Health Services (Argyll and Clyde)
The next item of business is a debate on motion S2M-3684, in the name of Andy Kerr, on future arrangements for health services in Argyll and Clyde.
I have asked for parliamentary time to debate the Executive's proposal on the future arrangements for health care services in the Argyll and Clyde area. This follows my announcement on 19 May of the Executive's intention to dissolve Argyll and Clyde NHS Board and to consult on the boundaries of successor national health service boards. I also announced on 19 May that the Executive would provide up to £80 million to write off the accumulated deficit.
First, I make it clear that the decision to abolish NHS Argyll and Clyde was difficult. However, I felt that decisive action was required to safeguard safe and sustainable services for local people. I remain convinced that that was the right decision. Members will recall that I had been concerned for some time that the board's efforts to return to financial balance were not going to be successful. The Auditor General for Scotland's opinion, given in his report of October 2004, was that the board's cumulative deficit might reach as much as £100 million. I am sure that members agree that that would have been simply unacceptable.
I also recognised that there were underlying difficulties in planning and delivering modern health care services because of the complex geography of Argyll and Clyde. There are disparate demands for services in very rural Argyll and in urban Inverclyde and Renfrew, and there is a natural patient flow into Glasgow, which is why it was important to consult on our intention to alter Greater Glasgow NHS Board and Highland NHS Board. That public consultation afforded everyone the opportunity to have their say. The process was organised by the Health Department, and public meetings were chaired by an independent health commentator. The feedback that I have received on the conduct of the public meetings has been positive. An advisory group also influenced the process; it comprised representatives of various voluntary organisations, patient representatives, the Scottish Health Council, the Scottish Consumer Council and the three health boards.
The consultation included several key elements, including 16 public meetings across the area from Fort William to Inverclyde, 22 workshops with community and voluntary sector organisations, and engagement with key local action groups. I was extremely pleased to hear that the public meetings were generally very well attended. It is clear that there is genuine interest in how local health services should be managed in the future. I also know that overwhelming support was expressed for the NHS staff who continue to provide high quality and highly valued health care services to the people of Argyll and Clyde. I take this opportunity to thank them.
The consultation focused on three options: option 1 proposed incorporating the Argyll and Bute Council area within NHS Highland and the rest of the Argyll and Clyde area within NHS Greater Glasgow; option 2 proposed incorporating most of the existing Argyll and Bute Council area in NHS Highland, with the exception of Helensburgh and Lochside, which would become part of NHS Greater Glasgow along with the rest of the Argyll and Clyde area; and option 3 proposed incorporating the northern part of the existing Argyll and Bute Council area into NHS Highland, with the rest of NHS Argyll and Clyde going to NHS Greater Glasgow.
From analysis of the consultation responses and from the views that were expressed at the public meetings, it became clear that there was little support for option 3, so I decided that it was not appropriate. Options 1 and 2 are very similar, the difference being that the Argyll and Bute Council area would remain complete and move to NHS Highland, or that the Helensburgh and Lochside area would be seen as a separate natural community whose health care planning and services would be better managed by NHS Greater Glasgow. In coming to my decision, my absolute priority has been to find a solution that will secure the right arrangements for coherent and integrated health care services for all the residents of Argyll and Clyde. To that end, I have thought long and hard about the merits of both remaining options.
During the public meetings throughout Argyll and Clyde, common concerns were expressed about access to local services and maintenance of current patient flows. People in Argyll and Bute were concerned that they would be disfranchised because of the management team of NHS Highland being located in Inverness. People from Renfrew and Inverclyde recognised that it makes sense for NHS Greater Glasgow to take responsibility for the planning and provision of their local services. However, some understandable concerns remained. Those were based largely on the fear that NHS Greater Glasgow would continue to concentrate its resources on the city, and that services in Inverclyde and Renfrewshire would therefore be marginalised. In response to that, I make it very clear to all those communities that the chair and chief executive of NHS Greater Glasgow have assured me that planning and provision of services will be based on the needs of all its resident population in the newly enlarged organisation.
I am sure that we all accept that Greater Glasgow NHS Board will indeed accept that as its duty. I do not, however, understand how the items in the first part of the minister's motion—on the dissolution of Argyll and Clyde NHS Board and its replacement—will address the board's structural and financial problems. Surely more than that must be necessary to address the problems. Will the minister address that in his speech?
I will come on to financial and planning matters later, but I point out that the deficit was accumulated over a number of years; that the matter relates to issues from some time ago as far as non-reconfiguration and change to services are concerned; and that the change will allow us more effectively to plan for the future around effective service provision.
The larger size of NHS Greater Glasgow will allow better use of the health care team—consultants, nurses, doctors and general practitioners with special interests—across the new area and will offer great potential. Similarly, in the Highlands, the coterminous boundary around Argyll and Bute will allow effective local care services to be delivered in partnership with the local council. That is integral to our view of the future. I will move on to the financial issues and some of the organisational aspects in a few moments.
The concentration of the more numerous and diverse workforce in the expanded Glasgow board area could offer additional opportunities to plan, provide and sustain more complex services closer to communities. That is not about the financial matter that Murray Tosh raised, but about service issues, which are my focus and the focus of others. Those services will be based in local hospitals such as the Inverclyde royal hospital and the Royal Alexandra hospital in Paisley.
People from Dumbarton and Helensburgh have been calling for increased access to services in Glasgow hospitals. There was concern about NHS Highland being experienced in delivering health services only in rural areas. Of course, NHS Highland deals with significant urban population centres such as Inverness, Oban and Fort William.
There was intense discussion about the opportunities that are offered by strong community health partnerships to plan, develop and deliver local services. It was refreshing to see during the consultation that communities are clearly up to date with health policy and see the CHPs as an effective way forward. The work of the CHPs reflects local needs and circumstances—they offer a much improved prospect of better-integrated health and social care services.
On that basis, I concluded that option 1 was the best option because it will enable a single focus for planning and delivering local health care throughout Argyll and Bute. I explained the reasons for my decision to people from Argyll, Helensburgh and Lochside this morning. I have concluded that the principle of coterminosity is important for the development of an effective and well-resourced community health partnership, which people want. I have sought and gained a commitment from NHS Highland that the CHP will have fully devolved decision making, with a budget of about £100 million. It will be the focus for joint work on health and health improvement.
My decision does not mean that I have dismissed the views of the people of Helensburgh and Lochside.
I accept that a significant number of people registered support for option 2, and I am conscious of the concerns that they have expressed at the prospect of their area falling within NHS Highland. I refer Jim Mather to the following: I have received many letters, including one from a Helensburgh resident who wrote to me during the consultation in support of option 2. He argued that Argyll and Bute Council and NHS Highland are concerned largely with rural services and that Helensburgh is a densely populated urban area with strong links to Glasgow. He feared that if I endorsed option 1, people who had been receiving acute services from NHS Greater Glasgow would be forced to undertake a long and arduous journey elsewhere in the NHS Highland area for specialised services. My clear response to him and to all such concerned residents in Helensburgh and Lochside is that where patients choose to access services will not be altered by this announcement—they will still access their nearest GP or nearest appropriate hospital when they need to.
There has never been any suggestion that people in Helensburgh—or, for that matter, in Lochgilphead or Oban—would be required to travel to Inverness to access specialised acute services. The natural patient flows from those communities to Glasgow are recognised and will be respected. That said, I want NHS Highland and NHS Greater Glasgow to work together to respond to those local concerns.
Will the minister expand on that and explain how the finances would work around the patient flows that he talks about?
Patient flows are nothing new to the health service; they happen every day, every hour and every minute. We are talking about the ability of the CHP to sit in the community with those strong coterminous boundaries and a professional core of staff. Given the work that the Executive is doing to encourage better management of patient flows, I am confident that they will be handled.
Patient flows happen just now in NHS Highland. Glasgow is a centre for Scotland in providing many of the services that we have all come to respect and rely on. There is no mystery or new thinking here. We are simply using our existing processes in respect of patient flow to ensure that the patient, who is at the heart of the matter, gets the choice so that patients from Helensburgh can get to Glasgow if that is what they want.
To reinforce that, I am placing a number of requirements on the boards in taking forward their new responsibilities. I am requiring NHS Greater Glasgow and NHS Highland to establish a joint locality planning group as a distinct arrangement within the Argyll and Bute CHP covering the population of Helensburgh and Lochside. We will thereby have an annual plan for the volume and range of acute services that are to be provided. That will include the related flow of patients and resources and, importantly, the extension of patient choice to access additional services in Glasgow hospitals. That will be set within an overall agreement between NHS Greater Glasgow and NHS Highland about joint working and about overall patient flows from throughout the former Argyll and Clyde Health Board area. I hope that that is reassuring to people in Helensburgh and Lochside, but we should also remember that, on access to services, more than 90 per cent of our lifetime health care needs will be sourced not in the specialised acute sector but locally.
A significant and increasing proportion of modern healthcare provision is dependent on effective partnership working between NHS boards and local authorities.
Will the minister take an intervention?
I must make progress.
I am convinced that the people's best interests will be served by option 1. The coterminosity that it offers presents the best opportunity for local services to be planned and provided most efficiently and effectively.
I will now address the key issue of financial allocations and budgets for NHS services in the Argyll and Clyde area. First, the Argyll and Clyde allocation will be split between the two successor boards using the Arbuthnott formula. The other key issue is how the task of achieving financial recovery will be taken forward by NHS Greater Glasgow and NHS Highland. It is clear that the Executive's decision to clear Argyll and Clyde NHS Board's accumulated deficit is absolutely central to enabling the enlarged boards to progress with a clean slate and a fresh start.
However, we are aware that there is at present a recurring financial deficit, because the outgoing board has allowed current expenditure to run ahead of current income. The task of returning to financial balance is tough; however, I am confident that NHS Greater Glasgow and NHS Highland will tackle that successfully.
I have been asked whether I will provide additional financial assistance through the transitional period to help the return to balance. Although I am not ruling that out, a number of vital issues need to be addressed first. The key requirement now is for the outgoing board and the two successor boards to work closely together to agree realistic financial plans for 2006-07 and 2007-08 that will secure the return to financial stability, which we need. We are prepared to consider the case for transitional financial assistance only once that planning task has been demonstrated to be complete and robust. The Health Department will assist the boards as much as possible in carrying out that task, but I must make it clear that any financial help beyond the £80 million that has already been pledged would have to be found from elsewhere in the health budget.
I believe that, by redrawing board boundaries, we will deliver more rational and effective planning of our services locally, as close to people's homes as possible and in line with my aspirations, as set out in "Delivering for Health".
I move,
That the Parliament supports the decisive action announced by the Scottish Executive on 19 May 2005 to dissolve Argyll and Clyde NHS Board and to redraw the boundaries of the neighbouring boards to take over its responsibilities from April 2006; believes that these steps will address the board's structural and financial problems; applauds the continued successful efforts of staff in NHS Argyll and Clyde to maintain comprehensive healthcare services for the people of the area; notes that a full public consultation has been held on the boundary option to be adopted, and supports NHS Highland and NHS Greater Glasgow in their task of returning services to financial balance while maintaining high standards of quality and access.
We need to pause to reflect on how we ended up in this situation and ask whether the Executive has learned lessons from its poor handling of the Argyll and Clyde debacle. It was the Executive's inaction and its failure to direct the management of Argyll and Clyde NHS Board effectively prior to its reorganisation of December 2002 that ultimately resulted in the Executive's decision to propose the dissolution of the board almost two and a half years later.
The motivation behind the SNP amendment is interesting. In 2002, the Executive facilitated the investigation of partnership working and financial management in Argyll and Clyde NHS Board. That led to the resignation of the senior management team. That was active intervention.
I am sure that the minister will be familiar with the report of the Audit Committee that was published earlier this year. It criticised the Executive, the lack of continuity among personnel representing the Health Department, the collective failure of the department and the board to agree a financial plan and so on. I am asking the minister whether lessons have been learned from that experience.
Yes, lessons have been learned about the issue of changing personalities. The member suggests that the lack of an agreement on a financial plan shows that we had some trouble with that financial plan, but it took so long to do that because we were trying to secure an effective financial plan, which takes time. Would Ms Robison just automatically have signed off the plan?
No—we would have expected a lot of action to be taken earlier. Is the Audit Committee wrong in its findings? I do not think so. I want to know whether lessons have been learned because my fear is that we might end up in a situation in which other boards have financial difficulties. What monitoring is the Health Department doing to ensure that, in such cases, intervention takes place earlier? We cannot have another Argyll and Clyde.
As I said at the time of the minister's announcement in May, I believe that the decision that we have heard about today is the only one that could be made, in the light of the lack of public confidence that people in Argyll and Clyde had in the health board. The predicted deficit of between £80 million and £100 million could not be allowed to develop. It remains to be seen whether lessons have, as the minister says, been learned in relation to the serious questions that were asked about the role of the Health Department in the Audit Committee's report.
The Auditor General's report gives cause for concern: it states that health boards are predicting a funding gap of £183 million, and that several expect to overspend on their budgets. We need to know that the Executive's new and improved procedures are robust enough when it comes to financial monitoring. As I said, we cannot have another Argyll and Clyde.
The minister must consider the underlying financial difficulties that are leading to some of the poor financial performances that have been outlined today. We know that health board chiefs have privately expressed concerns that, for example, the agreements that are being made at the centre are not being fully funded. We need an honest debate about that.
What agreements have been made at the centre without consultation of human resources managers and health boards? No deal is made at the centre without consultation of health boards.
I know that there is consultation, but I tell the minister that senior managers in health boards are saying that pay deals are not being fully funded from the centre. They accept that more money is coming from the centre, but there is also more money going out, specifically for pay deals, which is why some financial difficulties have arisen. If that is not the case, how does the minister explain some of the financial difficulties that were highlighted by the Auditor General's report? He must explain: if the difficulties do not arise from the source that I suggest, where do they come from?
We know that chiefs from Argyll and Clyde would sit in meetings with the minister and his predecessor and say that their choice was either to get more money or to cut services. As I understand it, both options were refused. The Executive must have been well aware that the situation was becoming difficult in Argyll and Clyde and must accept a share of the responsibility.
Despite the difficulties—
Will the member take an intervention?
Very briefly.
I made an offer to NHS Argyll and Clyde to go and argue with ministers that the board should have five years, rather than three, to achieve recovery. NHS Argyll and Clyde refused that offer, so the fault is the board's.
Obviously, it was silly of the board to do that but, despite what the member says, we know that the board raised with ministers the concerns that I mentioned.
As the minister said, it is important to recognise the contribution that staff have made; they have kept services going in difficult circumstances. We know that morale can be a problem when there is uncertainty.
Of course, the most important people are the members of the public who depend on health services in Argyll and Clyde. They need to know not only that there will be an end to the uncertainty but, more important, that services will improve under the new arrangements. Today, the minister outlined the changes that will be made to the boundaries of Highland NHS Board and Greater Glasgow NHS Board to include Argyll and Clyde. There is a great deal of concern about the proposal among people who live in the Helensburgh area. More than 80 per cent of the people who responded to Helensburgh community council's consultation were in favour of option 2, under which the Helensburgh area would have become part of NHS Greater Glasgow. People in the area will no doubt feel that even though they have been consulted their views have been ignored.
People are concerned that decisions on their health care will be taken miles away. People whose health care will be affected by the boundary changes must be given cast-iron assurances that they will be able to access local services irrespective of where the health boards' boundaries lie. The minister has to do some convincing on that.
In the minister's statement in May, he said that the geography of Argyll and Clyde precluded effective management by a single health board. That might be true, but the geography is still the same and the same challenges now face NHS Greater Glasgow and NHS Highland. The writing off of the cumulative deficit is helpful and welcome, but the structural deficit remains a problem for the new chiefs to resolve. The minister said that they will get Argyll and Clyde's share of the money, but he also said that it is in effect up to them to manage the process. I urge the minister to be a bit more forthcoming with transitional finance assistance, because there will be difficulties. With the best will in the world, if NHS Argyll and Clyde could not manage to address the recurring deficit, it will be difficult for the new chiefs to do so and they will need assistance. I hope that the minister will come back at an early stage and tell us how that will be done.
I also ask the minister for a guarantee that he will formally review the sufficiency of the financial settlement and how services are working for patients a year after the new arrangements come into force. The public require that assurance.
We need to consider the best way to deliver health services throughout Scotland and to consider which structures work best. At the moment, we have a bit of a dog's breakfast with health boards of dramatically different sizes. Changes need to be made on a planned basis that takes into account the Kerr report: crisis-driven restructuring must become a thing of the past.
I move amendment S2M-3684.2, to leave out from first "supports" to end and insert:
"regrets the failure of the Scottish Executive to direct effectively the management of Argyll and Clyde NHS Board prior to its reorganisation of December 2002 and the continuing lack of direction and support that resulted in the Executive's decision to dissolve the board two years and five months later in May 2005 and to redraw the boundaries of the neighbouring boards to take over its responsibilities from April 2006; applauds the continued successful efforts of staff in NHS Argyll and Clyde during these difficult times to maintain comprehensive healthcare services for the people of the area; demands clear evidence that input from the public consultation on the boundary option to be adopted has been fully and objectively considered; supports NHS Highland and NHS Greater Glasgow in their task of returning services to financial balance while maintaining high standards of quality and access, and demands that the Executive provides these boards with adequate support and more effective leadership and direction that will assist them to address credibly the structural and financial problems in NHS Argyll and Clyde."
Presiding Officer, I apologise to you, the minister and Parliament for my late arrival. I am afraid that I had thought that the debate started at 3 o'clock.
With a projected financial deficit of £100 million by 2007-08, the previous administration of NHS Argyll and Clyde faced significant financial and managerial problems and the urban and rural mix of the area contributed to the board's struggle. There is no dispute about that, but I have to say that we do not think that any of the options that were presented in the consultation would necessarily solve the problems.
I say at once that my party wishes to commend the staff and the clinicians of Argyll and Clyde for their hard work and their efforts to carry on providing services for the area against the backdrop of uncertainty for residents and the workforce. The current state of morale makes it all the more frustrating that the Executive has allowed a period of consultation without clarifying the specific structural, financial and management issues that lie at the heart of Argyll and Clyde's problems, and without explaining in detail not only how the proposed changes would address those problems but what the future service plans of the successor boards will be.
On the consultation, we are primarily troubled about the absence of sufficiently robust information on the funding implications of each consultation option that was presented by the Executive. Given the fundamental importance of preserving confidence in the administration of health care in Argyll and Clyde, the Executive should have extended the consultation until far more detailed information could be made available to the public to enable people to make a more informed choice from the options that were presented to them. Provision of information on the specific areas of failure and financial loss in Argyll and Clyde would have allowed the public to understand the extent to which better management in any option would contribute to financial and operational recovery.
There is no analysis or proposition in the Executive's consultation to clarify how changing the budgets will eliminate the deficit. The consultation paper suggests that part of the deficit arises from the mixture of urban and rural areas, but it does not really strip away the role that such incompatibility plays as opposed to poor management. If the problem is caused by geography, then changing the boundaries will only solve it if the funding mechanisms change. In fact, today's announcement is a geographical compromise; that is not a solution.
I understood the First Minister earlier to say—I might be paraphrasing him—that public services are not necessarily guaranteed improvement by changing boundaries. Perversely, that seems to be exactly what the Minister for Health and Community Care has put before us. It would have been appreciated if the consultation document had addressed the additional financial burdens that are projected for the short or long term for the prospective successor boards, and information concerning the specific sectors of Argyll and Clyde's accounting that made a loss.
Those concerns have been made all the more relevant with today's publication of the Audit Scotland report, "Overview of the performance of the NHS in Scotland 2004/05", which highlights some of the great challenges that the national health service will face in the future. We have seen those challenges for ourselves at first hand—long waiting lists, unpopular moves to centralise services and problems in rolling out NHS 24 and with finding dentists.
It is interesting that the Audit Scotland report recommends a review and improved financial management and workforce planning, which needs to improve if NHS bodies are to manage their finances properly, respond effectively to cost pressures and provide a health service differently in the future. The report even goes on to say:
"The NHS in Scotland faces a significant challenge in meeting savings as part of the Efficient Government Initiative."
In the face of all that, lack of analysis of problems in the consultation document is all the more significant. That is why my party is adamant that the consultation should be extended to ensure that that vital extra financial information is made available to the public so as to better inform people's choices.
Having indicated our position, I will move on to highlight other concerns that the proposals have raised in the interim. At many of the consultation sessions, the recurring message was that some residents of Argyll and Bute felt that they were on the edge of the health systems of which they have been a part, and they perceive that their needs and priorities have not always taken centre stage for the NHS board.
On another front, community health partnerships are central to delivery of joined-up health and social care services. It is understandable that proposals for CHPs in Argyll and Clyde depend on the final consultation on dissolution of the board, but that might affect the development of CHPs in NHS Greater Glasgow and NHS Highland. It will be a close-run thing if all those community health partnerships are to be established by April 2006. I would be grateful for further information from the minister on progress on that.
Given that centralisation and reconfiguration of acute services within an expanded NHS Greater Glasgow would be decided at board level, cuts in the current vulnerable acute services in Argyll and Clyde might take place in the interests of a cost-cutting agenda for the Greater Glasgow NHS Board. There is a fear that any change in administration would present an opportunity to further centralise and downgrade acute services—it is vital that that does not happen. Mr Tosh rightly alluded to that threat in his question to the minister. No one doubts the sincerity of the intention of the chairman of the Greater Glasgow NHS Board; it is what the board might be compelled to do that is troubling.
As far as local services are concerned, the fact that NHS Greater Glasgow has committed to taking the integrated care model from a concept on a bit of paper to a pilot at the Vale of Leven hospital suggests that it is committed to providing effective care for the local community.
I concede that that level of intent provides a modicum of reassurance to that particular area. However, what about Inverclyde on the other side of the Clyde, where—I must say to the minister—very real concerns have been expressed about the continuation of acute care services?
What guarantees can be given that the public in Argyll and Clyde will not suffer further losses of service as a result of the agenda of managers who are driven by costs? I certainly want to know what specific changes will be made under each option to ensure that there is a stable environment for acute services in the Argyll and Clyde area.
No one underestimates the perplexing complexity or the gravity of the current situation. However, people in Argyll and Clyde strongly suspect that the heavy hand of Government and bureaucracy has been sterile in assisting better provision of health services in the area. Indeed, they want that hand to be lifted and they want far greater restoration of control to patients and their local clinicians.
I move amendment S2M-3684.4, to leave out from first "supports" to end and insert:
"applauds the efforts of all clinicians and staff in NHS Argyll and Clyde, at this unsettling time, to maintain the delivery of services; expresses profound concern about the inadequate nature of the consultation process concerning the future of NHS Argyll and Clyde; believes that the consultation paper lacked both a clear analysis of the structural and financial problems facing the existing NHS board and any robust information about the implications of revised NHS board areas for acute hospital services, which the public needs to make informed choices about the options presented, and therefore calls for the necessary analysis and information to be provided for the public as a matter of urgency and for the consultation to be reopened, in order that informed decisions can be made."
The rather hasty decision to dissolve Argyll and Clyde NHS Board and the subsequent consultation did not address the central issues that led to a massive lack of confidence in the board. In about the second sentence of his speech, the minister said that the dissolution was undertaken for financial reasons, in particular the board's financial management and its deficit. At £80 million, that deficit is more than significant. I welcome the fact that the Scottish Executive will step in and address some of that deficit in order to maintain services.
However, tens of thousands of people did not, over the course of a year, come on to the streets to protest just because of a figure on a balance sheet. That activist protest was one of the biggest in the area for many years. Confidence was completely withdrawn from the board because it insisted on pushing through a clinical review that meant massive hospital closures and significant loss of services in the areas whose boundaries are being considered for change today.
The problem with the decision to dissolve the board and with the consultation is that neither course of action addresses the clinical review. The introduction to the consultation document made it absolutely clear that it was concerned only with redrawing lines on a map and that none of the decisions that the board, despite mass opposition, had already forced through in its clinical review would be revisited. Those issues would not be discussed. That consultation on the future of health services in Argyll and Clyde was a travesty of democracy.
I agree with Annabel Goldie that the decision to dissolve the board and the subsequent consultation do not address the loss of services. At no point does the motion on these two major decisions indicate the future for Inverclyde royal hospital, Vale of Leven hospital and the mental health care services that have been lost.
Is the member aware of the minister's announcement at question time that a pilot to develop integrated care will be introduced at the Vale of Leven hospital in January? Surely that will stabilise services at the hospital for the future.
The minister did not address the question whether any more beds will be available. The pilot does not allow for the way in which services have been withdrawn, and does not mean that the Vale of Leven hospital will become a general hospital. After all, that is the very reason why people were holding hands around it last year.
People are none the wiser about what stabilisation means or what services will be provided at the Vale of Leven hospital over the next six months to a year. That is not clear, nor is it clear whether services will be at Paisley or at Glasgow. Those were the central issues. The document does not address issues such as consultant-led maternity services in Inverclyde. Why should we not revisit that point? The health board in Caithness revisited it, making exactly the same arguments that were made in the Argyll and Clyde clinical review. Those arguments were that the services were unsafe and that the royal colleges said that there were not enough births.
Guess what? Highland NHS Board has done a U-turn, and those arguments are now irrelevant because consultant-led services will be introduced there. The document does not address the issues that the people in Paisley face. The clinical review meant centralisation of services. What will we see? The people who live in Greenock and Paisley did not have a choice. From the outset of this consultation there was no question that the only option of all those that were put forward was that those areas would join Greater Glasgow NHS Board.
Given how things have gone already and the way that services tend to be delivered, I conclude that services will be centralised. Argyll and Clyde wanted to further centralise services to Paisley. Will the minister tell us whether this decision means that we will now see a further centralisation of services to Glasgow? That is the situation that we face.
Will the member give way?
I want to ask another question about maternity services in Paisley, and I have only seconds left. There are huge implications for maternity services in Paisley. If the people in Greenock and the Vale of Leven elect to go to Glasgow, what are the implications for the Paisley maternity unit? The minister can take that up in his winding-up speech.
My final point is about staffing. If services are to be further centralised—which is what is happening across the whole of Scotland; I agree with Shona Robison about that—then we must ask about staff. They will also be centralised. If the recurring deficit is to be lowered or eliminated, and three quarters of the budget goes towards wages, that can only mean staff cuts. The staff are not clear about the implications for their continued contracts of employment and job provision where they work at the moment. The consultation addressed none of that, and until we have the answers and the people of Paisley and Greenock can make an informed choice about the services that they will be left with, we should not go ahead with this change. Local people feel that they do not have a voice. That came up repeatedly in the consultation meetings. The Executive is prepared at the stroke of a pen to dissolve a health board, but it is not prepared to allow the election of local people on to a health board so that they can have the services that they want.
I move amendment S2M-3684.3, to leave out from first "supports" to end and insert:
"believes that the Scottish Executive's decision to dissolve Argyll and Clyde NHS Board was hasty and the subsequent consultation document issued concerning the new boundary options for the services provided by NHS Argyll and Clyde was completely inadequate, lacking both financial information and possible impact assessment on service provision from a reallocation of resources to NHS Highland and NHS Greater Glasgow; further believes that no-one responding to the consultation could reach an informed view on these issues; therefore calls for this information to be placed in the public domain before any decision, which could have a major impact on jobs and services within the existing Argyll and Clyde NHS Board area, is taken by the Executive, and applauds the work of the existing staff to continue to provide healthcare services within NHS Argyll and Clyde despite the enormous uncertainty that they feel about their own employment."
I am grateful for the minister's remarks on this important issue. His news release, and indeed, this debate, ends a period of consultation and inevitable speculation on future arrangements. The minister was right to dissolve the Argyll and Clyde NHS Board. He needed to act to bring stability and to secure health services for the public, and he did so decisively. On behalf of the Liberal Democrats, I would like to add my thanks and appreciation to all health service staff, who have worked hard to maintain the quality of care and treatment for the public in what has clearly been an unsettling period.
I noted the points that several members and the minister made about the extent of consultation. There seems to have been effective public engagement. I do not know whether that means that all the questions were answered; I suspect that they were not. However, that is probably the nature of all consultations. I say to Annabel Goldie that it would have been unwise to have prolonged consultation to cover a whole gamut of financial issues because that would continue speculation and uncertainty and would probably have been counterproductive. However, that is not to say that there is not a lot of work yet to do on the financial arrangements for Greater Glasgow NHS Board, which has now been extended, and for Highland NHS Board.
We have supported option 1 in the consultation because it will ensure boundaries that are coterminous with those of local authorities. I come from an area in which there are coterminous boundaries and can testify to the advantages that result from them. My colleague George Lyon, who represents Argyll and Bute, strongly argued that the Argyll and Bute community health partnership area should be retained and should not be split across health board boundaries. That is an important point.
I wonder whether Mr Robson will clarify something else that Mr Lyon argued for—that, in effect, the Royal Alexandra hospital in Paisley should cease to be a major centre for acute hospital services and that Inverclyde royal hospital and the Southern general hospital should be developed as centres for medical treatment.
I am not in a position to do that—Mr Lyon can clarify his remarks on that subject.
The problems that geography caused were one of the minister's key reasons for breaking up Argyll and Clyde NHS Board. Coping effectively with the different demands of, say, Paisley and Campbeltown was difficult for a board to do. There is local financial and management control in the newly merged Highland NHS Board area. It is important that the mistakes that were made in the past are not repeated. There must be an element of local control through the community health partnerships.
Synergy will result from merging Argyll and Bute and Highland, which face similar challenges, such as rural remoteness and delivering primary care over a wide area. I understand that there is strong local support in Argyll and Bute for going into Highland, provided that there are guarantees that there will be local control. The minister said that £100 million of the budget would be devolved to the community health partnership, and we want to see that community health partnership being firmly established and delivering the necessary services.
The member said that he understands that there is a lot of support in the Argyll and Bute Council area for the transfer to Highland NHS Board. On what basis did he make that statement? I understand that a survey by the local community council showed 80 per cent support for going into Glasgow.
I was alluding to the fact that public perceptions are considerably altered when patient flows are guaranteed—the minister mentioned that. I think that there was a view that there would be a bar of some description on people going to the hospital of their choice, but the minister made it clear that patient flows can continue across boundaries and into Glasgow. I come from an area in which we are familiar with patient flows across boundaries—a number of my constituents need to go to Edinburgh, for example, and we receive patients from across the national boundary with England. The point is that it is clear that the NHS can cope with patient flows in a number of areas, which is a positive thing. The minister's reassurance is helpful.
I am pleased that Sir John Arbuthnott supports the minister's decision. His intervention was helpful. I suppose that he would support his own formula for allocations between the two new boards. That is probably the right decision, given the context of the changes.
It is good that Greater Glasgow NHS Board has already started to work out arrangements with East Renfrewshire and West Dunbartonshire for establishing community health partnerships in those local authority areas. I urge similar engagement in Renfrewshire and Inverclyde.
There are savings to be obtained as a result of taking away Argyll and Clyde NHS Board's administrative structure. At one stage my constituency had two trusts and one board, and when they were merged into one, the surprisingly large sum of £500,000 per annum was available. Considerable progress could be made from that point of view.
I would like to make a final point on the issue of accumulated deficit. The minister found resources to write off up to £80 million and to allow a start from a new base, to use his own words. We have seen boards bailed out from to time. However, there is a problem in that: there is a danger of sending the wrong message to boards that manage their affairs in the best possible way and stay in balance. We must be careful not to give the impression that we are rewarding failure at the expense of success.
Other boards have difficult challenges to meet. The lesson of NHS Argyll and Clyde has to be that financial control is essential not only for its own sake, but for those who really matter: patients and the staff who care for them.
We move to open debate. Time is tight, so members should make speeches of six minutes, with a little time for interventions.
No one in my community is naive enough to believe that structures in themselves will solve all a community's problems. Moreover, they came to believe that structures were part of the problem. The minister's announcement in May that he was to put NHS Argyll and Clyde out of its misery was as welcome as it was inevitable.
The minister was left with little choice. Over several years and under a series of management regimes, the board attempted to force through a string of ill-conceived reorganisation plans, its books were in a mess and, more important, it had lost the trust of those it served. Abolishing the board and pledging to write off its accumulated £80 million debt has, therefore, been warmly welcomed in my constituency. That move will, as I said in my submission to the consultation, tackle the two issues that cause the most difficulty for health services in my constituency: geography and debt.
Geographically, it never made sense to have a health board that tried to balance the competing interests of remote and urban communities—it certainly does not now. Writing off the debt means, I hope, that the new board can start planning services with a clean slate and with nothing but the quality of patient care to consider.
What of the new board? The minister announced today that health services in my constituency will come under the management of NHS Greater Glasgow. That is to be welcomed for a number of reasons. First, if we are serious about reducing inequalities, tackling the pockets of appalling public health in urban west central communities such as my own must be our priority. NHS Greater Glasgow has expertise in doing that. Moving health services in Greenock and Inverclyde to NHS Greater Glasgow will allow a focus to be put squarely on tackling those persistent, serious health problems as well as the high incidence of premature death.
Secondly, moving services to NHS Greater Glasgow reflects what happens in practice: many of my constituents who require highly specialised care have, for many years, received it in hospitals in Glasgow. Today's announcement also means that our health services will be provided by a board that boasts university-led acute services. It should not face the same recruitment and retention challenges that NHS Argyll and Clyde did. It follows that, with flexible working, that can allow acute services in Inverclyde access to a wider pool of clinical staff. In these days of reduced working hours, and royal college training requirements and guidelines, such a pool is essential to maintain near-patient local services. Furthermore, joining with NHS Greater Glasgow can deliver a strategic focus for the provision of services across all west central Scotland and make the best use of resources.
Although I have no wish to tread on the toes of members who represent other communities in the Argyll and Clyde area, I do have an interest in patient flows from outside my constituency. If the principle of patient choice is to remain—and people on the Cowal peninsula have made it clear that they wish to continue to have services delivered at Inverclyde royal hospital—we have to ask whether patient flows can be maintained. We would certainly hope so.
Notwithstanding all the benefits that I believe will come from this change, my constituents have certain expectations of NHS Greater Glasgow. There is an obvious need to create stability in local health services. For too long, it has been a question of what would go and what could stay. The future of Inverclyde royal hospital must be confirmed and alternative proposals to NHS Argyll and Clyde's discredited clinical strategy must be introduced as quickly as possible. Those alternatives must be acceptable to the community and to the clinicians. To achieve that, they must be consistent with the model proposed in the Kerr report. In other words, we must deliver services as locally as possible and as specialist as necessary.
I start by echoing Argyll and Bute Council's response to the minister's announcement today, which was a cautious welcome. I welcome an end to the period of uncertainty and I join others in commending the staff of NHS Argyll and Clyde, who have carried on providing a service throughout that period. I know from my experience in the NHS that nothing is worse for morale than uncertainty. It is because of the need to move on from that period of uncertainty that I feel unable to support the amendments in the names of Annabel Goldie and Frances Curran.
I tend to agree with Duncan McNeil that Argyll and Clyde NHS Board was a slightly odd administrative entity, although I would not have been calling for its abolition had it not been for the debt that it got into. I am grateful that the Executive has been able to write off that debt, but I am still concerned that the conditions that led to that debt may not have been fully looked into and got rid of.
On balance, I support the Executive's going for option 1, because coterminosity makes sense. There is a close working relationship between the NHS and local authorities and having the same boundaries makes delivering services a lot easier. I am reassured by the minister's words about patients still being able to go to the hospital of their choice. In some parts of the Argyll and Bute Council area, that will usually be in Glasgow. However, I would ask the minister to go a bit further. Should health professionals come across any little barriers, discouragements or difficulties preventing patients from going to the hospital of their choice, I ask that the minister act promptly to deal with those barriers. It should not happen, but I would like an assurance that, if it does, the barriers will be got rid of immediately.
NHS Highland deals with many issues that are similar to those dealt with by NHS Argyll and Clyde. There could therefore be quite a nice fit; in particular, there will be some synergy between the hospitals in Fort William and Oban. It is important that the addition of the Argyll and Bute area to the area covered by NHS Highland is positive. The debt has been a concern, as has funding—especially funding that takes into account the difficulty of providing health services in rural and island areas. The funding should be kept under constant review.
The recurring deficit will not disappear straight away and we will need a period of grace to allow us to manage the transition. Any need for additional funding should be considered sympathetically. It is likely that the new governance of the NHS in Argyll will have to make some changes to services. That would happen anyway; for clinical reasons, there will always be a need for redesign and reconfiguration. Unfortunately, that will always be regarded with a bit of suspicion and concern by the communities that are affected, so it will have to be handled sensitively. It certainly cannot be hurried into under a new regime. In order to take the people of Argyll with us, there may therefore be a need to move a little more slowly on things that would need to happen anyway.
A community health partnership will have many local and devolved powers but it will not be an autonomous unit and it will remain within the governance of Highland NHS Board. There is therefore an opportunity for Highland NHS Board to go for more devolution within its structure. Areas such as Caithness or Skye might benefit from a new look at the way in which community health partnerships operate under the NHS Highland umbrella. There is a chance to create more local accountability, which—as has been said—must involve fully devolved decision making. I hope that that happens.
I have another concern, which the minister mentioned in response to Shona Robison rather than in the main body of his speech. It relates to the role that the Scottish Executive Health Department played in what has happened, which the Audit Committee's report identified as an issue. The report raised serious concerns about the Health Department's analysis of the Argyll and Clyde financial plan and recommended that the department should review
"the financial data submitted by Boards; and its own practices and capacity".
That is crucial if we are to avoid another NHS Argyll and Clyde scenario. The accountability review process is another area that the department should look into. There are issues that face the department, as well as those that face individual health boards. I seek reassurance from the minister that such matters are being fully addressed.
I wish the new arrangements well and I hope that they are positive for Highland, for Argyll and for the rest of Argyll and Clyde. I have concentrated on what the proposals will mean for Highland, but there are many Clyde representatives here to say their bit. I support the minister's motion.
The proposals that we are discussing represent the Executive's second attempt to rectify matters at NHS Argyll and Clyde. As Shona Robison said earlier, it made its first attempt in December 2002, which was two years and five months before the minister's announcement to Parliament in May of the dissolution of NHS Argyll and Clyde—not three or four years previously, which is what he said when he made that announcement.
The action that the minister has taken is decisive, but it needs to be matched by leadership and ownership of the problems and public concerns. I welcome his assurance that that will happen; the SNP intends to hold him to that. The challenge that is faced is not just financial or managerial; it has other dimensions. There are clinical, social, familial and national and local economic aspects that must be addressed.
From talking to people across Argyll and Bute, Dunoon community council and action groups such as CATCHES—Cowal against the cuts in health services—that are worried about the health situation, I know that fundamental concerns persist, which must be addressed. There are still concerns about the consultation, for example. There is deep disappointment that few questions were answered factually, openly and completely. People feel that little feedback was provided on why the problems at NHS Argyll and Clyde arose. As Mr Tosh said, the motion makes only passing reference to structural problems. No in-depth analysis of the situation has been provided and, as Annabel Goldie said, no detailed financial information has been supplied. There has been no cross-referencing of the underlying problems to specific steps that will be taken to tackle them.
After years of centralisation, it is no wonder that there is residual fear about the services. There are worries about the economic impact of what has happened. Business investors might be frightened off and the retention of young people might be affected. The retention and continuing inward migration of older people might also be affected.
I believe that the crisis management that has led to the current situation is something that we are all concerned about. However, in the present crisis, there is a danger of a domino effect, whereby other small health boards, such as those that serve the Western Isles, Orkney or Shetland, could be sucked into bigger regional organisations. I hope that the member agrees that, if we want to keep the jobs that are vital to the economies of those places, that is not the way to plan their services.
I certainly agree with that. The key benefit of the present process—which will take place in the Western Isles, just as it has taken place in Argyll and Clyde—is that people are now aware of the situation, auditing it, carrying out organisational work and considering long-term performance and the future implementation of the Kerr report. That organisational work is not being done only by individuals. Councillor Allan MacAskill of Argyll and Bute Council is contacting every community council to get their views and his council has produced a comprehensive package that advocates a better way forward.
In essence, there has been a reorganisation and a dissolution in the space of 29 months. In my book, that does not qualify as decisive leadership. The Executive's role is to go beyond that. We have yet to get a full definition of the fundamental problems that were experienced in Argyll and Clyde. We need to have a clear view about what will be different this time around and proof that the core problems are being addressed.
People's willingness to be involved in the process is total: the public is willing to be involved, as are the staff of NHS Argyll and Clyde, who have done a sterling job. Perhaps that willingness is best demonstrated in the concerns of the Royal College of Nursing. Its submission is that a fundamental improvement in the consultation mechanism is required. I put it to the minister that, surely, it is now time to have the meaningful involvement of all stakeholders in consultation and for consultation to be done with a degree of equity that was not there in the past. That should happen for consultation with staff, and even suppliers; certainly, it should happen for consultation with patients and communities. We need to see that publicly motivated involvement is happening as an on-going process, right down to the level of democratically elected boards.
I am interested in the member's point on meaningful involvement. Sixteen meetings were held; consultations were held; documents were issued; and websites were set up. There was also involvement of the public—I met with many different dimensions of the community. That is meaningful involvement, but it does not mean to say that we always agree. That is leadership, and that is what has been provided.
I drive the minister back to what I was saying earlier. In my notes, I scored out the words "waste of time" and instead added the word "disappointment", but the message that I got was that the consultation was a waste of time. I agree that a good body of people came to the meetings and that they showed a lively interest in the proceedings, but they expressed very low satisfaction levels. They said that they had not been listened to or that they had not been given detailed answers. I strongly advocate that the minister should look at the RCN's concerns in some detail and that he should involve people. We need to move forward and that is the way ahead.
The people are on the case; they are the auditors and arbiters of what is right in this situation. People turned up to our meeting at the Queen's Hall in Dunoon and told us harrowing tales. One of them was a woman who was clearly still heartbroken as she sat in the hall and told us of her experience. Late at night, her husband had suffered a heart attack. For the lack of an ambulance and hospital care in Dunoon, he had to be taken to Inverclyde hospital in the back of their car. The idea that, in the early 21st century, people in our country have to leave an affluent part of the country, such as Cowal—which, if it were in the Potomac, Rhine or Hudson areas, would be a thriving place with its own hospital—to find a hospital elsewhere is unacceptable. Frankly, that makes them look like people exiting a Beirut war zone.
The standards that we want to achieve across Argyll and Bute are 21st century standards—the sort of standards that will allow us to grow our economy and attract more people to live in the area. Anything else is totally unacceptable.
I start by acknowledging that the minister was absolutely right in deciding to scrap NHS Argyll and Clyde. For many of us who suffered the consequences of the board's failure to plan and manage services effectively, the robust action that he took is very welcome.
I recognise that the decision was not easy. However, when one considers the challenging geography of the area, the anticipated financial deficit of £80 million, which would have impacted on patient care, and the nonsense that was the board's clinical strategy, one starts to see the necessity for such drastic action.
I remind the chamber of the madness of NHS Argyll and Clyde's proposal for the delivery of services to my constituents. At times, it felt as if people were incidental to the board's planning—we really did not matter at all. People were told, "Just you travel for two and a half hours on public transport to get to the RAH in Paisley"—incidentally, they would bypass five Glasgow hospitals en route. However, it was not only the small number of people who needed to access specialist services who were told that; many people from my area were told to travel that distance to access basic services that should have been delivered in their local community.
I turn to the future. I am pleased that people from Dumbarton and the Vale of Leven will now be part of NHS Greater Glasgow. That not only makes sense but is a proposal that enjoys considerable local support. However, it will come as no surprise to the minister that I am deeply disappointed in his decision on the boundaries for Helensburgh and Lomond. Bluntly, I think that the minister is wrong, as do the overwhelming majority of my constituents.
It is worth noting that an interesting divide was generated in the responses to my consultation and that of the minister. The vested interests—namely the health board, general practitioners and local authorities—wanted option 1; boundaries mattered to them. However, when we asked the people—the ordinary folk who receive the service—they clearly wanted option 2; they wanted NHS Greater Glasgow, not NHS Highland. A staggering 80 per cent of people across the area favoured option 2, but when one delves down into the figures one can see that 90 per cent of people in Helensburgh itself and 94 per cent of people in the Garelochhead area favoured that option. That view was supported by front-line staff, who provide the health care in our communities. However, the minister has heard all of that from me several times before, and although I still believe that he is wrong, nothing—but nothing—can be as bad as being part of NHS Argyll and Clyde.
Let me move on to a more fundamental issue of concern. In May 2005, the minister stood up in the chamber and said that the consultation was about protecting services for patients, not about boundaries. Well, hear, hear. I acknowledge that our debate about boundaries has perhaps been a proxy for our concerns about services, but in turn I want to know that he really means business about protecting services for patients. The essential prerequisites will, again, not come as a surprise to him. I have raised them many times before, not least when we met in Helensburgh this morning. I am grateful to him for listening and for applying his considerable talent to meeting those very concerns.
First, I asked specifically for the retention of the Helensburgh Victoria infirmary and the Jeannie Deans unit. There is no local provision that could currently substitute for those facilities, and NHS Argyll and Clyde, in its rush to implement its clinical strategy, intended to close them without adequate replacements. This morning, the minister promised their retention until we can provide and demonstrate something better locally, and I am grateful for that.
Secondly, and of equal importance, I asked for a clear commitment to making integrated care happen at the Vale of Leven hospital. So far, Andy Kerr and Professor David Kerr have been encouraging. Now is the time for action, not words. The Vale of Leven hospital must be sustained. NHS Greater Glasgow must support the model of integrated care that is being developed—I point out to Frances Curran that it will include in-patient beds. I am particularly grateful to the minister for having committed to a pilot on integrated care, which will stabilise services and deliver lessons from which all of Scotland can learn.
Thirdly, I asked for a written undertaking by both boards to be given to the minister and to the local community, covering patient flows, planning and finance. All of that is essential. We have had assurances before, and in the context of Argyll and Clyde they were found to be worthless. Because of that, the annual plan of the joint locality planning group should be sent to the minister for sign-off and not left to the boards. Our contract is clearly between the minister and the people in my constituency. This morning, he agreed with that.
Fourthly, we need to be clear about current and future patient flows. Current patient flows from Helensburgh and Lomond come to the Vale of Leven and to NHS Greater Glasgow. Indeed, much of the patient flow from Argyll comes that way too, as my colleague Duncan McNeil has said. I therefore do not envisage that there will be any patient flow for secondary services to anywhere other than Glasgow. Effectively, that will be the default position. This morning, the minister agreed work to underpin that. Equally, I expect that the default position will be for patients from that area to travel not to the RAH in Paisley, but to Gartnavel and the Golden Jubilee, if the service cannot be provided at the Vale itself. The minister has told NHS Greater Glasgow to review Argyll and Clyde's clinical strategy, and it has promised the delivery of services north of the river from 2007. Again, I am grateful for that.
Finally, I shall put it simply to the minister. If he can deliver on all of that, with the resources to back it up, boundaries will indeed become a secondary consideration. At the end of the day, what we want are services—in Helensburgh, at the Victoria infirmary and the Jeannie Deans unit, and in the Vale of Leven hospital with integrated care. For special services I ask him, please, to give us Glasgow rather than Paisley, because we can actually get there. He has shown us before that he means business. He has shown leadership in tackling the problem. I ask him to keep doing so.
Nothing that I am going to say in this debate is in any sense motivated by party-political considerations. I start by saying that I hope that the minister has made the right decisions and that the decisions announced today will pave the way for work that will be done to stabilise health services in the Argyll and Clyde area and to address the budgetary problems. In approaching the debate, our concern is that there is no clear analysis of those problems and no clear narrative to show how the changes that are to be made will respond to that analysis.
For example, reference has been made to the point about the incompatibility of the rural and urban mix in Argyll and Clyde, with which the consultation document began. The manifest impact of that has been the differential funding pattern, in that, under the previous arrangements, rural areas in the Highlands had a higher capitation payment than rural areas in Argyll and Bute.
My colleague Mary Scanlon, who unfortunately will not be able to speak in the debate, has calculated that, as there are 91,000 people in the Argyll and Bute Council area and a current differential level in capitation of about £80, the transfer of those people to NHS Highland ought to carry with it an additional financial bonus of just over £7 million. It would be helpful if the minister could confirm in his wind-up speech that NHS Highland will receive that allocation and that it will not suffer as a consequence of the decisions that are taken today.
I will focus my remarks on NHS Argyll and Clyde. It is difficult to get at exactly what the structural difficulties are and what is meant by the "bureaucratic boundaries" that the consultation document mentions, to which the minister attributes the financial problems.
In an intervention, I put to the minister the point that there is no clear indication of what the structural difficulties were. In his answer he instanced only what he called the failure to reconfigure services—I paraphrase, but I think that I do so accurately. I am not sure that that is a structural problem as opposed to a management problem. However, let us take that as the basis of the difficulties and agree that it is probably why NHS Argyll and Clyde has been bleeding some £30 million a year—the figure may have risen above that—and has been unable to redress the matter. I am curious about what will happen as a result of the changes that will allow those serious deficits, which must be addressed, to be disposed of.
The minister referred to better management of patient flows. It would be interesting to know what that means in relation to a cumulative deficit and a recurring deficit of £30 million. He also referred to economies of scale. That was a very interesting comment, which raises many wider issues about health boards and the future delivery of their services throughout Scotland. I would have hoped that it might have been possible—if not in the consultation, certainly now—to give an estimate of the economies of scale that might be achievable and to indicate whether those could conceivably close a £30 million gap.
Mr Robson referred to the likelihood that, through reorganisation, the NHS could economise in what we generally call back-of-house services. The NHS can economise in administrative support and back-up services, although costs and extreme management difficulties are faced in doing that. However, we have had no indication from the minister that such reorganisation is what the rearrangement is about, nor have we had a projection as to what target savings it might be reasonable to look for.
We have been told that the boundaries have been changed, that the changes do not affect service delivery and that service delivery is what matters. We believe that some management changes will follow and that the issues can be addressed. However, those changes have not been matched to the gap.
I wonder what more is involved in the reconfiguration of services that might dispose of the deficit. In all the briefings that many members have had over the years from the board, we were told that its clinical strategy review was driven by clinical considerations. There was a lot of argument about whether we believed that, but that is what the board always said. However, when the board explained the deficits to us, it always added that the deficits arose from the pattern of hospitals in the area: the four acute hospitals, plus the invisible fifth hospital that it used to talk about, which was the income transfer to Glasgow, not for specialist services but for elective services, for which people had gone to Glasgow.
What we all need to know, and what all the communities in Argyll and Clyde will want to know in the years to come, is whether the merger with Glasgow means a Glasgow solution, because we have been here before with Greater Glasgow NHS Board. I am not suggesting that the example of that board rationalising its seven hospitals to two—or two plus Gartnavel—is necessarily the blueprint, because I do not believe that there is any possibility that it could function without hospitals in Alexandria, Paisley and Greenock, but the key question is what services will be delivered in those hospitals. Communities will continue to have concerns about the possible centralisation and removal of services. It is important that we develop the integrated care model at the Vale of Leven, which I hope will work.
Duncan McNeil said that pooling Argyll and Clyde and Glasgow would provide the highest quality clinical staff and university-led services, end recruitment problems and give everybody in the expanded greater Glasgow area access to a pool of excellent consultants. I hope that he is right about that. My fear is that that is exactly what the Argyll and Clyde Health Board used to say when it was driving forward its clinical review strategy. It said that it would resolve all those problems by pooling the staff and pulling in patients.
We need to know that the new model will allow the delivery of consultant-led services at the existing hospitals and that we will not have a review by greater Glasgow that is, effectively, a replay of the centralisation that Argyll and Clyde offered. The jury is still out on that. I do not doubt the minister's good intentions, but an awful lot is riding on whether he is able to deliver what he has held out this afternoon.
I begin by commenting on the tenacity of my colleagues Jackie Baillie and Duncan McNeil in driving forward on behalf of their constituents a proper solution to the health needs of their area. I also pay tribute to John Mullin and Neil Campbell of NHS Argyll and Clyde, who have done a good job under difficult circumstances over the past three or four years, and have tried to maintain services in the difficult situation that followed the minister's announcement of the dissolution of the board. Having made that decision, it is entirely appropriate that the minister does what he can to reduce uncertainty. I am pleased that he has reached a decision on the future boundaries, because now we can begin to plan for the consequences.
The vast majority of my constituency lies within the NHS Greater Glasgow area, while a small strip lies within the NHS Argyll and Clyde area; therefore, removing the boundaries will be beneficial. West Dunbartonshire Council, which has had to deal with two health boards over the past period, welcomes the coterminosity that will be established for its area. That will improve the interface between the local authority and the health board and help with the planning of services throughout West Dunbartonshire, which is to be welcomed. It will also inform the debate on how the community health partnership will operate in our area. The CHP will have an interesting role to play in taking issues forward. I am keen to work with Jackie Baillie, the council and the minister's officials to ensure that we get the best possible service delivery.
I have some concerns about funding, given the minister's announcement. I acknowledge that, in connection with the financial consequences of the current position, it is difficult for Professor Arbuthnott to argue against the formula that he put in place. However, following the finance of the patient flows leads me to estimate that the cost will be £4 million or £5 million more than the budget that we will get. In other words, NHS Greater Glasgow will get more patients than money, and there will be £5 million less in the budget to deal with them. I acknowledge that, because the debts have been written off, NHS Greater Glasgow is not inheriting the history of accumulating debt. However, given that the minister said that the task of returning to financial balance is tough, starting with minus £5 million is an unwelcome additional burden.
Does Des McNulty have a handle—because I do not—on how the specific problems that led to the deficit will be identified and handled by the new amalgamated body?
I will come on to that.
It is probably fair enough calculate the financial flows at around £4 million to £5 million. If Jackie Baillie is correct, and patients are voluntarily assigning themselves to Glasgow more than is suggested by the theoretical model, the actual adverse financial flow to Glasgow might be greater than the figures that I advanced. The minister will need to address that issue.
I recognise the fact that the minister said that he is not ruling out providing financial assistance to the health boards during the transitional period. There is a particular issue for NHS Greater Glasgow, but we must consider the formula. I am concerned that, in addition to all the problems and issues that the board already has to address in its existing area, plus the additional management burden, which is partly an assimilation burden, it will also have to address the structural problems that have plagued Argyll and Clyde. There might be a lack of managerial focus, there might be an issue of capacity and there might also be an issue of funding. We need to point out those matters.
Picking up on a point that Jim Mather made, I should emphasise that, although there was criticism of Argyll and Clyde NHS Board in the Audit Committee's report, there was stronger criticism of the Health Department and the way in which it had been dealing with the continuing issues in Argyll and Clyde, particularly when it came to the failure to agree the clinical strategy, and perhaps also the failure to agree the proper steps required to address the matter effectively. The Health Department and NHS Greater Glasgow must engage in a clear debate on how the issues are to be addressed. It is not a question of simply deciding what the boundaries are and letting the board get on with it; a continuing debate needs to be had that must take into account not only finance but the way in which services can be delivered.
I have lobbied the minister on this matter in the past. A few weeks ago, he made an announcement about an anticipatory care model. I understand that there has been a broad allocation in relation to health board areas. I would like to lobby on behalf of Clydebank and, if I may speak for my colleague Jackie Baillie, West Dunbartonshire. We would like to be considered as a pilot area for anticipatory care. There are health conditions that need to be addressed in our area, and we would be very pleased if we could get some recognition and support in that regard.
I thank you for letting me speak in the debate, Presiding Officer, as my constituency does not exactly have anything to do with Vale of Leven hospital. However, everything that happens within the Greater Glasgow NHS Board area has a knock-on effect somewhere. My constituents have certainly been anxious about what will happen to them when NHS Greater Glasgow takes on the extra workload.
Patient flows are an extremely important matter, and I am pleased and encouraged by what I have heard from the minister today. However, I am still worried by the decision. I cannot honestly see how all this will work. This is one big prayer and although I hope that it will work, I do not know where the moneys will come from. Sometimes, health boards do not get the cross-boundary moneys that they should get.
My constituents from places as far out as Lennoxtown might have to go to the north of the city. When the new Southern general hospital is built, there will be no general hospital between Hairmyres and the Southern general. Hairmyres hospital might not have an accident and emergency department, so the patient flows might change. People who we might think will go to one place could cross the river instead and go to Glasgow royal infirmary. People in my area are not awfully keen to go through the Clyde tunnel to the Southern general, for transport and other reasons.
When I lodged my motion on the matter, I thought that it was important that patient flows should remain as they have been, and that it was very important that the Vale of Leven hospital should be part of the integrated care model that general practitioners and consultants had put together. While all hell has been breaking loose, while the board and everyone else have been trying to make up their minds and while the doctors, patients and NHS staff have been in despair and wondering what on earth is going on, the doctors and nurses in and around the Vale of Leven hospital have managed to get a wonderful integrated care model up and running. I am pleased that there is to be a six-month pilot; I like to think that the care model could be permanent. I have heard rumours that NHS Greater Glasgow is not all that keen on it. I would rather that it was and I would like to see the idea spreading.
I ask the minister to bear certain things in mind. For example, acute services left the Vale of Leven hospital, but in the past few days the hospital has been accepting acute emergency admissions for the overburdened Royal Alexandra hospital. Doctors there have told me that orthopaedic and general surgeons love coming back to the theatres at the Vale of Leven hospital, because they do not have enough theatres in the Royal Alexandra hospital. The original idea was to send everybody across the river to the Royal Alexandra hospital, but apparently it is becoming overburdened. The same thing is happening in Glasgow royal infirmary.
I will make this brief, because Argyll and Clyde is not my area. My plea is for everybody to keep an open mind, to see what is happening on the ground and not to go ahead with an idea because it was thought up goodness knows how many years ago and we have to make it work.
I have been reassured about Stobhill. I like to think that when the new Stobhill hospital is built, the general hospital will work side by side with it until we see how things go. I do not think that NHS Greater Glasgow has a clue how many hospital beds or theatres it will need and how the flows will go.
I would like the Vale of Leven hospital to be reassured that it will stay for as long as it is needed. The most important thing is that we do not have change for the sake of it. Patients want at least the same service as they have had, if not a better service, and they do not want to go all round the countryside to get it.
Please do not close down the Vale of Leven hospital, the Victoria infirmary or Stobhill until we see where we are going. There is no shame in holding back and reflecting, because it is the safety of patients and continuity of care that matter.
I have no idea how the change will work out for NHS Highland, despite its experience. I have grave doubts about how NHS Greater Glasgow will take on board the extra work. I wish everybody well; I sincerely hope that the change works for the staff, and that they will be reassured in the end, and that the patients know where they are going and where they can go safely. Considerable education and perhaps an advertising programme will be needed to reassure people not only in the area of Vale of Leven and Argyll and Clyde, but in greater Glasgow. Lots of people, north and south of the river, are extremely worried about how their health service is turning out.
Although I had serious reservations about the decision to dissolve Argyll and Clyde NHS Board, I, like others here, have to accept the inevitable. I put on record the fact that the chairman, the board members and the officials have always been readily available and accessible to me as the local MSP and they have been prepared to listen to my complaints. I accept that, among other things, the Argyll and Clyde area is not a natural geographical area for one health board and that things had to change to allow better services to be provided. Most of what I wanted to say has been said by Jackie Baillie and Duncan McNeil, among others. As Des McNulty said, they have pursued the matter diligently.
I want to talk about practical issues that still worry me. Despite financial difficulties, there had been real achievements by the board, with the move to the single system and a reduction in waiting times and delayed discharges. The targets were reached well in advance of the Executive's time goals. It is clear that staff have worked hard to achieve those goals. I want to be sure of job security for the staff and their continued potential for promotion. I need guarantees that they will not find themselves at the end of the queue when it comes to promotion.
Argyll and Clyde has brought down its waiting lists. I would welcome the minister's comments about where my constituents will be placed on the lists when they are combined with Glasgow's lists. I accept that a clinical decision is paramount, but I do not want my constituents to be pushed down the list because they come from outwith Glasgow. For example, I do not want someone who knows that only one bed is available simply to give it to the person who lives nearest. Those issues have to be addressed.
We face a different future. A shift to a network that is dominated by Glasgow means that we have to have a copper-bottomed guarantee that the NHS services in Renfrewshire and Inverclyde do not suffer from being on the periphery of the new set-up. Although this change can be seen as an opportunity to redesign services, the issues of where they are delivered, how they are delivered and who they are delivered by must be central to our decisions if we are to assure constituents that services are safe and sustainable.
The Kerr report made clear the distinction between specialist treatment and procedures and sustainable, safe services delivered locally. Regarding the change, I must be sure that there is a guarantee that local does not mean Glasgow. For people who live in Port Glasgow, Lochwinnoch, Kilmacolm and Bridge of Weir, Glasgow is not local. Local services for people in those places should be continued in Inverclyde and Renfrewshire.
Patients who expect to travel to get specialist hospital treatment do not care how far they have to travel as long as they get the best treatment. However, what further impact will the changes have on such patients and their families if they have to travel even further for that treatment? Are there any plans, for example, to help with travel expenses? My experience of this area is bad but, if such plans are in place, I suggest that the system by which expenses are claimed needs to be much less complicated than the present one.
We must ensure that the representatives of the board from the Argyll and Clyde area are tough minded, practical, sensible and active. I do not want time servers on the board; I want representatives who will fight their corner in order to ensure that their area gets the best possible services. The communities that I represent must not be marginalised or overlooked as a result of the decision.
The minister has stated that the changes are about not bureaucracy, boundaries and borders, but people and services. This is a fresh start and a clean slate. I want patients to feel secure in the knowledge that there will be security in services and that those services will be delivered locally where that is appropriate. Most of all, I want them to feel confident that we have made the right decision today.
In the short time that I have, I would like to say that the debate has been revealing. The minister said that the Executive had ensured that there was meaningful involvement. He also said that there had been consultation, although many of us in the chamber did not believe that. However, in those consultations, the minister specifically ruled out discussion of the clinical review of Argyll and Clyde. The Executive said that that would stand and would not be discussed. Loads of things were said about the clinical review in the meetings, but they were not put on record because the consultation specifically ruled out a discussion of the clinical review. However, Jackie Baillie got up in the chamber today and revealed that, as a result of private conversations with the minister, there will be a moratorium in relation to the Jeannie Deans unit and the Victoria infirmary in Helensburgh, there will be an integrated bed service—
There were no private discussions. The discussions took place in front of the community councillors and the very people who were actively involved in the consultation. They found out my views because they asked me questions. Does the member suggest that I do not tell the public what I think?
How can the minister guarantee that? We wanted to discuss many things, but Jackie Baillie gets a guarantee and an agreement. Lots of other people would have liked to have an agreement on service transfer and service retention in the clinical review, but we did not get the opportunity to have that discussion. The arguments against the proposal were clinical and were contained in the clinical review, which the minister signed off, based on clinical arguments from Argyll and Clyde. We lobbied on the issue but, all of a sudden, we find that those clinical arguments no longer hold. That is extremely revealing.
Secondly, how can the minister guarantee that that is the situation? How can he guarantee that the integrated pilot at the Vale of Leven hospital will continue or that units such as the Jeannie Deans unit will continue to open? I thought that that was supposed to be part of the clinical review of Greater Glasgow NHS Board. How on earth is the minister involved in that decision making if he has already signed it off?
How many other discussions have taken place about parts of the clinical review that are guaranteed to change? As Murray Tosh said, the minister asked Greater Glasgow NHS Board to review the clinical review, but we were not allowed to discuss it in the consultation. Is that not Greater Glasgow NHS Board's decision among the much wider measure of the services that we are going to have? Will Duncan McNeil get a guarantee that Inverclyde royal hospital in Greenock will remain an acute general hospital? He made that request today, but he has not got any agreement on that and that was a huge part of the clinical review.
What about the people of Paisley? What will be the impact on them? They live the nearest to the rest of the Glasgow hospitals. What will be the impact of the decision on their acute general hospital? The big fear, which Murray Tosh mentioned, is that there will be centralisation of services as a result of the changes. People in Paisley live only 10 minutes away from the Southern general hospital and other health care services. Ordinary people have not had the opportunity to comment and it is not clear from the consultation how a requirement for local voices to be heard will be built in. Nobody is convinced that the community health partnerships will do that. In addition, they will not make the decisions. The board will still do that.
There is genuine fear that services in Argyll and Clyde and representation from those areas will be swallowed up in the big Glasgow pond. That fear came up in the consultation meetings. The minister has not given us an answer on how people in Helensburgh, Greenock, Paisley and Renfrew will have a voice in the reconfigured Greater Glasgow NHS Board. That is the biggest fear. The minister shakes his head, but we will see what happens with the clinical review. We will see what proposals there are for the centralisation of services as a result of the changes.
I agree that change happens for a reason. I am in favour of change and of integrated care. I was in favour of the model that NHS Argyll and Clyde proposed, whereby people would get access to services as near as possible to where they live and would not have to travel for miles. We should go for that model, but we should test it first and convince people that it works, then they may let go of the other services. The problem here was that acute services were ending with a pilot that nobody knew would work. People are still concerned.
It has been a good debate and I listened to it with interest. I reiterate our conclusion that the minister made the right decision. As Duncan McNeil and Jackie Baillie said, the minister probably had little choice but to act and the fact that he did so is greatly to his credit.
To all intents and purposes, the decision about the boundaries has been made. There are certain key requirements that must be met. Perhaps Jackie Baillie put it best when she said that it is now all about services and not about boundaries. The minister gave several welcome assurances during his opening remarks. The key assurance that he gave patients and doctors is about allowing patient flows across the boundaries. He might care to reiterate that reassurance in his closing speech, because it is particularly important.
We heard that the review of the clinical strategy of Argyll and Clyde was essential and that there were deficiencies in what the soon-to-be-dissolved board had set out. Clearly, the successor boards will need to take on the work that was in hand and draw conclusions.
The minister will need to ensure that there is effective engagement between his department, NHS staff and patients.
Does the minister have any specific arrangements in mind to ensure that his department monitors developments? For example, does he intend specifically to review progress after a year? How does he intend to monitor what is going on? How does he then intend to report back to Parliament? How does he intend to keep track of the commitments that were made today and of the developing picture around the finances of the newly configured boards?
Mr Robson might also ask the minister whether he might expand on the transitional funding that he indicated might be available to ease the changes through.
Mr Tosh is sitting close to me; he must have read my notes, because I am just about to come to that point.
In an earlier debate on the Kerr report, I said that the minister should retain some financial flexibility in his budgets to help cope with the changes that arise when services are modernised. I said that in the context of the Kerr report, because there are difficulties ahead for some smaller boards that might have to take difficult decisions and find extra resources. The minister nodded at the time, and I welcomed that because a case can be made for ensuring that there is some flexibility. In the context of this debate, the minister might need in due course to invest to allow the transition to the new arrangements. However, that will come about only if the minister monitors closely how the situation develops.
Does the member agree with the minister's choice of option 1, or does he go along with his colleague George Lyon, who said that he backed option 1 but then said that he would not reject option 2, and finally said that option 3 might be the way forward? Admittedly, that was his second shot at the question. Does the member agree with George Lyon or the minister?
I have tried to explain to Mr McGrigor that if there are three options, they are all possibilities. The key thing is that Mr Lyon is in favour, as are the Liberal Democrats, of option 1. I made that absolutely plain at the start.
There is an important point around the development of community health partnerships. I referred earlier to Greater Glasgow NHS Board's intention to engage with local authorities, which is very welcome. The board has made good progress with two of those local authorities and its intentions for dealing with the others are excellent.
I welcome the assurance in the minister's press release that the Argyll and Bute community health partnership will be given maximum scope to take decisions locally and that it will receive the necessary support from the boards to do so.
The local planning group that has been established for the Helensburgh and Lochside area is important and I hope that it will give residents a structured opportunity to make an input into the planning of hospital and other services in greater Glasgow.
This has been a very difficult period for health services in the west of Scotland. I reiterate that the staff have done immensely well in coping with a difficult and unsettling period. I wish those who are creating the new structures every success in so doing.
I start by thanking the minister, Andy Kerr, for responding to me directly about my letter that was published in the Argyll and Helensburgh newspapers. I am delighted to know that he reads the Argyllshire Advertiser. Unfortunately, he did not answer my question about where the £60 million—or is it now £80 million—has disappeared to.
In the past two and a half years since the debate on the Argyll and Clyde health service problems began, I have attended and spoken at health meetings in Oban, Dunoon, Campbeltown, Helensburgh and the Vale of Leven. I remember the west Highland project, which was produced by students from Birmingham, and which told us that the status quo is not an option. That provoked such an outcry from those dependent on the hospitals in Oban and Fort William who feared losing their core acute services that the approach was dumped in favour of the Lib-Lab solutions group's wishy-washy compromise that broadly supported the status quo.
Not surprisingly, nothing came of that. In any case, it was overrun by the report by Professor David Kerr, which pronounced—correctly, in my view—that local hospitals should supply core services. In that time, Argyll and Clyde NHS Board lost £60 million.
If the people are being asked to make up their minds about options, they should be told what caused the debt in the first place. How did the overspend occur? What items went over budget? The minister has referred to structural problems affecting Argyll and Clyde, but he has not explained what they are. In his letter dated 5 December, he says that resources are allocated to all NHS boards on the same basis. In that case, and given that there were structural problems, why was less money allocated per head in Argyll and Clyde than in NHS Greater Glasgow or NHS Highland? Was that a main factor in the overspend? Did the urban percentage of Argyll and Clyde stop the rural upgrade from kicking in and/or did the rural percentage stop the urban upgrade from kicking in? In other words, did the Arbuthnott formula come up with the wrong answer for Argyll and Clyde, despite the minister's refusal to accept that it might have been flawed?
At a recent meeting in Oban that was attended by about 300 people, including a representative from the Executive and another from NHS Scotland, the audience was told that a recording of the meeting would be sent to the Minister for Health and Community Care and that answers to all the questions would be in the public domain. Will the minister now tell us where the £80 million went? It could have been used to build three or four hospitals or to do wonders for community care.
In his letter, the minister also talks about the geography of Argyll and its mix of urban and rural communities with their very different challenges. I can tell him that Campbeltown depends on its own hospital, whose rehabilitation unit has been cut, and, for specialisation, on hospitals in Glasgow and Paisley. Because Dunoon's local hospital has been much downgraded, it relies heavily on Inverclyde. North Argyll and some of Argyll's 26 inhabited islands depend on Lorne and the Isles hospital in Oban, the Vale of Leven hospital and other hospitals in Glasgow and Paisley. The psychiatric hospital in Lochgilphead is extremely important; Helensburgh depends on the Victoria infirmary, including the Jeannie Deans unit; and for the people of Helensburgh and Lomond, keeping an integrated care model up and running at the Vale of Leven is an absolute must. At this point, I congratulate Jackie Baillie on making a rather brave speech about the people of Helensburgh and Lomond.
The situation is not that complicated and should fit in with the findings of the Kerr report, which highlights the importance of keeping core services local. Does the minister know, for instance, that Oban hospital recently had 1,200 applicants for four junior doctor posts? Who says that rural hospitals cannot attract doctors?
The minister has chosen option 1—I have already mentioned George Lyon's choices—but he now has to convince the huge majority of people in Helensburgh and Lomond who wanted option 2 that they will not have to go to Raigmore hospital in Inverness and that NHS Highland will have enough money to buy services from NHS Greater Glasgow. In the past, NHS Argyll and Clyde received about £80 less a head than NHS Highland, and changing that situation is vital. Will such a change happen with the merger with NHS Highland?
The north Clyde group said:
"it is critically important for health services in Lomond that we do not again make the mistake of drawing boundaries on maps that are without adequate regard for natural community, direct lines of responsibility, local knowledge, and the facts of geography and transport."
Given that, I hope that the minister listened to the people at this morning's meeting in Helensburgh, which I have to say was called at remarkably short notice. It has been recognised that local services should not be taken away to service the needs of centralised specialisation. On that point, the Kerr report is helpful.
It takes a special kind of incompetence to spend billions more in the NHS only to preside over a significant increase in waiting lists and times and still not know where the £80 million has gone. Will the minister please apologise to the people of Scotland for the loss of their money; to the people of Argyll and Bute for the anxiety that they have suffered over the past two and a half years; and to the doctors and nurses in the Argyll and Clyde area who have somehow kept services running despite appalling executive management?
The debate has been interesting, and it was worth having at this time, given the radical changes that are occurring. As many members know, the Argyll and Clyde NHS Board area ranges from dense urban areas such as Dumbarton, Paisley and Greenock, to remote, rural areas, including a clutch of west coast islands. The area covers nearly 3,000 square miles of territory and both sides of the Clyde, with a population of approximately 420,000. Unfortunately, almost 50 per cent of that population is in deprivation quintiles 4 and 5, which is nearly 10 per cent higher than the Scottish average. That clearly had something to do with the problems.
On many occasions, the Executive has claimed that geography was the problem. However, the geography has not changed. The Clyde did not suddenly appear last year, the islands did not suddenly pop out of the sea six months ago and Paisley did not suddenly appear last Tuesday. The geography has always been there. The core problem was the failure to plan to deal with geography. In May, the minister said:
"It is apparent that the geography of the NHS Argyll and Clyde area is simply not a natural area for a single health board."
Duncan McNeil said earlier in the debate—and I hope that I quote him correctly—that "it never made sense". If it was so obvious that Argyll and Clyde NHS Board should not exist, who was daft enough to create it in the first place? Perhaps it was those evil Tories, back in the dark days. Funnily enough, it was not the Tories—the Labour Government set up Argyll and Clyde NHS Board in 1999. The Labour Government set it up, failed to invest in it and failed to see the geography that is now apparently so obvious to us all. It could never exist and should never have existed as a single health board. As I said, the geography has not changed, so the structural funding problem remains. The minister has not addressed the structural deficit and has failed to guarantee funding that will deal with the issue. He has said that he has an open mind on transitional funding. I hope that in his closing remarks he will say how the structural deficit will be dealt with if there is not to be at least transitional funding over the next while.
Why choose option 1 if all patients from north of the river go to Glasgow? That makes little sense, and I know that Jackie Baillie perhaps shares that view. Her point about patients being forced to go to Paisley is correct. Therefore, can we have faith that there will not be similar pressures under the new structures? The Executive's decision to abolish Argyll and Clyde NHS Board was nothing more than a panic measure. Others have called it crisis management. I agree that it had to go, but unfortunately, the change should have happened on the basis of forward planning and strategic thinking, not crisis management. It was made in isolation; it was not part of a wider plan for health boards. There was no advanced research on its likely impact on patients, staff or adjoining health boards. There was no attempt to address the real problems that Argyll and Clyde face. We go back to the flawed funding mechanism, which was there from the start.
In May, the Minister for Health and Community Care said:
"What matters most to me is protecting services for patients. It's not about boundaries".
He then went on to launch a consultation exercise that is about nothing but boundaries. The consultation was not about the many problems that Argyll and Clyde face, such as deprivation, rurality and funding, and it did not address the possible outcomes of the decision to abolish.
Does the member recognise that we have heard a whole series of commitments to service provision north of the river? I hope that he can find it in his heart to welcome that as a positive step.
Some commitments have been made on service delivery. However, there was nothing in the consultation document; there is nothing in anything that has been published today; there is no detail; and there is no evidence of outcomes or of the structural funding problems being dealt with. I welcome any statement that the minister may wish to make. Let us get some detail so that we can consider the matter properly.
The consultation did not deal with the impact on the future plans of the surrounding health boards, which is obviously extremely important. The consultation was just about boundaries.
One of the respondents to the consultation summed the position up quite well. Dr Bell said:
"by limiting the scope of the consultation to where the new boundaries should be drawn, a real opportunity to try … new ways of providing Health and Social Care, which, with imagination and political courage, could have been discussed, has been excluded from comment".
The consultation was very narrow.
It is clear that the consultation was completely inadequate. It did not ask people what they really wanted; instead, it provided only three possible options on boundaries from which people could select. I say to the minister that no analysis of those responses has been made available on the Executive's website. Why has analysis of the responses not been provided? Perhaps they were too embarrassing.
There were around 400 responses from individuals. In the time that was available to me, I managed to sample 250 of them. Option 1 received 45 positive responses; option 2 received 57 positive responses; option 3 received 25 positive responses; and the none of the above option received 123 positive responses. In the sample that I considered, 50 per cent of the people who responded could not express a preference. Many of them expressed dissatisfaction with the consultation process and because all the options from which they had to choose were unsatisfactory.
I will quote various people who submitted responses. One said:
"Having studied the consultation paper and having attended several meetings … I still feel that we have not been given sufficient information on which to base a positive decision".
Another person said:
"Having considered the evidence I would support the formation of an Argyll and Bute Health Board".
Many people said that, although it was dismissed as a possible option. Another person said:
"I do not accept the broad brush reasons given for rejecting options 10.3 and 10.4".
Even the 50 per cent of people who expressed a preference were unhappy with the consultation process. People who expressed a preference often did so grudgingly and with deep reservations. For example, one person said:
"Option 1 seems the best of a bad bunch".
Somebody else said:
"If I had to pick any of the options it would be no 3 though this is far from satisfactory".
Somebody else said:
"option 1 is the best of a bad lot".
The consultation failed. Many people expressed a negative preference during the consultation process and said that they could not choose between options 2 and 3, but that they definitely did not want option 1. How can the minister make decisions on the basis of such a consultation? Why was there no proper analysis that gave details of the responses on the Executive's website?
We all hope that the new set-up will work because people in the Argyll and Clyde NHS Board area deserve a first-class, locally accessible service, but the consultation exercise was not carried out properly and the minister must still explain how he will deal with the underlying problems in the area.
Trying to deal with all the points that have been made is a difficult task. However, on the point about the analysis of responses, there will be an analysis today on the website that we set up for the process.
This is an important debate. Various views have been given from around the chamber, but I still think that the Executive's decision on boundaries was right.
I will run through some of the big issues. Last May, I said that the Health Department had a role, a responsibility and culpability in respect of the matters that we are discussing. I have made it clear to the Health Committee that we have changed the way in which we work. We have put in place clear escalation procedures for intervening, which have been shared with the committee; we have moved from frequent reporting and we have put in place support teams, management change and board change, which, of course, we have found to be necessary in this case.
I am sure that members are aware of many other matters relating to the Executive's Health Department. I refer to the delivery unit, our focus on and review of data, data management and management reporting in the organisation. However, we are not micromanaging every board in Scotland from the Health Department—that is at the heart of the matter. Boards must take responsibility for decisions and ensure that they carry out the extremely difficult task of coming in on budget.
I want to deal with a point that many members—particularly Duncan McNeil—made. The chief executive of Greater Glasgow NHS Board has made it absolutely clear that the much larger number of staff—especially doctors—in the bigger board area makes possible consideration of a wider range of acute service options. Of course, it is too soon to talk about the outcomes of such consideration, but I strongly believe that there will be new opportunities and possibilities for services in the area. As I said during the debate in May, I think that the futures of the Royal Alexandra hospital and Inverclyde royal hospital are better protected, safer and more secure and that services will be more local and diverse as a result of our decisions.
I thought that Frances Curran's speech was barely based on reality. The decision in question was not hasty—it hung about for too long. It was difficult for staff to read constantly about a crisis-ridden, debt-ridden board whose future was in doubt. We have made a decision and we should now look forward and ensure that we deliver better services in the area. There are clear partnership arrangements for staff. The organisational change policy in the Executive and in the health service in Scotland is second to none with regard to protecting the staff whom we value so dearly.
Euan Robson talked about having to make tough decisions. He is right: they were tough decisions, which were made as a result of the consultation. I did more than just read bits of paper, which is what some members suggested. I have met the communities and the community councils; they have come to see me in Edinburgh and I have been to see them. I have looked them in the eye and discussed my proposals for the health service and listened to theirs. I have given them the reassurances that they wanted on local services in places such as the Vale of Leven hospital, the Jeannie Deans unit, the Helensburgh Victoria hospital and on issues such as patient flow. I have assured them that I will sign off the patient flow arrangement and will look to ensure that it is protected. That burden and responsibility will rest with health ministers in the future.
Duncan McNeil made a passionate point about inequality and deprivation. Let us lift our horizons a wee bit higher. Let us look at what the World Health Organisation said about the NHS in Scotland and about the Executive's health policy. It says that we are at the cutting edge of the health improvement agenda in Europe—indeed, in the world. That is why Erio Ziglio of the WHO is in Scotland to learn about what we are doing so that he can take our message on health improvement all round Europe.
We are improving Scotland's health, starting in the nurseries and in our schools, through the hungry for success campaign and by supporting our communities. It is happening and it will continue to happen. Duncan McNeil mentioned the IRH, and I see an opportunity to extend services in it.
Eleanor Scott raised similar issues. One of the barriers that we need to remove concerns support services in the NHS. I hear too much about bureaucrats and managers. Information technology professionals allow us to localise our NHS care—the very people whom some members want sacked and put out of the way. Managers, IT consultants and support staff will make changes to the health service possible. People should stop slagging them off, get behind them and make the change happen.
Will the minister take an intervention?
No, thank you.
Eleanor Scott raised the issue of barriers to patients and clinicians exercising choice—[Interruption.]
Order. There is too much noise.
I expect NHS Highland and NHS Greater Glasgow to respect that choice and I made that clear this morning and have done so throughout the debate.
Jim Mather was very selective in quoting the RCN. In the quotes that I have, the RCN welcomes my assurance that the changes that have been announced today will not affect where patients access health care and goes on to explain and support many of the issues that we have discussed today.
Jackie Baillie is absolutely right to say that she thinks I am wrong. I accept her point of view; it is a reasonable one. Nevertheless, I think that I am right, and I think that I was able to reassure the Lochside communities about many of their concerns about Helensburgh Victoria hospital and the Jeannie Deans unit. I gave them my personal assurance, which they wanted and which I was happy to give, about—
I am coming to the money in a moment.
I am more than happy to reassure those communities.
In summing up the debate—which is what I thought I was supposed to be doing, although some members did not respect that protocol—I want to address the issue that Murray Tosh raised and the point that I presume Mary Scanlon was going to make about resources. The Arbuthnott formula will be used. I do not agree with the figure that was suggested, but it is not far off. The resources have not been allocated and the budget has not been set. Nonetheless, that is the ballpark figure.
Economies of scale are important, as are streamlined management structures. Also important is the potential that the NHS has to use its staff more widely and effectively. Let us take consultants from Glasgow and—my goodness—put them in Greenock; they could start doing some clinics there as well. The 900 or so consultants in Glasgow and the 250 in Argyll and Clyde give us an opportunity to ensure that such wide and effective use of staff can happen.
Many members have supported the Executive's views on coterminosity. Improvements in health, health services and care of our children and elderly people are not just about the NHS; the voluntary sector, the private sector and local councils are also involved. Therefore, it is right to go for coterminosity, with a strongly managed locality plan, which I will sign off, and a strong community health partnership, which will be of central importance.
Jean Turner spoke about cross-boundary flow, which we have been working on for a number of years. We are getting better at it. The changes that I announced in the Scottish Executive Health Department and the work that we are doing on cross-boundary flow will help to make our arrangements easier.
There are many other issues that I would like to address but, unfortunately, I cannot because of the time. If I have not addressed issues that members would like me to address, I ask them to write to me and I will get back to them.
The decision at the heart of our proposals for the future of health services was not taken lightly or rushed. The decision had to fit into our strategy for health delivery and it had to respect communities' desires for local services. I strongly believe that that is what the Executive has delivered today.