Official Report 517KB pdf
PE2099, on stopping the proposed centralisation of specialist neonatal units in NHS Scotland, was lodged by Lynne McRitchie in May 2024. 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 the decision in light of contradictory expert opinions on centralising services. Jackie Baillie has joined us, and Meghan Gallacher, Helen McDade and Clare Adamson will make representations on the petition, too. I thank all of you for joining us.
In its legacy report, the session 6 Citizen Participation and Public Petitions Committee highlighted its extensive work on the petition, including two oral evidence-taking sessions and a visit to University hospital Wishaw’s neonatal intensive care unit. As a result of that work, the committee wrote a substantive letter to the then Minister for Public Health and Women’s Health to highlight outstanding questions and concerns regarding the new model of neonatal care. The legacy report stated that there were ongoing concerns about capacity in NHS Grampian and about additional support to be provided to families impacted by the new model, and it recommended that this committee should consider the issues raised in the petition and review what progress had been made on the outstanding issues set out in that committee’s letter to the minister.
The submission that we have received from the Minister for Mental Wellbeing, Public Health, Sport, Alcohol and Drugs provides an update on work that has been carried out since the session 6 committee last considered the petition. In her submission to the committee, the petitioner sets out why she disagrees with the minister’s position.
Given the interest from colleagues, I will invite them to make representations first before we consider what further steps we might take. I will go from left to right, so, Ms McDade, would you like to start?
Oh—you are talking about your left, convener.
Thank you for allowing me to come and speak to the petition. As a Mid Scotland and Fife MSP, I will highlight that the units that are suggested for downgrading from level 3 to level 2 include those at Ninewells hospital and Victoria hospital in Kirkcaldy, although other units elsewhere are also being affected. I have had many representations from mums who have given birth and had babies at Ninewells to ask for the units to be kept at their current level.
It is important to note that these are people who have already had this experience; they are not making those representations in their own personal interest, unless they are planning to have more family and the worst happens. They have already been there, and they feel strongly enough to make a representation and say, “Please rethink this.”
The minister has told the committee that the plan is
“deliverable and clinically appropriate”,
but a number of
“outstanding elements”
such as
“cot capacity and patient flow … will be incorporated into the next phase”
of looking at the issue. That seems to me to be a bit back to front. If you do not know what the cot capacity or the patient flow will be, it is hard to know whether it is clinically appropriate. We have seen the same problems in other areas of the NHS, where we have reduced things and then found ourselves short of beds.
As we have seen, centralisation is often not the answer. We need only think about, for example, the maternity unit in Caithness; I come from the north of Scotland, and I sometimes think that people do not know how far it is from the north to, say, Dundee, Edinburgh or Aberdeen. There are many areas of Scotland where people would be many hours away from the three units suggested, if their babies had to be taken there.
I note that the initial report says that babies will be safer in specialist units. That might conceivably be true, but the question is: are they safer if they are having to be taken there in ambulances? How many hours will it take for people to get to those units? Will mothers increasingly be sent to other areas to give birth? That is already happening in Caithness, with mothers being taken 100 miles to give birth in case there are potential difficulties.
More centralisation is definitely not the answer. In one of her submissions to the committee, the minister said that families should stay together and that local care is important, so I suggest that we listen to families and to specialist staff. In other areas of the health service, we have seen that, if we reduce specialist areas, we lose staff—they are motivated to leave or go to other units—and there is a downgrading cycle whereby units are downgraded further as a result of staff shortages.
I ask the committee to consider writing to ask the Cabinet Secretary for Health and Care to reconsider the proposals, particularly in the light of the NHS reorganisation that is about to happen, so that we keep experienced staff and so that local people’s views are taken into account.
I recognise that there are concerns about the plans and that there has been a lot of debate. I am very proud of the Wishaw unit in my constituency. It is an award-winning unit that provides exemplary care, and it will still care for the vast majority of babies. The change will impact only the smallest babies and those in the poorest condition—the ones who need extra help—and those babies often already have to travel to Glasgow, because the Wishaw unit does not have the capacity to provide neonatal surgery.
In general, I support the proposals, given the expert clinical advice, the reassurances that the Government has provided and the fact that we have ScotSTAR—the Scottish specialist transport and retrieval service—which is a dedicated ambulance service for babies that is not subject to some of the challenges that there have been in ambulance procurement for patients in that area.
However, I recognise that there has been a major public service reform announcement regarding health boards, so it is important that we focus on what those big national health service changes might mean for these plans.
I have supported the campaign since it began back in the previous session of the Parliament. The work that has been undertaken by Lynne McRitchie and other mums, particularly those in the Motherwell and Wishaw area, can only be commended, because they want what is best for mums, parents and vulnerable babies.
“The Best Start: A Five-Year Forward Plan for Maternity and Neonatal Care in Scotland”, which is not the only plan that relates to neonatal and maternity services, paints a very clouded picture of the provision that is available, what the proposals will mean for new parents and their newborns and what maternity and neonatal services will look like in the future. We have had too many reviews, and the Scottish Government has not implemented their recommendations. Downgrading of neonatal departments—particularly those in my region—is causing concern to a lot of families in those areas.
I still do not understand why the Government has not chosen to have five neonatal specialist departments instead of three. Even now, that has not been properly explained. I do not believe that the Government can continue with the downgrading without assessing all the issues that have been put on the table by the petitioner and by MSPs, who have been seeking clarity and answers to questions for quite some time.
I refer members to my recent question to the Government about when the neonatal departments would be downgraded. I received a response on 1 September, but we still do not have an answer. That puts families in limbo and makes expectant mums fearful about what might happen. If the Government is serious about implementing the best start plan, it must be honest with the mums, children and families who will be impacted.
A lot of things are in limbo, and I do not believe that the petition should be closed when we still have so many unanswered questions. The least that we can do—if we are not fighting the proposals, which I will continue to do—is get answers for the mums and families who will be impacted.
10:30
I agree whole-heartedly with Meghan Gallacher’s contribution. I am still in contact with Lynne McRitchie of the Wishaw neonatal warriors and with Lauren Bruce, who represents Ninewells parents.
So far, the debate has been characterised as being about lived experience, emotion and common sense versus the evidence. The Government is keen to say that all its changes are evidence based, so we spent a bit of time taking a deep dive into the evidence, and I make a challenge today, because the evidence does not support taking the reorganisation of neonatal intensive care units at level 3 to the level of centralisation that is proposed by the Government. We should remind ourselves that we would have fewer level 3 NICUs per capita than in England, and that has also to be combined with the geography of Scotland.
The evidence does not show that pre-term infants are more likely to be born in level 3 facilities, and it shows that transporting pre-term babies is dangerous. There is evidence to suggest that hospitals that hold level 3 NICUs are driving improved outcomes, but that needs to be set against the chances of survival for babies.
The argument that centralisation develops expertise and allows clinicians to maintain that expertise works for Glasgow, Edinburgh and Aberdeen. However, the trade-off is that the level of benefit to babies in Wishaw and Ninewells is not acceptable, because the transportation means that those babies will have a lesser chance of survival.
The Scottish Government has recently shifted to using as its evidence base babies who are born at less than 27 weeks’ gestation. I am not surprised that it is doing that, but that accounts for only 40 to 50 babies born per year, whereas its written submission suggests that 100 very low birth weight babies would be considered as a suitable level in Scotland every year. There is, therefore, a real discrepancy in the figures. That becomes more interesting when looking at Bliss Scotland and Public Health Scotland figures, which show 850 to 1,100 level 3 admissions. None of it adds up, convener.
Most interesting of all is that Finland did a study of babies born at high, medium and low-volume hospitals and found little material difference in outcomes, so it did not go on to centralise. The evidence says something different from the Scottish Government’s interpretation.
On that basis, I invite the committee to consider the fact that an independent review of maternity and neonatal services is about to be conducted, to be led by Professor Christine McCourt. Its remit is not yet published, as far as I am aware, and there is no explicit consideration of neonatal services in level 3 NICUs. To be frank, given the patchy evidence, I hope that the committee will invite the independent review to look at the issue and, at the same time, keep the petition open.
I thank all colleagues who have joined us to make representations on the petition. I now invite comment from committee members.
In light of the information that we have heard from our colleagues, I whole-heartedly agree that there should be an independent review. What is proposed appears to be a dangerous move, given that there is not sufficient evidence for carrying it out.
Given the nature of the issue and the public interest in the matter, particularly in relation to the assurances that are sought by the petitioner on capacity et cetera, I suggest that we keep the petition open and take further evidence from the minister, to expand on the previous letter to the committee.
I am happy with that.
We note a number of proposed actions from colleagues and committee members. In particular, we note the forthcoming review of maternity services by Professor Christine McCourt, as well as the minister’s view and the health board restructuring that has been proposed in the programme for government. All of those point to the necessity for continuing scrutiny of the issue. I thank everyone for attending to discuss this matter.
It is worth noting that the committee intends to hold petitions debates in Parliament in due course, and this petition might be a good candidate for a wider debate with members.