Hansard

On behalf of the members of the Parliament's Health and Community Care Committee, I welcome the opportunity—[Interruption.] I welcome the opportunity to watch Iain Gray wreck the furniture and to open the first debate initiated by a subject committee. Members are a little sparse on the ground this morning. There must be something going on somewhere else. We all know about that.

I take this opportunity to pay tribute to our committee clerks and to our researcher for their hard work and input into the committee's work to date, which I will outline. I pay tribute also to the tremendous contribution of MSPs of all parties to the committee. In the months and years to come, the committee will play a significant role in the improvement of health services in Scotland.

It is significant and a sign of the changing political climate in the country and in the health service that we have decided to initiate a debate on accountability and consultation. The debate should and must send a clear signal that a new light of scrutiny must fall across the work of the health service. The debate must place the rights of patients at its heart.

During recent months, the committee has become increasingly concerned that, despite reassuring words in Government document after Government document over many years, people still feel that their voices are not being heard by health boards, health trusts, professionals and politicians. People believe that we have a national health service in which clinical voices will always be heard above lay voices. They believe it is a service in which, historically, the culture is one of secrecy rather than of openness; in which managers would rather hide information from the public and the media than engage with them to improve the quality of care; in short, that we have a secret service.

We all know the benefits of consultation. Indeed, in the debate earlier this morning, we heard that even this Parliament does not always get things right. I am sure that my committee colleagues will agree that we still have a lot to learn about how to consult bodies in the health service on the committee's work. Nevertheless, the Parliament seeks to engage in effective consultation with those bodies.

One of the key aims of the consultative steering group was to make the Parliament open and accountable and, through it, to make others more accountable to the public. The committee will play its part in that wider vision in several ways: through taking written and oral evidence; through meeting and listening to individuals, groups and statutory bodies; through visits to health and community care services throughout Scotland, beginning with our review of community care; and through working in innovative ways with users, carers and patients.

Our role includes scrutiny of the Executive's legislation and health budget and investigation of major areas of local and national concern. We have already called several boards, trusts and others to give evidence to the committee and to be scrutinised by us. It is likely that by the end of this first parliamentary session, each and every health board in Scotland will have been called to give evidence to us publicly about the state of the health service across the country.

The Public Petitions Committee plays a crucial role in making us more accessible. The committee, which acts as a public gatekeeper to our parliamentary procedures and processes, has passed two petitions to the Health and Community Care Committee that I want to mention in relation to the need for greater accountability and better consultation in the health service.

The first petition, which had 25,000 signatures, was presented by the Stracathro staff action committee. It highlighted concerns about the possible closure of the Stracathro district general hospital in Brechin. The second petition was presented earlier this year by the Glasgow North Action Group and concerns the proposed siting of a medium secure unit in the grounds of Stobhill general hospital in Glasgow. The motion refers to the first of those petitions, but the concerns of the committee outlined in the motion relate to both, and to a wider range of anecdotal comment that we have received.

It is perhaps useful at this stage to mention to colleagues that committee members have taken the view—and will probably continue to do so—that although petitions may refer to local services and situations, the role of the Health and Community Care Committee should be to take a national view and to learn strategic lessons from local examples. It should not be for us to deliver or overturn local decisions.

The committee decided, as part of our Stracathro report, to focus on communication and consultation with patients, staff and the wider communities of Angus and the Mearns, as well as on other aspects of the management of hospital resources. It became clear from the evidence that we took that there had been faults in the consultation process, including a failure to hold public meetings in key areas, and a poor standard of communication between Tayside University Hospitals NHS Trust, its predecessor trust, Tayside Health Board, patients and concerned groups. Critically, there was a failure to work in partnership with staff. We found that staff had been inadequately consulted and had found out about closures and changes through the media. Their morale and recruitment problems had worsened because of continuing uncertainty.

Compare that with the warm words of the new human resource strategy, "Towards a new way of working":

"we need to ensure that . . . as change impacts on employment and jobs, an employee relations framework is created which gives staff the opportunity of real consultation, involvement and the ability to influence decision making".

The Health and Community Care Committee agrees with that whole-heartedly, but has expressed its concern at the difference between that aspiration and the way in which hard-working, dedicated professional staff had been treated at Stracathro. We recommended that the board's and trust's non-compliance with the terms and spirit of that strategy should be investigated by the Executive in the accountability review of boards and trusts. We recommended that staff at all levels should be consulted timeously at all stages of the acute services review in Tayside.

The thousands of men and women who staff our health service are its backbone and they should be treated with respect. It is obvious that that means decent pay and conditions, training, educational opportunities, family-friendly and safe working conditions and decent environments in which to work; it also means that they must be encouraged to make an early input into any discussions about service changes and new initiatives.

We can improve the quality of our health services by working in partnership with staff at all levels, listening to their concerns and channelling their expertise. Many of our concerns that arise from our examination of the situation in Tayside have been heightened by the latest petition concerning Stobhill. We have been led to make a series of key recommendations.

I am sure that my colleagues, particularly the Health and Community Care Committee's reporter, Richard Simpson, will wish to comment in greater detail on the complex situation there. I wish to highlight a few of our recommendations and then move on to the wider picture.

The fact that the health service is lacking clear guidance on proper and effective consultation has been highlighted. Despite our finding the consultative process of Greater Glasgow Health Board to be flawed, we are bound to note that it has gone further than it is required to do to fulfil its statutory obligations. The sad truth is that there are no guidelines advising health boards that they have to inform, engage with and consult staff and the general public about new proposals, such as the new medium secure unit, or the walk-in, walk-out ambulatory care and diagnostic unit, which is planned for the same site.

Whereas there are no guidelines for consultation on new service provision, the guidelines for consultation on the change of use or closure of facilities are 25 years old—older than Duncan Hamilton, a member of the Health and Community Care Committee. Much of what is in the management executive letter from 1975 is good. It tells boards to consult all bodies with a valid interest and gives some examples—health councils, staff associations, local authorities and MPs—but it falls silent on the wider needs of the public at large and leaves it to boards to determine the necessary range of consultation. That is just not good enough these days. There is no excuse for a modern-day health service to be guided by such archaic rules. That is why we have asked the Executive to deal with the concerns as a matter of urgency, to draw up guidelines and to instruct health boards to draw up interim consultation programmes immediately.

Given the Executive's commitment in "Designed to care" to create a partnership between patients and the professionals who care for them by giving both a bigger say in the design and management of the national health service, I hope that the Executive will embrace our suggestions.

Over the years, successive Governments have published a range of booklets and other publications that outline the need for consultation. That on the closure and change of use of health service premises, the code of practice on openness in the NHS, "Designed to care", "Towards a new way of working", "Consulting Consumers" and the carers strategy are just a few of them.

However, rather than being at the heart of the consultation process, the public have often been treated as an afterthought or an inconvenience. Too often, the practice on the ground is different from the aspiration in the policy document. Some health professionals desperately want to engage with the public, their patients, but do not know how to. We should not underestimate the fear factor. Consultation and accountability are not easy. We, of all people, should know that.

There should be a clear strategy and clear guidelines that cover the minimum levels of consultation and give examples of best practice. Clinicians, for so long treated by so many as some form of deity, will have to engage with the public, but we cannot expect them to do so effectively without proper training and guidance. Further, we cannot expect health service bodies to do so without the relevant back-up and financial support from the centre to make representative participation a reality.

If we are serious about involving patients more in decisions about health care, either at the level of their own treatment or at the level of local service provision, they must have access to good information. If we are serious about planning and delivering services from the perspective of patients, we must involve them and give them the tools to make effective contributions. Without proper information, patients will either uncritically defer to the views of professionals or make ill-thought-out, nimbyesque decisions that fail to consider the full picture of service provision.

Provided with accessible and appropriate information, patients are a valuable asset. The Scottish Consumer Council is right to point out that service providers have much to learn from consumers, who are an expert resource. Knowledge of people's experience of illness, disability and using the health service is invaluable. We must all be honest enough to acknowledge that, sometimes, even the best consultation process will result in hard choices having to be made and people being disappointed. There will be times when we will have a responsibility to step back and see the wider picture. Everyone has that responsibility—health service managers, professionals, members of the media, politicians and patients.

If we want to have a better-informed patient base, we must find ways of engaging in continuing consultation and involvement, and not just have one-off meetings in public halls. The service's consultation techniques must evolve to make use of new technologies. There must be a move away from traditional public meetings towards the use of citizens juries, quantitative surveys, carers and users groups, road shows, stakeholder conferences and so on.

At all times, the changing health service must try to retain public confidence. Of course, that confidence will be built by greater funding and better services, but it will also be built by more openness, through measures such as the Freedom of Information Bill, and greater accountability. At the moment, the accountability of health boards, trusts and health councils can be called into question because of the democratic deficit. In our Stobhill recommendations, we ask the Executive to consider options to address that deficit, either through the direct election of health commissioners to the bodies or through the involvement on those bodies of local elected representatives such as councillors or MSPs.

The Executive has a crucial part to play in modernising the system of public appointments to NHS bodies. I am happy to say that that is being taken seriously. It is critical that public appointments are made on merit and are not just jobs for the boys—I use that term advisedly—or political appointments. It is essential that we get the right people in the right place at the right time and that we widen the range of people serving on those powerful bodies. I believe that there is a role for parliamentary scrutiny of those appointments and favour some form of pre-appointment scrutiny, possibly by parliamentary committees.

Scotland's health councils are the only publicly led statutory organisation representing patients and have a right to be consulted on service changes. That puts them in a powerful position. While we acknowledge that they do a great deal of good work, we retain concerns about their funding and the fact that council members are partly appointed by the health board, which might call into question their independence.

Health councils and elected representatives could play a stronger role in terms of scrutiny and accountability by, for example, attending the annual accountability review to comment on boards' performances in relation to, say, public involvement. Currently, the management executive holds health boards accountable for their performance at an annual accountability review meeting that covers many other subjects. Health councils are now asked to comment on health board performance, but are given only a short time in which to do so and are not invited to attend the private review meeting.

Public involvement must be regarded as an integral part of the health service in the acute and primary care sectors. In primary and community care, well-thought-through patient involvement may have the most significant impact in the creation and development of local health board care co-operatives and other new service developments. There must be a place for patient and user input to ensure that the services that are delivered are what patients need.

Many of the public involvement issues of recent years have arisen through the decommissioning of long-stay facilities and the move towards care in the community, along with the impact of acute services reviews. Although changes to acute services are always more likely to generate petitions and public concern, the voluntary sector and others are right to be concerned about funding issues, equity issues—such as postcode prescribing—and issues that arise from care in the community.

The onus is now on us to lead an honest debate on what the NHS can and cannot afford. The onus is on our citizens to decide whether they want to pay for health services through taxation, through increased taxation or by other means. Only last week, Dr John Garner of the British Medical Association said that it is time for the Government to admit to rationing in the NHS and for the general public to engage in a debate on what the NHS should offer. There is a role for all of us in that debate.

In placing the rights of the patient at centre stage in this first committee debate, I would like to end my speech on the subject on which I began, by stating the Health and Community Care Committee's commitment to open and accountable government at all levels of health care. We will monitor the Executive's response to our work on this matter and, through our continuing work, seek to consult and engage with patients and professionals throughout Scotland.

The committee is part of a new multidisciplinary health force that will improve health care in Scotland. We are determined to play our part to the best of our abilities. The latest priorities and planning guidance for the NHS says that the NHS should give renewed impetus to its efforts to involve patients in the planning and delivery of care and should respond positively to their views and preferences.

I commend to Parliament the Health and Community Care Committee's report into Stracathro and our on-going work as examples of our commitment to placing patient care and involvement at the heart of our health service and to tearing down any remaining vestiges of the veil from the secret service that is—or was—our health service.

I move,

That the Parliament notes the concerns of the Health and Community Care Committee, in relation to the accountability of health boards and NHS Trusts and notes the need for a new approach to public consultation as illustrated in the recent and ongoing work of the Committee, and in this connection the Parliament notes the 9th Report, 1999 by the Committee, Report on Stracathro Petition PE13 (SP Paper 48).