Petitions
There is likely to be more discussion about the first petition than about the second one. Petition PE129 calls on the Scottish Parliament to
"initiate an enquiry into geriatric provision and the continuation of local health services in the Oban area".
Duncan Hamilton has an interest in that, so I am sure that he will want to talk to us about it in a moment. Is Mary Scanlon also involved?
Jamie McGrigor is handling it.
More generally, we must consider what our role is with reference to local service decisions. In the case of Stobhill and Stracathro, we decided that we would examine procedural issues. It could be said that we have already done work on how consultation should be conducted, but we have been careful not to get involved in the decisions themselves. We should bear that in mind when making a decision on this petition. We should probably hear from Duncan Hamilton first, as he has been involved locally, before other members comment.
I would like to draw the committee's attention to the Official Report of the meeting of the Public Petitions Committee of 14 March, at which I made precisely the point that the convener has just made. I am acutely aware that this committee will not examine specific local issues. At the meeting of the Public Petitions Committee, I emphasised that the Health and Community Care Committee was likely to want to examine this issue because it is symptomatic of a wider problem in the health service, which was evident also at Stracathro and Stobhill, and would help inform our discussion.
I am not pleased with the way in which matters have been handled. I understand that Argyll and Clyde Acute Hospitals NHS Trust sent the letter last night that we received this morning. I do not think that that reflects a spirit of openness, particularly when the letter relates to the petitioner, a councillor in Oban, who does not have an opportunity to respond to it. It would have been more courteous and useful if we had received the letter in advance, so that the petitioner, who was invited to attend, could have decided whether he wanted to do so.
Some of the points that are made in the letter are self-explanatory. It addresses the issue of the CT scanner at Lorn and Islands Hospital, which was referred to at the meeting of the Public Petitions Committee and about which there has been much public concern. The trust has now accepted the offers of support, and the scanner will be provided. That has taken the matter forward.
However, there are three outstanding issues on which the committee might want to focus any inquiry or report. First, there is the issue of consultation, which the Public Petitions Committee addressed. The letter suggests that no decision has been taken and that there are plans for extensive consultation. That is a very different story from the one that people have heard locally. I attended a public meeting at which the chief executive of the trust indicated that a decision had been taken. At the very least, there is some confusion as to what is happening.
It is important to note that the consultation exercise has been bolstered by the role that this committee has assumed. The fact that we have examined the Stracathro and Stobhill situations in such detail is one reason why Argyll and Clyde Acute Hospitals NHS Trust is taking this forward. It might be trying to learn from our earlier reports, which is useful. However, people are still unsure about whether consultation will be effective, and I ask the committee to consider monitoring it.
The second issue is the potential confusion over resource transfer from health board to local authority. There is real local concern about what will happen in future if the ward in question shuts; that will involve resource transfer. So far, there is no agreement on what should happen—no plan and no sense of direction. Again, that is a more general Scottish issue that we might want to take this opportunity to consider.
Thirdly—and perhaps most important—there is the issue of the split between rural and urban health provision, which the petition gives us the chance to examine. As we know from our deliberations on the Arbuthnott report, Argyll and Clyde Health Board covers both very urban and very rural areas. If you remember, convener, we made a recommendation based on the fact that the rural areas in Argyll and Clyde had not been dealt with adequately. That is why the Scottish Executive has said that Arbuthnott will revisit the issue of funding for such split health boards.
It would be useful for the committee to take the opportunity to consider whether the current structure of health boards is inhibiting, or permitting, the adequate provision of health care. If the current set-up is not to the advantage of areas such as Oban, we should ask the Scottish Executive to monitor the set-up much more closely, with a view to introducing changes. The community has a real fear that it is being bypassed in favour of other areas. I appreciate that that happens in many communities, but I feel that this particular case highlights a structural problem in the NHS in Scotland.
There were three points there: consultation, which we have considered before; resource transfer, which we are also considering as part of our general inquiry; and the urban-rural split, which is a new element.
I saw the petition only this morning, and I am concerned that every change that is mooted will end up in this committee. That will be a problem for us.
I do not share the view of Duncan Hamilton and his party that we have had cuts because of bed numbers. Significant advances have been made in the treatment of patients, with the result that people often do not have to stay overnight. The public have not grasped the fact that not having a bed does not mean not having a service. The service is being provided in a different way.
I share Duncan Hamilton's concern about resource transfer. We should give more consideration to that in our investigation into community care. The situation in Argyll and Clyde will not be any different from the situation that I have experienced in Ayrshire and Arran, where the health board has not transferred all the moneys from long-stay closures to allow the appropriate level of service to be maintained in the community. I would be happy if we could do something about that. However, I would not be happy for us to say that we had to have an input every time that a ward closed in a hospital. That would not be the best use of the resources of this Parliament or of this committee.
I agree with Margaret Jamieson. As we go through the acute services review, a number of communities throughout Scotland will feel aggrieved at local decisions. We cannot substitute ourselves for the local decision makers. We must ensure that the guidelines that are established by the Parliament—which we expect the Scottish Executive to accept—are being implemented. If procedural matters are being ignored against the express wishes of the Parliament or of the Scottish Executive, we have a legitimate role to play. However, we are not a local forum that can consider all local decisions.
There will be understandable local concern, but the three elements that Duncan Hamilton mentioned in response to the petition can be dealt with by the committee. On consultation, we can draw the attention of the trust to the conclusions that we have already reached and to our expectation that trusts and health boards will undertake proper consultation in local communities. We should draw the attention of the Scottish Executive to yet another area in which concerns have been expressed, but go no further than that.
On resource transfer, Margaret Jamieson is absolutely right. The matter is being addressed. Following the discussion this morning, I look forward to getting more information on how money from resource transfer is being used. That information will form a substantial part of our community care deliberations. That is the proper way for us to proceed, rather than considering everything issue by local issue.
On the rural-urban split, as Duncan Hamilton said, we have made a recommendation that expressed our concerns about the implications for areas such as Argyll and Clyde. We have expressed a view, and we can remind the trust, the Executive and the petitioner of that view. Duncan admitted that our views had been accepted by the Executive. It would not be appropriate to examine the consequences of the rural-urban split in specific communities. We have already considered the general issue and there is not much more that we should do on the petition.
This is an example of bad practice. People in Oban and the islands are not so naive as to think that one needs a hospital bed in order to get treatment—there is as much day care going on there as anywhere else. I am concerned that a lack of trust will become a lack of confidence. The whole thing gathers momentum and undermines people's faith in the health service. That stems from bad management, poor consultation and poor participation. That is a problem and we should acknowledge the bad management of the health board. Councillor McIntosh said that the petitioners would rather be part of the Highland Communities NHS Trust, because they feel that it covers a large area and recognises island and rural needs. The petitioners feel that their health trust is not listening to them.
Duncan Hamilton mentioned that the issue is in the public arena. It is a bit like Stracathro, where the patients and staff read about what was happening to their local hospital in the Brechin Advertiser. There is talk about closing the maternity unit and people have raised issues about breast cancer screening and treatment. It is a fair trip from Tiree or Oban to Paisley or Greenock and that adds to the trauma of needing to undergo such treatment.
We should recognise the fact that bad management, such as that in Oban, undermines faith and trust in our health service.
I agree with what has been said on consultation. The committee undertook a useful exercise in relation to Stobhill and Stracathro. I hope that we have sent out a clear message on consultation, although I do not think that it has got through to health boards yet. I am concerned that every decision might come back to the Health and Community Care Committee for endorsement. In my constituency, there is a petition that has more than 3,000 signatures, and I am worried that all members could bring such petitions before the committee. We must send out a clear message about consultation.
I should have said that the petition asks us to
"initiate an enquiry into geriatric provision and the continuation of local health services in the Oban area".
I do not think that that should be the role of the Health and Community Care Committee. The Public Petitions Committee said that the committee might want to consider the approach taken by Argyll and Clyde Acute Hospitals NHS Trust in relation to public consultation on its proposed reduction in services. Hugh Henry has suggested that we draw the trust's attention to the work that we have already done on consultation.
We are not that diverse in our opinions. I take the point about local issues being taken to the parliamentary committee. That is why I began by referring to previous comments. I am not attempting to push a local issue at the expense of the rest of the committee's timetable. The matter is symptomatic of problems in the wider NHS. There is scope for inquiry on the matter.
It has been said that we do not want to duplicate our work on consultation. I completely agree with that. Now that Argyll and Clyde Acute Hospitals NHS Trust has said that it is at the beginning of the consultation process, what you have said is right: we should draw its attention to the matter and hope that the consultation is followed through.
Two other points are worth considering as they relate to different points in the process. The first is whether there will be any closure, which is the central concern. Although we addressed resource allocation in our discussions on the Arbuthnott report, that is very different from my current proposal. There is complete distrust of the decision-making process and the daily and strategic management of Argyll and Clyde Acute Hospitals NHS Trust. Do people feel, as a rural community, that local needs and concerns are being adequately addressed by that trust? I feel that that is more of a national issue.
Secondly, any closure will raise the issue of resource transfer. We would examine replacement provisions only if the ward were closed down and, in doing so, would need to investigate the interaction between the health board and local authorities. That secondary consideration flows from the first decision.
Although I take your point about the Public Petitions Committee's recommendation on the petition, it is merely a recommendation and does not rule out the possibility of the committee conducting an inquiry with the terms that I outlined.
We all agree that we should draw the trust's attention to our conclusions about the consultation process. However, Duncan Hamilton's other points are a matter of disagreement. Perhaps it is fair to say that he is taking the committee beyond the wording of the petition.
That might well be true. However, events have moved on since the petition was submitted.
We might have to vote on the matter. Do any other members want to comment on Duncan Hamilton's proposal?
My concern is that, where there is already a lack of trust, one problem can gather momentum and the whole partnership can collapse. I can see that the matter has moved on.
We are agreed that we will highlight our conclusions on the consultation process to the trust. I will have to put to the vote Duncan Hamilton's proposal to do further work on the issues of resource transfer and the rural and urban nature of that particular health board.
Before you do so, it might be helpful if I clarified my proposal. Any further work would examine whether the structure of Argyll and Clyde Acute Hospitals NHS Trust adequately addresses Scotland's urban-rural split. I want to take the threat to Nelson ward as an example of that.
Are you not including the issue of resource transfer in your proposal?
Indeed. That is the second issue.
We already have the petition. However, because Duncan Hamilton is involved locally, we have received additional information that would not have been available if the hospital had been in another area and the MSP were not a member of the committee. We can deal only with the terms of the petition. Although Duncan's information is helpful, it is not part of that petition.
Although that tends to be my view, I think that we should just put Duncan's proposal to the vote.
Is Duncan seeking a review of the health boards throughout Scotland?
No. I am merely taking Argyll and Clyde Acute Hospitals NHS Trust as an example of where the urban-rural divide has not been adequately addressed. The committee can then decide whether the trust's decision-making process gives enough balance to the rural communities. My other point concerns resource transfer between local authorities and health boards.
Although I am sympathetic to Duncan Hamilton's proposal, I do not want the committee to take on any more work. Could we tell the health board that concerns have been raised with us and ask what is being done to address them?
No, because that presupposes that the committee has reached a consensus on the matter. We cannot infer anything about the attitude or decisions of the trust from an individual's comments. If we are going to do that, I would want a more fundamental investigation, to give everyone concerned the opportunity to express their case. Duncan Hamilton is taking us 100 miles away from the petition's terms, on a fishing expedition of momentous proportions. Although I can understand the politics behind the proposal—
No—
We are not stupid.
I am not suggesting that you are.
Now that I understand what the proposal involves, I think that Duncan is trying it on just a wee bit.
First, no one is suggesting that anyone is stupid. I am not playing political games; the Parliament has to show some flexibility on the issue. Ten thousand people in Oban have signed a petition expressing their public concern about the lack of transparency on the part of the trust and their confusion about the future of a ward in their hospital. They want to know what the Parliament is going to do about that.
I am suggesting that, because events have moved on and in light of the fact that the consultation exercise has been undertaken in a different review, we should use this situation as a prime example to get to the root of the problem in Oban, which is all about whether the decision-making process gave enough weight to Oban and the rural areas. That is it.
We have agreed to address the issue of the consultation process, which is the recommendation of the Public Petitions Committee, and I am sure that we will come back to resource transfer on many occasions over the next few weeks.
The question is, that the committee investigate the management structure of Argyll and Clyde Health Board together with the question of possible resource transfer. Are we agreed?
No.
There will be a division.
For
Hamilton, Mr Duncan (Highlands and Islands) (SNP)
Against
Henry, Hugh (Paisley South) (Lab)
Jamieson, Margaret (Kilmarnock and Loudoun) (Lab)
Oldfather, Irene (Cunninghame South) (Lab)
Motion disagreed to.
The next petition is from a certain Mr Frank Harvey, whose name I seem to recognise, asking us to take urgent action on various pension payment issues arising from hospital stays. The recommendation is that we simply note the petition. Is that agreed?
Members indicated agreement.
That ends the public part of the meeting. We will discuss advisers for the budget process in private.
Meeting continued in private until 12:22.