Petitions
Let us settle down and batten down the hatches. We have a lot to get through, and I hope to get through it all. I will take members through the petitions. I refer the committee to paper HC/S2/04/11/2. Members also have all the other relevant correspondence and, in some cases, the Official Report from the previous meeting at which the petitions were discussed.
Epilepsy Service Provision (PE247)
Petition PE247, from Epilepsy Scotland, is on co-ordinated health and social services to benefit people with epilepsy. I ask members to look at the paper on possible action. What should we do with the petition? I shall give the elderly and the infirm among us, as well as David Davidson, a moment to assemble their documents. Can I have views, please?
Although petition PE247 is geared towards epilepsy, it highlights a number of issues about co-ordinated health care and social services across a range of conditions. Could the clerks pull together the range of such petitions that have come to the committee this year, so that we can examine whether we can discuss the generality?
There are obviously serious concerns about that specific petition and what it covers, but there are other considerations that have also to be balanced in any future discussions. It is not a case of putting off a course of action; it is just a matter of putting the issue into the right environment for discussion.
I refer to paragraph 4 of the letter of 31 March 2004, from Trevor Lodge on epilepsy specialist nurses. It states:
"The petitioners, and indeed the Committee, have asked about the results of the Executive's census of specialist nurse provision. The information has now been gathered and is being prepared for publication, but unfortunately the process is not yet complete. The Committee will recall that it is not exclusive to epilepsy nurses. The results will be made available to the Committee as soon as possible."
That is something that we may want to track. Otherwise, what do we do with the petition?
We could continue the petition in the light of that action.
Should we continue the petition until we have that information, which we can then forward to the petitioners?
There will be recommendations that we take up a number of petitions as the subjects of inquiries. If we decide to do that, is there a pool into which we can put such petitions when we think that we want to consider them further in an inquiry? As we go through them, we continually run out of time and cannot plan for them. Is there a place where we can pool them or park them and then come back to those that we believe are worthy of consideration in an inquiry? That way, we could balance one against another and plan our work properly.
One of the things that we want to do is to have an audit of petitions so that, when the time is right, we can go back into a pool of petitions and pull issues into our current work programme. As you know, we would love to take on lots of those petitions, but we have limited time. However, I agree that many of them are extremely worthy, and it may be possible to draw them into other areas of our work or to have inquiries on them in their own right.
I am unhappy about the letter, which states at the end that
"the planning and management of services is … best carried out at local level".
I agree absolutely with that, but the letter goes on to mention
"the unified budgets made available to NHS Boards, which will be increased by 7.25%, more than twice the rate of inflation, in the coming financial year".
I worry that the public will think that boards have 7.25 per cent extra money to spend on improving services and starting new services. As we have already discussed today in relation to the budget, most of that money is committed, as there is extra pressure on boards because of consultants contracts and the new general medical services contracts. It is worth putting it on the record that there is not actually 7.25 per cent extra for boards to spend, which is the impression that one would get from reading that letter.
That is a worthwhile point. It is also worth confirming that the petitioners have copies of all the correspondence that we receive.
This is the first petition that we are considering, and I cannot remember exactly how many there are—
There are 20.
If there are 20 petitions before us now, there will be another 20 in the next quarter and another 20 after that.
Let me stop you there. There will not be another 20 next time, because we intend to cut down on the number of petitions that we continue. A number of the petitions that are before us today are new. We will not have 20 next time because it is hard to do justice to them.
If that is the case, that is helpful, but it is easy for us as MSPs—because we are not inclined to say no to people—to decide to do this or that with a petition. The recommendations that are made are either that we take up a petition as an inquiry or that we take no further action in relation to the petition—it is not recommended that we simply take no further action. The petition calls on us to ensure that there are co-ordinated health and social services to benefit people with epilepsy. My point is that we should be saying to the people who present petitions to us, "We've heard what you say and we believe that it is worth our looking at the issue. Since you have raised the issue with us, we will look at it, but as far as the petition is concerned, we will close it." I am not saying that we should do that in this case, but I am saying that it could be done as a matter of course.
That would be quite appropriate in other cases.
That way, we will not raise people's hopes.
Absolutely—it is not a problem. Furthermore, we have the caveat that we have a log of petitions and, if we have the opportunity—perhaps in an inquiry—we can absorb relevant petitions into whatever we are doing at that point, if possible. We are doing the best that we can with limited resources.
However, we have not yet finished with PE247. Do we agree to await responses to the issues that have been raised and to return to the matter when they have been received?
Members indicated agreement.
Chronic Pain Management (PE374)
We have also dealt previously with this petition. I suggest that we simply hold on to the petition until we have Professor McEwen's report. There seems to be little point in our doing anything else at the moment. Do we agree to follow that course of action?
Members indicated agreement.
Myalgic Encephalomyelitis (PE398)
I welcome Alex Fergusson to the committee. He is here to speak to petition PE398. The recommendation is that we take no action on the petition until we have seen the health board progress reports on implementation of the short-life working group, on the understanding that the clerks pursue responses from health boards prior to the committee's next consideration of the petition. We would not close the petition until we receive further information.
I do not want to take up the committee's time. I could not ask the committee to do anything other than what you are doing, given that we have not yet received responses from the health boards, which were due on 19 March. There has not been an Executive announcement on that and I do not see how the committee could take any steps until that has happened.
I commend your pursuit of the issue.
Does the committee agree to follow the recommended action?
Members indicated agreement.
Deceased Persons<br />(Law and Code of Practice) (PE406)
We understand that new legislation might be considered by the Executive after consultation on issues that relate to the concerns that are expressed in petition PE406. The deadline for submissions to that consultation was 27 September 2003; findings will be released some time after the summer recess. I therefore suggest that we hold on to the petition until the first meeting at which we deal with petitions after the summer recess. Does the committee agree to do that?
Members indicated agreement.
Autistic Spectrum Disorder (PE452) <br />Psychiatric Services (PE538) <br />Autism (Treatment) (PE 577)
We will deal with petitions PE452, PE538 and PE577 together. We are not awaiting reports on the petitions, so we should come to a conclusion on them today.
The committee could simply write to the Scottish Executive with a call for it to set up an advisory committee, as PE538 requests. We could also ask the Executive to set up an autism-specific facility, as called for in PE577.
I notice that Kate Maclean is frowning, but I do not know whether she is expressing a view.
Could Helen Eadie repeat what she suggested? I was frowning with puzzlement rather than disapproval.
Helen Eadie suggested that we follow the first two recommendations in our papers.
I see.
Autism is an important subject and many people's lives are affected by having an autistic child or adult in their family. I do not know what we can do to find out what the Executive is doing in relation to the provision of diagnostic and support services to people who are labelled as being autistic.
I notice that the last paragraph before the options in the paper on the petitions says that, on 3 March, the Executive announced funding for a variety of autism-related initiatives—a press release is attached—and that the petitioners' comments on the announcement have been invited. It would be useful to know whether the petitioners are satisfied by what has been announced and, if not, whether they still believe that their needs will be met only by what they request.
To be fair, parents who have autistic children have a variety of views about the best delivery of services. Some would favour a centralised centre but others might differ; it is difficult to come to a conclusion about who is right. It would be ideal to have choice; that would be the best situation.
On petition PE538, it would be helpful to find out what the Scottish Executive position is on setting up an advisory committee, because such a committee could be charged with considering a range issues in relation to autism. We would need to see some kind of response on that before we could call for an autism-specific medical treatment facility, because a number of issues on recognition and capacity need to be addressed before such a facility, which is what petition PE577 calls for, could be set up.
I agree with Shona Robison and David Davidson. It would be useful to see the petitioners' comments on the recent announcements, but I note that the correspondence from the Executive is basically about research. We have not asked for the Executive's comments on an advisory committee or an autism-specific medical facility. The first step would be to seek the Executive's comments on those issues.
I have my concerns about an autism-specific facility because I have met parents who would really not be happy about one. There is a range of views on the matter.
I take it that the committee agrees to get the petitioners' comments on the announcement—we have only comments—and that we will also write to the minister to find out his views on setting up an advisory committee, and continue the petitions.
Members indicated agreement.
We got one response, from the petitioner for petition PE577.
We have one and we await two others.
The petitioner has also given us an informative enclosure.
Heavy Metal Poisoning (PE474)
Petition PE474 is from James Mackie and concerns heavy metal poisoning. I ask for committee members' views on the petition.
The information that the Executive has supplied is thorough and comprehensive. I was previously unaware of much of it. We could ask for the petitioner's views on the Executive's response, but given its comprehensive nature, I am not sure what further action we could take on the petition.
The petitioner has not seen that letter from the Executive, so we require his comments.
Does David Davidson have anything to add?
No—I agree completely.
Jean, are you content now?
Yes.
Might the committee endorse the principle that every reply that we get from the Executive be forwarded automatically to the petitioners?
The reply has just come in. I have just checked that, because what you suggest usually happens. We have not had the reply for the period of time that the date on it implies. We know to our cost that that sometimes happens when we get letters from ministers.
Aphasia (PE475)
Petition PE475 concerns aphasia. I ask for committee members' views.
There is an issue here about national standards. I am not sure that we have got a very full response from the Scottish Executive on the matter. This might be a situation in which we are told, "This information is not held centrally." The Scottish Executive needs to undertake a mapping exercise on roll-out of services in this area, and that needs to be put before the petitioner.
A letter to the committee states:
"Speakability, the organisation that represents people with aphasia, has not been asked to participate or contribute to the planning of services."
That is an important issue, and representations should perhaps be made to the Scottish Executive on the matter, requesting that Speakability be included in any planning of services. I remember being present on the day when Speakability gave evidence to the Public Petitions Committee. That was a moving experience, as a number of aphasia sufferers were there.
That letter, which is dated 3 March, did not go to the minister; I think that it should have done. We will send it as an attachment. I take it that David Davidson's mapping proposal is to do with the second option on the paper that is before us? It suggests that we should
"call on the Executive to place a requirement on health and social care professionals to record aphasia specifically and separately regardless of cause".
Is that what you were aiming at?
Yes—more or less.
We are trying to find out about the occurrence of aphasia and to establish whether it arises in clusters, so that we can get some kind of handle on it.
We should also try to find out how treatment is handled locally. We should find out what service provision exists in the various areas.
So, we want to find out about service provision, occurrence and the placing of a requirement on health and social care professionals to record aphasia specifically.
Members indicated agreement.
We will run the letters—those that are not just standard enclosures—past members, to ensure that they reflect the committee's view.
Digital Hearing Aids (PE502)
On PE502, there seems to be—
Before we go on, I want to ask the clerks to check what correspondence has gone out to the petitioners.
There seems to be some confusion within the Scottish Executive, judging from its response. The letter is headed "PETITION ON DIGITAL HEARING AIDS", but it does not go on to refer to digital hearing aids at all; it refers to "neonatal hearing screening". That is crackers. Somebody needs—I don't know what they need.
They need a digital hearing aid—or perhaps a visual aid.
We must take the matter up with the minister. We will ask for a response to the specific issue and suggest that the Executive's response was sent in error. We will be kind.
Mental Welfare (Complaints Procedure) (PE537)
PE537 is from Alexander Mitchell, and is on the complaints procedure in mental welfare.
I have tremendous sympathy with people in the situation that is described, but this is a matter for the Scottish public services ombudsman. I appreciate that that office has only recently been set up, with different divisions coming together. I wonder whether Professor Brown might be asked for further comment. I do not believe that we can sit in judgment on a complaints procedure. We must be satisfied that the complaints procedure exists, that it is accessible and that it is operated correctly. I am not sure whether we are the right committee to sit in judgment on that.
I agree with that. I noted the correspondence from the cross-party group in the Scottish Parliament on mental health, whose convener states:
"the members agree that the Ombudsman is in the very early stages of coming into being and time is required to allow the process of settling in."
Given that the cross-party group focused on those particular issues, I tend to agree with its observations. On that basis, I believe that we should not continue the petition.
I have a great feeling for people who have complaints about the NHS, because it takes so long for many of them to get answers. I was a little disturbed about the observation at the bottom of the first page of the ombudsman's letter, which says:
"it would be unlikely that firm conclusions could be reached on what was said or done nearly 6 years ago."
You are a lawyer, convener: you know that many cases might go on for six years before they get to court. Professor Brown is implying that it would be difficult to get information on the case after nearly six years. Obviously, the NHS still has a long way to go in how it deals with complaints in order to ensure that they never reach the stage of litigation or of going to the ombudsman. I do not know all the petition's background details, but I would hate to think that there was a time bar on such matters. Would not the NHS deal with a case that was more than 12 months old? The ombudsman's letter states:
"the ombudsman would not normally consider a complaint which was more than 12 months since the events complained about occurred."
It could easily be 12 months before a case could be got off the ground and get to the ombudsman.
You should focus on the words:
"not normally consider a complaint".
Perhaps it would satisfy you to know whether there were specific circumstances in which a time bar would not be mandatory, which would allow the ombudsman to consider cases that were beyond the 12-month limit. I am cautious about saying that the words "not normally" might refer to trivial complaints as opposed to serious ones, but I believe that that might be relevant.
I remind the committee of what I said earlier, which was that we should write directly to Professor Brown to ask her for a view because the petition was originally dealt with before her post was established and the current mechanisms put in place. We could ask her for a definitive answer about what she regards as her role in this particular case. Perhaps we could expand that into finding out what the rules are about reopening cases.
Yes. Would that satisfy members? We can focus on the words "not normally" to give us a kind of steer on that.
Can we enclose Adam Ingram's letter when we write to Professor Brown, and ask her to comment particularly on his reference to independent advocacy? It would be useful for us to be reassured that independent advocacy is used in cases such as this.
I am happy to do that. We will also copy to Professor Brown the letter from the convener of the cross-party group on mental health.
Landfill Sites (PE541 and PE543)
The next petitions are new petitions PE541 and PE543, on landfill sites. The Public Petitions Committee referred the petitions to the Communities Committee for consideration and that committee has forwarded them to us to consider the health implications. Therefore, we are like a secondary committee in this case. I ask members to consider the guidance paper on the petitions and to give their views.
I am minded to seek the support of colleagues to give the issue priority and to take the guidance paper's second suggested option, which is to agree that, because of the cross-cutting nature of the petitions' subject matter, the Communities Committee should investigate the public health implications and the Health Committee should appoint a reporter to attend the relevant meetings of the Communities Committee. Many of us, including me, have in our constituencies areas that are similar to the one in Karen Whitefield's constituency. There is an issue here about a community's mental health and well-being—which are not usually measurable—as opposed to the more obvious environmental health issues that arise in such contexts.
We should take on board a report that I read a couple of years ago from Dr Bull—or Professor Bull—who comes from the United States of America. He said that the areas that tended to be dumped on were always the poorest communities and those that were least able to act as their own advocates. Certainly, that is what happened in Karen Whitefield's constituency. It is also happening in my constituency, the northern part of which includes one of the poorest areas in Scotland. I feel very strongly about the issue.
I am trying to recall whether you are still a member of the Public Petitions Committee.
Yes, but I am talking about a report of about five years ago.
Do you still serve on the Public Petitions Committee?
Yes.
I see. I was just trying to recall whether you were informed about the petitions for other reasons as well.
I take it that the Communities Committee has agreed to investigate the public health implications of the matter raised in the petitions.
No. The Communities Committee has asked us to look into the health implications. It is looking into other issues that relate to the petitions.
Right. So—
That was a very hostile "Right".
We will suggest that consideration of the petitions should be the other way round, although there is no guarantee that the Communities Committee will accept that suggestion. All that we can do at this stage is return the petitions to the Communities Committee and ask whether, due to the pressures of our work load, it would be prepared to look into the health implications if it had our full support and co-operation by means of a reporter being appointed and so on.
I misled you.
I do not think that we can do anything else about the matter given that the Communities Committee has not yet said yes.
Right. Is it the committee's view that the Communities Committee should investigate the public health implications but that, subject to a suitable volunteer being identified, we are content to send a reporter to meetings of that committee to report back to this committee and to make an input into the investigation?
Yes. I nominate Shona Robison.
Without descending into frivolity, if we are to take that course of action, I have to ask for a volunteer. We cannot simply do what we propose without appointing a reporter, and we should do that today.
Helen Eadie is very knowledgeable on the subject.
Is Helen Eadie content to be the reporter?
Yes.
That is excellent. You should come to some of my branch meetings, Helen. We need volunteers but we never get them.
Multiple Sclerosis (Respite Homes) (PE572)
We move on to our consideration of petition PE572, which was submitted by Patrick and Jennifer Woods. They call on the Parliament to investigate whether there is adequate provision in Scotland of respite homes with no upper age limit for sufferers of multiple sclerosis and other disabling conditions.
I direct the committee's attention in particular to the last paragraph on page 1 of the clerk's paper. Members will see that a map and data have been provided. The details have been lifted from the Scottish care homes census. The material has not been sent to the petitioners yet, which is something that we could do.
In the second paragraph of the letter from Jacqui Roberts of the Scottish Commission for the Regulation of Care, she says that she should be able to supply us with the information that we have requested later on this year. Obviously, we will want to continue petition PE572 until we receive that information.
I suggest that we send the maps and data that we have received to the petitioners, along with a copy of Jacqui Roberts's letter of 25 February. Given that we are awaiting more information, I also suggest that we continue the petition. Are members agreed?
Members indicated agreement.
Eating Disorders (Treatment) (PE609)
If I can have the attention of the committee, we will move on to our consideration of petition PE609, which was submitted by North East Eating Disorders Support (Scotland) and the Scottish Eating Disorders Interest Group. I ask for comments on the petition, which is another continued current petition.
I declare again my interest, in that I have a daughter who suffers from the condition.
I draw members' attention to the hand-written letter in which Heather Cassie, who is the secretary of North East Eating Disorders Support (Scotland), highlights the continuing problems. At the previous committee meeting at which we considered the petition, I mentioned the Huntercombe hospital—it was recorded as Huntingdon hospital, but that could be because I mispronounced Huntercombe. I know that Dr Millar, who works for Grampian NHS Board, and his colleagues who work for Highland NHS Board are still lobbying the Scottish Executive to make an allocation for the creation of a specialist eating-disorder ward within the Royal Cornhill hospital.
Personally, I am not satisfied that the Minister for Health and Community Care has addressed the issue correctly. In the chamber, he has twice told me that the mental health framework document takes care of the issue. However, the nature of the condition requires co-operation across health boards, as the treatment cannot be provided by every health board. We are dealing with just the tip of the iceberg.
Perhaps we should take further evidence from the health service professionals so that they can explain at first hand what they seek to do. We could perhaps also take evidence—either written or verbal—from the director of the Priory hospital in Glasgow. He previously operated within the health service, but moved because of the lack of support that he was receiving. Taking evidence might help us to get a handle on what the professionals think.
I apologise to David Davidson for being distracted while he was speaking.
We are in an odd position, in that the Public Petitions Committee, which previously said that it would initiate inquiries into petitions, has decided on a policy of not taking on inquiries. However, petition PE609 was referred to us prior to that decision and the Public Petitions Committee is awaiting further evidence on the petition. Therefore, I suggest that we should wait to see what the Public Petitions Committee decides. David Davidson's comments are now on record, and we share his concerns about the issue. However, I think that it might be more appropriate for us to wait until we hear from the Public Petitions Committee before we decide to continue with an inquiry into the issue.
Helen Eadie has inside information, so perhaps she will confirm what I have said.
I can confirm that the new policy of the Public Petitions Committee is not to take on board any inquiries.
I agree with David Davidson that the issue of eating disorders is of such concern across Scotland that we should put the petition into the pool that Duncan McNeil mentioned earlier. Depending on the Public Petitions Committee's decision, the petition would be a worthy candidate for further work at a later date.
I agree that this is a worthy petition on a serious issue. I defer to David Davidson's first-hand knowledge of what is obviously a distressing issue. However, no petition that I have seen has been unworthy. I note that the Public Petitions Committee is considering petition PE609. If I may repeat what I said earlier, I do not want to give the petitioners the message that their petition is unworthy but we have a wider duty to tell people that we cannot keep saying yes to all the petitions. So far, we have not closed a single petition. We are in danger of sending people the wrong messages. The committee needs to be courageous and to say that, although the petition is on a worthy issue, another committee is considering it so we will not be able to take it further.
With respect, we have specific reasons for not closing petitions, such as the fact that we are awaiting correspondence. The petitions may be closed next time round.
If the Public Petitions Committee decides not to take petition PE609 any further, the petition will come back to us and we will then have to take a substantive view one way or the other. At the year end, we may have to prioritise the many petitions that we have been sent. When that time comes, we can gather the important petitions together under our forward work programme and carry them forward.
I agree that we have a duty to respond not just to what the Executive or we want to put on the agenda but to what the public wants. It is a difficult balancing act. We will come back to several of the petitions at some point later in the year and say, "Here we are. Which ones are we going to prioritise, if we have a space to pick them up again?" That will be a matter for the committee to decide.
The Public Petitions Committee has stated clearly that it will not be undertaking inquiries.
We know that.
However, in some instances it is asking for further information.
I thought that I made it clear that that is the policy position, but the Public Petitions Committee might be able to undertake an inquiry into the matter because the change in policy post-dated the petition coming to us. That is a matter for you, as a member of the Public Petitions Committee, to resolve with that committee's convener. No doubt you will do so on our behalf and come back to us.
We have resolved that we will go back to the Public Petitions Committee to ask what it is going to do—it is awaiting evidence—and whether it will undertake an inquiry under its old rules.
Hospital Closures (Public Consultation) (PE643)<br />Consultant-led Maternity Services (PE689)
Health Service Configuration (Consultation) (PE707)<br />Maternity Services<br />(Island and Rural Communities) (PE718)
The next petition is PE643, which we will take together with PE689, PE707 and PE718, as they are all on the same topic of hospital closure consultation and consultant-led maternity services. These are all new petitions. We have a trio of MSPs here—how blessed we are at this late stage in the day—and our practice is to allow them to say a few words. I ask you to be brief and to indicate to which petition you are referring.
Is somebody here to talk to PE643, in the name of Dorothy-Grace Elder, on hospital closures?
I am here to talk to PE707 and PE643. It is important to emphasise that millions of pounds of public money have been provided to the Queen Mother's hospital. We should be aware of that if we are going to close it down. The equipment, and the money that is used to buy equipment, will be sucked straight into the health service. We should also flag up the prospect of more petitions being submitted, and the fact that there were thousands of names on the Evening Times petition, which led directly to petition PE707.
I thank the committee for inviting me along and allowing me to speak. As I am normally the one who sends petitions to you, I hope that you do not give me a hard time of it. I suggest that somebody on this committee should submit a petition to turn down the heating in this room—I admire members' fortitude in sitting through this heat.
Pauline McNeill and others will raise other aspects, but my point is on guidelines and consultation, which are important. The Minister for Health and Community Care has said that he will consider them carefully when he makes his decision. In fact, I think that a guidelines working group has been set up.
Not only I, but other MSPs, the public and clinicians, feel that decisions were taken by Greater Glasgow NHS Board that did not go through formal consultation and did not follow proper guidelines. For example, regional planning, which is part of the report by the expert group on acute maternity services, has not been taken into consideration. The health board consultation document cites EGAMA, but there are two EGAMS reports, which are contradictory, and the document does not mention the differences between them. We should be looking at that.
I wrote to the minister about the report by the British Association of Paediatric Surgeons. Peter Raine, who wrote part of that report, told the health board that although it said that it had quoted from the 1999 BAPS report, it had actually quoted from the 2002 BAPS report. Mr Raine e-mailed the health board two weeks before 35,000 copies of the consultation document were circulated throughout hospitals and the health board—the consultation was also reported in a national newspaper—with that mistake in it.
Since then, I have written to the minister and the deputy minister, Tom McCabe, to point out what has happened. I received a reply from the deputy minister—thankfully—and I can certainly circulate copies. He says:
"If … a Health Board had either wilfully or accidentally made a false statement, my colleagues and I would wish to know"
so that they could
"determine what, if any, action would be appropriate".
In his reply to the Public Petitions Committee, which members have in front of them, Sir John Arbuthnott says that there was a "minor" error. I do not think that the error is minor, given that a warning was given two weeks before the consultation document was circulated; I think that it is a big error. The committee should take cognisance of that. As I have said, the error is still being quoted.
Clinicians have raised concerns. They wished to come along to the Public Petitions Committee to give evidence but were not able to because there were so many petitions.
Obviously, I cannot tell the committee what to do; you have to make up your own minds. However, considering the EGAMS report, the BAPS report, the lack of consultation and the mistakes that have been made, I would say that the consultation has been flawed. I would like the clinicians who lodged PE707 either to come to the committee or to submit a written report. Perhaps the minister could come along and clarify some of the points that I have raised.
I think that we will leave it to the committee to decide on that.
I acknowledged that, convener; I was only making some suggestions.
Duncan McNeil and others have asked what is proper consultation and what is not. We are well aware of the difficulties.
I will work my way along the line of witnesses. Jamie Stone is next.
First of all, I thank members for allowing me to come to the committee today. I hope that I do not bore you by repeating myself.
Heaven forfend, Jamie. You are never boring.
Members have heard me on this subject before. Three and a half years ago, the NHS in the Highlands proposed downgrading the maternity unit in Caithness to a midwife-led unit. Indeed, the very last question that Donald Dewar ever answered was a supplementary question that I put to him during First Minister's question time on that very subject. The Executive backed off then but the issue is back on the agenda now.
What makes the situation so desperate and so singular is this: taking women and their unborn children well over 100 miles from Caithness down to Inverness and back again poses huge safety problems. What if the weather is inclement? What if the roads are blocked? What if the helicopter cannot fly? To put the situation in a central Scotland context, it is the equivalent of asking women in Glasgow to go to Carlisle to have their children. It is an absolutely huge issue in Caithness. Caithnessians will not take this lying down.
At a meeting of Highland NHS Board, I was very struck by a contribution that was made by the Church of Scotland parish minister from Wick, who said that it came down to a human rights issue. Marbled through EGAMS is mention of risk, risk assessment and the minimisation of danger. It is admitted in EGAMS that midwife-led services in very remote areas are untested.
Professor Andrew Calder, who was a party to the EGAMS report, was asked to carry out a review of maternity services in the Highlands. In his report, he outlined the transportation and inclement weather difficulties and the dangers associated with them. However, when he concluded that, inter alia, consideration should be given to having a midwife-led unit, he did not attempt to answer the question of transportation. I put it to the committee that in areas as remote as Caithness, even with the finest ambulances in the world, and even with a fleet of helicopters, when the weather comes in, the weather comes in and you simply cannot move people. I talked to somebody the other day whose family had lost children who died with the mother in an ambulance on that journey in the bad old days.
I have put these points to ministers and Tom McCabe has been good enough to admit on the record in the press that distance is the big issue. As I say, it is the equivalent of Glasgow women having to go all the way to Carlisle.
Highland NHS Board has backed off somewhat, in as much as it has conceded that it will consider some sort of hub-and-spokes rotating service, incorporating consultants. However, the bottom line is that, in view of the unacceptability of increasing the risk, we must endeavour not to accept that.
Finally, I reiterate to the committee that surely women who live in really remote areas, such as John o' Groats, Canisbay or Bettyhill, have just as much right to a decent—indeed, the best—maternity service as women who live in Fife, Lothian or wherever. The issue is about weather and distance and will not go away. Indeed, I believe that it is so fundamental that it transcends the responsibility of NHS Highland; it involves ministers and the Parliament.
I want to speak to petition PE707, in the name of Professor Dan Young, on maternity services. The petition has been signed and submitted to the Public Petitions Committee by five eminent retired professors who worked at Yorkhill in the Royal hospital for sick children and the Queen Mother's hospital.
Three issues arise from the petition, the first of which is the quality of the consultation process. In that respect, I urge the committee to include some of the aspects of this petition in the work that it has already been carrying out. The issue is not about the process itself but about the quality of expert opinion. Although these professors, who are eminent in their own field and have run the service, gave evidence in the consultation process, they cannot see where that evidence appears in the paperwork that was given to board members. The important distinction to make is that that evidence was expert, not public, opinion. The professors want the committee to address that aspect of the quality of the consultation process. After all, if an expert opinion has been given, it should be easy to find out where it has ended up and the extent to which it was taken into account.
Secondly, the petition asks the committee to examine the model of care at Yorkhill with the Royal hospital for sick children and the Queen Mother's hospital, particularly in relation to the delivery of a national service. There is work to be done on the delivery of children's services in Scotland. Although national services are delivered not by NHS Greater Glasgow but under the direct auspices of the Scottish Executive, the health board appears to have taken a decision on the future of children's services on behalf of every MSP around this table and beyond. As a result, the professors are asking the Parliament to examine whether all of us—not just me as a Glasgow constituency MSP with an interest in the matter—have a stake if we lose that model of care.
I will not talk about the conclusion that the board reached, because that is not the issue in question. However, there is a feeling that the decision was based on inaccurate information, which again highlights the very question of the quality of the process. An example of the inaccurate information that was released in the name of NHS Greater Glasgow was its claim that there are two foetal medicine departments in the city. There is only one such department, which is based at the Queen Mother's hospital. It has delivered training not only for the whole UK but worldwide and is the only referral centre for foetal medicine.
Moreover, the day before the decision was taken, board members received a minority report that was signed by almost 30 doctors and which stated that the plan following the closure of the hospital would be impossible to implement. Again, that report should have been made available to decision makers well before any decision was taken. Such incidents highlight the serious problem at the heart of this matter: the quality of the consultation process. Finally, the expert evidence of paediatricians such as Charles Skeoch contains a warning that transporting neonates to the extent allowed in the implementation plan raises serious issues with regard to the morbidity of children.
I have tried to steer away from expressing my feelings about the closure and ask the committee to add some of the issues that have been raised to its on-going work. I know that committee members are concerned about the quality of the consultation process and that the minister has still to respond. I do not want to add to the committee's work load; however, I would be very grateful if it could consider the distinct and important points about the quality of the process; the accuracy of the information on which decisions were based; the work that needs to be done on the model of care for children's services; and how we deal with expert rather than public opinion.
I thank members for the very clear exposition of their cases.
As far as the minister's response is concerned, petition PE707 calls on the Scottish Parliament to
"consider a new legal framework for consultation".
Malcolm Chisholm notes in his letter that that is part of the petition. He says:
"It would not be appropriate for me to make any comment … at the current time",
but that he is
"taking careful note of all representations made."
He says that he
"will need to be satisfied that Greater Glasgow NHS Board has fully engaged with stakeholders"
before he approves any proposals. That takes care of one bit of petition PE707.
Another part of the petition concerns expert advice. Later in his letter, the minister says that he
"will … ensure that the guidance provides advice on the selection of expert advice",
in particular when
"the provision of a national service is affected".
Without going into the decision that is to be made locally, the minister's response covers the points in that petition.
After listening to what has been said today and reading the copious paperwork that accompanied the petitions, I think that the petitions could be split into two groups of two petitions. Petitions PE689 and PE718 are about the availability of consultant-led maternity services and petitions PE643 and PE707 are about consultation. I do not know whether we could take on board the petitions about consultant-led maternity services during our work-force planning deliberations. We could question people on that in the areas that we visit for our inquiry. We must understand that such decisions are consultant led. That is one driver of our work and of the inquiry that we are about to undertake.
Petitions PE643 and PE707 deal with consultation in the NHS, on which the committee's predecessor laboured long and hard in the previous session. The previous committee took the strong view that it would be inappropriate to involve itself in local decisions by health boards. However, we took a view on consultation in general and investigated it further. At that time, we obtained from the minister a commitment to guidelines, which I understand that we are about to see. Those guidelines are likely to say that end-process consultation is unacceptable and that boards must give their reasons for not choosing a particular option.
I am not saying that that means that consultation will be good, because the problem that we have always had is not so much with the consultation process, which has become more comprehensive, as with the cognisance that is taken of comments that are made during a consultation and how all the comments are evaluated, whether they be from expert witnesses or from the public. The issue is more how the outcome of a consultation process is evaluated. I am interested to hear other members' views on that.
The petitions are timely, given the committee's work on work-force planning. I agree with Janis Hughes that we need to separate issues that relate to work-force planning and fit them in with our inquiry. That will include talking to the petitioners in more depth about the issues that they have raised when we go to our respective areas.
I do not know whether members are aware that when the committee undertakes that inquiry, we will divide into three groups of three to make informal visits from 25 to 27 May. We have not set a structure for that, but we could take informal soundings that will inform the structure of our formal evidence-taking sessions, which our work plan says will commence on 7 September. That is in train. It is difficult to track what other committees are doing.
It would be useful if the clerks pulled out what can fit in with our inquiry into work-force planning. However, there are clearly remaining issues that do not fit in with that inquiry, which we cannot just leave hanging. I was struck by what Pauline McNeill said about the quality of the consultation process. There are issues on which we need to go back to the ministers. There are clear concerns about the weighting that is being given to some bits of evidence and not to others—if they materialise. I do not think that we can allow that just to pass.
As we are in the difficult position of waiting for a decision from Malcolm Chisholm, there is a limit to how far we can go. However, I draw members' attention to something that the minister announced today—the expert group to plan for NHS service change, which will establish a national framework for the reconfiguration and redesign of services. Some might say—as I would—that that should have been in place before health boards around the country started to embark on the rationalisation and centralisation of services. The press release states:
"The group will not decide on current or imminent major service reviews by Health Boards. However, its work will complement future planning by Boards by giving a strategic national focus for the reconfiguration and redesign of services."
We need to take that specific issue up with the minister. Surely he cannot be saying that, from a point in the future, things will be done differently, with a strategic national focus, but that everything that is done until then will be done on an ad hoc basis and in a piecemeal manner. We should either write to the minister or ask him to give evidence to the committee, as he has taken the initiative on this. It could be argued—to be controversial—that what is going on and the decisions that are being taken around the country fly in the face of what the expert group may come up with. We do not know, as we have not heard what the expert group is going to say—it will reveal its deliberations in the next few months. There is a strong argument that there should be a pause until the expert group reports.
Those are all issues that we could put to the Minister for Health and Community Care. He has put the cat among the pigeons with his announcement today, and we should, as a minimum, have him before the committee to discuss how the expert group will impact on what is going on around the country at the moment.
Can you give us the number of that Scottish Executive press release?
It is on the Executive's website.
I am told that the minister wrote to me today, but I have not seen the letter yet.
There is a letter.
On the point that Shona Robison has raised, I think that it is urgent that the committee call for a moratorium on any closure until the matter has been properly debated. It is fairly obvious that the piecemeal approach is hitting a national issue—access to services throughout Scotland. It is not a matter just for individual health boards, because when the National Health Service Reform (Scotland) Bill is passed, there will be a duty on health boards to look after patients from other health board areas. In other words, it is vital that the left hand and the right hand start working together.
I agree with the minister's letter that the subject of petition PE643 is not necessarily an issue of note for the committee to take any further. Many hospitals have acquired pieces of kit through public donation, and so on. The real issue is access to services and whether those services can be manned. That brings us back to our work-force planning exercise. However, there is an issue in the letter on which we could ask the minister to respond further. He takes a simplistic approach on page 1 of the letter, on which he cites
"declining birth-rate, changes in practice and impending changes to clinicians' working patterns".
This is to do with access and getting hold of clinicians. In fact, more and more people are having their first child later in life, which is far more complex. That complexity is a factor in the requirement to be able to access consultant care.
I received a very moving letter from a lady who lives to the north of Wick but who, until recently, lived on the outskirts of Aberdeen. She and her husband were going to start a family but discovered that there were going to be no consultant services there. She was advised that she would have to live in Inverness for the eight to 10 weeks—if not 12 weeks—before the scheduled birth, because of the risks of her age, which was 35. She has been very public about that. The issue is far more complex than the minister seems to acknowledge, and much of it is to do with work-force planning. Pauline McNeill made a comment about a centre of excellence; that is a national issue and not just one for Greater Glasgow NHS Board.
We all have a great deal of sympathy for those who experience the frustrations of the consultation process. That is reflected in Professor Young's petition and in the petition in the name of Dorothy-Grace Elder.
The National Health Service Reform (Scotland) Bill gives us the opportunity to raise those issues with the minister and I expect members to take advantage of that opportunity during the stage 3 debate. As well as that, when he is making his final decision on Glasgow, the minister has to take into consideration the quality of the consultation. There is a statutory requirement for that, so the committee might be being a wee bit previous on the Glasgow issue. It is certainly something that we have discussed and been aware of for some time.
Of course consultation is important and we have made some progress in the National Health Service Reform (Scotland) Bill. However, it is not enough progress and, as I suggested to the minister when he gave evidence to the committee, it does not deal adequately with issues such as the redesign of maternity services. On such issues we almost have to go outside the standard consultation. I believe that, although others might not support me.
However, consultation being the way it is, the minister has announced another review group today. As I understand it, consultant-led facilities at Caithness general hospital, Vale of Leven hospital and the Rankin memorial hospital in my constituency are being taken away irrespective of consultation. It is a dangerous game when politicians start to call for moratoriums or standstills. We face a difficult issue. It is easy to say that we should stop something, but the challenge is to ensure that we can get proper cover for mothers in those hospitals. The three areas that we are talking about are operating under a contingency plan and do not have sufficient skills to enable them to carry on delivering safe procedures. That is the reality of the situation. I do not know how we can create a moratorium in those three areas. I just pose the question.
Thankfully, the work-force planning inquiry gives us an opportunity to roll the issue up. We could consider several areas when we are out and about and touching base with people who have concerns. We could also consider case studies and the impact of the issues in areas such as Argyll and Clyde and Caithness. We could focus on maternity services. That is what drove me to call for a work-force planning inquiry, so I hope that we can bring others into the inquiry.
Before I bring other members in, I point out that the minister is before the committee next week. We could certainly slot in an item to deal with the quality of consultation and the issues raised by the minister's letter about the setting up of the expert advisory group. If the committee agrees, I could put that on the agenda rather than write to the minister. He will be here anyway, so we could just extend the session.
We should put the general issues on the agenda. With all due respect to the members from Glasgow, this is not just an issue for Glasgow. There is an issue with the quality of consultation and how we engage the public and redesign consultation. I do not think that the committee is in a position to evaluate the evidence that was given, but we have to remind the minister that we are aware of what petition PE707 says about expert opinion and doubt about the quality of evidence.
I am trying to be helpful by separating the issue of the withdrawal of certain services, which is a staffing issue, from the consultation issues and the letter of April 2004 about the national framework for service change and the expert advisory group. As the minister is to appear before the committee, the sharpest way to deal with the matter is to question him then. We can extend the session and move on to the matter after addressing the budget process. Do members agree?
Members indicated agreement.
Do Mike Rumbles, Jean Turner and Helen Eadie want to come back in, or can we come to a view?
No. I have a contribution to make to the debate.
That is fine—I have no problem with that. I was just thinking about the time, as usual, and about whether there is anything additional to say.
Petition PE707 calls on the Scottish Parliament
"to urge the Scottish Executive to consider a new legal frame work for consultation"
and Dorothy-Grace Elder's petition PE643 calls on the Parliament
"to take the necessary steps to improve public consultation".
I agree that that is exactly what we are doing at stage 3 of the National Health Service Reform (Scotland) Bill. As the minister says,
"The guidance will be underpinned by a new duty upon NHS Boards to involve the public which will be established by the NHS Reform (Scotland) Bill."
As MSPs, we are doing that as we go through the process; the petitions are addressed by the work that we are doing collectively at stage 3. To put it crudely, I think that those two petitions are ticked. They should be noted, we should thank the petitioners for raising the issue, and the petitions should be concluded—that is the best way to proceed.
The other petitions that are before us, PE689 and PE718, are similar. PE718 calls on the Parliament
"to urge the Scottish Executive to urgently review the provision of maternity services for Scotland's island and rural communities."
Jamie Stone's petition PE689 calls on the Parliament
"to ensure the availability of consultant-led maternity services throughout Scotland."
The key word is availability. It is a national petition, and it hits the nail on the head in relation to what we are trying to do in our consultation. I am conscious that the committee has sat formally—I am not talking about going out on fact-finding missions—only in Edinburgh. If we are serious about the consultation and if we are to consider the effect of the availability of services throughout Scotland, we should leave Edinburgh. To take the two new petitions as examples, we could go to Rothesay or north of Inverness, perhaps to Wick. We should get out there and take evidence in the September sessions to which the convener referred rather than be focused here in Edinburgh.
If we decide to subsume the petitions in whole or in part into our work-force planning inquiry, they will be closed down, because the inquiry will end the petitions.
I am quite happy to hear from other members, but I am trying to move things along.
I will try to be as quick as possible because I know that you are dying to close the meeting.
No, not at all.
What really concerns me about the consultation process, which is important, is that although we are frequently told that doctors hold such-and-such an opinion, we know that many doctors have other opinions. The latter seem to be secret and are lost to the public. I do not know how we as a committee can bring out the information that is given in the consultation process so that we can see all the evidence. I wonder whether that information is also withheld from the minister, who has to make a decision about a national institution. Is he privy to that information? Perhaps Pauline McNeill and Sandra White know the answer to that.
Malcolm Chisholm states in the final paragraph of his letter that it is vital that there will be a
"duty and the guidance will expect Boards to inform, engage and consult with the public in the relevant area(s)".
To clarify matters for the Official Report, Malcolm Chisholm states that in his letter to Michael McMahon.
The important bit of what he says is that boards will be expected to
"feed back the results of the consultation, including reasons for the eventual decision and explanations of how the public's views were taken into account."
It is important for us all to remember that.
I very much agree with what Duncan McNeil said. It would be inappropriate for us to engage in a moratorium and it is right that such matters should be embraced in our inquiry.
In answer to what David Davidson said, section 3 of the letter from Greater Glasgow NHS Board clearly brings out how vital expert consultant-led assistance is in the event of a difficult child birth and that it would want to be sure that any delivery takes place in a maternity hospital with an on–site intensive treatment unit. David Davidson made an important point, but it has been covered in the response from Greater Glasgow NHS Board.
I want to draw the discussion to a conclusion. Petitions PE643 and PE707 are on consultation. In respect of those petitions and the letter of April 2004, with the announcement by the minister, do members agree that we will question the minister with regard to consultation processes after we have asked him about the budget process?
Members indicated agreement.
Petitions PE689 and PE718 relate to work-force planning and so on. Do members agree that we should let the petitioners know what our plans are for our first informal foray and for informal evidence-taking sessions, at which they are welcome to give evidence? We will take on the petitions as part of our inquiry. The two petitions will be closed down at that stage, as we will have taken them on board as part of the inquiry. Are members content with that proposal?
Members indicated agreement.
That deals with those four petitions. I thank members for waiting and for speaking to them.
Terrestrial Trunked Radio Communication Masts (PE650)
The final petition is PE650. I welcome Mark Ruskell, who has been patient.
The petition was referred by the Public Petitions Committee to the Communities Committee, which agreed to consult this committee. The Communities Committee is still considering the petition. Members should bear with me—we are nearly finished. The petition was forwarded to us to allow us to consider its health implications. Members may give their views once Mark Ruskell has spoken. This is the first time that we have considered the petition.
I will take no more than a minute or two, as the committee has had a mammoth session.
I should emphasise that a degree of urgency surrounds many issues with which the petition is concerned. The public is concerned by the issue, which first came to my attention in April last year, before I was elected, when I attended a public meeting in Cupar in Fife. That meeting was about TETRA, which is a new type of mobile communication system. In the 12 months since that meeting, seven community-based campaign groups that are concerned about TETRA technology have been set up in Mid Scotland and Fife alone. Many of those groups have organised public meetings, which have sometimes been attended by more than 200 people. There is a lot of public concern.
While that concern has mounted, the TETRA communications system has been rolled out throughout Scotland and local authorities have approved new TETRA masts. In fact, the briefing material that members have received from the Communities Committee is now out of date. I think that, apart from two applications, all the 14 applications in Fife, which Fife Council was holding back on, have now been approved. The system will be operational in Dumfries and Galloway in the summer.
The petition was lodged last autumn. The Executive, the Public Petitions Committee and the company have corresponded, but I do not believe that the correspondence has addressed many issues that the petitioners are concerned about and it might be time to take oral evidence and to consider the issues that are involved.
The petitioners' concerns are not about mobile phones as a whole. I am aware that an inquiry into mobile telecommunications masts took place in the first session of Parliament. The specific concern of the petitioners and of many communities throughout Scotland is that the TETRA system pulses using very low frequency radiation. The companies that are involved and members of the scientific community disagree about whether the masts pulse.
Another concern is about the potential health effects of the masts and handsets that will be used by the emergency services, starting with the police this summer. Further, the standards that have been devised for mobile communications systems predate the new technology—they deal with the mobile phones that we are used to using, not mobile telecommunications systems that use the very low frequency. The Stewart committee said that we should use the precautionary principle in relation to the new technology. We should not roll out a system that uses low frequency radiation until we are sure about the health effects.
The committee could examine those issues. The petitioners have not yet given oral evidence to a committee, although they have been working with scientists who are concerned about the contradictions in the standards and in the evidence on whether the system pulses, which is the petitioners' primary concern.
It is fairly common knowledge that, in the past three to five years, the science community has not agreed about the safety of new systems, as a result of which certain areas in other parts of the UK have declined to use them, either because of the potential risk or because of inefficiencies in the process. Frankly, I do not think that the committee is qualified to deal with the science aspects, although we are concerned about the public concern. We need to collate information on various aspects of the science from both sides of the argument. Perhaps a body such as the Royal Society ought to consider the issue on a UK basis.
When systems are rolled out, the planning authorities often have no positive evidence to argue against them. If an application does not breach the local plan or the strategic plan, the planning authority cannot do much about it. If we do not get the science right and do not have the knowledge, none of the committees of the Parliament can reach a firm conclusion and give the system a clean bill of health. I agree with Mr Ruskell that we should adopt the precautionary principle, but if we are to take evidence on the matter, we must do so in conjunction with Westminster.
I was a member of the Transport and the Environment Committee in the first session of Parliament when it carried out an inquiry into telecommunications masts, which concluded that no conclusive evidence existed and encouraged the use of the precautionary principle. The Transport and the Environment Committee took evidence from a huge number of people, which included evidence on the health aspects. I make that point because I think that the matter is best taken in the round, as part of a Communities Committee inquiry on the issue, if it intends to carry out such an inquiry. I do not know what can be gained from our input, except if it is asked for.
For clarification, was a report issued as part of the Transport and the Environment Committee inquiry to which you refer?
Yes.
Mr Ruskell, were you aware of that?
I am aware of the good work that was done in session 1, but it did not relate to the TETRA system. Perhaps the heading for PE650 in the agenda is misleading. We are talking not about mobile phone communication masts but about terrestrial trunked radio masts, which are a different technology that was not considered in session 1 because it did not exist then.
I was simply suggesting that the petition could be dealt with by the Communities Committee. We have been asked to comment; my comment is that if the Communities Committee is to carry out an inquiry, it should take evidence on the potential health aspects in the round, rather than have a two-committee discussion.
Like Janis Hughes, I was a member of the committee that examined the issue. We found that a scientific committee has been set up at European level to investigate the issues. David Davidson's point that we must have regard to the science is well made. If the petition is to go anywhere, it should go to the Communities Committee and be considered in conjunction with work at European level.
We must recognise the huge concern about the issue. I was contacted by constituents this morning about proposals. Has the Communities Committee offered to carry out an inquiry?
The Communities Committee is in the same position with this petition as it is with the petition that we discussed earlier.
We should suggest to the Communities Committee that there are unanswered questions, that more work needs to be done on the matter and that we hope that that committee will be able to do that work. If required, we will have input through a reporter.
We do not need to agree on a reporter today. We will defer the matter until we see what the Communities Committee decides to do.
Before members leave, I have an issue to raise. I am sure that members have read in the newspapers that the former chief executive of NHS Scotland, Geoff Scaife, was killed in a dreadful car crash on Tuesday 20 April. He leaves a wife and four children. Do members agree that we should write with condolences to his family and his former team members?
Members indicated agreement.
That concludes the meeting. I thank members for their forbearance in a sauna. We will try to meet in the chamber next time, where it is cold.
Meeting closed at 17:32.