Acute Services Review (Tayside)
The final item of business today is a members' business debate on motion S1M-1575, in the name of Roseanna Cunningham, on Tayside acute services review consultation.
Motion debated,
That the Parliament expresses its lack of faith in the consultation process associated with the Tayside Acute Services Review and the way in which public opinion is being ignored; is concerned that Tayside Health Board are intent on imposing a centralising agenda which will remove services from Angus and Perthshire and overload the service in Dundee, and believes that the Health and Community Care Committee should undertake an inquiry into the evidence base for the proposals and the effectiveness of the consultation process undertaken.
I am pleased to have this debate this evening, but I am not quite so pleased to see that the Minister for Health and Community Care is not in the chamber. Unfortunately, it has been par for the course over the past 18 months to two years that the Minister for Health and Community Care has not wanted to address any of the concerns and problems of the people of Tayside about what is happening in the national health service there.
Uncertainty has been the watchword for the health service in Tayside over the past few years. The acute services review has caused a great deal of anxiety and insecurity among patients, practitioners and the general public alike. The final report from the co-chairs of the review, Professor David Rowley and Dr Andrew Russell, has now been published—it is a weighty tome, as members will see. Although there is still to be a three-month period of formal public consultation before the final decision is officially reached, the people of Tayside believe that the final decision was reached some time ago. They believe that the consultation to come will be a cosmetic exercise and that the entire process has been a sham and a farce.
The proposals that are of particular concern to me and the people of Perth are the plans to remove consultant-led maternity provision and 24-hour children's services from Perth royal infirmary and to centralise them in Ninewells hospital in Dundee. I have colleagues who have particular concerns about the implications of the review for health services in Angus and Dundee, where the concern is that Ninewells will become overburdened. My colleague Andrew Welsh very much hoped to be in Parliament this evening; unfortunately, Heathrow is fog-bound and he has been unable to get back to Scotland in time. He has been working hard in his part of Tayside to further the interests of his constituents.
My main concern is, of course, Perth. Taking maternity and children's services away from Perth royal infirmary is akin to ripping the heart out of the hospital. There have been warnings over the past few months that a loss of paediatric cover would pose a threat to the accident and emergency department. That possibility has not even been addressed by the report.
Over the past year or two, there has been a vigorous public debate in Perthshire; both the public and the professionals have participated fully in that debate. The clear perception all along has been that no one involved in the review has listened to anything that has been said.
There is now some cynicism in the public's response to any announcement on the health service in Tayside. The public think that the aims of the review and the charade of the consultation process that has been associated with it have been cost driven, that its management has been publicity driven and that its direction has been politically driven.
Three years ago, Tayside Health Board assured me that there were no plans to close the children's ward at PRI. Since then, a petition to oppose any reduction in children's services at PRI has received 10,000 signatures, and two public meetings have been held, each of which was attended by more than 1,000 people. Five thousand people demonstrated in the streets of Perth and hundreds marched up the Mound to demonstrate at the Parliament on St Andrew's day, delivering more than 20,000 postcards to the Minister for Health and Community Care—who, unfortunately, did not see fit to meet the people who had come here.
Despite all that, Professor Rowley still proposes centralisation. He dismisses the thousands of genuine expressions of concern as the work of a "vociferous minority" and the public concern as "emotionally held". Of the hundreds of communications to me about the threat to PRI, not one has supported any of the frequently leaked proposals that have characterised the process. Vociferous the representatives of the Hands Off PRI campaign may be—and I welcome them to the Parliament, particularly the organisers Kate Gillanders and Julie Fielding—but a minority they are not. They speak for Perthshire. It is Professor Rowley who is not listening.
In an injured response to the criticism, Professor Rowley insisted that he was
"presenting a range of options".
However, the truth lies in phrases in the report, such as
"it is difficult to come to a conclusion other than that a single service is the only viable strategic option",
which he said of paediatric services, or
"it is difficult to come to any logical conclusion other than that a single site model for maternity services is appropriate."
In the face of such comments, Professor Rowley continues to insist that, somehow, a range of options will be proffered to the public.
The final report paid no attention to the important issues of distance and transport links. People who face an extra 20-odd miles of travel along the notorious A90 Perth to Dundee road to give birth, attend clinics or visit loved ones have raised those issues time and again. The conclusion of most is that the process has been a sham.
Those who are responsible for the review seem thirled to a centralist agenda. They have come up with a solution that threatens to set area against area and will be no good for any part of Tayside. I want the Health and Community Care Committee to set up an inquiry into the review process. Apart from ignoring public opinion, the process has now been responsible for destroying public confidence in the national health service in Tayside. That matter should be of concern to every member.
Susan Deacon has been conspicuous by her absence here today and in Tayside throughout the past two years, apart from one interview with Radio Tay, in which she committed a major gaffe. She had to admit her ignorance of the fact that waiting lists in Tayside soared by 47.3 per cent from September 1999 to September 2000.
Acute services reviews are causing problems in places other than Tayside and similar stories are emerging around the country. Public confidence in the consultation process of each review is at rock bottom, but the minister refuses to take any responsibility. She refused my invitations to come to Perth to hear what the public have to say. She refused to meet the campaigners when they came to Parliament. She has shrugged her shoulders and said that the decision is not up to her. She even chooses not to attend today's debate.
I hope that members of the Health and Community Care Committee who have attended the debate—I see some of them here—will agree that somebody needs to get a grip and restore public confidence in the delivery of health services in Tayside and throughout the country. They can play a part in that by undertaking an inquiry that will actually listen to the views and evidence put forward by public and professionals—views and evidence that, so far, have been summarily ignored by the acute services review in Tayside.
I congratulate Roseanna Cunningham on securing the debate. However, her remarks about the absence of the Minister for Health and Community Care were unfortunate, as she knows that it is routine for deputy ministers to speak in members' debates.
As the member for Perth, Roseanna Cunningham made a strong case for the implications for Perth of the acute services review in Tayside. I cannot comment on that, as I have not been elected to represent anyone in Perth and I would not seek to interfere in that part of the Tayside area. However, I am a constituency member for Dundee, and the review has implications for Dundee, so I feel that I must make a few comments in the debate, not least on the motion.
Parts of the motion give me considerable problems. For example, we are asked to express a
"lack of faith in the consultation process associated with the Tayside Acute Services Review".
That is not because the process was less than comprehensive, as I can remember SNP members complaining that the cost of holding focus groups of people in Tayside who use the health service, in order to establish their views, was a waste of money—money that could be better used on front-line services. SNP members are not worried about the extent of the consultation.
I represent the Mearns, which is served by Stracathro. I can guarantee that the people of the Mearns feel that the consultation process has not been comprehensive and that the whole process is flawed.
I was merely pointing out that the SNP complained that the consultation process was too comprehensive and that too much money was being spent on it. Nine public meetings were held in the second phase, only one of which was in Dundee. That does not sound like a centralising agenda to me. The main argument in the motion is that public opinion in Tayside has been ignored in favour of a health board agenda that is centralising by putting too many health services in Dundee and not enough in other parts of Tayside, such as Angus and Perth.
Constituency members have every right to argue for their corner of Tayside; I will argue for mine. I have not come across anyone in Dundee who says that too many health services are located there, that we are spoiled for choice at Ninewells and that it is time that some of the services in Dundee were taken away and sent elsewhere in Tayside.
Will the member give way?
I am sorry, but I do not have time.
I have heard John Swinney argue passionately for the consultant-led maternity service at Ninewells to be closed down and transferred to Perth. Despite the fact that the majority of births in the area take place in Dundee, that most of the poverty is in Dundee and that the greatest need for that service is in Dundee, the leader of the SNP wants to close down the service and move it to Perth. If he expects me to support that, he should find something else to do.
I understand the pain that lies behind the debate—we are all being hurt by the acute services review in Tayside and I will shout for Dundee in the same way that Roseanna Cunningham shouts for Perth—but I recognise that there must be an acute services review, because the current structure of services in Tayside is distorting the way in which services are delivered to people in the area. One in five of the beds at Ninewells is inappropriately occupied—that has to change, and it can change only by moving resources from acute to primary services. If politicians cannot face up to that, they are not telling the truth to their constituents.
What we have just heard shows the lack of understanding on both sides of Tayside—Perthshire and Angus. The stony silences from many Labour members at Tayside Health Board meetings speak volumes.
I am incredibly grateful to Roseanna Cunningham for securing the debate. It is important that somebody who has spent a lot of time at Tayside Health Board, trying to understand what has been going on, should consider the matter objectively and should take into account the needs of Angus and Perthshire and, indeed, Dundee. However, the history of the Tayside acute services review is one of mismanagement, lack of consultation, high-handedness and centralisation. All the while, the Executive has buried its head in the sand, leaving mass uncertainty and fear.
It was only after constant pressure and a Health and Community Care Committee investigation that the Minister for Health and Community Care sent in the task force. Professor Clark's report found management to be at fault and took the appropriate action. However, having found the cause of the £90 million deficit—most of which, I concede, resulted not from Government policy, but from bad administration by the board and some of the trusts—the Executive now seems content to go further and punish the patients of Perth, Angus and Dundee for that mismanagement.
The review is undeniably dictated by cost alone. For every clinical voice in its favour, there is a clinical voice against it. More important, not one patient's voice praises the plan. The review's launch, days before the date that was promised to us, the elected members of Parliament, shows the contempt in which the people of Tayside are held.
The review makes a number of errors. It recommends—before the Executive's own national review of maternity services is published tomorrow—changes to maternity services in Perth and Angus. The review is pre-empting some of the Executive's views, and the knowledge that the maternity services review will provide, which we hope will lead to better maternity services throughout Scotland. If that is not a clue as to how the acute services review has been conducted, I do not know what is.
The changes that are proposed would leave no obstetrics services between Pitlochry and Dundee or even between Loch Rannoch and Dundee. How long, I wonder, would an ambulance take? I notice that there is no provision for extra money to be spent on ambulance or emergency services, should the review's proposed changes to maternity provision go ahead. I recognise that midwifery services in Tayside, Perth and Angus need to be valued and promoted more. I have been informed that retention of maternity services as they are would cost about £1 million a year. Is not that a price worth paying? Would the service be subject to such change if the review were not driven by a deficit of £90 million?
Having met patients in Angus, I know that there is a curious omission of naming Stracathro hospital in the review. Angus is a county that already has a hospital—perhaps we should remember that as Stracathro begins to be dismantled. Stracathro serves 130,000 people, including people living up in the Mearns. That is the same number as live in Perth and Kinross. We were once proud of that hospital and we should be proud of it again. To suck services in from Perth and Angus will, in short, leave Perth royal infirmary and Stracathro as empty shells.
We must not forget that, in the end, the review is in the hands of the Minister for Health and Community Care. We must not forget that it is she who will take the final decision and it is on that that she will be judged.
The Tayside acute services review affects not only the people in Tayside. As Ben Wallace said, most of the people in the southern part of my constituency, notably in the Mearns, are served by Stracathro hospital. The acute services review says that the aging Stracathro hospital should be replaced with a new-style community hospital that offers hi-tech diagnostic and ambulatory care facilities. Although the report does not preclude the development of the new hospital on the Stracathro site, it does not specify a location. How convenient.
There is strong local support for the retention of Stracathro hospital—a 20,000-signature petition has already been raised. Many members attended a rally outside Stracathro hospital, where almost 1,500 people gathered to voice their concerns about the future of the hospital. I am not talking about the bricks and mortar of the hospital. I am talking about that hospital's facilities for people who live in rural Scotland, north and south of the boundary between Tayside and Grampian.
If Stracathro hospital closes, the people in the Mearns will lose out tremendously. A new hospital in Arbroath, for example, will be no good to the people of the Mearns. In my view, the report is flawed. My constituents in the Mearns have not been properly consulted. When we attended public meetings, I was astounded that there was no mention of the people of the Mearns. Health board representatives attended public meetings in Brechin and did not even mention the people of the Mearns, never mind consult them. They had to be prodded and reminded. The health board's focus seems to be that centralisation is the key. The problem is that Stracathro hospital is located in the far north of Tayside. How much more managerially convenient it would be to remove that hospital and centralise facilities in Dundee and elsewhere, but that would not help the local people.
I almost said that there seems to be a lack of honesty in the report, but I would not lay such a charge. I will lay the charge that there is a lack of forthrightness. Why is there no recommendation on the location of the new Angus hospital? The suspicion remains that Tayside Health Board has it in for Stracathro. If that is so, my constituents will lose a much-needed facility. People in the rural part of my constituency—the Mearns—will be in trouble. They will have to travel north to a hospital in Aberdeen or to the new hospital, which might be in Arbroath; that seems to be the suggestion, although the board has not had the courage of its convictions and said so in the report. We must save the Stracathro facility for the people who need it. That is what this is about.
I congratulate my colleague Roseanna Cunningham on her success in obtaining this debate, which gives us a welcome opportunity to air the issues that are connected with the acute services review. It has been a revealing debate so far. I did not know that the great conscience of the Parliament, John McAllion, had such an affection for focus groups, which he vigorously defended in his speech, while misrepresenting the views and attitudes of others who have spoken in the debate.
It is entirely natural and sensible for individuals to promote the concerns of their constituents. I represent a large landed area of Perthshire and Angus, which depends on the services that are provided by Stracathro hospital, Perth royal infirmary and Ninewells hospital. What concerns me is that we face an acute services review that denies the geography of the area in which we live and makes no attempt to propose any sensible alternatives, for example, on the use of vital ambulance services which, before we even embark on the acute services review, are under enormous strain in large rural areas of Scotland. We have before us a prospectus of change, all of which is done in the name of modernisation and improvement of the efficiency of services, but which denies the fundamental reality of the geography in which we live.
I represent constituents who, to get from their homes in Kinloch Rannoch or Loch Rannochside to Perth royal infirmary, would be engaged in a journey that might take them up to two hours in good weather. They are now expected to undertake a journey of two and a half hours to get to Ninewells hospital. There are no credible alternatives in place in relation to vital transport facilities and making services available in the locality. I express to the minister in the strongest possible terms my concern about the plans to remove the consultant-led maternity unit from Perth royal infirmary. That unit is vital to an area of Scotland where there is, in fact, a growing population—ministers should not ignore that.
My second point is on Stracathro hospital in Angus, at the other end of my constituency. Nobody can deny that the bricks and mortar of Stracathro hospital are under strain and do not deliver the modern-day health care facilities that are required. That is not an excuse for running down the provision of services in the county of Angus. The only reason why those facilities are so run down is that health service planning in that part of Scotland has been the victim of the most appalling neglect for 20 or 30 years. The sooner health service management in Scotland faces up to its neglect of some of our vital country health care services, the better our debate about the future of those services will be.
I have one specific question for the minister, to which I hope he will respond in his summing-up. My constituents, while they are asked to accept the closure of Stracathro, are being promised a new facility. How might that come about? I have heard far too many promises from Tayside Health Board about an integrated package. I am quite prepared to accept that change might be needed, but I suspect that my constituents will have to face bad news before they have any prospect of reliable good news from Tayside Health Board.
Kate MacLean has withdrawn, so I offer her slot to Richard Simpson.
Thank you, Presiding Officer.
I congratulate Roseanna Cunningham on getting this debate, which will be, I think, one of a series of debates on acute services reviews up and down the country. The issues are not totally dissimilar in different areas. I question some of what I have heard. Having been responsible for the Stobhill report, which has changed the pattern of consultation by health boards, I listened with some dismay. It seems to me that, in many cases, consultation has undoubtedly improved.
In the case of Tayside, the report that I have received indicates that the board established a patient reference forum of 30 individuals, consisting of patients, carers and Tayside Health Council. Members of the forum were involved in every single group that was consulted in the review. Forty public meetings were conducted, involving over 5,000 people. Two deliberative conferences, facilitated by external organisations, were held, involving 160 members of the public.
No. I do not have much time.
Tayside Health Board was involved in meetings with pressure groups that were held by Professor Rowley. The patient reference forum, staff partnership forum and professional bodies jointly determined the criteria against which the options, benefits and risks would be determined. That does not sound like an appalling consultation process. Rather than rhetoric, we need to hear specifics of the sort that Mike Rumbles put forward when he said that no public meeting had been held in the Mearns area, and that people in that area were not consulted.
I can accept that, but I cannot accept, on the basis of this evidence, that there has not been some measure of consultation, even if that process remains flawed. The problem on Tayside is that it is bedevilled by the funding issue in the background, which has resulted in a lack of trust in the trust boards and the health board. That makes consultation difficult, because it is not based on trust.
The problems of south Glasgow were recently debated and, as I said, there will be debates about many other areas. The main issue across Scotland must be that, in preparation for the next 10 to 15 years, we develop safe services. Nobody would suggest that we should expand neurology services beyond the areas that they are in at the moment.
I am sorry. I do not have time as I only have three minutes. I am going to run out of time anyway.
No one is suggesting that those services should be expanded. Are we suggesting that the services that we have, in the places that we have them at the moment, are safe? Unless that is the case, members must sign up to modernisation along with everybody else and produce proposals as to how that is to be achieved.
I will finish by dealing with obstetrics.
I am sorry. I do not have time to take an intervention. If I had more time, I would let Margaret Ewing intervene.
The advice that I have received about obstetrics from the colleges is that 3,000 births are necessary to sustain the clinical work of consultants. If that is not the case, we can have a different debate. The same massive debate took place when centralisation occurred in Ayrshire and Arran some 10 years ago. No one in Ayrshire and Arran would now propose to divide those units again. In Forth Valley, although we are having a debate about where the services should be centralised, they are being centralised. The dilemma that is being faced is that services must be safe, but must also be as local as possible.
Susan Deacon should not be in the chamber, because she will have to make the ultimate decision. It is inappropriate for Roseanna Cunningham to attack her on that basis.
Four members still want to speak, so speeches will have to come down to just over two minutes if they are all to get in.
I have to say that I feel slightly aggrieved, as a member who represents constituents across Tayside, to see my time being eaten up by someone who spoke more or less on behalf of the Government and does not represent the area in this debate.
On a point of order, Presiding Officer. Is it correct for a member to accuse another member of speaking when he does not represent the area, when in fact he represents constituents in the Tayside area? Mr Monteith should do a bit of geography.
I confirm that that is not the case.
I think that the accusation was directed as much against the Deputy Presiding Officer's lack of control of time as anything else, so can you now please use your time expeditiously, Mr Monteith?
I welcome the opportunity to debate this issue. I especially welcome the opportunity to raise the issue of Angus and the Mearns and Perth and Kinross.
It is well recorded from the speeches that have been made that it is being suggested that acute services should be moved from Stracathro to Dundee, which could result in only 67 beds being left in Stracathro. That would mean that there would be one bed per 170 people in Dundee and one bed per 3,793 people in Angus and the Mearns. Where is the social justice in that? Where is the value for money under those proposals, when high-tech beds are being occupied by patients being treated for ingrowing toenails and hernias?
Although distance is a crucial issue, a more important issue is the travelling time. Areas such as Inverbervie, Fettercairn, Laurencekirk and Johnshaven are within the reach of Angus and the Mearns and are served by Stracathro hospital. If an area with a population of 130,000 such as Perth can justify a hospital, Angus and the Mearns should expect a hospital at Stracathro.
We should also be aware that the number of cases of obstetric litigation is high and rising across Britain. Anyone taking their wife or partner to the maternity unit might get stuck behind a snow tractor or a tractor carrying bales of hay and will still have that extra distance to travel from Perth to Dundee. Furthermore, if we take into account the other health board reviews in which, for example, the maternity unit at Stirling could be moved to Falkirk, we could have a situation where there is no maternity provision between Dundee and Falkirk.
Obstetric emergencies are unpredictable and can be catastrophic. I know friends who have experienced great difficulties; as I have already said, the distance and the travelling time are crucial issues. As a result, I do not think that the proposals before us are what we need.
We have good reason to believe that Angus and the Mearns and Perth and Kinross did not contribute to Tayside Health Board's deficit. Those areas should not pay for the incompetence of others by losing their local services. Instead, we should be seeking local provision from these health boards. I welcome the opportunity to state those facts and thank Roseanna Cunningham for securing the debate.
Although I cannot extend this debate for the normal 30 minutes, in these circumstances I am minded to accept, with the minister's agreement, a motion without notice to extend the debate by 10 minutes.
The Deputy Minister for Health and Community Care (Malcolm Chisholm) indicated agreement.
Motion moved,
That the debate be extended by 10 minutes.—[Mrs Margaret Ewing.]
Motion agreed to.
Mr Monteith actually got three and a half minutes, so the remaining members are back on course.
For the past three years, local people have made it abundantly plain at every opportunity that they want to retain Stracathro hospital as a base for acute services in Angus and the Mearns and local maternity services in the three current sites. Those views could not have been more clearly expressed or more overwhelmingly endorsed at public meeting after public meeting. However, the review recommends a single-site maternity unit with no acute services for Angus and the Mearns. That situation is causing unprecedented concern.
The review team has tried to spin the promised new community hospital as good news, but the fact is that even if it is eventually built, it will mean a severe reduction in health services in Angus. The people in Angus and their elected representatives must not be sidetracked into fighting about either the siting of this illusory new hospital or the location of the single-site maternity unit. Instead, they must unite to save all acute and maternity services in Angus and the Mearns.
The financial context of the review means that the deficit must be resolved before the report's proposals can be implemented. That was confirmed by the new chair of Tayside Health Board, who said yesterday:
"In reality, no major changes will be made until Tayside's £19 million deficit is wiped out, and that will not be until 2003."
It was further implied that there was no prospect of ministers writing off the deficit. Tayside Health Board and the Scottish Executive must therefore make clear their plans for dealing with the massive deficit. Given the dire financial state of Tayside Health Board, it is very hard to see where funding will be found for a £20 million hospital. Indeed, it is such a burden on the whole situation that it is very difficult to be optimistic about the prospects for Angus.
From the start, there has been very real concern about the lack of concrete evidence to support any of the review's proposals, all of which will decimate services in Angus. Certainly with regard to maternity services, there is nothing to suggest that the proposals would result in significant cost savings nor that the units are in any way unsafe or unsatisfactory.
As for acute services, closer examination of the review report reveals that 67 beds will be provided in Angus, of which only 29 would be quasi-acute. That represents one bed per 3,793 people in Angus and the Mearns, compared with one bed per 427 people in Perth and one bed per 170 people in Dundee. Where is the evidence to justify that degree of inequality?
The people of Angus and the Mearns are being made to bear a disproportionate and unacceptable burden, in an attempt to reduce debt throughout Tayside. What the people of Angus and the Mearns want is not a reduction in health services, but an enhancement of them and increased choice.
I am delighted to speak directly after Irene McGugan. Along with Andrew Welsh and one or two other members, she and I attended a meeting organised by the Keep MUM campaign in Montrose on Saturday. The campaign supports the maternity unit in Montrose. At that meeting, it was decided to divide those present into focus groups, to discuss the prospects for maternity provision in Angus. Cleverly, all the politicians were allocated to the same group. At the end of our 10-minute discussion, we decided that we should seek the retention of maternity services at the present three sites in Angus. It is essential that maternity units are provided where local people want them—in their own locality. That principle can be applied more broadly across all health service provision.
The county of Angus is geographically very different from other regions in the Tayside Health Board area. Instead of having a single centre of population around which everyone can rally, it has a spread-out population and four main centres, including the Mearns. The result is that a few promises have been made—the possibility of a new hospital here and the development of a single maternity unit there—which have divided opinion. Coupled with that, the review team has been playing Angus off against Perth and has taken every possible opportunity to divide opinion and reduce the pressure for any one solution.
In Angus, the politicians have decided to unite behind Stracathro. That is no accident: we have spoken to each other.
And in the Mearns.
And with politicians in the Mearns. I am sorry. I was born and brought up in the Mearns, so I should know better.
In Angus and the Mearns, the politicians have united behind Stracathro. It is our intention to seek the preservation of acute services on the Stracathro site. Without those services, there will be an acute services wasteland between Aberdeen and Dundee, and unless we continue to unite behind Stracathro there will be no future for the provision of those services. I thank Roseanna Cunningham for securing the debate and lend my support to the motion.
Presiding Officer, I thank you for suggesting that the debate be extended so that I could participate. I, too, congratulate Roseanna Cunningham on securing the debate.
It is crystal clear that Tayside Health Board faces a huge task in restoring public confidence, let alone the confidence of politicians. The minister can only endorse that fact. His boss sent a task force into Tayside Health Board, such was the degree of mismanagement and the seriousness of the financial problems that it faced.
I do not want to go over old ground. We are now in a six-week period, following the publication of the acute services review, in which the board intends to hold further discussions with interest groups, clinicians—especially obstetricians—midwives, nursing staff and others. I can only encourage the board to do that. At the end of that period, the board intends to publish a further 25 to 30-page document prior to a three-month formal consultation period.
I hope that, during that consultation period, Tayside Health Board will take a close look at the way in which Fife Health Board is carrying out its consultation and trying to regain public confidence. There will have to be many meetings with community councils, residents' associations and a multitude of interest groups, and perhaps roadshows at local events and a newsletter distributed to every household. The board must undertake such actions now, to maximise public involvement and participation.
I will comment briefly on three aspects of the review. First, we must not side-step—as the review has done—where the proposed new Angus community hospital should be located. The population may be concentrated on the coast, but locating the hospital at Arbroath, so close to Dundee, would be a mistake. It should be central to the population as a whole, which Stracathro is. I strongly support the case for Stracathro—indeed, I first got to know it as a boy when my father was a consultant anaesthetist there. It might be where it is due to an accident of history, but it commands huge local loyalty and it is in the right place for all the people of Angus and the Mearns, whom it serves.
Secondly, I am deeply concerned about the proposed centralisation of maternity and children's facilities at Ninewells hospital. That could result in there being nothing other than a midwife-only facility between Dundee and Stirling—or, worse, between Dundee and Falkirk, should Forth Valley Health Board go ahead and centralise its maternity facilities there.
I recently visited the maternity facility at PRI and participated in one of the marches, along with Roseanna Cunningham, who could not see me for the crowd. PRI, rightly, commands strong local support. The board must use the six-week period to find a way out of the current impasse through further discussions with obstetricians in particular.
Thirdly, the Tayside acute services review should not be considered simply in terms of the Tayside Health Board area. It is crucial that it is discussed in relation to the proposals for Forth Valley Health Board and Fife Health Board. I say that as a regional member and hope that that demonstrates the value of having regional members, with the overview and perspective that they bring to the Parliament. Those who live on the boundaries must not be forgotten or marginalised.
I had better stop before I am stopped. What is essential and of paramount concern to members is the highest standard of health care for all who live in Tayside Health Board area and for those outwith its boundaries who use its services.
I congratulate Roseanna Cunningham on securing this debate today. It is entirely appropriate for her to represent the views of her constituents on local health proposals. Equally, it is inappropriate for me or Susan Deacon to comment at this stage on specific local plans—it was unworthy of Roseanna Cunningham to attack the minister on that ground. The Executive's job is to set the framework for the local plans and it is up to local health bodies to translate that national framework into local action. As John McAllion said, I am clear about the fact that we need acute services reviews and that they must not be driven by money.
As the national review of acute services made clear, the objective of acute services reviews is modern, high-quality services with the correct balance between hospital and community services. They also offer an opportunity to assess, systematically and objectively, how the location of services balances local access with the scope and delivery of specialist services.
The balance between hospital and community services is also critical for maternity services. I note what Richard Simpson said about Ayrshire, which, although it has one centralised maternity unit, also has excellent community services. I am not saying that Ayrshire should be the model for the whole of Scotland—decision making must be local—but we have to beware of being alarmist because, clearly, the service in Ayrshire is entirely safe.
I am slightly disadvantaged because the framework on maternity services will be launched tomorrow and, obviously, I cannot talk today about its specific contents. I can say, in general, that it adopts a woman and family-centred approach to care and support and has been planned in partnership with women. I am also pleased to hear that Tayside Health Board will examine that framework as part of its on-going work. I am told that the health board will consult stakeholders and consider—significantly and importantly—cross-border issues in conjunction with Forth Valley Health Board.
I am conscious that the minister has said that he cannot comment in detail on the acute services review, but would he say that it was unwise for the health board to produce its review before that framework was published?
Many maternity service reviews are being conducted at the moment. The point that Ben Wallace has made could be made of all of them. A lot of work has been done by the health board and I have been assured that it will examine the framework.
Although I have said that decisions that affect local communities are best taken at a local level, it is clear that the Executive has great interest in how those decisions are made. That is why "Our National Health: A plan for action, a plan for change", which came out in December 2000, pledged that
"we will establish an expert group supporting and advising local NHS Boards in managing changes in the configuration of services and advising the Health Department of the appropriateness of local reconfiguration".
Roseanna Cunningham expressed concern that the NHS in Tayside has not fully engaged the public in its consultation exercise. Full, genuine and meaningful public consultation is of paramount importance in developing proposals that will have far-reaching consequences for everyone who lives in Tayside. The idea that change can be imposed without the support and involvement of the many stakeholders is unsustainable.
Does the minister accept that, whatever the process of consultation, the people of Perthshire, Angus and the Mearns have expressed a consistent, sustained view that appears not to have been taken on board at any time by those who are conducting the review and producing the report?
The issue is the extent to which the consultation is real rather than apparent. It can be real consultation only if the people who are making their views known have some confidence that those views are genuinely being taken on board. The problem is that people in Tayside simply do not believe that their views are being taken on board.
Many views have been expressed today about the effectiveness of the consultation. I suppose that I had some involvement in that, in that I was on the Health and Community Care Committee when it produced its report on Stracathro hospital, as referred to by Ben Wallace and others. Looking back, I think that the committee took a balanced view. Among the recommendations in its report was the following:
"The Committee strongly urge the Trust and the Board to maximise efforts to consult timeously all levels of staff at Stracathro and the public in Angus now and at all stages of the Acute Services Review."
The committee also acknowledged that the health board had made significant efforts to consult the public. Looking at the matter from outside, it appears to me that there have been good developments—Richard Simpson referred to recent developments and consultation. I am not here today to announce that the consultation has been perfect; I merely note that the Health and Community Care Committee took a balanced view, and that its conclusion may well be reasonable.
There is room for a great deal of improvement in the way in which health boards consult. That is why the Executive, in "Our National Health: A plan for action, a plan for change", pledged to ensure that statutory guidance on formal consultation will be reviewed to ensure that it meets the needs of modern health care systems and takes into account the changes to NHS planning that are announced elsewhere in the plan.
The Executive also pledges to provide guidance, training and support to local NHS leaders to enable them to involve the public effectively in the management of changes to local services.
Presiding Officer, can you tell me how long I have?
You have another three minutes.
While I fully understand people's support for their local hospitals, that has to be weighed against the need for appropriate quality of care and the balance of benefit for the community as a whole. What takes over in an area when services move has to be considered. There has been much discussion about what may emerge in Angus. I am told that there are proposals for a new community hospital there, and I am also told that the people of Angus will be consulted on the precise location of their service. To an extent, the answer to Roseanna Cunningham's point is that people in different parts of a large area will take different views about where they want services to be located. That has been evident in this debate, with conflicting speakers representing different areas.
Two members wish to intervene. I will give way to John Swinney.
I do not want to get bogged down in the issue of the location of services, but I hope that the minister will set out what the Scottish Executive's attitude will be to supporting the development of a new hospital facility in Angus. I fear that my constituents will have to bite the bullet of bad news long before they get any prospect of good news in the form of high-quality services to which they will have reasonable geographic access.
That issue will form part of what is eventually presented to the Executive. In principle, if public funds are needed for a capital development in Angus, that money will be found. Many issues of funding have arisen in the debate, and I do not have time to address those in detail.
We all understand that the task force was sent in because of massive trust shortfalls. That was nothing to do with the Health and Community Care Committee, whose report did not refer to money—although I stress that am a great supporter of the Health and Community Care Committee.
That is the background to some of the financial problems. I remind members that funding to Tayside increased by 7 per cent this year, and will increase next year by 5.5 per cent.
The minister said earlier that the acute services review is not driven by money. Why then have the health board and the trust said that the affordability of the Tayside acute services review is entirely dependent on eliminating the existing deficit? How can services be developed unless the deficit is dealt with? How can the deficit be dealt with without the assistance of the Executive?
I acknowledge the point that Shona Robison makes about the deficit. Clearly, the board and the trust are also saying that the two exercises are quite separate from that point. There are complex arguments about the deficit in Tayside that I would pursue, but I think that the Presiding Officer will not allow me to.
In her motion, Roseanna Cunningham calls on the Health and Community Care Committee to undertake an inquiry into the proposals. It is not for me to tell the Health and Community Care Committee what to do. I merely observe that when I was a member of the committee, we took the view that we would be interested in matters such as the process of consultation but would not interfere in local decision taking, which, appropriately, is for local health bodies.
I feel bad about not giving way to Mr Rumbles.
Oh, give way to Mr Rumbles.
The minister referred consistently to consultation in Angus. Even Tayside Health Board is falling into that trap. Even when the minister was a member of the committee, the committee did not mention the Mearns. People in the Mearns feel somewhat neglected as a result of the lack of consultation. They are served by Stracathro hospital, which is only 500m across the border, and they need to be properly consulted and involved.
If my memory serves me correctly, I think that we referred specifically to consultation in Angus. I will not go down that path because my time is almost up.
We will encourage the health board and its partners to work urgently, openly and transparently. When the extra work, which I have been assured will take place, is completed, we expect the board to take decisions—however difficult—that balance competing demands but fundamentally improve the quality of services for everyone in Tayside.
Meeting closed at 18:02.