Chamber
Plenary, 12 Mar 2008
12 Mar 2008 · S3 · Plenary
Item of business
NHS Independent Scrutiny
While preparing for the debate, I looked back over several debates on service changes proposed by health boards in many parts of Scotland. They do not generally make very happy reading.
In 2004, we heard the fears of the people of Caithness that a predicted loss of their consultant-led maternity services would result in mothers having to travel more than 100 miles to Inverness, on poor roads, often in bad weather, or stay in bed-and-breakfast accommodation or hospital wards immediately before their expected delivery date. Fortunately, active campaigning resulted in common sense prevailing, as when services were retained at the Belford hospital in Fort William, which has a proud record of trauma management.
The Vale of Leven hospital was not so fortunate. In the two years following the closure of maternity facilities there, 11 mothers gave birth in ambulances en route to hospitals in Glasgow or Paisley.
In April 2005, many of us attended an excellent public debate on reshaping the NHS, which was attended by patients, campaigners and NHS professionals across the spectrum. It became obvious that people want a safe, accessible and sustainable NHS that is delivered locally wherever possible. Centralisation was accepted as necessary for highly specialised treatments only. There was a clear demand for more meaningful public involvement in the planning and organisation of services.
People wish to retain local services wherever that is possible, especially in more remote and rural areas where, over the years, facilities have developed around communities. The hope was expressed that the Government would listen to the voice of local people and work with them to achieve a health service that was able to respond to all who wished to use it, that would be the pride of Scotland and that would give satisfaction to all who worked in it.
The Kerr report backed up those aspirations: it recommended that health care be delivered as locally as possible. But, by 2006, in the wake of Kerr, it was obvious that there was widespread concern about some proposed reconfiguration of health services. Some changes were welcome, but others—such as the well-known proposals to close A and E units at Monklands and Ayr hospitals—provoked intense and sustained campaigns against them. Those campaigns had the backing of politicians of all parties and of local people. They also had medical opinion on their side. Similar campaigns in the Borders put a strong case to ministers to retain hospitals in Jedburgh and Coldstream. Unfortunately, they were not successful.
In Grampian, there were active campaigns to retain maternity services in Aberdeenshire. Local people branded NHS Grampian's consultation merely cosmetic. That view was supported by the Scottish Health Council, which initiated further consultation. Only after that—and the further lobbying of ministers—was agreement reached to retain the capacity to give birth at Aboyne and Fraserburgh hospitals, which gave a measure of choice to the mothers-to-be who did not wish to travel many miles to give birth in Aberdeen.
We all agree that the public has a right to be consulted about major service change. Such consultation must be genuine and meaningful. When whole communities feel that that is not the case and responsible elected members of all parties support local opinion, ministers should be wary of taking decisions that are contrary to that weight of opinion.
Such decisions were not uncommon in the previous Administration. Often, public opinion was heeded only after strenuous local campaigns that cost a lot of time, effort and—sometimes—cash. The result was cynicism and a public perception that the Government was hell-bent on centralisation. Far from local people being involved in service redesign, they were brushed aside and ignored.
The Cabinet Secretary for Health and Wellbeing's decision, soon after coming to office, to set up an independent scrutiny process with regard to A and E services at Ayr and Monklands was very welcome and it has already gone some way towards restoring public confidence in decisions on major changes to service delivery. I welcome the consultation, which has just finished, on the establishment of an independent scrutiny system and concur with the British Medical Association's view that an expert panel might well prove to be the most effective way of providing independent scrutiny of proposed options for significant operational change and that such scrutiny must not only be evidence based but focus on the criteria of safety, sustainability and value for money for NHS boards.
I agree that panel members, however they are selected, should have the skills, experience and stature to inspire public confidence and that their findings should be put into the public domain. Such an approach should go at least some way towards increasing public confidence in how changes are progressed. If the health service is to be responsive to increasing demands and improvements in technology, there is no doubt that change will be required and that, at times, very difficult decisions will have to be made. In such cases, independent scrutiny of proposals will restore public faith in the consultation procedure and help to gain co-operation when necessary changes have to be implemented.
I hope that the consultation, the responses to which are currently being considered by the Government, will lead to a process that gives the public confidence that proposals for service change are indeed in the best interests of the communities at their receiving end.
I do not profess to have any detailed suggestions on how an independent scrutiny strategy might be implemented, but I look forward to the Government's proposals with great interest and an open mind.
In 2004, we heard the fears of the people of Caithness that a predicted loss of their consultant-led maternity services would result in mothers having to travel more than 100 miles to Inverness, on poor roads, often in bad weather, or stay in bed-and-breakfast accommodation or hospital wards immediately before their expected delivery date. Fortunately, active campaigning resulted in common sense prevailing, as when services were retained at the Belford hospital in Fort William, which has a proud record of trauma management.
The Vale of Leven hospital was not so fortunate. In the two years following the closure of maternity facilities there, 11 mothers gave birth in ambulances en route to hospitals in Glasgow or Paisley.
In April 2005, many of us attended an excellent public debate on reshaping the NHS, which was attended by patients, campaigners and NHS professionals across the spectrum. It became obvious that people want a safe, accessible and sustainable NHS that is delivered locally wherever possible. Centralisation was accepted as necessary for highly specialised treatments only. There was a clear demand for more meaningful public involvement in the planning and organisation of services.
People wish to retain local services wherever that is possible, especially in more remote and rural areas where, over the years, facilities have developed around communities. The hope was expressed that the Government would listen to the voice of local people and work with them to achieve a health service that was able to respond to all who wished to use it, that would be the pride of Scotland and that would give satisfaction to all who worked in it.
The Kerr report backed up those aspirations: it recommended that health care be delivered as locally as possible. But, by 2006, in the wake of Kerr, it was obvious that there was widespread concern about some proposed reconfiguration of health services. Some changes were welcome, but others—such as the well-known proposals to close A and E units at Monklands and Ayr hospitals—provoked intense and sustained campaigns against them. Those campaigns had the backing of politicians of all parties and of local people. They also had medical opinion on their side. Similar campaigns in the Borders put a strong case to ministers to retain hospitals in Jedburgh and Coldstream. Unfortunately, they were not successful.
In Grampian, there were active campaigns to retain maternity services in Aberdeenshire. Local people branded NHS Grampian's consultation merely cosmetic. That view was supported by the Scottish Health Council, which initiated further consultation. Only after that—and the further lobbying of ministers—was agreement reached to retain the capacity to give birth at Aboyne and Fraserburgh hospitals, which gave a measure of choice to the mothers-to-be who did not wish to travel many miles to give birth in Aberdeen.
We all agree that the public has a right to be consulted about major service change. Such consultation must be genuine and meaningful. When whole communities feel that that is not the case and responsible elected members of all parties support local opinion, ministers should be wary of taking decisions that are contrary to that weight of opinion.
Such decisions were not uncommon in the previous Administration. Often, public opinion was heeded only after strenuous local campaigns that cost a lot of time, effort and—sometimes—cash. The result was cynicism and a public perception that the Government was hell-bent on centralisation. Far from local people being involved in service redesign, they were brushed aside and ignored.
The Cabinet Secretary for Health and Wellbeing's decision, soon after coming to office, to set up an independent scrutiny process with regard to A and E services at Ayr and Monklands was very welcome and it has already gone some way towards restoring public confidence in decisions on major changes to service delivery. I welcome the consultation, which has just finished, on the establishment of an independent scrutiny system and concur with the British Medical Association's view that an expert panel might well prove to be the most effective way of providing independent scrutiny of proposed options for significant operational change and that such scrutiny must not only be evidence based but focus on the criteria of safety, sustainability and value for money for NHS boards.
I agree that panel members, however they are selected, should have the skills, experience and stature to inspire public confidence and that their findings should be put into the public domain. Such an approach should go at least some way towards increasing public confidence in how changes are progressed. If the health service is to be responsive to increasing demands and improvements in technology, there is no doubt that change will be required and that, at times, very difficult decisions will have to be made. In such cases, independent scrutiny of proposals will restore public faith in the consultation procedure and help to gain co-operation when necessary changes have to be implemented.
I hope that the consultation, the responses to which are currently being considered by the Government, will lead to a process that gives the public confidence that proposals for service change are indeed in the best interests of the communities at their receiving end.
I do not profess to have any detailed suggestions on how an independent scrutiny strategy might be implemented, but I look forward to the Government's proposals with great interest and an open mind.
In the same item of business
The Presiding Officer (Alex Fergusson):
NPA
The next item of business is a debate on national health service independent scrutiny.
The Deputy First Minister and Cabinet Secretary for Health and Wellbeing (Nicola Sturgeon):
SNP
I am pleased to open this debate about building confidence in the process of proposing and agreeing change to local NHS services.Members will recall that we ...
Margaret Curran (Glasgow Baillieston) (Lab):
Lab
I am sorry to stop the cabinet secretary so early, as she is getting into her flow. Will she give us fair warning when she is about to announce her response ...
Nicola Sturgeon:
SNP
I give that assurance.Before I take the decision, I will also reflect on the lessons of the successful applications of independent scrutiny in the NHS Ayrshi...
Dr Richard Simpson (Mid Scotland and Fife) (Lab):
Lab
The cabinet secretary has made some very important points. She mentioned the skills mix within the independent panels. According to the consultation document...
Nicola Sturgeon:
SNP
I thoroughly agree. The delineation between the current role of the Scottish health council and the role of independent scrutiny panels is important. I have ...
Margaret Curran (Glasgow Baillieston) (Lab):
Lab
I welcome this debate, which is of key interest to many of us in the chamber and throughout the country—especially those who are engaged in the challenging d...
The Presiding Officer:
NPA
Members should ensure that their mobile phones are turned off. One is switched on very close to Ms Curran's microphone.
Margaret Curran:
Lab
I will move my bag, just in case.Change is a constant in the area of health, in terms of technology, service improvement and debate. It is sometimes difficul...
Nicola Sturgeon:
SNP
The Scottish health council is considering the development of a tool that will help in making a decision on what is major and what is not. It has always been...
Margaret Curran:
Lab
I accept that argument, but it is nonetheless important that if we suggest to people that we are introducing an element that can give them confidence about c...
Jackson Carlaw (West of Scotland) (Con):
Con
The Scottish Conservatives acknowledge at the outset of the debate that the Cabinet Secretary for Health and Wellbeing's decision, made on coming into office...
Dr Simpson:
Lab
Does the member accept that, following the 1999 Stobhill inquiry, interim guidance was issued in 2002 and a reform bill was passed that insisted on consultat...
Jackson Carlaw:
Con
No. As I said a moment ago, the public perception of some consultations that have been initiated on major service change—not just in the health service but e...
Ross Finnie (West of Scotland) (LD):
LD
No one has disagreed that we faced a position, which the cabinet secretary outlined, of a public lack of confidence in how health boards were reaching major ...
Dr Simpson:
Lab
Does the member accept that an independent consultancy looked at the consultation process in at least two cases and in one case an independent individual—a p...
Ross Finnie:
LD
That might be right, but I want to stick to the generality. There are serious issues facing the health boards in question and boards in general.There is clea...
Nicola Sturgeon:
SNP
Ross Finnie raises an important point. He is absolutely right. The independent scrutiny reports that we have received identified weaknesses that must be addr...
Ross Finnie:
LD
I am grateful for the point that the cabinet secretary makes, but let us consider it, along with my final point. If there continues to be doubt about somethi...
The Presiding Officer:
NPA
We now come to speeches from back benchers. I allowed a little leeway with the opening speeches, as we had a little time in hand. We no longer have time in h...
Ian McKee (Lothians) (SNP):
SNP
There will always be a balance to be struck in the health service between the desire to provide care as near to a person's home as possible and the quality o...
Ross Finnie:
LD
Is Dr McKee suggesting that the cabinet secretary's proposal to change radically the composition of the boards by introducing elected non-executive directors...
Ian McKee:
SNP
Having elected members of health boards would be an enormous improvement. One of the problems at the moment is the fact that no one in an area knows who thei...
Helen Eadie (Dunfermline East) (Lab):
Lab
I welcome the chance to hear members' views this afternoon. One of the key issues for me is the opportunity to read in detail the responses to the consultati...
Nicola Sturgeon:
SNP
I answered that point in response to Richard Simpson. The Scottish health council's job is to quality assure the consultation. The envisaged role of the inde...
Helen Eadie:
Lab
I respect that the minister answered Richard Simpson's question, but I want to read the consultation responses on that point. The minister has given her view...
Willie Coffey (Kilmarnock and Loudoun) (SNP):
SNP
Let us be clear about the importance of the subject that we are debating. We are discussing not the advantages and shortcomings of service models, but a Scot...
Nanette Milne (North East Scotland) (Con):
Con
While preparing for the debate, I looked back over several debates on service changes proposed by health boards in many parts of Scotland. They do not genera...
Malcolm Chisholm (Edinburgh North and Leith) (Lab):
Lab
After reading the consultation document and some of the responses to it, I support the concept of independent scrutiny that has been outlined and am inclined...
Stuart McMillan (West of Scotland) (SNP):
SNP
I welcome the debate and the introduction of independent scrutiny panels. I fully agree that every circumstance must be examined on a case-by-case basis and ...