Chamber
Plenary, 21 Feb 2008
21 Feb 2008 · S3 · Plenary
Item of business
Democracy in Local Health Care
This has been a good and timely debate, which is being held during the consultation on the forthcoming—and also well timed—local health care bill. It has allowed a comprehensive airing of many of the issues related to increasing democracy in local health services. Interesting and constructive contributions have been made by members from throughout the chamber.
As many members have said, in the past few years the desire for meaningful public engagement in the development of the NHS has been growing, alongside increasing dissatisfaction with the way in which a number of health boards have interacted with the public when major changes were planned in the local delivery of health care provision.
A number of us in the chamber today—including the cabinet secretary and the minister—will remember the enthusiasm and optimism in the chamber when the anticipated Kerr report on the future of the NHS in Scotland was being discussed, because patient groups and other NHS and public representatives who were present felt that at last they were having a real and meaningful input to the future shape of the NHS.
Sadly, as health boards across the country began the process of reconfiguring services in response to the Kerr recommendations, too many people in too many areas felt that health boards were consulting the public on a fait accompli and were paying scant attention to the reactions and responses of their local stakeholders—as Christine Grahame described graphically with regard to her region in the Borders.
The many campaigns that ensued across Scotland clearly showed the public's dissatisfaction with the consultation process. In my own area, the retention of the option for women to give birth in community hospitals in Aboyne and Fraserburgh was achieved only after a protracted, well-organised and vocal campaign by local people against NHS Grampian's proposals to close those maternity facilities. We are all familiar with the equally strong campaigns to retain A and E provision in various parts of Scotland and with the campaign that Mary Scanlon highlighted to save the Belford in the Highlands.
The battles to retain local facilities have taken time, commitment and resources. They could have been avoided had health boards been made aware of the strength of public feeling and the cogent reasons for that feeling before recommendations for closure were made. Instead, in several cases, the impression was that the consultation process was a sham, with decisions already having been made by the boards, out of the public's view.
I, for one, am pleased that the Scottish Government has brought forward its "Better Health, Better Care" action plan, and I welcome its intention to promote a local health care bill within the first year of this session of Parliament.
There is no doubt that there needs to be improved public engagement. That need stimulated Bill Butler's Health Boards Elections (Scotland) Bill and has led to the current public debate on democracy in local health care.
Like many MSPs from across the parties, I had a great deal of sympathy with Bill Butler's member's bill, which was defeated at stage 1 last year. I saw the merit in members of the public being directly involved in discussions about important changes to services and having a direct input to the process before recommendations are made. However, I also felt—and still feel—that a majority presence of directly elected members on a health board could lead to short-term decision making and, at times, a distortion of priorities or delay in reaching difficult decisions, which could result in inequalities of care or undermine the planning of regional services. Ross Finnie, Mary Scanlon and others have highlighted the fact that there are also issues around likely single-issue candidates.
As has been pointed out in the debate, significant steps have already been taken to improve public engagement with the NHS in Scotland. The legal requirement in the National Health Service Reform (Scotland) Act 2004 for health boards to consult their local populations on service change was a step in the right direction, even though the implementation has sometimes been flawed.
Recently announced plans for the Scottish health council to establish standards for consultation, the independent scrutiny boards that will examine proposed service changes, the intention to strengthen the public participation fora of community health partnerships and the opening up to the public of the annual review process between health boards and ministers should all help, together with other Government initiatives, to ensure that communities have a say in the design and delivery of local services. The BMA, together with some other opponents of direct elections to health boards, thinks that those proposals have greater potential to improve public involvement in decision making than directly elected health boards. They may well be right to say that money would be better spent on direct patient care than on administering elections, with the attendant risk of the voter apathy that has been experienced south of the border.
Clearly, there is a serious debate to be had about the best way to achieve the stronger public involvement and enhanced local democracy that are requirements of 21st century health care planning.
My colleagues and I welcome the Government's drive to improve public and community involvement in the work of NHS boards. We also welcome its conviction that local people must always be at the heart of decision making and that the process for service changes should be rigorous, evidence based and open to scrutiny. We hope that the on-going consultation will be meaningful, as the cabinet secretary indicated it will be, and that the Government will pay careful attention to the suggestions of its consultees when formulating its proposals for the local health care bill, particularly any innovative ideas from those who are most closely involved with the NHS, be they staff or patients. We look forward to seeing the responses to the consultation and the content of the bill in due course, and to the ensuing scrutiny of the bill as it progresses through Parliament.
As many members have said, in the past few years the desire for meaningful public engagement in the development of the NHS has been growing, alongside increasing dissatisfaction with the way in which a number of health boards have interacted with the public when major changes were planned in the local delivery of health care provision.
A number of us in the chamber today—including the cabinet secretary and the minister—will remember the enthusiasm and optimism in the chamber when the anticipated Kerr report on the future of the NHS in Scotland was being discussed, because patient groups and other NHS and public representatives who were present felt that at last they were having a real and meaningful input to the future shape of the NHS.
Sadly, as health boards across the country began the process of reconfiguring services in response to the Kerr recommendations, too many people in too many areas felt that health boards were consulting the public on a fait accompli and were paying scant attention to the reactions and responses of their local stakeholders—as Christine Grahame described graphically with regard to her region in the Borders.
The many campaigns that ensued across Scotland clearly showed the public's dissatisfaction with the consultation process. In my own area, the retention of the option for women to give birth in community hospitals in Aboyne and Fraserburgh was achieved only after a protracted, well-organised and vocal campaign by local people against NHS Grampian's proposals to close those maternity facilities. We are all familiar with the equally strong campaigns to retain A and E provision in various parts of Scotland and with the campaign that Mary Scanlon highlighted to save the Belford in the Highlands.
The battles to retain local facilities have taken time, commitment and resources. They could have been avoided had health boards been made aware of the strength of public feeling and the cogent reasons for that feeling before recommendations for closure were made. Instead, in several cases, the impression was that the consultation process was a sham, with decisions already having been made by the boards, out of the public's view.
I, for one, am pleased that the Scottish Government has brought forward its "Better Health, Better Care" action plan, and I welcome its intention to promote a local health care bill within the first year of this session of Parliament.
There is no doubt that there needs to be improved public engagement. That need stimulated Bill Butler's Health Boards Elections (Scotland) Bill and has led to the current public debate on democracy in local health care.
Like many MSPs from across the parties, I had a great deal of sympathy with Bill Butler's member's bill, which was defeated at stage 1 last year. I saw the merit in members of the public being directly involved in discussions about important changes to services and having a direct input to the process before recommendations are made. However, I also felt—and still feel—that a majority presence of directly elected members on a health board could lead to short-term decision making and, at times, a distortion of priorities or delay in reaching difficult decisions, which could result in inequalities of care or undermine the planning of regional services. Ross Finnie, Mary Scanlon and others have highlighted the fact that there are also issues around likely single-issue candidates.
As has been pointed out in the debate, significant steps have already been taken to improve public engagement with the NHS in Scotland. The legal requirement in the National Health Service Reform (Scotland) Act 2004 for health boards to consult their local populations on service change was a step in the right direction, even though the implementation has sometimes been flawed.
Recently announced plans for the Scottish health council to establish standards for consultation, the independent scrutiny boards that will examine proposed service changes, the intention to strengthen the public participation fora of community health partnerships and the opening up to the public of the annual review process between health boards and ministers should all help, together with other Government initiatives, to ensure that communities have a say in the design and delivery of local services. The BMA, together with some other opponents of direct elections to health boards, thinks that those proposals have greater potential to improve public involvement in decision making than directly elected health boards. They may well be right to say that money would be better spent on direct patient care than on administering elections, with the attendant risk of the voter apathy that has been experienced south of the border.
Clearly, there is a serious debate to be had about the best way to achieve the stronger public involvement and enhanced local democracy that are requirements of 21st century health care planning.
My colleagues and I welcome the Government's drive to improve public and community involvement in the work of NHS boards. We also welcome its conviction that local people must always be at the heart of decision making and that the process for service changes should be rigorous, evidence based and open to scrutiny. We hope that the on-going consultation will be meaningful, as the cabinet secretary indicated it will be, and that the Government will pay careful attention to the suggestions of its consultees when formulating its proposals for the local health care bill, particularly any innovative ideas from those who are most closely involved with the NHS, be they staff or patients. We look forward to seeing the responses to the consultation and the content of the bill in due course, and to the ensuing scrutiny of the bill as it progresses through Parliament.
In the same item of business
The Presiding Officer (Alex Fergusson):
NPA
The next item of business is a debate on democracy in local health care.
The Deputy First Minister and Cabinet Secretary for Health and Wellbeing (Nicola Sturgeon):
SNP
I am pleased to open an important debate that, in many ways, will go to the heart of the kind of national health service that we want to build for the next 6...
Bill Butler (Glasgow Anniesland) (Lab):
Lab
Is one way of avoiding an unwieldy number of board members to return executive members to their pre-1981 state, when they simply offered advice? There is a s...
Nicola Sturgeon:
SNP
I agree very much with Bill Butler that that is an option. It will be considered, and I look forward to receiving his contribution to the consultation. He ha...
Margaret Curran (Glasgow Baillieston) (Lab):
Lab
I welcome the debate. Nicola Sturgeon was correct to contextualise it as she did. We acknowledge formally that, when Labour requested a subject debate on the...
Mary Scanlon (Highlands and Islands) (Con):
Con
We, too, welcome this debate on the consultation on a local health care bill to directly elect members of health boards. Like Margaret Curran, we will monito...
Ross Finnie (West of Scotland) (LD):
LD
I welcome the opportunity to participate in this debate on the consultation on democracy in local health care. I note that the consultation ends, somewhat un...
Mary Scanlon:
Con
Paramedics.
Ross Finnie:
LD
Never mind the paramedics. I well remember that when Michael Forsyth first campaigned in Scotland, he came here with a reputation for campaigning avidly for ...
Christine Grahame (South of Scotland) (SNP):
SNP
This is an extremely interesting debate—I keep scoring things out and changing my mind as I am persuaded by one or other of the arguments. As members all kno...
Bill Butler (Glasgow Anniesland) (Lab):
Lab
I will refrain from head-butting anybody, politically or otherwise. I am pleased to take part in this subject debate on democracy and local health care. I co...
Gil Paterson (West of Scotland) (SNP):
SNP
It is with great pleasure that I support the concept of democracy in local health care, which is long overdue. Since the start of the current parliamentary s...
Helen Eadie (Dunfermline East) (Lab):
Lab
I thank the Cabinet Secretary for Health and Wellbeing on two counts. I hope that she does not faint. First, I trust that you will forgive me, Presiding Offi...
Tricia Marwick (Central Fife) (SNP):
SNP
Will the member give way?
Helen Eadie:
Lab
No. I do not have time.In oral evidence on Bill Butler's bill, Pat Watters of the Convention of Scottish Local Authorities said:"The bill would simply tinker...
Elaine Smith (Coatbridge and Chryston) (Lab):
Lab
Like other members, I am pleased to participate in this debate on democracy in our local health care provision. I commend the cabinet secretary for conductin...
Bill Butler:
Lab
To set the record straight, the idea is not an original one from the SNP or me. Does the member agree that there is an echo back to the 1980s, when the Torie...
Elaine Smith:
Lab
I am happy to agree with that.As Bill Butler pointed out earlier, direct elections would not be the panacea that produced democratic accountability in the he...
Jamie Stone (Caithness, Sutherland and Easter Ross) (LD):
LD
I, too, thank the cabinet secretary for bringing forward this debate. She correctly set the scene by saying that we are preparing the NHS for the next 60 yea...
Peter Peacock (Highlands and Islands) (Lab):
Lab
I have listened to the debate with great interest and agree with many of the points that have been made about the need for change. I am intrigued by what Jam...
Jamie Stone:
LD
I shall return to that point in my final remarks about my party's position, but the point is well made.When Mary Scanlon came into my constituency—as she has...
Mary Scanlon:
Con
Will the member give way?
Jamie Stone:
LD
In a minute.Surely it would be appropriate to have the districts of a large NHS area and a council area, such as Highland Council, represented on the NHS boa...
Mary Scanlon:
Con
I acknowledge the points that the member makes as they relate to care in the community and delayed discharge. To correct him, I said that there should be at ...
Jamie Stone:
LD
I accept that point.The idea behind the consultation and the debate is about where to set the pointer between an entirely elected board, a board the vast maj...
Nanette Milne (North East Scotland) (Con):
Con
This has been a good and timely debate, which is being held during the consultation on the forthcoming—and also well timed—local health care bill. It has all...
Dr Richard Simpson (Mid Scotland and Fife) (Lab):
Lab
As many members have reminded us, we have had 60 years of the national health service. During that time there has not been a single model of the health servi...
The Minister for Public Health (Shona Robison):
SNP
We have had a constructive and stimulating debate and I thank members of all parties for taking part. We have debated a topic that is of crucial importance t...
Jamie Stone:
LD
As part of the consultation process, will the minister take a close look at areas in Scotland where some of the most difficult arguments have been taking pla...
Shona Robison:
SNP
Of course we will do that, and we encourage people from the area to contribute to the consultation.As we are in the middle of a consultation, members will no...