Public Petitions Committee,

Meeting date: Tuesday, May 22, 2001

Official Report 225KB pdf

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Stobhill General Hospital

The first item on the agenda is petition PE354, from Councillor Charles Kennedy, concerning the removal of acute medical and surgical services from Stobhill general hospital. At our previous meeting we considered a response from Greater Glasgow Health Board. Specifically, we discussed the process of consultation that the health board and the local trust are undertaking—how they are involving local representatives and taking on board local concerns.

At that meeting, the local member, Paul Martin, raised a number of concerns about the consultation process. In particular, he said that the North Glasgow University Hospitals NHS Trust is about to embark on a consultation exercise on the future of specific acute services currently provided at Stobhill. He also said that at a recent meeting he was told that the option detailed in the health board's letter to us, which would have seen Glasgow royal infirmary closed and Stobhill rebuilt as the sole hospital for the north and east of Glasgow, was unrealistic and would be discounted.

In response to those concerns, we asked Greater Glasgow Health Board and the trust whether they would send representatives to this meeting to answer questions. I welcome Chris Spry, the chief executive of Greater Glasgow Health Board, and Maggie Boyle, the chief executive of North Glasgow University Hospitals NHS Trust. I thank them for their positive response to our request to attend this morning's meeting.

Before I take questions from members, I remind them that it is not for this committee to intervene in the executive decisions of health boards or to question the suitability of any of the options or proposals that they suggest. Our concern should be to establish that the processes being followed by Greater Glasgow Health Board are appropriate as regards local community involvement and that local concerns are being taken into account.

I invite Chris Spry and Maggie Boyle to make a short statement to the committee.

I would like to comment, first, on what we see as the focus of the petition; secondly, on the position of small specialties; and thirdly, on the point that was made at your previous meeting about the possible closure of the GRI. It may help the committee if I say something on those three issues.

When we received the petition, it seemed to us to relate explicitly to the strategic future of Stobhill. During the consultation period so far, the role of acute general medicine and acute general surgery has been at the heart of the debate about Stobhill's long-term future. It seemed to us that the Public Petitions Committee had taken a similar view, because the questions that you put to us focused on the strategic issues—on the consultation process, options, the role of the reference group and the status of the proposals. That is why our reply of 2 May to the committee also focused on those issues. In it we described how our thinking had moved on the substantive issues during the past year. We also said something about the process that we were putting in place to resolve the still unresolved issue of the strategic future of Stobhill general hospital.

In the past few months, we have been worrying away at three principal specialties. The first is elective orthopaedics, which has 17 beds at Stobhill. There are also two beds for ophthalmology and six beds for ear, nose and throat patients. In December, when the health board reviewed the outcome of the consultation to date, it said that it was difficult to see how those small specialties could be sustained in the face of severe pressure on doctors' hours. The board agreed to ask the trust to produce consultation proposals.

Since then the trust has been considering the issue. The board and the trust have been hesitant in dealing with this matter, as we recognise that proposals relating to the immediate future of small specialties would be interpreted as significant for Stobhill's strategic future—although we would argue that they are not. We were heartened by the fact that in January the Stobhill medical staff association recognised the need to consolidate small specialties. In early May, the orthopaedic surgeons confronted us on the issue, saying that it needed to be addressed. However, we have always maintained that none of the small specialties can be moved without specific public consultation.

The small specialties are not strategically significant. Orthopaedics has 17 beds, ophthalmology two and ENT six. Such numbers do not influence strategic choices about the future of Stobhill general hospital. In 1999-2000 there were about 23,800 in-patient cases at Stobhill. Of those, about 18,500—77 per cent—were in general surgery, general medicine and care of the elderly. That gives some indication of the strategic significance of those three specialties. In the same year, orthopaedics had 706 in-patient cases—3 per cent of the hospital's in-patient work load.

Of the four strategic options that have still to be examined as part of the process that we have initiated, two would locate orthopaedics at Glasgow royal infirmary and the other two would retain it at Stobhill. Orthopaedics might move to Glasgow royal infirmary in the short term, to deal with a medical staffing issue, but if one of the two last options for the long-term future of Stobhill were selected, it would move back to Stobhill in several years' time as part of a general realignment of services.

My final point relates to the closure of Glasgow royal infirmary and whether that is a real option. The suggestion was first made to us by members of the public during the consultation period between the summer of last year and December. Because it had come to us from the public, we felt that it should be examined as part of the option appraisal that we were setting up, with exactly the same rigour and transparency as any other option. Our view is that that is what listening to consultation is all about—it is about taking on board what people are suggesting; it is not about applying our own values to those suggestions, but about saying, "That suggestion has been made and it should be considered in the same way as any other."

Closure of the royal infirmary is also the closest realistic approximation to another suggestion that people have made from time to time, which is that a greenfield site should be chosen in north Glasgow for a new hospital—in other words, that Stobhill and the royal infirmary should not be used, but a new hospital should be built on a totally new site. The economics of that suggestion would be a deadweight against it. Shutting the GRI and concentrating on Stobhill would be a cheaper and more efficient option, and that suggestion is still of interest.

Those are the three areas that were raised at the previous meeting on this subject. I hope that that is helpful in setting the scene for the committee.

Thanks very much. Paul Martin and Fiona McLeod are here. They are not members of the committee, but they have a keen local interest in the issue.

Can you clarify that the four acute services that you propose to conduct further consultation on, including urology, are, in fact, acute services?

Yes, they are. When I spoke to you, Paul, I said that we were considering consulting on a number of specialties. As Chris Spry said, we gave thought to whether we were in a position to do that. We have now narrowed our options to three of those specialties and urology is not one that we are discussing at the moment. ENT, ophthalmology and orthopaedics can be described as acute services, as they are carried out in an acute hospital setting.

Those services were included on page 13 of the acute services strategy, which was launched in 2000. Regarding the proposed concentration of services at Glasgow royal infirmary, the document asks:

"Are there any persuasive and practicable alternatives to this solution?"

However, you are proceeding to consultation without allowing the acute services review to reach its conclusion, which will be published in September.

Following public meetings and meetings with our clinicians and staff, the medical staff association and the clinicians at Stobhill concluded that the future of Stobhill lies in acute medicine and acute surgery being retained there. However, it was acknowledged that we would be unlikely to be able to sustain the smaller surgical sub-specialties at Stobhill even in the short term. The recommendations of the acute services review will take between five and seven years to implement; we cannot continue to run those services on the Stobhill site for five to seven years and still provide effective patient care and the best service. That is why smaller surgical sub-specialties were taken out of the mainstream debate that we were having about medicine and surgery as the main services to be retained on the Stobhill site.

Can we clarify the point that on page 13 of "Modernising Glasgow's acute hospital services"—

I am sorry, convener, but I do not know which document the member is referring to.

Which document are you quoting?

I am reading from "Modernising Glasgow's acute hospital services", the document that was published by Greater Glasgow Health Board.

Is it the September document or the December document that was sent to the Executive?

It is the original document that was launched by Greater Glasgow Health Board.

At the start of the consultation?

Yes, on 29 December 2000.

I do not have that paper in front of me.

I appreciate that. The point that I am making is that it was originally decided that four of those services in the Greater Glasgow Health Board area would be subject to the full acute services review.

The acute services review is a vehicle to enable us to consult the public about the provision of services in Glasgow. I do not think that it will ever be a concise enough process for us to be able to delay changes until the review is concluded. Even when the document was launched, there was never a suggestion that we would leave all services in Glasgow untouched and unchanged for seven years, until new facilities were available.

We extended our first round of consultation because people felt that they had not had the opportunity to make all the comments that they wanted to make. At the end of that first round, we believed that there was a general consensus that the smaller sub-specialties could not and should not be sustained at Stobhill. That is the basis on which we thought that we should proceed, while recognising the bigger issue concerning medicine and surgery on which we had reached no general conclusion with either the public or the medical staff association. That bigger issue is still the subject of debate and will be dealt with as part of the option appraisal.

Nevertheless, the point is very clear:

"Are there any persuasive and practicable alternatives to this solution?"

The public were being asked their views on 29 December. The debate will not have had the opportunity to take its full course until the outline business plan is submitted to the minister in September.

Let us be clear about this. Are the public being consulted on the small sub-specialties?

Absolutely. That is why I have difficulty with Paul Martin's comments. A large part of what is proposed must be subject to a wider debate, but there are some patient services on which we believe we can reach agreement, and we are consulting the public on the proposal to move those services earlier. That is the purpose of the exercise.

We are considering the consultation process, which we hear is now fluid, with consultation being undertaken on sub-specialties that were not in the original consultation. Are there any other specialties at Stobhill that you may have to consult on, with the intention of moving the departments to the Glasgow royal infirmary?

I shall try to unpick that a bit. This is incredibly tortuous; a complex set of choices is faced by hospital services in Glasgow.

Right from the beginning, we differentiated between the strategic significance of medicine and surgery and care of the elderly. Either they will remain and Stobhill will provide those services for its local catchment area, together with ambulatory care services and so on, or alternative or additional facilities will be provided at the royal infirmary to allow a concentration of those specialties. That is a fundamental strategic choice. Services could not be moved to the royal infirmary until we had built another ward block there. That would be a long-range strategic choice and the move would not take place next week or next year. We have been clear about that all along. The issue remains unresolved and is a matter of deep passion in the local community. We have put in place a process to examine those issues in a transparent way that is inclusive of public representation and gets at the essence of the problem.

The smaller specialties such as orthopaedics, ENT, ophthalmology, urulogy and gynaecology are much less in numbers than medicine and surgery. Increasingly in modern hospital practice, such specialties are based in all district hospitals. For example, there are three large hospitals in north Glasgow—the Western infirmary, Glasgow royal infirmary and Stobhill—and we would expect there to be only one ophthalmology in-patient unit, one urology in-patient unit and one ENT in-patient unit. Not every hospital has smaller specialty units.

We have said consistently that smaller specialties cannot wait for long-term capital investment to resolve their problems. The building of new hospital facilities will take years. The problems facing orthopaedics, ophthalmology and ENT units are here and now. They concern medical staff and the difficulty of providing cover when there is a small number of beds in a particular hospital. We must find a way forward for those specialties. We have said continuously that we want clear, worked-up proposals. How can it be explained to the public that cover is a problem?

To use a radio analogy, it is worth thinking about consultation and a long-wave strategy for medicine, surgery and the number of hospital sites in Glasgow. Short-wave proposals concern small surgical specialties that cannot wait for the big capital investment that is associated with long-wave strategy.

Will the consultative process that you have set up to deal with the long-wave strategy be used to deal with the short-wave strategy, too? Will the reference group be involved in the short-term consultation process?

We do not expect that to happen. We set up the reference group mechanism to deal with long-wave strategic choices. Because of their tenuous medical cover, some smaller surgical specialties are more critical than others. For example, urology and gynaecology at Stobhill do not face the immediate pressure of inadequate medical staff cover that is faced by orthopaedics. We could comfortably sit specialties such as urology and gynaecology in the long-wave consultation process and let that work through. A pattern will emerge and proposals can then be implemented. Short-wave proposals can be implemented quickly because they do not require large capital expenditure.

The particular problems facing orthopaedics mean that we cannot spend another few months trying to resolve them because its difficulty with medical staff cover is here and now.

How will the consultation process on orthopaedics be conducted?

We included some proposals for orthopaedics in the document that we produced in September, which was subject to widespread public consultation. In December, when we reviewed the results of that consultation, the local health council, which has a specific role in such processes, said that it wanted additional information about staffing and cost implications. It did not think that those matters had been covered sufficiently in September. The health council said that if that additional information could be provided, it would be content to take a fast-track approach towards reviewing such issues.

We have done that successfully on the south side of Glasgow: we had a fast-track consultation on increasing the number of general medical beds at the Victoria infirmary; concentrating breast surgery from the Southern general and the Victoria into one unit at the Victoria; concentrating vascular surgery at the Southern general when there had been two units; concentrating haemato-oncology, which is leukaemia services, at the Victoria instead of them being split between the Southern and the Victoria; and concentrating gynaecology at the Southern.

We have been through a raft of public consultation on that. There was widespread agreement that the service benefits to patients justified making those moves, even though the long-range strategic choice about the south side, whether the new hospital should be at the Southern general or at Cowglen, is still to be dealt with by the equivalent reference group process south of the river.

I apologise for coming in late, after you had started giving your evidence. I had transport problems coming in from Fife.

The consultation process has concerned me most each time we have had this matter brought before us. We are all aware that there are many ways to carry out consultation. I know that you have set up the reference group, but can you outline more fully the consultation process that has taken place? Have you used citizens juries and focus groups?

It is fair to say that we have been learning as we have gone along. Everybody's expectations on consultation have moved significantly compared with what they were two years ago and they are still moving. If I were asked, "What would a perfect form of public consultation be?" I am not sure that I would know and I am not sure that anyone really knows.

We have so far used a series of public meetings. We have had smaller meetings with, for example, community councils, meetings with the local health council to discuss the issues, and a wide range of meetings with clinicians and NHS staff. We have also tried hard to produce information on the changes in plain English and in readily accessible small booklets rather than the usual A4 document the size of a telephone directory which the public sector has a habit of producing. We have tried to make the issues more accessible and easier to understand.

We have taken the thinking out on the road. Progress has been made on some important matters. For example, there is now widespread agreement that there should be one hospital south of the river. That is quite a breakthrough as agreement on that did not exist a few years ago. It became clear in December that the controversy is where the hospital should be. We have set up a process to examine that issue in a transparent way so that people can take part in it.

We have not used citizens juries or focus groups. Given the sequence of how one brings these issues into the public domain, the time to have done that would have been about 18 months ago. We might have done that if we had our time again, but we were where we were a year or so ago.

We have learnt that there is a dilemma about what to put into the public domain for debate and discussion. We made specific proposals for some parts of the city when we started the consultation last April, because we had done quite a bit of work on those matters. We had checked out the options and decided that one was better than another.

We had not done so much work on other parts of the proposals: we said, "Here are some questions." We started the Stobhill part of the consultation by asking questions rather than by making proposals. In the case of child and maternal health, we said that someone had suggested that we should consider whether to concentrate children's services on an adult site. We had not done much work on that, but we thought that it would be worth having a debate.

We found that when there were no worked-up proposals we got no comment back, because people did not quite know what they were reacting to, but that when detailed proposals are put out, people react to them, saying, "You've already made up your mind." There is a dilemma there that we have never really got to the bottom of.

What statutory powers will the reference group have? Where will it fit into the chain of command? In such a hothouse atmosphere, with long-wave and short-wave radiation and yet another group, we are in danger of having a greenhouse effect.

That is true. On the basis of the consultation so far, the Scottish Executive health department has given approval for us to draw up outline business cases—which is a stage in the capital procurement procedure—for the west part of the city, where it is about bringing Gartnavel hospital and the Western infirmary together; the south side of the city, where the service model is clear and it is just a question of where it should be; and the north and east of the city, where we do not have agreement on a service model. In the case of the north and east, whatever the outcome is, one way or another, capital investment will be required. Drawing up those three outline business cases includes going through a process of option appraisal—weighing up the choices and so on.

The responsibility for drawing up the outline business cases lies with the NHS trusts. They will produce them and submit them to the health board, or—if it is after 30 September—to the unified board in greater Glasgow. If the unified board agrees with an outline business case and thinks that it is affordable and so on, it will forward it to the Scottish Executive. The formal statutory responsibility lies with the trusts to produce those business cases and the health board to sign them off. The reference group is there to assist the trusts in working up the option appraisal element of the outline business cases. Because the two principal reference groups—one for the south and one for the north and east—have MSP involvement and so on, it is clear that they are open and transparent. We cannot, as a health service, proceed covertly and without lights—it is all in the full glare of publicity. However, the formal statutory responsibility lies with the trusts and the health board.

When are the first meetings of those reference groups?

South Glasgow reference group had its first meeting last month. We have only just completed our discussions with the various political parties for the north and east reference group. We expect the first meeting of that reference group to be in June.

Will the business plan and the means of financing be exposed to the public at public meetings? Will there be open discussion on whether the financing is private finance initiative, public-private partnership or public funding, and will the differences between those be set clearly before the public? We are all aware of the massive weight of the petition—43,000 signatures really says something.

Would you be good enough to tell us what consultation has taken place over the many months about traffic and the availability of cars to some of the residents? A number of the patients we are talking about come from the poorest and most deprived and unhealthy constituencies in Britain, such as Shettleston and Springburn. Have there been any projections on an increase in the availability of car transport for people? At the moment, according to the statistics for Glasgow that I have seen, there has not been a considerable increase in the availability of cars to people in the north-east of the city. Is that a major factor in your general plans? If car ownership is not increasing—indeed, the Parliament is not in favour of it increasing much—the necessity for a more local hospital might be greater than ever, and will continue far into the future.

The means of procurement will come into the public domain, because the outline business cases will need to show a public sector comparator. We will have to show what the model would look like if it were a PPP procurement and what it would look like if it were a public sector procurement. The reference group will be privy to all of that detail and will have overseen the process by which those numbers are worked up.

Will the means of procurement be discussed in public meetings beyond the reference group?

We need to discuss that with the reference group. The option appraisal process will require the definition of some benefits criteria—whether certain options improve patient care and access and so on and in what way they do so—and the weighting of those benefits. We will have to determine whether access is more important than quality of service or vice versa, for example. As part of the option appraisal, we will also have to measure the options against financial considerations, an economic analysis and a risk assessment.

We expect that there will need to be a workshop, which will come up with a definition of the benefits criteria and how they will be weighted. We are advised that that should be done on a Glasgow-wide basis. In other words, the criteria for hospital redevelopment should be the same across Glasgow. We have discussed that with the south reference group, which has agreed that that should be so. We will need to discuss it with the north and east reference group to find out whether it takes the same view. After we have done that, we will have another workshop, at which we will measure the options against the criteria. Our expectation is that we will agree with the reference group who should be involved in those workshops. We expect that members of the public would be involved, but we need to discuss how to identify those members of the public.

I must point out that a workshop is not the same thing as a public meeting. In view of the huge amount of public interest in the deals and whether the public are getting best value, could you assure us that you will put the financial arrangements and comparisons before full public meetings that would include representatives of, for example, relevant trade unions?

There is sometimes a perception that we exercise choice on whether to finance privately capital investment in the health service or whether to opt for Treasury funding. There is also a perception that it is more expensive to get private money than Treasury money. As we do not exercise that choice, I do not know that there would be much benefit in putting the issue into the public domain in the way that you suggest. It would be helpful if you could explain what it is that you want us to put in the public domain. Chris Spry has described a process by which we can help people to understand that we determine what investment is required and what it would cost to raise that money from a private source as opposed to a public source. In a sense, we are governed by policy decisions, and the Treasury has determined that it would prefer that public funds were spent on equipment and small capital investments in the health service and that PPP arrangements were used to pay for large capital investments. We cannot influence such policy decisions.

We are straying into a debate on the politics of the issue. The Public Petitions Committee is here to ensure that the public are properly involved. The reference groups have MSP representation, and there should not be a problem about the information that they are receiving getting into the public domain. If I know MSPs in Glasgow, they will make sure that it gets into the public domain.

Can I pick up Dorothy-Grace Elder's point about traffic? We are in the process of appointing traffic and transport consultants, who will do a full analysis of the traffic and transport issues for all the options across Glasgow. That will ensure that thorough professional information is available for all the processes, so that access issues can be taken into account as part of option appraisal.

We have an extremely full agenda this morning, and I would like to bring this part to a close. I will offer the two Glasgow members a final chance to ask questions.

The reference group is important. Earlier, the option of closing Glasgow royal infirmary was discussed. I am asking Mr Spry for a clear yes or no answer. Would he close Glasgow royal infirmary if the reference group recommended that? Can I ask Maggie Boyle whether she would support that proposal? Would she recommend that to the Scottish Executive?

The reference group has the job of overseeing the option appraisal process. If the option appraisal process came up with an analysis that showed that closing the infirmary was the best option, that is what the health board would have to consider at that time. I do not want to prejudge the outcome of the option appraisal. It is a very technical process. People might have all sorts of hunches and expectations, but the important thing is that we must honour the process, given that we have put it in place. If the process produces an answer that people find surprising, but the answer is well worked out, we must take it seriously.

My question was very clear. Would you recommend that to Greater Glasgow Health Board?

Mr Spry has said that if that is the recommendation, he would have to go with it.

Would it have the chief executive's recommendation? That is what I am asking about.

I would not make a recommendation that was divorced from the outcome of the option appraisal.

We are interested in the process. We cannot jump to the argument about the conclusions that come out of that process. That is a matter for local decision—it is not for the Public Petitions Committee.

Mr Spry said that he would honour the process. Could you explain to us more fully the membership of the reference group? So far, you have mentioned only MSPs. Can you tell us who the other members of the reference group are and how you have sought those members? Will the new reference group have a stronger voice than that of the current group on the siting of a secure care centre?

We have discussed the membership of the reference group with each of the main political parties. First, in March, we had a meeting with the Glasgow city Labour MSPs group. We shared with them our concern about constructing the reference group. When we considered the number of local authorities and community councils that had an interest, it was clear that we might end up with a cast of thousands. That is not a dynamic that can do business. The suggestion that came out of that discussion was that we should work closely with MSPs. The group of Labour MSPs came up with four suggestions on their MSPs who should be involved. Those MSPs are Paul Martin, Frank McAveety, Pauline McNeill and—

Sandra White.

She is an SNP member. I was listing the Labour members. Patricia Ferguson is the fourth Labour MSP.

We then had a conversation with the SNP's health spokesperson, Nicola Sturgeon. As a result of that, Sandra White was nominated to the group. We have had discussions with the Liberal Democrats and the Conservatives. The agreement that we have reached with Robert Brown and Annabel Goldie respectively is that we will set up watching brief arrangements for them—that is because of their particular commitments. We have also been in touch with the Scottish Socialist Party about how we can involve it in the process.

That is the MSP component, but there is also a local health council component—the chair of the local health council will be involved. There will also be representatives of the Stobhill medical staff association, the Glasgow royal infirmary medical staff association and the staff partnership forums at Stobhill and the GRI. There will be GP involvement, and we will write to the local authorities asking how they want to be involved in the subsequent work, such as the option appraisal workshops.

But at the moment you do not have specific names that you can put against the groups other than MSPs' names. That must cause problems in setting a date for the first meeting.

The names for the other groups, which are mostly internal to the clinicians and so on, can be produced pretty quickly by the trusts. What took time was the completion of the discussions with the political parties.

Thank you for taking the trouble to come and give evidence to the committee. You have been very helpful this morning—answering all the questions openly and honestly.

Before we move on to the rest of the agenda, we must discuss whether we believe that the evidence that we heard from the trust and the health board reassures us that sufficient weight will be given to local opinion in the process. It appears to me that there will be local involvement and that local points of view will be taken on board. The trust and the health board seem to be listening.

I agree.

The approach of the health board and the officials has improved enormously—they have responded to the public outcry. At the beginning, Glasgow was given Hobson's choice, but now the board and the trust seem to be prepared to explore other avenues. However, overall, we are stymied by the fact that we are not working from a blank sheet of paper. The plan for the monster-sized hospital down in Govan is overshadowing the thinking of the health board.

We are where we are.

I am sorry, but we are now discussing how we should deal with the petition.

In my view, a local mechanism has been set up, which involves MSPs, local representatives from the health council and staff interests from both hospitals; the option appraisal process will go through their views. The petition should go to the reference group to be taken into consideration as part of the option appraisal.

I agree with that. We could keep the petition live and stay in touch with what is going on. We could monitor the situation and if it transpires that people still feel that the option appraisal is not working out as it should, perhaps we could revisit the matter. In the meantime, there is an improvement on the previous situation, which is what the petition called for. Let us see whether that works.

That seems to be the view of the committee. Do the two MSPs who are not members of the committee—Paul Martin and Fiona McLeod—want to comment?

I have already made the point that I believe that we have contaminated the process by reducing the four services and deciding to go to consultation on them. It is unfortunate that we have done that. Once again, I make the point that the trust should consider awaiting the outcome of the acute services review before going to consultation on those four services. It is unfortunate that we have contaminated the process in that respect.

I want to make a point in response to the comment that during the public consultation process there was some suggestion within my constituency and perhaps within the constituency of Fiona McLeod, that Glasgow royal infirmary should be closed. On no occasion did I hear anyone suggest that. Perhaps Fiona McLeod can give further information.

When we proceed to the completion of the acute services review in September, we will not have had a full and open consultation process. The petition does not ask the committee to take a view, but asks it to consider whether the public consultation process was carried out properly. I appreciate that the outcome of the review is not a matter for the committee.

If Paul Martin were in the position to make a recommendation, what would he recommend to the committee? We have been talking about the consultation process. I know that he is awaiting the outcome of the acute services review. Is he suggesting that further consultation be deferred? I am not clear about what he means.

It is not for me to make a recommendation, but it is for the Health and Community Care Committee to decide whether the process was contaminated. To proceed to consultation on the four services was unfortunate and should not have happened. That was meant to be the view of the medical staff association.

If the committee said that the process was contaminated, what would we do then? What would Greater Glasgow Health Board do? As a local MSP, what would Paul Martin do?

With respect, the issue is to ensure that the acute services review is carried out properly. Initially, I signed up to the consultation process, but I will not support it now because four services have proceeded to consultation.

Each member has a right to take his or her position on matters, but the committee must concern itself with whether a local process has been set up to consult the people of Glasgow and local representatives. In my view, that has happened. The issues that Paul Martin raised about the separate consultation for the specialties can be dealt with locally by the reference group, and I am sure that it will deal with them. As a Parliament, however, we cannot become involved in decisions about the shape of strategic services in Glasgow. That is a matter to be decided by local representatives. Our job is to assure ourselves that the process is involving local opinion, and I believe that it is.

Can we pass on the matter to the Health and Community Care Committee?

No. We have already consulted the Health and Community Care Committee. It is reluctant to have the petition referred to it, because it would for ever be involved in all acute services reviews throughout Scotland. Each time people did not like something that was happening locally, they would drag the Scottish Parliament into such matters. Parliament cannot intervene. All it can do is satisfy itself whether a local democratic procedure is being followed and local people consulted. Unless evidence can be brought to my attention that that is not happening in Glasgow, we cannot do anything other than to pass the petition to the local mechanism for resolution.

Many petitions that we receive are about public consultation and how that process has broken down. I accept that we cannot pass on the petition, but can we not write to the committee and ask it to examine ways in which communities can be consulted? It might be able to issue guidelines on consultation for public bodies. People often say that they have not been consulted properly. If either this committee or another committee took on such work, that would reduce the number of petitions that we receive.

That is something which we can do as a committee in general, but not specifically in relation to this petition.

I do not know about "in general", because this is the biggest matter of its kind in Scotland. It could be a flagship for the future and influence the way in which consultation is handled elsewhere. No one believes that orthopaedics can be moved from Stobhill to Glasgow royal infirmary for seven years and return. The public are still concerned that it is the usual plan of death by a thousand cuts.

As we heard this morning, a local reference group made up of political and local representatives will consider the whole process and pass comment on it. It can influence matters. I do not agree that the group will not consider the petition properly. Indeed, it should consider it, as part of the process of looking at the appraisals for the north-east of Glasgow. I am sure that it will influence the outcome. The petition will be sent to the group for consideration and action.

I will be very brief. You say that you are satisfied on the evidence that you heard that the public consultation has been adequate.

It will be adequate, once the reference group is set up.

You said that you would need evidence to prove the contrary. Apart from inviting you to public meetings, it is difficult for Paul Martin and me to make you see that although on paper the consultation process looks adequate, in practice, it is not. It is not satisfying the needs of the public so that they feel that their views have been taken on board.

I have concerns about the reference group. We have not heard exactly who will join it or how it will perform its task.

We have said that we will have a reference group of fairly strong-minded MSPs. We must have confidence in the local MSPs and give them their chance. We also said that we would be happy for them to return to us if they felt that the consultation process of which they had become an open and public part was inadequate. Give the proposal a chance.

I thank the witnesses again for attending. It is my view that we should pass the petition to the local reference group that Greater Glasgow Health Board will establish and ask that group to take the petition into consideration as part of its appraisal of the four options that are available for north-east Glasgow. Is that agreed?

Members indicated agreement.