Hansard

I thank Jean Turner for securing this debate. As she knows, I have consistently supported the call for a national bed assessment. Indeed, the case of NHS Lanarkshire illustrates very well the need for an overall regional and national strategic view of the number of beds that we require. Rosemary Byrne referred to figures that I obtained a wee while ago from the Executive that show that, over a very short time, 20 per cent of beds were lost across Scotland and in NHS Lanarkshire with absolutely no national or regional consultation on such a fundamental shift in bed provision. It took place bit by bit without any public engagement or accountability.

Moreover, when we entered into the consultation on "A Picture of Health: A Framework for Health Service Provision in Lanarkshire", NHS Lanarkshire made it categorically clear at the outset that—even though it had carried out no work on bed modelling, workforce planning or cross-boundary flows—bed numbers would stay the same. The fact that it did so before consultations in the neighbouring health board areas had been completed and before plans had been implemented in those areas makes me highly sceptical about the science behind such commitments and about whether health boards are planning for the provision of need rather than cutting their coats according to their cloth—the resources that are available.

The issue of beds is not just about beds and the hospital estate; it is about the staff who go along with the beds and their skills mix. NHS Lanarkshire is either unable or unwilling to give figures on the number and skills mix of the staff whom they envisage being attached to the beds at Monklands hospital.

The motion involves so many issues that it is impossible to pick up on all of them. However, it is fair to say that communities throughout Scotland have no confidence whatever that the Executive or the health boards are planning future health care provision on any sound arithmetical, scientific or philosophical basis, or are taking into account the quality of care that will underpin that provision.

That brings me to my next point. Not long ago, Jean Turner and I both spoke at an NHS Consultants Association conference. The tendency to move towards subspecialisation is having a major impact on the availability of beds and on boards' ability to provide local health services, and it is distorting the patient journey. I speak from recent experience—Rosie Kane and I both have recent experience of the patient journey in the NHS.

The fact that patients often have a number of conditions that do not come in neat packages gives rise to a significant issue in some areas where there has been centralisation. It is difficult for a person who is ill with two conditions to get holistic care if treatment of one condition has been centralised in one hospital while treatment of the other has been centralised in another. That will be a huge issue for the health service in the future. An overall assessment of the balance between generalisation and subspecialisation needs to be carried out in a way that takes into account the patient and their holistic needs. Sometimes patients do not need superspecialists; sometimes they need generalists who are able to look after their whole health rather than specialists who constantly refer them somewhere else and have them buzzing about all over the city.

I have spoken about the skills mix, but I want to finish on a point about the hospital estate, in which I include public-private partnership and private finance initiative new-build hospitals. The hospital estate is not kitted with enough beds to isolate patients who have hospital-acquired infections, which means that barrier nursing has been made extremely difficult in our old estate and our new estate. There is no sense that the problem has been acknowledged or that planning is being done for enough beds to be provided so that patients can be isolated.