National Health Service (Framework for Service Change)
I reconvene the meeting and thank the minister for his prompt return to the table.
I draw members' attention to the letter from the minister, dated April 2004, on the national framework for service change in NHS Scotland. The issue was referred to at the committee meeting last week in relation to two of the petitions that we discussed. I welcome Sandra White, who will sit in with the committee on this item.
We agreed to question the minister on the issues raised in petitions PE643 and PE707, in the context of the announcement. Do members have any questions?
I will quote from your letter, minister, in order to put my question in context. The letter states that you are establishing an expert group and that its work
"will provide strategic direction to the service as it reconciles the various pressures on sustainable healthcare arising over the coming years."
The group will
"develop a national framework for service change. My intention is that we should provide a strategic framework as well as guidance to NHS Boards to assist them in developing new configurations of service."
The letter also states:
"I envisage an exercise lasting no more than a year, in order to limit uncertainty or delays for local change plans."
Would it not have been good to have had a national framework in place some time ago—perhaps when the Parliament was established—in order to give a context to the centralisation of services that has taken place throughout Scotland? It has struck a number of people on the committee and throughout Scotland that many decisions are being made in isolation and that there is a lack of communication between boards and a lack of public consultation. It seems strange that in 2004 a national framework is suddenly being developed when in some cases the horse has already bolted. Although I welcome the initiative, is it not too little, too late?
I do not think that it is too little. It can always be argued that things are too late. People can always say, "That is a good initiative—why did you not introduce it last year or the year before?" Shona Robison could probably pick out a large number of things that we are doing and put them in that category, but I do not know how useful it is to go down that route. People can say that the work should have started last year or the year before, or in the first year of the Parliament, but at that time the focus was on other health issues. This issue has certainly become increasingly prominent. People who were members in the previous session of Parliament will recognise that the matter has become the number 1 issue in this session in a way that it never was in the previous one. I am not saying that Shona Robison is wrong—no doubt an argument can be made that we should have started the work sooner—but the important point is to do the work rather than argue about the precise date when it should have started.
I am keen to get on with the work and to involve a large number of people in it. I believe that I have brought together some of the most progressive and enlightened health-care thinkers available. I have great confidence that the group will make a very helpful contribution.
We are where we are, but as I said, your letter states:
"I envisage an exercise lasting no more than a year, in order to limit uncertainty or delays for local change plans."
That seems to acknowledge or imply that the expert group's recommendations could certainly impact on some of the service changes that are happening locally. You acknowledge that point in your letter and in the terms of reference and scope for the expert group's work. One of the terms of reference that is outlined is:
"providing services in a consistent and equitable manner across the whole of Scotland".
You will be aware that a number of decisions are pending about local services—whether it is maternity services in Caithness or at the Queen Mother's hospital in Glasgow—where a national framework could be of crucial importance. Would it not be better to acknowledge that the framework should be established before further decisions are made? Otherwise, some of the decisions that are taken at a local level could run counter to what is recommended by the expert group in a few months' time.
There are a few things to say on that. It is interesting that the examples that you give are about maternity services. Many of the issues and current controversies that are in the forefront of people's minds happen to relate to maternity services. We already have a framework for maternity services and the expert group on acute maternity services—EGAMS—has produced its report. I should probably also have made this point in response to your previous question: it is not as if we are starting this piece of work cold. Work has been done on maternity services and the white paper on health, published last year, dealt with some of the issues, albeit in a more general way. Other pieces of work, such as the acute services review, were done before the Parliament took over.
Obviously, the group will carry on from where its predecessors left off. I do not envisage that its comments on maternity services will be dramatically different from those of EGAMS. When all is said and done, EGAMS consisted specifically of experts on maternity services. The piece of work that we are discussing will not change fundamentally the framework for maternity services that already exists. That is one reason for not freezing decisions about maternity services.
Some issues—for example, those relating to staffing—are very urgent. It may not be possible to delay making some decisions, whether or not one thinks that that is desirable. The group was not set up as a way of freezing decision making and creating planning blight for a year in the NHS. Rather, the aim is to create a synergy between local work and the national framework. A national blueprint will not be imposed. There will be a partnership between the centre and local systems. No one wants us to go down the road of planning the whole Scottish NHS from Edinburgh. However, we think that it is important for us to have a framework. It is consistent to have that framework developed while local systems go ahead with producing proposals for service development.
It would have helped if your letter had made it plain that maternity services had already been dealt with elsewhere. It does not do that and refers merely to "configurations of service", which implies all kinds of service.
No one would disagree that it is a good thing to have an expert group develop a national framework for service change. The group includes members from Tayside NHS Board for whom I have a great deal of respect and in whom I have considerable confidence. However, I agree with the point made by Shona Robison. We have already had the Primary Medical Services (Scotland) Act 2004 and the National Health Service Reform (Scotland) Bill, which are intended to modernise the delivery of service and to increase patient involvement in the planning of services. There have also been a maternity services review and an acute services review, to which you referred. One would have thought that those measures would have been predicated on the work of the sort of group that you are now establishing.
It confuses me when you say that maternity services have been dealt with because there has been a maternity services review, the result of which will be pinned on to the findings of the framework expert group. Does the same apply to the acute services review that you mentioned? If that is the case, and given that other issues have already been decided by the legislation to which I referred and will not be affected by the national framework, what will the expert group recommend? In most areas everything is already cut and dried.
I was not aware that I was saying that. Shona Robison raised the specific issue of maternity services. I did not say that that issue was excluded from the remit of the group, but that a major framework for maternity services was produced just over a year ago and is available to be used by boards now. Boards do not need to wait for the new expert group to complete its work before they make decisions on maternity services. I do not envisage that maternity services will be central to the group's work, but should the group wish to examine those services further, they will not be excluded from the group's remit.
I am not sure about the other issues to which Kate Maclean referred, but the group's work is not pre-empted. Obviously, it must work within the context of health policy in Scotland. The group knows the parameters within which it will work and will not recommend that we throw out the National Health Service Reform (Scotland) Bill, for example. However, we want bold and innovative thinking. I agree with Kate Maclean's comments about the two representatives from NHS Tayside, whom she knows. The same is true of the group's other members.
One of the issues around service change that challenges me is that, although we need service change—which is, perhaps, better described as service development and improvement—we have to make absolutely sure that we have considered all the options and are coming up with the best possible configuration of services. That is partly what makes me think that we need to do this piece of work. I am not saying that I do not have confidence in boards or that I do not want them to get on with their work; I am saying that I want them to be able to draw on the best available models of care and to be able to work in the best available framework. The work of the expert group is important and is not pre-empted by previous pieces of work except to the extent that it is being done within the general parameters of health policy in Scotland.
If the expert group finds that the provisions in the National Health Service Reform (Scotland) Bill are not the best way to manage services, allow public involvement and consultation and deliver joint-agency working, or finds that the results of the maternity services review or the acute services review are just mince and do not represent the best way to deliver those services, will it be able to announce those findings or has it been told that it must work within certain parameters? If it does come to those findings, where do we go from there?
We should distinguish between differing issues. Most of the National Health Service Reform (Scotland) Bill, which we will debate on Thursday, is not about the configuration of services as we understand that in terms of the on-going controversies about the hospitals in which certain services should be located and about whether services should be local or centralised. Obviously, the National Health Service Reform (Scotland) Bill is relevant to that in so far as it sets up community health partnerships and ensures that single-system working is enshrined in legislation through the abolition of trusts. All of that is a given for the expert group, which means that it is not going to say that trusts should be reinstated or that community health partnerships are a bad idea. Those areas are not within the group's remit.
From the controversies that are going on around Scotland at the moment, most of us know what we mean by service reconfiguration and that is the remit of the group. The public involvement parts of the National Health Service Reform (Scotland) Bill are relevant to that, but that will not be central to the remit of the expert group. However, we have policies on public involvement that we want to develop and we want the group to have a major involvement with the public and this committee.
My question is in a similar vein. We have been talking about this for a long time. About two years ago, as a result of a petition about acute service change and proposals relating to a medium secure care unit in Glasgow, the Health and Community Care Committee conducted a similar exercise about consultation. I am sure that I remember you telling the committee at that time that new guidance would be brought forward. We now have a national framework with terms of reference and a distinguished group of people who will consider the situation and report back in a year but I wonder what on earth will be left to be changed in a year's time. Over the past four or five years, the NHS has gone through some of the most dynamic and far-reaching changes that it has experienced since it was established. It strikes me that, by the time the group reports, there will be nothing major left to change. I accept that change is an on-going process and that the group will do good work to help that process, but the major changes will have taken place.
In the terms of reference that are attached to the letter before us, you mention "partnership" a couple of times: once in relation to the themes contained in "Partnership for Care"; and once in relation to working in partnership with patients, staff and other stakeholders. That has been the problem all along. In the context of the petitions that we want to talk about today, one of the problems is that the nature of the partnership is such that the views of staff have not been taken on board at an early enough stage. In particular, the views of some clinical staff are different from those of the board. I know that you will never get everybody to agree, but it is important to try to take as many people with you as possible, and in the situation that we are talking about, that has not happened. What are your views on that type of partnership? I do not think that we have got it right, and I am not sure how the terms of reference will deal with that. You talk about working in partnership, but how will you ensure that people's views are taken on board before consultation starts?
There are two issues. We have talked on many occasions about public involvement and consultation, and I understand that the petitions are basically flagging up those issues. The process issue about how we involve people in service change is part of the National Health Service Reform (Scotland) Bill. The expert group, which is made up substantially of staff along with some members of the public, is considering that; more substantively, it is concerned with models of care. I have no direct control over the group whatsoever, and who knows what it will come up with. I am not saying that the two issues are not closely related, but there is the public involvement agenda, which needs to develop and which we will discuss further on Thursday, and then there is the substantive issue of what the best models of care are, in terms of quality of care, clinical safety, local access and so on. The two subjects are related but separate.
I will pick up on your last point, because I did not answer the earlier question on it. As you know, we set up the expert group, which is like the other expert groups that have been set up under the Scottish Parliament—we will, no doubt, touch on a previous expert group under the next agenda item. The group may well come up with things that are challenging or different from what I, you or whoever has been saying. That is part of how we do policy in the Scottish Parliament; we try to draw on the expertise that exists in the field rather than to control and direct everything from the Scottish Executive. The expert group is a bold attempt to capture and tap into the expertise that is out there to benefit the whole of the NHS in Scotland—that is a substantive issue. The public involvement issues are proceeding separately, and I have not asked the group for its views on them because that is not its remit. We have a substantial body of policy on public involvement, which will be further developed by the National Health Service Reform (Scotland) Bill, which we will discuss at stage 3 on Thursday. I am asking the group for its views on how services should be configured in Scotland.
I accept that, but one of the most important groups of stakeholders in the argument consists of people who work in the NHS. The difficulty in the situations that the petitions address is that groups of clinical staff have different views and are at odds with each other. We can understand how that upsets the public, who look to clinical staff for their expert knowledge and advice. How do you quantify that?
My difficulty is that it seems that I am being asked about two distinct issues. The agenda item is on the national framework for service change in the NHS, but I know—by chance, as it happens, not because it is on the agenda—that there is an issue about the petitions that the committee discussed last week. As I understand it, the issue is public involvement and, no doubt, staff involvement in service change—I think that it is particularly about maternity services in Glasgow, but I am not sure. All that I am saying is that the two issues are separate. We can disagree about the details, but I agree entirely that we need to get better at public involvement—that is what we will discuss on Thursday during stage 3 of the National Health Service Reform (Scotland) Bill. I agree that staff should be involved in that too, but the present agenda item is about something different. I am not saying that it is not related, but it is a different issue from that of the petitions that you flagged up. However, you have made an important point—
Minister, if I may interrupt, I have checked the position. Your department was informed that we would refer to the petitions as well as to the letter.
Sorry. I followed the agenda rather than anything else, but I accept what you say. I suppose that I was confused when I saw the agenda because I did not know where the petitions would come up. That is the point that I was trying to make.
I agree entirely with Janis Hughes that the particular problem in Glasgow is that different staff groups have had conflicting views on maternity services. In part, that is because different specialists have taken different views of the situation. However, that does not mean that we should not involve staff fully and at an early stage in proposals for service change. It is probably regrettable that more agreement could not be found at an earlier stage among the obstetricians and different specialisms in Glasgow, because it is confusing for the public when one group of clinicians sends out a message that is completely contrary to that of another group of clinicians. It is not surprising that people are confused when clinicians come out with different messages on maternity services in Glasgow.
I echo the respect that others have shown for the people that the minister has managed to get as members of the expert group.
Paragraph 4 of the terms of reference and scoping paper that the minister has provided for us mentions that the national planning exercise
"will draw on a set of values underpinning the modernisation of health services".
The values that are listed contain nothing that one could disagree with. However, in theory the NHS has been run on those values for years.
In paragraph 7 of the paper, the 14 bullet points are written up as if they were new activities. As far as I am aware, the Health Department already takes demographic changes into account. I presume that it also examines trends in epidemiology—although I have raised several questions on those over the past two or three years without receiving a clear answer. One would assume that many of the activities listed in paragraph 7 are going on already. Is your department simply beginning to realise that there is a need to pull together all the bits and pieces of work that are currently being conducted by universities, by the Health Department and so on? If that is part of the exercise, it strikes me that it is a wee bit late.
I will stop at that point to let the minister respond.
The fact that work is already taking place in those areas does not contradict the need for the expert group to consider it. In fact, if the work was not taking place, it would be difficult for the expert group to take the work into account.
Paragraph 7 fills out some of the factors that the expert group will want to consider. The first two bullet points provide good examples, because we cannot plan for the future without having some view of demographic and epidemiological trends. Work has been done on those issues, but that does not mean that further work is not required. You may remember that, during the cancer debate that we had before Christmas, I said that we wanted to do more work on cancer scenarios, such as making projections about the future incidence of cancer and the morbidity associated with that. We are simply saying that, in the conclusions that it comes to, the expert group needs to consider and take account of the many on-going bits of work. I do not think that those things are contradictory.
In other words, the expert group will pull together the state of knowledge—
They will do more than just pull that knowledge together; they will need to take account of it. They will use that work to come to conclusions about service reconfiguration and redesign.
The group will report to you in a year's time. For the record, will you confirm that you will consider openly any proposals from the group, even if it proposes that some changes that have been made during your stewardship of the health portfolio should be undone?
As you will know, I have great confidence in the group—although that is not surprising when one considers that I have appointed it.
The minister may be giving a hostage to fortune by saying that. "Hand-picked" is the phrase that comes to mind.
I am not sure. Who do you think appoints groups?
As the next agenda item might illustrate, previous reports have been challenging for the Executive. For the report on hepatitis C, "challenging" is without doubt a fitting word. We cannot say that we will necessarily accept every single word that an external group says before it has reported. That would be foolish. However, I have great confidence in the expert group, and I will set great store by whatever it comes up with. We have to set things in the framework of how service change is carried out by NHS boards in Scotland. If you are suggesting that all the service changes that have recently taken place will have to be revisited, I would say that that is not necessarily the case.
In the first parliamentary session, the Audit Committee and the Auditor General for Scotland started examining carefully the outcomes from health delivery. Is the report a one-off, or does it mark the start of a rolling review? Is that an option for the future that you might have up your sleeve? If a rolling review is being undertaken, what are the terms of reference?
In a way, it is both. The expert group has been asked to come up with a report within a year, but the work will continue for the Health Department. Obviously, we are not just going to say, "Well, that is done—we'll forget about it for the next few years." It involves both a piece of work to be done within the year and on-going work thereafter.
As a matter of interest, what budget has been allocated for the group to do its work?
I do not know the answer to that question, but we can find out for you.
I was encouraged when I read the minister's letter. I go along with what other members have said—that the horse has bolted—but I would like to think that this horse, despite having bolted, might somehow be retrieved and brought back to the stable. It is commendable to accept that things have to be reviewed. I am glad to hear that a report will be produced within a year, and that the Executive will be considering the on-going review of the changes that are taking place. There have never been so many changes within the health service, and they have put a tremendous strain on every part of it. The consultant contracts, the European Community regulations and so on have put enormous strains on the delivery of services throughout Scotland.
We must take stock of the situation. We will not be able to sustain communities throughout Scotland if we cannot provide them with NHS services. I am glad that maternity services have not been excluded from the review. When acute maternity services are taken away from an area, say in Thurso, that changes what anaesthetists are able to do for maternity and other services. It is not just maternity services that are under threat throughout Scotland; it is also general medical and general surgical services.
Returning to the subject of services in Thurso, I met some friends two weeks ago, whose niece was going up to stay in the Thurso area. That young girl and her husband were thinking about starting a family there. They were extremely worried when they realised that consultant maternity services were going to be based 100 miles away, and they are rethinking whether they should in fact stay there and set up a family there. I would not like to be a young woman in that situation, knowing that consultant services were located 100 miles down the road.
I did anaesthetics, and I saw the worst side of maternity services when anaesthetists were called in for emergencies. I have seen the acute side of obstetrics. Once we have taken stock, we should perhaps revise how we provide such services. We might wish to consider rotational consultant contracts, to allow doctors to rethink how they work and to provide services outwith the big towns. At present, I see everything moving east and south. We certainly do not have enough capacity in Glasgow to cover the work that we are supposed to be able to do now.
I commend the Executive for what it is doing. The first paragraph of the Executive's paper on the terms of reference for the national planning exercise says:
"These include a commitment to safe, high quality, sustainable patient-centred care delivered close to the patient wherever possible and in appropriate, modern specialist facilities when necessary. These themes are supported by increased public investment".
That will be difficult to achieve, but I give you 10 out of 10 for coming up with the idea.
There was a section on public involvement in "Partnership for Care: Scotland's Health White Paper"—I think that it was on page 43. You wanted to ensure that you knew what the public required before you took decisions. However, public involvement, no matter what form it takes, seems to be ignored. Janis Hughes mentioned the secure unit at Stobhill hospital and others mentioned the Queen Mother's maternity hospital. If Greater Glasgow NHS Board's blinkered remit was that only two maternity hospitals could exist in Glasgow, it had to close a hospital, although surely the point about the maternity unit in Yorkhill is that it is a specialist unit. No one has difficulty with centralised specialist units, but everyone in Scotland has difficulty in accessing general services. I support a national framework and I look forward to hearing the expert group's recommendations.
The Executive's paper says that one intention is to remove
"barriers from the patient's pathway of care".
The expert group has just been appointed so it might not yet know how that can be done, but will you give us more information about that?
Paragraph 7 gives a long list. I mentioned line management earlier and it is extremely important that management listens to staff. That would remove a lot of stress from their lives. A good manager would not allow the grievance procedure to continue for longer than was necessary to deal with it: a month is too long and three years is ridiculous. Perhaps that should also be considered.
You raise many issues, but you got to the heart of the matter: all those controversies in Scotland centre on the tension between local delivery and centralisation. My approach has always been that we must do both; some services must flow into localities and others into a more centralised location. That is a key tension that the expert group must resolve.
I entirely agree that staff should be involved, but in reality, staff and clinicians disagree about maternity services in Glasgow—and about other matters. You are a clinician and you take one view, but it is fair to say that a large number of your clinical colleagues take a different view. The group will have to address those issues.
The removal of
"barriers from the patient's pathway of care"
is a general objective. The phrase refers to the development of single-system working in Scotland, which we hope will get rid of the acute sector, primary care and social care silos and try to join up those different sectors. Obviously we want to make that pathway as smooth and as quick as possible, with no big delays at any stage.
The phrase "pathway of care" is a bit jargonish—when we talk about the patient's journey people sometimes think we are talking about the journey from the bus stop to the hospital, rather than through the different parts of the health system.
Jean Turner raised an important point. I have a supplementary question, which might seem frivolous.
Will anyone in the expert group consider the socioeconomic impact of changes in services, rather than the narrow—in the most polite sense of the word—clinical provision? That might be useful.
That is an interesting dimension, which I do not say is unimportant. As I said in the recent debate on maternity services in Caithness, I recognise the big issues around the service in Wick and I certainly do not want to pre-judge that situation. However, when I responded to the question on maternity services in Oban during question time last Thursday, I was thinking about population centres in Scotland that do not have consultant-led maternity services.
With regard to the area north of the Clyde, I asked myself when, in the history of Scotland, any of those major population centres, such as Oban, had a consultant-led maternity unit. The answer is that they never have had one—I am not saying whether that is a good or a bad thing.
I was not narrowing the issue down to maternity services, although they are important. It simply seems that a Government that prides itself on addressing issues in a cross-cutting way should address the issue that I was talking about.
I will reflect on what you are saying, but I am merely reflecting the context in which the matter has been raised. I am not saying that the analysis that you mention should not be undertaken, but it would be quite difficult to do so; that is my point. Oban is a major centre of population, but is its maternity care provision stopping people living there? Perhaps that is the issue that we should be considering—I am not saying that it should not be considered—but my thoughts about the population centres north of the Clyde gave me a bit of perspective on the idea of how catastrophic it would be if a certain centre of population did not have a consultant-led maternity unit. Everywhere on the west coast of Scotland has been in that situation forever.
The kingdom of Fife has been through the process of the acute services review and as a result has experienced changes that are reflected across Scotland. Above all, people want to feel safe. Whether you are a patient or someone who works in the NHS, you want to know that you have a future. That is the loud and clear message that has been given. That is why I like the point that you make in paragraph 5 in the terms of reference that are attached to your letter, which covers an area that was missing from the work that took place in Fife. There was no big picture or vision of the various models that might support sustainable healthcare provision in Scotland. As Jean Turner said, it would be extremely welcome if that were to be set out. Everyone has seen the process as one that brings threats rather than opportunities. However, in talking to medical people—as we have the privilege of doing from time to time—we learn that they would like some changes to be made in the interests of bringing patient care much closer to the patient. For historical reasons and for reasons of custom and practice, they have been prevented from making those changes. It is important that we get across to the public the message that the process presents opportunities and not just threats.
On the theme of communicating with the public and the staff, it is concerning when we turn on the news—whether it is on the BBC or another broadcaster—and hear someone such as Dr Rosemary Leonard saying that the contracts have been imposed on GPs. Often, no counterbalancing voice is raised when such suggestions are made. The Scottish Executive must be alert to such issues and strive to add balance when misrepresentations have taken place.
Developments in new technology are interesting. I e-mailed the clerk and one or two of my colleagues with information relating to the massive new developments at the Robert Gordon University in Aberdeen, in which Scottish Enterprise is involved. New machinery, such as digital x-ray machines, is being brought in and new practice is being adopted. We are not communicating to the public the ways in which those advances, which will help to bring treatment much closer to home, will impact on service delivery. How are you going to tackle that?
I hope that, for best practice, you will look to the ophthalmology unit in the Queen Margaret hospital in Dunfermline. That is an example of the Executive's targets being delivered way ahead of schedule in the treatment of cataracts and other conditions. The redesign of the service there has been driven by the consultants, the clinicians and the patients together in a team-based approach. The one concern that I have about the paper that we have in front of us is that, although I appreciate the fact that expert groups have to be made up of individuals who are chosen from your expert team, I do not see any representation from the kingdom of Fife.
That last point is a fair one, but I am not sure that we can construct groups by taking one person from each health board. Kate Maclean was kind enough to point out that there are two representatives from Tayside on the expert group. I am happy to say on the record that NHS Tayside has been one of the most successful health boards in engaging with the public and in dealing with the difficult issues of service change, whether at Stracathro or in Perth. Notwithstanding the controversies around maternity services, the board has managed to put a lot of services into Perth in its plans. It is correct that we have two outstanding people from Tayside on the expert group. I apologise that there is no one from Fife on the group, but I do not think that it would be possible to construct the group on that basis.
I thank Helen Eadie for all her other comments. She started by talking about the models. That is the heart of the matter. We want to have the best models that we can possibly get, and we want to learn from the best practice that is available. The trick in health care improvement is to find out fast what the best models are and what the best design of services is and to find ways of disseminating that information as rapidly as possible. I hope that this exercise will be part of that process.
It is back to basics with me, Malcolm, as usual—the big, bad wolf.
The paper makes a classic mistake in raising expectations that will not be met. It states that one of the objectives of the exercise is
"to promote opportunities for local access to services and balance local delivery with the need to have centres of excellence providing high quality, modern, specialist care".
That will not happen with the type of panel that has been appointed. I do not believe that the panel will challenge the status quo or the dominant thinking, which is to concentrate and centralise consultant-led in-patient services. That will be the conclusion of the group, just as it was the conclusion of the EGAMS group and others, and that will put a professional seal on the process. I am not saying whether such an approach is necessary or unnecessary in the wider debate, but we must get people out there arguing. However, if that is the way in which we will deliver our health services in the future, we need to be more honest about it. I am sorry. It is not like me to be negative, but—
We love it when you are negative.
I do not expect the expert group's deliberations to have any dramatic consequences; I expect only that the group will confirm the centralisation of our services. In rural communities that feel disadvantaged or in communities such as those in my constituency, which have a poor health record and a low level of car ownership—Paisley is just as far away for some of my constituents who have to travel to visit relatives—that disengagement cannot help. Such issues are worrying to constituents up and down the country, and we need to be honest about them.
The Executive's paper states that guidance is going to be developed "in tandem". Does that equate to support now for the reviews that are under way in Argyll and Clyde, Glasgow and various other places? Does "in tandem" mean that we can consider those reviews as they unfold? Will these experts, with their blue-sky thinking, consider measures to support health boards in dealing with the issues that they are struggling with now?
We hear that people throughout Europe and the rest of the world would not consider the problems that we are dealing with as significant. They have overcome them, or they work differently or whatever. They would certainly not get as excited about those problems as I do. However, where is that European or worldwide context? Where is that new thinking, or is it just that establishment people will come together and do what they have got to do? Where is the thinking about how other countries overcome geography to deliver effective services in a way that is acceptable to their citizens?
Well, we certainly want to draw on international experience. We have close relations with Norway, for example, on rural health care. Without going into all the details, you will find that the solutions are not fundamentally different from the kind of approach that we have taken. For example, community maternity units, which are used extensively in Norway, are proving quite controversial in some parts of Scotland. We want to make those international connections, and we do not want to be parochial. The phrase "in tandem" means, at one level, that the solutions will be developed simultaneously, but I have used the word "synergy", and I would expect that there will be some kind of relationship between the solutions.
Argyll and Clyde NHS Board is doing some major work this year—it will be aware, as I am, of the work that is being done by the expert group. At the end of the day, Argyll and Clyde's plans, and anybody else's plans, will come to me.
I consider the expert group to be important. I am not a member of the group, but I have adopted a certain position in it; I attend its meetings but, because its members are the experts, I speak only if they ask me a question. If they want, they can ask me questions, drawing on my knowledge and my awareness of what is going on in the world. I am basically there as an observer. I listen to the group and I am influenced by what it is saying. That will feed into the on-going discussions with boards and the approval of boards' plans. The phrase "in tandem" suggests that there will be a creative relationship between what is going on at the centre and what goes on locally. The Executive is not saying that local systems can opt out of what is going on, or that that is not their responsibility any more. We just want to help and support them. In fact, local systems have been asking for some more national work around these difficult issues, so that they can be confident that they are thinking of all the best models that are available.
Malcolm Chisholm mentioned the fact that maternity services, which are the subject of petition PE707, are not covered by this agenda item. He talked about the strategic framework and the remit of the expert group, and mentioned regional planning, which used to come up all the time in the Public Petitions Committee. He also mentioned that he is asking the boards to get the best services possible, and to consider the best models of care. How to get the best model of care will come through the strategic framework and guidelines, which the minister says will come along in a year's time. Those issues were mentioned by the petitioners—not just those involved in PE707, which concerns the Queen Mother's hospital, but those involved in the three petitions on maternity services and hospital closures—when they submitted their petitions; the petitioners also highlighted their concerns about how they had been handled in the consultation process.
Like Janis Hughes and others, I went along to meetings on the consultation process for nearly two and half years. The Executive has received so many complaints from around Scotland—not least Glasgow—about the way that consultation processes have been handled that it has felt that it has had to have a strategic framework. That is both a knee-jerk reaction and—I agree with Duncan McNeil on this—a rubber-stamping exercise. I would like to ask the minister—and I think that other members would like to ask this as well—why there is a strategic framework all of a sudden, when there will be no services to have guidelines or a framework about. Why is it that, despite the fact that the Queen Mother's hospital at Yorkhill gives the best services to the public and represents the best possible model, the board's recommendation is to close it down?
I want to turn to the two petitions on the closure of the Queen Mum's, which I am concerned about. The EGAMS report has been mentioned, but we know that EGAMS produced two separate reports, which were contradictory. People have also cited the report from the British Association of Paediatric Surgeons, but we know that the BAPS report included misinformation because it used the wrong year. Despite what the EGAMS report says, the Queen Mother's has operated for more than 40 years without any mother fatalities, yet all of a sudden, we are told in one part of the EGAMS report that the hospital cannot possibly be allowed to continue.
On the new consultants contract, which Jean Turner touched on, we know all about the new framework. However, if the minister shuts the Queen Mother's, he will still have to provide paediatric care and he will still have to service the Royal hospital for sick children in Yorkhill, the Southern general and the Royal infirmary, which are three different hospitals. Basically, closing the Queen Mother's will make no savings on staff costs.
Last, but not least, will the minister tell us when he will come to a conclusion on the future of the Queen Mother's hospital? Will it be before or after the strategic framework is produced?
In fairness to the minister, that question is not within the remit of what we are asking him about today. However, the main question that Sandra White and others have asked is reasonable. Given the closure of maternity units and the huge fights that are taking place throughout Scotland about the closure of various other services—which I am sure all committee members have come across—why is the minister only now setting up an expert group that will report a year down the road, when all the battles with the public, such as the ones in Sandra White's area and in other areas of Scotland, are taking place now? That is what mystifies me.
As I pointed out at the beginning, we already have a framework for maternity services. That is not to say that the new expert group will not consider maternity services, but maternity services are unlikely to be the main part of the group's work, given that we have a recent framework by another expert group on that subject. That was the balance that I wanted to establish.
Sandra White's question highlights the fact that, as I said earlier, we are dealing here with two closely connected but separate issues. In the case of the Glasgow proposals, one issue that I must consider is the substance of those proposals. The new expert group will consider substance but, in a sense, the way in which the board has handled the proposals is a separate issue. It would be possible to come to the conclusion—I am talking only hypothetically here—that the Glasgow proposals are right but that they have been handled terribly. That is not what I am saying, but one could say that. The reality is that those are two separate issues—
But there could be an issue about both the process and the substance—
Or, vice versa, one might conclude that the board had handled the proposals brilliantly but that the proposals were wrong. The reality is that those are two issues that I will need to take into consideration. Throughout this whole discussion, we need to consider both these issues: how we involve the public and engage with them effectively, and what the best model of care is that will give the best quality of service.
I do not know that I can say much more than that. I could talk endlessly about Glasgow maternity services, but it is right that I and others take time to consider the matter. The issue is complex. The proposal is probably the most controversial one that has arisen in the five years since the Parliament was established, so it would be a bit strange if it was rubber stamped. I have already said that the decision will not simply be rubber stamped.
The issue is very complicated. The convener may need to hold me back from making a speech about this, but part of the problem is that senior clinicians are sending out completely different messages. That is difficult for anybody to deal with. Some members have homed in on the arguments from the people at the Queen Mum's, but I have met the different groups. I have sat in a room with a large number of obstetricians and anaesthetists who have told me that it is not safe to provide maternity services without co-located adult services. It is very difficult when senior clinicians tell you different things. That is another reason why it should take quite a long time for me to consider the issue.
I know that some members have further questions, but I am afraid that I need to close down this discussion. We might return to the subject, or individual members might do so, once we have had an opportunity to read the minister's comments in the Official Report of this meeting.