeon:
SNP
I am more than happy to engage in debate, but debate usually involves suggesting solutions as well as making criticisms. Does Margaret Curran agree that she ...
Margaret Curran:
Lab
I think you should pay attention to the exact details of what I said. My argument is not about the amount but about the share, and you know that full well, c...
The Minister for Public Health (Shona Robison):
SNP
Will the member take an intervention?
Margaret Curran:
Lab
No. I did Nicola Sturgeon the courtesy of taking an intervention, but she did not do me the same courtesy. I would prefer it if you would allow me to pursue ...
Shona Robison:
SNP
Will the member take an intervention?
Margaret Curran:
Lab
No, thank you.We are talking about the range of resources from funding for ambulance services to funding to ensure equal access to major Government commitmen...
Nicola Sturgeon:
SNP
Margaret Curran makes an important point, but will she acknowledge that the appointments in NHS Western Isles that have attracted much criticism were made un...
Margaret Curran:
Lab
I say with the greatest respect that the cabinet secretary has missed the point. The point is not party political. Laughter.
The Presiding Officer:
NPA
Order.
Margaret Curran:
Lab
The point is not political. It is about the NHS's management. The NHS's appointments procedures are governed not by politicians, but by its administration. W...
Mary Scanlon (Highlands and Islands) (Con):
Con
Margaret Curran talked about Western Isles NHS Board. On behalf of all of us and for the sake of NHS staff and patients in the Western Isles, I hope that peo...
Ross Finnie (West of Scotland) (LD):
LD
I am delighted that we are having a debate on rural health care, as this is the first occasion since the new Government was formed on which I have been able ...
Dr Richard Simpson (Mid Scotland and Fife) (Lab):
Lab
Will the member give way?
Ross Finnie:
LD
No—I will press on, because I want to make a point about the purpose of our amendment that I hope will be helpful to Mary Scanlon and other Conservative memb...
The Presiding Officer:
NPA
We move to the open debate. Speeches should be around six minutes, please.
Christine Grahame (South of Scotland) (SNP):
SNP
I welcome the temperate and considered speech that my colleague on the Health and Sport Committee, Ross Finnie, has just made.The foreword to "Delivering for...
Margaret Curran rose—
Lab
Christine Grahame:
SNP
I want to move on. I have only six minutes in total.On staff issues, we should consider the delays in implementing the agenda for change. That is not a Scott...
Rhoda Grant (Highlands and Islands) (Lab):
Lab
I am pleased to take part in this debate on remote and rural health care and I welcome the report. The cabinet secretary is pleased to endorse its recommenda...
Shona Robison:
SNP
The member has just said that the report referred to the minimum level of service that we would expect. Where there are more comprehensive services, we would...
Rhoda Grant:
Lab
I am grateful to the minister for that reassurance. I am sure that the people of Caithness will be grateful for it, too.The report states that there has been...
Jamie Stone (Caithness, Sutherland and Easter Ross) (LD):
LD
The Howard Doris centre is funded jointly by NHS Highland and Highland Council. Does Rhoda Grant agree that there is a question mark over Highland Council's ...
Rhoda Grant:
Lab
Indeed. However, my point is that if the community had not brought forward that initiative, there would be no joint funding. It was the community that raised...