Hansard

Obviously, Sandra White would have liked to be here to speak about NHS Greater Glasgow and Clyde, but I will address the wider issues that are identified in the debate's title, "National Bed Assessment", and pick up on some issues that have been raised in the debate.

John Swinburne is right to reflect that, although in Parliament we by and large deal with management processes in the health service at a strategic level, ultimately it is about individuals and people. That must colour our perceptions of and discussions on the health service.

When I was first elected to the Parliament in 1999, my first question at my first meeting with representatives of Lothian Health Board was, "What are you going to do about MRSA?" They replied that the design of the new royal infirmary would cut down MRSA figures. Unfortunately, recent figures show that the incidence of MRSA at the Edinburgh royal infirmary is high—at a time, interestingly, when St John's hospital has made great progress in reducing it.

If we are to tackle the issue of hospital bed assessments, we need to learn from elsewhere. I am interested in hearing the minister's reasons for not carrying out a national bed assessment in Scotland, given that such an assessment took place in England as a means of directing resources.

The changes to A and E services that members have already highlighted also have implications. For example, in the Lothians, emergency surgery and orthopaedic trauma services were moved from St John's hospital to Edinburgh royal infirmary. Indeed, because of that decision, Edinburgh royal infirmary has to increase the capacity of its reception area by 40 per cent. Many requiring orthopaedic trauma treatment are elderly people who, for example, have broken bones. In the Lothians, they have to go to ERI for their initial treatment and either are sent home with a care package—which, in the case that John Swinburne highlighted, was obviously sadly lacking—or, if they need to remain in hospital for treatment, are sent back to St John's. I wonder whether elderly people should be shifted from pillar to post in that way.

We have rehearsed the arguments about those clinical arrangements, but I want to look at how the situation pans out across Scotland. I know that planning work has been undertaken on health board catchment areas and so on. However, with the closure of the A and E department at Monklands hospital, the ambulance services will have to make a judgment call whether to take people who live in the west of West Lothian to the ERI or to St John's. Of course, if people require emergency surgery or orthopaedic trauma treatment, they can no longer be taken to St John's. At the moment, my constituents are quite often taken to Monklands hospital but, if that A and E department is closed, where can they go? A hospital is planned for Larbert, but that in turn raises questions about the size of its catchment area. I also know that clinicians at St John's are concerned about the sustainability of some services if the hospital at Larbert begins to take some of the patients from West Lothian. As a result, bed assessments are important not only for individual treatments but for service sustainability.

Of course, hospitals tend not to keep people in for as long as they used to, but that practice has serious implications for patients who have had to travel great distances. Moreover, members have highlighted the impact of evening discharge on individuals and their families. It has become increasingly clear from my constituency case load that centralising services has led to patients being discharged at awkward times of the night. Of course, that is fine for patients whose families live in the immediate vicinity, but the situation can prove difficult for patients who live an hour away and have, for example, to negotiate the Edinburgh bypass.

I hope that we can reflect calmly and coolly on the reality on the ground. We know that the area is complex and that issues have become compounded but, unless we know what we are working with, we cannot make any judgments. The call for a national bed assessment, which the SNP supports, is probably the least that we can ask to take this matter forward.