Official Report 696KB pdf
Specialist Neonatal Units (Centralisation) (PE2099)
We suspend consideration of item 2 and resume item 1, which is continued petitions.
The final continued petition, for which we have been joined by the petitioners, is PE2099, which was lodged by Lynne McRitchie. The petition calls on the Scottish Parliament to urge the Scottish Government to stop the planned downgrading of established and high-performing specialist neonatal intensive care services across NHS Scotland from level 3 to level 2, and to commission an independent review of that decision in the light of contradictory expert opinions on centralising services.
We last considered the petition on 11 September 2024, when we agreed to write to the Minister for Public Health and Women’s Health, and to undertake a visit to explore the issues raised in the petition. Since then, members of the committee have visited the neonatal intensive care unit at the University hospital Wishaw and have met the petitioner, families with experience of neonatal intensive care, Wishaw staff and NHS Lanarkshire staff. We thank those individuals who took the time to meet us. A tremendous number of people turned up; those of us in the committee who were present really valued the personal exchanges that we were able to have, not only with people who have been effected but with a considerable cohort of staff who also turned up to speak to us.
Hearing the perspectives and experiences of families with direct experience of neonatal care—some of which had happy outcomes and some less so, so it was a highly charged discussion—helped with our understanding of the issues raised in the petition. We are also grateful to the staff at NHS Lanarkshire and University hospital Wishaw for their work to arrange the visit, which was a first-class operational opportunity for us all. A note summarising the issues raised during the visit is available in the papers for today’s meeting and has been published on the petition’s website page.
Since we last considered the petition, the Minister for Public Health and Women’s Health has provided two written submissions. The first submission reiterates that the recommendation was based on evidence that outcomes, including survival, for the very smallest and sickest babies are best when they are cared for in units with high volume throughout and where there are collocated specialist services. The response states that the review team visited all 14 health boards and met teams from maternity and neonatal services. The Scottish Health Council led a programme of service user engagement across all national health service territorial boards in Scotland, which was supplemented with bespoke service user events. The submission states that more than 600 staff and 500 service users contributed to the review process.
The minister’s most recent written submission notes that, although the principles underpinning the changes are supported by the Scottish executive nurse directors group—SEND—and by the directors of midwifery, concerns were raised about the implications of the change for maternity services. The submission says:
“The Directors of Midwifery highlighted that additional data and evidence gathering was required for maternity services to inform maternity capacity implementation planning.”
It states that a national-level data collection is under way to understand the impact of the neonatal care remodelling on maternity services.
10:15Bliss Scotland has provided a written submission that details its support for the new model of care and shares its view that the volume of babies born needing intensive care in Scotland is
“far too low to sustain more than three NICUs in Scotland.”
The submission shares concerns that
“progress is stalling”,
with a lack of clear communication about the task and finish groups’ priorities, work plan and progress to date. Bliss believes that
“Ongoing concerns regarding resourcing have not been addressed, including adequate staffing at the designated three intensive care units.”
I should say that there were issues raised in regard to Bliss by those who attended the visit that the committee held at the hospital.
Monica Lennon MSP is unable to attend the meeting this morning and has instead provided a written submission. The submission states that a
“truncated process amounts to tokenism, leaving families, clinicians, and local representatives feeling betrayed.”
Ms Lennon’s submission calls on the committee to consider recommending that an
“independent, multidisciplinary review be undertaken before Scottish Ministers reach a final decision”
regarding the future of neonatal intensive care services.
It is important to remember that the recommendation was not necessarily to have three NICUs; it was for a reduction in the number of service centres, and that it would have been perfectly possible for the award-winning unit to have been retained.
Meghan Gallacher had hoped to join us this morning for the consideration of the petition but was unable to do so. Jackie Baillie is still with us, and she would like to address the committee.
I am going to attempt the impossible, which is to try to get the committee to keep the petition open. As you rightly pointed out, the Wishaw neonatal unit was the best neonatal unit in the country—not Scotland, but the whole of the United Kingdom—in 2022. For some reason, the Scottish Government then decided that it should close.
You are quite right to reference an earlier report that was presented to the Scottish Government, which recommended that there should be three to five neonatal units to cover Scotland, instead of the seven or eight that we have now. Nobody disagrees with that. What we disagree with is that the Scottish Government opted to go for three units—one in Glasgow, one in Edinburgh and one in Aberdeen—and that Lanarkshire, the third-largest health board, which covers a population of 655,000 people, would have its neonatal unit removed. I have to say, in contradiction to what the minister contends, that the evidence was partial. There was no voice from NHS Lanarkshire sitting around the decision-making table, but there were representatives from Glasgow and Lothian.
The thing that we need to hold on to is that the Wishaw neonatal unit does not only deal with mums and babies from Lanarkshire; it deals with those covered by Greater Glasgow and Clyde, because the two Glasgow units that are currently there do not have enough capacity to cope with the mums and babies from Glasgow. Lanarkshire plays a key role for the whole of Scotland. It has been said that when the Wishaw neonatal unit closes and mums and babies cannot go to there, to Glasgow or, potentially, to Edinburgh, Aberdeen could be the default.
We think that there is not enough capacity in Glasgow to cope, so you would be putting the sickest babies in ambulances to make the two-and-a-half to three-hour journey to Aberdeen to be seen. It is entirely ridiculous, not just because of the risk, but because the sickest babies are likely to be in hospital for long periods. What happens to the mums and families who are rooted in their community in Lanarkshire? How do they spend time with the baby up in Aberdeen? That would be impossible and impractical.
It is not only the families who are very pragmatic in resisting these changes; it is the clinicians as well. The committee saw that very powerfully in its visit to the unit.
The solution, if I can posit one, is that we should have four units. It is common sense—it is not rocket science. I wonder whether we could invite the committee to write to the Government to suggest that it pauses any changes, that there should be a fully independent review and that it should consult the clinicians and the families affected in more than just a tokenistic way. Perhaps the committee could even invite the minister to come before the committee.
That would be a valuable conclusion to the committee’s visit. To be frank, if we do not keep the petition open, the Government will downgrade the neonatal unit between now and May, and that will not benefit anybody.
I am sure that when you said “you” would be putting people in ambulances, you were using “you” in the most general sense.
Absolutely. Not you, convener—the Government.
Not me personally. You make a number of salient and relevant points.
One of the parents whom we heard from in relation to the prospect of their baby being in Aberdeen said that the mother was left in a critical condition and was not going to be transferred with the baby, so what was he supposed to do? Was he supposed to stay with his wife, who was in a critical condition in Wishaw, or was he supposed to travel to Aberdeen, where the baby would be? He said that it would be a dreadful choice for any husband and father to have to make in those circumstances.
I have an interest in this matter, as it is a constituency matter. I agree with everything that Jackie Baillie said. It is about not only the parents but the clinicians and the public. It is an emotive subject for citizens in Lanarkshire. My inbox is full every time there is mention of the unit closing. It is an emotive subject and needs to be looked into further. At minimum, the information needs to be reviewed.
I do not think that there is any question but that the committee wants to keep the petition open. Before we make any further recommendations, I think that we need to take some evidence. I suggest that we invite the Minister for Public Health and Women’s Health to give evidence on the matter, and that we invite the British Association of Perinatal Medicine’s best start perinatal sub-group to the committee so that we can interrogate the process that led to the recommendation for three rather than four or five units. That seems to be the critical issue, as far as I can see. It would have been wholly consistent with the original report and recommendation for a fourth unit to be retained.
As Jackie Baillie said, this is an award-winning facility that provides support to such a large health board. Given all the issues that have been identified, those of us who visited the facility thought that the petition ought to be considered, and we are very sympathetic to its aims.
I entirely agree that the petition should be kept open and that evidence should be taken from the minister, so I am entirely satisfied with that suggestion.
I want to make two points. First, if there are to be three units, that means that the whole of the Highlands, including Morayshire, Argyll and the isles will not have such a facility. We should reflect on that, because there are very strong feelings in hospitals there that face potential closure. That has been a very live issue, particularly in Wick and Elgin, over the years. My late wife was involved in saving the maternity unit in Moray many decades ago.
Secondly, I ask Jackie Baillie to clarify something, either now or, if she needs to get more information, later. You indicated that the performance of the Wishaw unit was the best, not just in Scotland but in the whole of the UK. I am interested to know, either now or later, but certainly before we take evidence from the minister, what the statistical evidential basis is for that judgment.
I am capable of many things, convener, but that level of detail is not in my gift. I will be happy to provide the information later.
That would be great—it may have been one of the issues that was raised when we were on the visit. I cannot specifically remember whether we were given detailed information in support of that position, but perhaps, together with the clerks, we can establish what the situation is.
It is also important that we make it clear that the petition is about the downgrading of facilities, not the closure of facilities. That could cause additional alarm to people, but the core aspect of the ask of the petition is about sustaining the specialist units.
We are content to keep the petition open. There is some further information that we want and, in the time that is left to us, we will seek to hold a further evidence session with the minister and those who have been involved in the consideration of the recommendations, so that the committee can interrogate them and, potentially, make recommendations for the future. Is the committee content to proceed on that basis?
Members indicated agreement.
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