Public Petitions Committee

Meeting date: Thursday, March 16, 2017

Official Report 574KB pdf

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Continued Petitions

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Pernicious Anaemia and Vitamin B12 Deficiency (Understanding and Treatment) (PE1408)

Agenda item 3 is consideration of current petitions on which no evidence will be taken. PE1408, by Andrea MacArthur, is on updating understanding and treatment of pernicious anaemia and vitamin B12 deficiency. Members have received a note by the clerk and submissions from the Scottish Government and the petitioner.

As members will see from the submissions, the petitioner is seeking a new method of diagnosing and treating pernicious anaemia. Since she submitted the petition, the British Society for Haematology has published new guidelines. Initially, the Scottish Government took the view that the format of the BSH guidelines was inappropriate for use in the practice setting and that its recommendation for second-line testing was not standard in Scottish laboratories.

For that reason, the Scottish Haematology Society was given the task of summarising the BSH guidelines for use in Scotland. The society has completed that task, but the petitioner has expressed concern about the contents of the guidelines and the draft summary document. In this context, the Scottish Haematology Society has noted that it is not able to contribute any further to the process, citing its limited resources. The Scottish Government does not seem willing to publish the draft summary document and now suggests that the BSH guidelines will suffice. It is not clear why that is the case, and the petitioner is dissatisfied with the lack of progress on the issue and with the Scottish Government’s engagement with her throughout the process.

Do members have any views on what action we might take on the petition?

I suppose that we could invite the minister to come and enlighten us.

That would be useful, because there is a lot here that we might not be getting to the heart of. Some of it is very technical. It seems odd that the BSH guidelines were not appropriate to begin with, but now they are. Of course, there might be a very simple explanation for that, but it would be worth while pursuing the matter with the minister.

Do we know why the Scottish Haematology Society’s work has not been published? Was any reason given? Was it lack of resources, as has been mentioned?

I do not think that we know that. The society has now stepped back; my sense is that it was just trying to provide a service, but that it found itself at the centre of the issue with ownership of the guidelines and was having to deal with questions and the back-and-forth around that.

So it was the Government’s decision not to make the report public.

As far as I understand it, it does not seem willing to publish the draft summary document. It might be worth while exploring that issue. I know that the petitioner has already given us a lot of evidence, but I think that having a session with the minister would provide her with another opportunity to focus on the matter. As I have said, I think that that would be useful.

Is the committee agreed?

Members indicated agreement.

Members appear to have no other suggestions. I have to say that it feels to me that that course of action provides the best opportunity. I know that we have received a briefing, but we might see whether there is any more information about why we are where we are, as it would help our deliberations. Perhaps we can also ask the minister to provide some clarification ahead of our meeting.

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Healthcare Services (Skye, Lochalsh and South-west Ross) (PE1591)

The final petition this morning is PE1591, by Catriona MacDonald, on behalf of SOS-NHS, on the major redesign of healthcare services in Skye, Lochalsh and south-west Ross. I welcome Kate Forbes and Rhoda Grant to the meeting for this item. Members have received a note by the clerk and submissions from the Cabinet Secretary for Health and Sport and the petitioners.

Members will recall that when we previously considered the petition in December, we agreed to write to the cabinet secretary, inviting her to respond to the points raised in the critique provided by the petitioners and to address concerns on patient transport provision. In the context of the decision-making process, the cabinet secretary is quite clear in her view that she cannot reasonably add anything to what she has already communicated in previous submissions to the committee. She notes that, with regard to patient transport provision, the Scottish Ambulance Service has confirmed that the region is covered by two service vehicles, both of which have stretcher capabilities and are covered by three full-time posts. She indicates her understanding that the service will

“work with NHS Highland and other partners to deliver services which support the public and local communities”.

11:00  

The petitioners consider that the cabinet secretary has failed to answer specific key questions and has ignored the “fundamental issues” that were set out in the critique that was submitted on 8 December last year. They identify five areas that they feel have not been sufficiently addressed, which are a response to the critique, the mandatory guidance in the Scottish capital investment manual and the Treasury green book, a failure to include evaluation of the relative costs and risks of the possible locations for the new hospital, the role of the Scottish health council, and concerns that were highlighted by elected representatives.

Do members have any views on what action we might take on the petition?

In the cabinet secretary’s letter, she says that she is

“content that independent scrutiny would not significantly contribute to the local consideration of options.”

She goes on to say, with regard to the Scottish Ambulance Service, that it

“will continue to work with NHS Highland and other partners to deliver services which support the public and local communities”

in Skye and Lochalsh.

Given the cabinet secretary’s assurances and her statement that

“the decision to approve the Health Board’s proposals has been made”,

there is little more that the committee can do to allow NHS Highland and local stakeholders to move forward on the issue, other than to write to the cabinet secretary along the lines that the convener has suggested.

Does Kate Forbes or Rhoda Grant, with their local perspectives, want to help us with our deliberations?

There is concern in the community still, and things that have happened recently have not provided people with any comfort. We heard about there being two ambulance vehicles supported by three full-time staff. Three full-time staff for two ambulances? You do not need to do the maths.

There were press reports last week about the ambulance staff—who are now being balloted for industrial action—saying that they were falling asleep at the wheel. Quite often, ambulance staff take people not just to Broadford or Portree hospitals, but to Inverness. If they are in Inverness and a 999 call comes in, as theirs is the closest vehicle, they have to attend the incident, so it is not without reason that both ambulances could be off-island. If those staff report that they are fatigued in Inverness, they are not allowed to travel home, so there is a huge disincentive for them to report fatigue when they are in Inverness. They are on duty until they can find a window of opportunity to get home, which leads to many of them reporting that they are falling asleep at the wheel trying to get home.

That is the situation, so when that service is cited to provide comfort on the new set-up, you can imagine why the community does not feel particularly comforted.

The community also does not have the services. I have said previously to the committee that we have waited a long time for the new hospital in Skye. Although it is not ideal and I understand what people saying, a further delay will impact on patient care—it is already having an impact. Procedures are being moved back to Inverness that could take place in Skye.

There are big issues about how patient care will be dealt with, what care will be available at the north end of Skye—where people have been used to having their own hospital—and patient transport. One of the issues with the emergency ambulance service, which is why the staff are balloting on strike action, is that they feel that they are being used as a patient transport service rather than an emergency service. There is not enough resilience in the other services such as general practitioners and the out-of-hours service. In Raasay—which came up at the last committee meeting—there is no qualified health professional to provide cover on the island outwith the hours of 9 to 5. Their help comes from Portree at the moment and, under the new set-up, it would have to come from Broadford.

There are a lot of unanswered questions. However, rather than hold back the building of the hospital, which has to go ahead, we need a lot of reassurance with regard to what will be provided in the north end of Skye and Raasay, and what support there will be from GP services, out-of-hours services, NHS 24, the Scottish Ambulance Service and others.

It might be helpful to the committee if I break down the three strands of concern, because it can get quite complicated. The first strand is the current healthcare provision, the second is the decision-making process that has got us to this point and the third is the location of the new hospital.

On current healthcare provision, I echo everything that Rhoda Grant has said, particularly on emergency and out-of-hours care. I add to that my concerns about palliative and elderly care. There are reports in the West Highland Free Press today, which I have not been able to verify, that the Haven, which has the only 13 elderly care beds available in north Skye, is due to close in three months. Whether it be ambulance services, beds closing or the fact that a ward in Portree community hospital had to close because staff were unavailable, issues to do with service provision are causing tangible fear in north Skye, which is the area of higher population density. There is concern about transport, care beds and emergency and out-of-hours care.

The concern about the decision-making process, which the petitioner picks up in her response, is that mandatory guidelines in the Scottish capital investment manual have not been followed. That is the issue that the committee needs to decide how to take forward today.

The third matter is the location of the new hospital. The cabinet secretary has said there would always be disagreement about whether the new hospital should be located in Broadford or Portree. The bigger question is whether there are sufficient health services in the north and south ends of Skye. Is there sufficient transport? Are enough care beds being offered? Is palliative care sufficient? Is there enough stakeholder engagement to ensure that there is confidence in the service redesign?

To summarise, current healthcare provision, particularly in terms of care beds and ambulances, is causing genuine concern in the north end. The petitioner picks up on the decision-making process and the mandatory nature of the SCIM. Thirdly, on the location of the new hospital, there must be clearer and more substantial promises made on care bed provision in the north and south ends.

That is helpful. I suggest that we might want to ask the cabinet secretary to reflect on the concerns arising as a consequence of the decision of where to locate the hospital and what the provision of all services—not just the ambulance services—looks like across the island. An unintended consequence might be to centralise services that, in the past, could have been delivered in Skye. There is also the whole question of ambulance services and their conflation with patient transport services. We should look for reassurances on those points.

Presumably, the argument on process is a consequence of an objection to the conclusion on where the hospital is to be sited; the petitioner has raised process because she is not happy with that conclusion. As Angus MacDonald said, the cabinet secretary has been clear that the correct process has been followed; others have said that the correct process has not been followed. I might be wrong, but that might be a judicial matter. How else would a decision on that aspect be made? Although it does not feel as though the local members are asking us to focus on that aspect, we can certainly ask the cabinet secretary to clarify the points that have been raised and get reassurances on the consequences of the decision.

The point has been made in our previous reflections that, although the cabinet secretary says that she is absolutely clear that she has done the right thing in reaching her decision, if local people are unhappy, what responsibility does the Scottish Government have to bring people together to reassure them? We might want the cabinet secretary to reflect on that. Although the Government might consider that it has done the right thing legally, there is a fracturing of relationships in the Skye area, and there is no confidence in the health board or a proper understanding of the consequences. Given that situation, we could ask whether the Government sees itself as having a role in pulling that back together, and we could say that we expect to get a report on its work in that regard.

For clarification, is the cabinet secretary aware of all the points that Kate Forbes and Rhoda Grant have made? Was the decision made in spite of everything that has been said and the views that have been put forward?

I assume that what you are saying is that these issues are not insurmountable. They may have been used as arguments for the siting of the hospital but, once the site is chosen, the question of the ambulance drivers still has to be addressed.

It is about the transport side and the current services—I wonder whether all that has been thought through.

There is the example in my city—everybody agreed that the new hospital should be built on a particular site there, but then consequences occurred that had been not envisaged and which have to be dealt with in terms of provision.

The last time I had a meeting with the petitioners, I asked whether their main concern was current healthcare provision, the decision-making process or the location of the new hospital. The current healthcare provision always comes into it. If people feel confident that services will remain locally and that they will not be disadvantaged by the location of the new hospital, they will be far more confident in the redesign. The critical point at the moment is to ensure that there is confidence that the life of somebody in Staffin, for example, will not be at risk because of where they live—that is what it boils down to. The recent unfortunate situation of beds having to be closed in Portree hospital due to staff being off, the new reports of care homes there closing and the very serious issues with ambulance services are all making confidence fall even further.

I suggest that we write to the cabinet secretary about the consequences of the decision that was made and ask what reassurance can be given about provision. We can also say that we feel that there has been a fragmenting of confidence in the process and that, although the Scottish Government is confident in its view—we do not know the technicalities of that—we think that the Government has a job to do in bringing people together. We can ask for a response from the Government to our points. Does the committee feel that that would be reasonable?

Members indicated agreement.

I thank everybody for their attendance, but particularly Rhoda Grant and Kate Forbes.

Meeting closed at 11:12.