Accident and Emergency Units
The next item of business is a debate on motion S2M-5389, in the name of Nanette Milne, on health, with specific reference to accident and emergency provision.
It is with real regret that I speak in today's debate about the need to stop hospital closures. I regret that an opportunity has been missed by the Scottish Executive to take the Kerr report and develop its ideas into a flexible blueprint for the delivery of health care in this country.
As members would expect, I will address NHS Ayrshire and Arran's decision, which was endorsed by the minister, to close the accident and emergency department at Ayr hospital. My colleague Margaret Mitchell will debate the issues surrounding Monklands hospital and Wishaw general hospital, and Bill Aitken will debate the issues of the Glasgow hospitals.
I thank the minister for contacting me on the day on which he announced his decision to close the A and E unit at Ayr to explain his reasons; I very much appreciated that courtesy.
Although I acknowledge that there is much in the Kerr report with which I and my party agree, that does not mean that we accept it in its entirety or every decision made in its name. Indeed, given Scotland's population, one could not reasonably argue against the inevitable focus of a measure of specialisation in our major cities. Although I would prefer all services to be delivered locally if there is no time-critical element to their delivery, it makes sense in the west of Scotland to deal with heart problems at Clydebank, head injuries at the Southern general and cancer care at the Beatson oncology centre.
The trade-off for me and my constituents is that time-critical accident and emergency care should be delivered locally. This is where, regrettably, the minister and NHS Ayrshire and Arran part company with me and my constituents. It would not be unreasonable to ask why there is so much disagreement about the changes after so much consultation. There is disagreement because NHS Ayrshire and Arran has not made the case convincingly that its proposals to centralise A and E care for Ayrshire at Crosshouse hospital will be an improvement. It is entirely correct that communities and politicians question such fundamental and far-reaching proposals, and it is important that those who make the case for change convince service users that the proposed changes will be for the better.
That has not happened in this case. Neither NHS Ayrshire and Arran nor the minister has made a compelling case for the proposed closure of the A and E unit at Ayr hospital. The consultation simply emphasised the existing problems with A and E provision in Ayrshire without offering adequate solutions to the new problems that the proposals will create.
I say to the minister quite simply that we need two A and E units in Ayrshire, notwithstanding the Kerr report or the views of Ayrshire and Arran NHS Board.
It is a matter of capacity. Since the new year, I have been informed by local health professionals that demand for A and E services has exceeded capacity in Ayrshire hospitals. As recently as Monday night, I heard that, despite the best efforts of hospital staff, around 20 people were lying on trolleys at Crosshouse, waiting for beds to empty so that they could be admitted to the hospital through the A and E unit. On Tuesday night, 135 people were admitted to Crosshouse through the A and E unit between 8 pm and 2 am, while on Tuesday 2 January, the A and E unit at Crosshouse was completely closed, even to ambulance admissions, because of its inability to cope with demand.
Currently, 16,000 people a year are admitted to Ayr hospital following presentation at the A and E unit at Ayr. In future, all those people will need to be accommodated at Crosshouse, which cannot cope with current demand. More than 300 people a week will need to travel the extra 18 miles to Crosshouse from Ayr to find a hospital bed, and some of those people will be in a life-threatening state. Consultants at Ayr hospital have warned that lives will be lost. Ambulance provision for the task is currently inadequate and I have grave concerns that it will remain inadequate in the future. There are insufficient paramedics to meet current demand, never mind the extra and longer journeys that are envisaged.
Journey times to Crosshouse for visitors from the southern part of Ayrshire are horrific. Having spent a significant part of the Christmas recess taking my blind father from Ballantrae to visit my mother in Crosshouse, I can tell the minister and colleagues that the 100-mile round trip is not enjoyable for the able-bodied—by car—never mind the disabled, many of whom are restricted to the use of public transport because of their disability or age.
Will the member give way?
No, thank you.
On his brief visit to Ayrshire, Professor Kerr spoke about the geography of Ayrshire and south-west Scotland as important in the decision-making process. However, I fear that no heed has been taken of the geography of the south-west of Scotland in terms of A and E provision. The decision of the minister and NHS Ayrshire and Arran will leave only two A and E units in the south-west—one at Dumfries and one at Kilmarnock. That is fundamentally wrong.
As a result of the flaws in the consultation process, many people in the northern part of Ayrshire are unaware of the increased journey times that they will face when visiting family or attending for elective surgery at Ayr hospital. There will be much unhappiness about that in future.
I regret the decision to proceed with the planned closure of the A and E unit at Ayr hospital. It is utterly the wrong decision. I urge Parliament to support the motion in Nanette Milne's name and overturn the decision, which, in the view of my constituents and many health professionals in Ayrshire, will cost lives.
I move,
That the Parliament does not accept the case put forward for the closure of accident and emergency units at Ayr Hospital and Monklands Hospital; recognises the real dangers of the proposals for accident and emergency provision in Greater Glasgow, and calls on the Scottish Executive to re-examine its decision to approve these closures.
I am sometimes depressed and often disappointed by the jaded, ill-informed arguments that I hear from Opposition members who either do not understand or choose to misunderstand how we need to respond to the increasing demands that are placed on our national health service. We need to ensure that the NHS provides high-quality, effective services now and into the future. "Delivering for Health" addresses Scotland's long-term health needs and shapes services to meet the needs of all communities.
When we debated the Kerr report and "Delivering for Health" back in 2005, I hoped that we had found some consensus on some big issues. The publication of the Kerr report was broadly welcomed, and when we debated our response to it in October 2005, in the "Delivering for Health" debate, members voted in favour of the Executive's position by 70 votes to 20.
There was widespread agreement about the key principles for the future of our services in Scotland: shifting the balance of care into communities; tackling health inequalities by anticipating and preventing ill health; streamlining emergency care, which is very important in this debate; and providing the majority of care closer to communities in community casualty facilities, which John Scott did not even have the courtesy to mention, while more specialised A and E units deal with more serious cases.
Will the minister give way?
I will not give way.
There was also agreement on separating planned care from emergency care, so that we make the best use of services, facilities and staff, cut down on cancellations, reduce waiting times and manage staff in a way that is better for patients and better for them.
I would like to remind members of what they have said in the chamber. Nanette Milne said that she commended Professor Kerr
"for his excellent report… Given that it is a long time ahead, how quickly can we expect to see changes in the services and local services being put in place for patients?"—[Official Report, 25 May 2005; c 17161.]
She also said:
"The Kerr report … addresses the most fundamental issues that face the NHS today."
Will the minister give way?
Sit down, Mr Scott.
Nanette Milne continued:
"We, like the Executive, are very positive about much of the report."—[Official Report, 27 October 2005; c 20039.]
That was the Tory spokesperson's view.
Shona Robison said:
"I welcome the report and pay tribute to those who have been involved in its production."—[Official Report, 25 May 2005; c 17160.]
She also said:
"If the minister ensures implementation and delivery, he will have our full backing on the broad thrust of Kerr."—[Official Report, 27 October 2005; c 20038.]
Mary Scanlon said:
"This is an excellent report".—[Official Report, 8 June 2005; c 17750.]
Adam Ingram acknowledged
"that most, if not all, of us can agree with the prescription that Kerr gives us for the reconfiguration of the NHS in Scotland."—[Official Report, 18 May 2006; c 25764-5.]
I want to make one point about interventions. I have five minutes—the Conservatives, not me, decided how much time was available for the debate—so I will not take any interventions.
Those are all fine words from Opposition members, but they do not have the backbone to make the tough decisions in the best interests of patients throughout Scotland. We have to get behind the NHS, guarantee its future through action and implement the proposals that members said that they would gladly welcome.
John Scott comes late to this debate. He has absolutely nothing to offer. I want his constituents to know that they will get from me—
On a point of order, Presiding Officer. The minister has made it clear that he is not taking interventions, but is he duty bound during the debate to respond to the damning figures given by John Scott in his excellent presentation of the motion?
I am sorry. That is a political comment, not a point of order.
I do not think that John Scott mentioned the £40 million investment in Ayrshire health services or the five community casualty units that will be opened in Ayrshire—
What about the waiting lists?
Order.
As I said, John Scott comes late to the debate. I will respond to every one of the postcard campaigners whom he supported, and I will give them my assurances that the service changes in Ayrshire are in the best interests of the community.
It is easy to make political points through alarmist statements—the Tories and the Scottish National Party are very adept at that—but it is more difficult to make decisions that are based on the best interests of patients and the NHS.
Will the minister give way?
No.
That is because it is always difficult to make changes locally. They are not universally popular at the time but, as we all know from the Kerr report and "Delivering for Health", they are right and in the best interests of patients and our NHS.
The decisions on A and E services have been particularly difficult, and I do not underestimate the strength of feeling in local communities about the changes. The changes that we must make must provide a sound basis for the delivery of safe, sustainable and high-quality services into the future. The proposals make the Kerr principles—which members supported—a reality.
In taking such decisions, we have been accused of having blood on our hands by some in this chamber. I put it to John Scott and others of his ilk that they should examine their consciences. They are the ones who are proposing to perpetuate a service for communities that is sub-optimal—a service that is not all it can or should be. The Executive will not do that.
It is self-interest at its worst. It is blatant short-termism and puts patients at risk. Time and again, we see the Opposition supporting the principles of change but then campaigning against them when tough decisions are needed at a local level.
I do not stand alone in that view. Peter Terry, chairman of the British Medical Association in Scotland, recently said of "Delivering for Health":
"As we near the 2007 … elections, the various parties will present policies for their vision of the NHS in Scotland. It is therefore vital that they do not deconstruct the various parts of this strategy, picking and choosing elements upon which they campaign for or against, including hospital closures and service reorganisation. This strategy is a package and to break it apart would be to return to the old problems that have dogged the NHS for too long."
That is sound advice from the leader of Scotland's doctors, and it would be a foolish politician who did not heed it. I know where I stand—for the interests of patients, for the NHS and for the future of Scotland.
I move amendment S2M-5389.3, to leave out from "does not" to end and insert:
"reaffirms its view that Delivering for Health provides a coherent and consensual basis for service change in NHS Scotland; notes the support expressed in previous debates by Members from across the Parliament and health stakeholders for key aspects of the policy, including promoting local access to services and balancing local delivery with the need to have centres of excellence that provide high-quality, modern, specialist care, focusing on primary care services, separating scheduled and unscheduled care and providing community casualty units; commends the progress being made to implement the key directions set out in Delivering for Health; supports the unparalleled investment in health and health improvement made by the Scottish Executive; welcomes the requirement for investment in primary care and in community casualty services before changes are made to existing accident and emergency services; commends the hard work and outstanding commitment of NHS staff to new and flexible ways of working needed to provide modern and responsive services; supports the principle of a modern, well-resourced NHS in Scotland, free at the point of need, and believes that any necessary changes in the NHS in Scotland should be based on the needs of local communities."
I welcome this debate, but perhaps a bit of new year's advice to the Minister for Health and Community Care is that he should calm down a little.
The debate follows on from a similar debate that the Scottish National Party brought to the chamber last September to highlight the folly of further cuts to Scotland's A and E units.
The consultation processes in both Lanarkshire and Ayrshire have been accepted by many in the chamber as little short of a sham. The clearly expressed views of the public have been ignored and it is apparent that decisions were taken before the consultation process even began.
In our submission to the Kerr review, the SNP was clear that we regard A and E not as a specialist service but as a core service that must be delivered as locally as possible. Although there is consensus on some of the Kerr recommendations, there is not agreement on all of them. As I and many others have said, the interpretation and implementation of the report are the critical issues.
Ministerial approval has now been given to plans by NHS Ayrshire and Arran to close the A and E unit at Ayr hospital, centralising all emergency services at Crosshouse hospital in Kilmarnock. That is despite the massive opposition that John Scott outlined. Health professionals have also been at the fore of raising concerns about the potential impact on patients, given Ayrshire's geography and the current use that is made of local A and E facilities. Switching to Crosshouse, which would be the only specialist casualty unit in Ayrshire, could add at least 30 minutes to some patients' journeys. Therefore, we believe that there is a strong case to be made for retaining two A and E departments, one at Ayr hospital and one at Crosshouse hospital.
That is not to say that community casualty units are a bad thing—they are not, but neither are they a replacement for core, well-located A and E services. Community casualty units should be regarded as a supplementary service, particularly in rural areas, to take some of the strain off under-pressure A and E departments.
As we know, Monklands has one of the best performing A and E units in Scotland. It meets the four-hour waiting target in 94 per cent of cases and only four years ago received investment of £4 million to develop innovative ways of delivering accident and emergency services. The hospital serves some of the poorest communities in Scotland. As those communities have some of the lowest levels of car ownership, that makes it difficult for people to travel to alternative sites. There were more than 17,000 emergency admissions in 2005. Many of those people will have to be transported across Lanarkshire by ambulance, which will put enormous pressure on the ambulance service.
The move will have serious knock-on consequences for the other Lanarkshire hospitals, which are already experiencing pressures. Monklands has one of the busiest A and E units, and the second busiest is in Wishaw. Only last year, we released figures that showed that Wishaw general hospital was running at more than 20 per cent overcapacity. The pressure came to a head only this week, when Wishaw had to close its doors, taking only the most severe emergency cases. How much worse would the situation be if there was a repeat of those winter pressures with only two A and E units operating in the area? The change is extreme folly given the pressures on services—and that is before we think about the pressures on Glasgow royal infirmary and the new-build hospital at Larbert.
These are bad decisions and the Executive should think again—but let me be absolutely clear: if it does not, an SNP Government will think again on both proposals. We will go further by addressing the democratic deficit in heath boards by putting local people at the heart of decision making in the health service.
I move amendment S2M-5389.2, to insert at end:
"particularly in the light of recent events at Wishaw General Hospital which was forced to close its doors to all but the most severe emergency cases."
I am dismayed at the attitude of the minister, particularly given the reports that we have had of patients having to lie on trolleys—including a 92-year-old man who had to lie on a trolley for 13 hours. Wards are stretched to the limit and demand is overstretching capacity. I am dismayed that he did not deal with those points and that he would not take interventions from members. That kind of arrogance is likely to lose the minister his position, and I advise him against it.
The crisis that faces us in the winter is anticipated and technically planned for each year. However, this year, something has gone seriously wrong. Why? Historically, over 10-plus years, thousands of bed reductions have been made without the use of proper bed modelling and capacity planning. The minister is shaking his head, but I challenge him to produce the science and the figures. Where are the Executive papers that would show that the Executive has ever scientifically predicted capacity or undertaken bed modelling? The minister knows that the Executive has failed to do that work. Closures have taken place in the absence of proper figures and planning.
Will the member give way on that point?
I have not got much time. I want to progress.
That is all right, then.
I might give way later, if I get through my speech.
Instead of running at average capacity—which, in the 1980s, was 70 to 80 per cent—wards, particularly acute admission wards, are running at more than 200 per cent capacity. There is no slack in the system to absorb peaks in demand. That is a fact; I challenge the minister to disprove it.
In one ward at Stobhill hospital, throughput is more than double the available admission beds and staff complement. It is no wonder that there are trolley waits of 13 hours. It is a disgrace that people are waiting for patients to die for beds to be freed up. It is also no wonder that multiple transfers are being made between wards and departments. People are being woken up at 3 o'clock in the morning to move departments in order to make way for new admissions. That is not quality of care. I challenge the minister to say that it is. It is disgraceful.
I turn to the Tory motion. The issue is not only accident and emergency provision but capacity within the NHS to admit and treat patients. Indeed, the gaping omission in the Executive amendment is its failure to discuss capacity. The minister knows that I have consistently raised concerns about the Kerr report, including my concerns over interpretations, consequences and the report being all things to all people. Even if people agreed in principle with the aims of the Kerr review, we are debating not just the principles or the quality of service, but the quantity of provision. The minister refuses to discuss capacity—he refuses to do so because it is not in place. The work that the Executive needs to do is on capacity—needs need to be measured, as do the resources that are required to meet those needs. The Executive needs to deliver on that. If it does not, there will be more trolley waits and more unmet demand.
I am very concerned about staff who are absolutely run off their feet and under intolerable pressure. Over the past couple of days, I have spoken to a few of them. They said that there is little job satisfaction in being forced to apologise for long trolley waits and for having to provide less-than-optimum care. That is not what people went into the health professions to do.
I hope that the minister will speak to Jack McConnell on the subject. In Wishaw, in the First Minister's constituency, an accident and emergency department had to be closed recently, yet NHS Lanarkshire—which recognises the increased level of demand in its area due to demographic change—is to reduce emergency provision with the downgrading of Monklands, and it is making no increase in bed numbers or staff.
I support the Tory motion and the SNP amendment. Obviously, I will vote for my amendment. I am utterly opposed to the Executive's abdication of responsibility in its amendment. It is disgraceful.
I move amendment S2M-5389.1, to leave out from "and calls on" to end and insert:
"further expresses concern that hospitals are showing the strain caused by insufficient capacity with, for example, Wishaw General closing to admissions; believes that PFI costs are sucking resources from the NHS, and calls on the Scottish Executive to reverse the closure decisions and conduct an urgent review of NHS capacity with reference to meeting actual need and to abandon the wasteful PFI policy to fund capital projects."
I, too, recall the debate when "Delivering for Health", the Scottish Executive's response to the Kerr report, was published. I recall the welcome that was given from almost all quarters in the chamber to that document. Clearly and obviously, different interpretations can be made of parts of the document. Nevertheless, the tone of that debate was memorable for its cross-party consensus.
On pages 35 and 36 of "Delivering for Health", the Executive could not be clearer on the future for unscheduled care:
"in 1983, 59% of bed days were occupied by emergency patients, compared to 80% today."
That objective of reducing the number of emergency patients has not yet been mentioned in the debate. In section 3.2 of "Delivering for Health", the need for a reduction in unscheduled care is underlined. The series of actions and interventions that would be required to bring that about are also set out.
Can I take it from the member's remarks that Liberal Democrat policy in Central Scotland is to close Monklands A and E?
The decision has been taken. As I will come on to say, it is irresponsible to revisit decisions after they have been taken; doing so creates uncertainty for communities.
In "Delivering for Health", the Executive went on to say:
"We intend to redesign the model of unscheduled care throughout Scotland, building on the National Framework and the Unscheduled Care Collaborative Programme."
The actions to develop a stratified unscheduled care system included making more efficient use of limited facilities and specialised staff across the country while maintaining at the local level care for the majority of unscheduled cases.
On page 36 of the report, seven actions are set out, two of which are significant for today's debate: the Executive's commitment to
"support the development of networks of Community Casualty Units linked to appropriately staffed and resourced Emergency Centres"
and to
"allow emergency specialists to concentrate on dealing with complex cases by focusing key medical resources in well-staffed and resourced Emergency Centres".
No one who reads the report can be in any doubt about the changes that would occur as a result of its publication:
"NHS Boards and Regional Planning Groups have begun to work on these issues. They will be required to report their conclusions by the end of 2006."
The objectives were clear:
"to deliver urgent care that is tailored to individual needs locally if possible, but always safely."
Given that background, it was clear that difficult decisions would have to be taken—not everywhere, but in certain areas, two of which were Monklands and Ayr. I do not underestimate the difficulty for local communities. Substantial new investment is going into Monklands hospital. At the time of the debate on the proposed closure, I had concerns about the impact on neighbouring health board areas. However, the decision has been taken, as has the decision on the A and E unit at Ayr hospital.
John Scott raised a number of important points on the practicalities of what is happening at Crosshouse. Those issues should be addressed within the context of the decision that has been taken. To be frank, a return to the debate to reopen those issues would create further uncertainty. As the decisions have been taken, they should be implemented and made to work. For example, if there is a requirement for additional paramedics and for improvements to the ambulance service, those changes should be made. If there is to be another A and E unit in south-west Scotland, I cannot see that locating it at Ayr is as appropriate as locating it further to the south.
The decisions on the two locations that are mentioned in the motion have been taken. It is now important that everyone gets on with the job of ensuring that there is proper emergency, unscheduled care in those areas.
The review of emergency and unscheduled health provision in Ayrshire and Arran has not been an easy process. As we all know, it is never easy when hard decisions must be made.
It is unacceptable that some members, in particular John Scott, refuse to see or even consider the big picture for the 310,000 people who live in Ayrshire and Arran. John and his colleagues continue to wave shrouds and focus on accident and emergency services at one hospital. I remind the chamber of a comment made by Nanette Milne in the debate on the Kerr report. She said:
"We welcome the focus of Professor Kerr's report on primary care services".—[Official Report, 9 June 2005; c 17779.]
Do I take it that the Tories have changed their minds and want to deprive local communities of enhanced primary care services?
Will the member give way?
Will the member take an intervention?
Our health service is more than buildings. It is about meeting the needs of patients. That means delivering the highest quality care in the most appropriate facility, which is not always a hospital building.
I correct Shona Robison in relation to the consultation that was undertaken in Ayrshire and Arran. The process met the criteria of the Scottish health council. The process of lay involvement in the evaluation of the options within Ayrshire and Arran was novel. I will quote from some of the people involved in the process. Mrs Collins of Girvan said:
"It was about securing health services for the whole of Ayrshire and Arran—it couldn't become personal."
Mr Gallacher of Troon, one of John Scott's constituents, said:
"Although accident and emergency services as we know them may close at Ayr hospital, what is being proposed in their place with centres at Girvan, Irvine, Cumnock, Ayr and Kilmarnock should be a more local and better service, serving more."
They were able to see the big picture and put patients first. Why can John Scott and the Tories not do the same, or is his approach just intended to prevent a hospital candidate from standing?
When the Minister for Health and Community Care announced his decision just before Christmas, he identified issues that he wants NHS Ayrshire and Arran to take forward. I fully support him in his desire to improve transport links. I welcome John Scott to that debate. The issue was raised by all the people who responded to the consultation in Ayrshire and Arran.
Will Margaret Jamieson give way?
The decision to make £150,000 available over two years to NHS Ayrshire and Arran to enable infrastructure to be established is very much welcomed.
The minister's decision also provides for £30 million to be made available to NHS Ayrshire and Arran over four years from 2009. That is over and above the normal capital allocation. It is to be spent on improvements to theatres and a much welcomed integrated cancer unit at Ayr hospital. That means that the theatre project will be delivered a year ahead of schedule and the integrated Ayrshire cancer unit will be delivered two years ahead of schedule.
Are the Tories seriously prepared to jeopardise that welcome improvement in care and outcomes for the 310,000 people in Ayrshire and Arran through their continued blinkered view? The people of Ayrshire and Arran deserve the best possible health care and only this Labour-led Executive will deliver that.
I will concentrate on the proposed closure of Monklands A and E unit in Lanarkshire. Given the minister's comments, it is worth setting this debate in the context of the wider debate on service reconfiguration, which—let us be clear—has been triggered by the Labour-Liberal Democrat coalition's failure to anticipate the need for change, consult widely and appropriately, drive service change and conduct effective workforce planning. As a result, NHS boards have had to undertake, as a matter of urgency, reviews of service provision and delivery that take into consideration local and regional needs. It is therefore a disgrace that those failures are now being compounded by decisions taken against the background of a flawed consultation, which took no account of the overwhelming opposition to the closure from Lanarkshire's population at large and the potentially disastrous consequences.
The arguments for the retention of three A and E departments in NHS Lanarkshire have been well rehearsed in the chamber, but that does not make them any less compelling.
Lanarkshire's unique geographical considerations, congestion problems and poor transport links all confirm the necessity to retain three A and E departments. Furthermore, each of Lanarkshire Health Board's three assertions on which the decision not to retain three A and E departments was predicated—the financial viability, the anticipated staffing problems and, best of all, the Walter Mitty-type assertion that the closure of one A and E department would result in the delivery of a better standard of care—have all been comprehensively shot down in flames.
Will the member give way?
I am sorry, but I do not have time for any interventions.
Nonetheless, the decision to close the A and E department has been approved by the minister, who has taken no account of the opinion of numerous members of the medical staff who do not believe that there is evidence to support the decision. Their arguments reflect the work of Dr George Venters, a former consultant in public health medicine in Lanarkshire, which shows that closure would not only be against the interests of the people in the west of Scotland but would further deprive communities who need services most and would have serious consequences for all other Lanarkshire hospitals as it would increase already significant pressures on them for access to acute hospital beds and other services.
Those were prophetic words, given the pressure on Lanarkshire hospitals over the festive period. On 28 December, Hairmyres hospital A and E department, in the minister's constituency, had so many cases, ambulances and people arriving for treatment that although it did not officially close its doors to new patients they had to be directed to the A and E department at Monklands hospital. That creates real uncertainty for the future, Mr Robson. The consequences for acute hospitals would be similar to those in adjacent health boards, such as Greater Glasgow and Clyde Health Board and Forth Valley Health Board, where the valid concerns that have been expressed have been accepted. I commend the decision by Greater Glasgow and Clyde Health Board and now call on the Scottish Executive to go back to the drawing board. I therefore have much pleasure in supporting the Conservative motion before us today.
Andy Kerr's announcement in Christmas week that he approved the local health board's plans to downgrade Ayr hospital's A and E department came as no great surprise. The timing was certainly cynical, but that is par for the course for the Executive on this issue.
The substance of the announcement was also entirely predictable, given that the health board had claimed throughout the review process that it was adhering to the Executive's policy.
Nevertheless, the minister's announcement was still a severe shock to many people, not least the many community groups that had made direct representations to the minister and believed that they had got across to him both the depth of feeling against the proposals and the real risk to life and limb involved in such a decision. The sense of betrayal felt by the Ayrshire public served by Ayr's A and E unit is now palpable and I will be very surprised if the Labour vote at the forthcoming elections does not suffer accordingly.
What is clear now is that the only hope of saving Ayr's A and E unit comes in the form of an incoming SNP Administration on 3 May. Of course, Labour candidates will try to sweeten the bitter pill by insisting that no changes will be made to Ayr A and E unit until all the community-based facilities and services that have been promised are in place. Both the minister and the health board have made that pledge but, frankly, it is not worth the paper that it is written on. It will carry no weight with a public sickened by a sham consultation process, in which overwhelming public opposition—55,000 signatures on a petition, protest marches and the like—made no impact. I say to Margaret Jamieson that, as the Scottish health council pointed out in its report on the process, the board failed to consult on all feasible options and instead promoted its own preferred option. People are not stupid. They recognise a fait accompli when it is shoved in their faces.
The minister can protest all he likes about his pledge. If it were genuine, he would announce a moratorium on A and E downgrades for the next parliamentary session. By all accounts, community casualty facilities such as the proposed new hospital at Girvan will not be built—far less fully operational—until 2009. It will take several years for new staff to be recruited and trained to provide the promised new services. There is no way in which those services can be put in place without deploying existing hospital staff, including A and E staff. I did not come to my own conclusions on that. That informed view was provided to me by no less an authority than Professor David Kerr, when, along with MSP colleagues, I met him to discuss the health board's proposals last year.
When he is making his pledge, the minister knows that existing A and E staff will be looking around for jobs with better prospects as of now. Once they move, it will be extremely difficult to recruit for an A and E department in its last days. There will be no stability at Ayr A and E over the next few years. The minister is adding insult to injury with his handling of the issue. I trust that his party will pay a heavy price in this year's polls.
The important factors that have emerged from the debate are that everyone is uncertain and that capacity is important. I have been going around the casualty and intensive care departments in Glasgow and the importance of capacity shines out. Staff in intensive care say that they should not work above 75 per cent capacity. Staff in ordinary wards say that they should not work above 82 to 85 per cent capacity. Every new hospital reduces its beds and we think that we can put everything into the community—we cannot. A small percentage of patients will still need to be seen in a hospital bed. If we want to reduce the work of an A and E department, we must support primary care, where 98 per cent of the work of the NHS is carried out.
Working at its best, primary care can reduce the work of any hospital but that can be done only if we have highly experienced nurses, doctors and other skilled staff. It is about teamwork, and there should be a good skill mix. I am anxious about whether, with agenda for change, the skill mix and the highly trained staff will be there to do the work that needs to be done in order to keep people in the community. Patients are increasingly discharged quickly from hospital into the community. The community is not a Nightingale ward. It is difficult to look after people in their homes unless we have highly qualified staff.
We have a situation in which there are trolley waits and in which patients are moved from their beds in the middle of the night to make room for other patients. The more frequently we pass people around a hospital, the more we increase cross-infection. It should not be done. There are other problems, such as influenza, cases of which have been increasing. Wards, and even hospitals, are being closed, not only because of MRSA but as a result of influenza and Clostridium difficile. We should consider the number of buildings that we have and the ability to barrier nurse. Despite some patients having influenza and other conditions, they should still be admitted to hospital.
I will tell a little story from when I was a doctor. While I was doing my rounds in the middle of a summer epidemic of diarrhoea and vomiting, I visited three children in one household who all had the same symptoms. However, something made me go back and check one of them, and he had appendicitis. I was very glad to send that child to hospital—I knew that they would not like me, because he had diarrhoea and was vomiting; he would not be a welcome patient—but it saved a life.
Numbers are important. We were told that A and E figures in Glasgow were dropping by 20 per cent. Professor Stewart-Tull, from the north Glasgow monitoring group, has looked at the figures. For 2004-05, the figure for A and E in Glasgow was 147,430. In 2005-06, the figure was 155,486. In 2006-07 the figure of 155,074 is a little bit down but is still roughly the same. If the minister gets incorrect information from a health board, how can we plan? It is totally irresponsible. If we do not check decisions, we end up feeling foolish and people suffer. I am truly surprised that we do not act as caring human beings. There should be cross-party recognition that something is wrong.
We have not got transport right. The Erskine bridge is closed today, and was closed the day I went to see the Golden Jubilee hospital. The downgrading of Monklands A and E is having a knock-on effect. The closure of other hospitals in the area will swamp Glasgow. Glasgow royal infirmary cannot cope. The Executive must re-examine its decisions.
Unfortunately, I am not sitting close enough to the Tories to see whether their tongues are actually in their cheeks. That the Conservatives should raise concerns about the state of the NHS is astonishing given the extent to which they undermined it during the terrible Thatcher and Major years.
Will the member take an intervention?
Mr Scott took no interventions, so I am not prepared to take one from him.
Like the people of Scotland, I am clear that the Tories failed the NHS during their reign in the 1980s and early 1990s. Repeated underfunding left the NHS estate in a dreadful physical condition, with demoralised staff, ever-lengthening waiting lists and inadequate information technology systems. The Tories steadfastly refused to acknowledge the link between poverty and ill health and, as a result, the poorest people of Scotland suffered. The Tories' attempts to impose a market philosophy on the NHS only helped to exacerbate the so-called postcode lottery of care.
In contrast, since Labour came to power, spending has risen in the NHS and the results are flowing from that. Since 1997, hip replacements have increased by 37 per cent, cataract operations by 58 per cent and knee replacements by 104 per cent. Labour investment has resulted in a significant increase in the number of nurses, midwives, occupational therapists and doctors. In fact, compared with 1979, we now spend an extra £902 on the health of every man, woman and child in Scotland. That is twice what was being spent on our health service when we got rid of the Tories. It is therefore difficult to suspend my disbelief sufficiently to take the Tory motion seriously, especially since, during their years in government, they closed hospitals.
The Tories closed Dunfermline maternity hospital. They closed Bellshill maternity hospital and relocated it to Wishaw—which has led to some of the current decisions in Lanarkshire.
Let us give the Tories the benefit of the doubt. There are some parts of the Tory motion with which I agree. However, as with the Scottish National Party debate in September, I do not feel that the motion goes far enough in relation to the decision at Monklands. Whereas the Tories called for the re-examination of the Executive's decision, I and my colleagues Elaine Smith and Cathie Craigie firmly believe that the Executive should reverse that decision. When it was made, we firmly believed that it was the wrong decision and we still hold that opinion. Following the recent temporary closure of Wishaw general hospital, I must raise my continued serious concerns about the wider impact of the decision to downgrade Monklands A and E. Significantly increasing the size of an already overstretched A and E at Wishaw can do nothing other than worsen the problems faced at Wishaw this week. We have no guarantee that Wishaw general will have sufficient capacity to deal with the increased demand generated by the closure and relocation of Lanarkshire's busiest A and E or any other "unprecedented" surges in demand.
I urge the minister to consider the matter closely and to reverse his decision to downgrade Monklands A and E. Cathie Craigie and I also joined Elaine Smith in asking the Auditor General to examine the decision by NHS Lanarkshire and the minister. We await the Auditor General's comments.
Like the Tories' stance, the Scottish National Party's position on this subject is at best confused and at worse disingenuous. The SNP signed up enthusiastically to the Kerr report's central recommendations, but its members now wish to distance themselves from any change whatsoever, purely for electoral gain. Where change is proposed on the ground, rather than in theory, the nationalists revert to their default position of opposition, always telling people what they want to hear.
I recognise the implications of the Kerr report. Sometimes, difficult decisions will have to be taken. Let me be clear, however: in the case of Lanarkshire, I believe that the wrong decision has been taken, and I stand by that position today.
I will not comment in detail on the merits and demerits of the examples in Lanarkshire and Ayr to which the motion refers, because I wish to address the broader issues of which the units there are examples. The overarching issue is one of trust: trust between communities and their local NHS; trust that services will be there when they are needed; and trust that consultation is genuine.
It is true that the NHS must continually evolve. Many hospitals are located where they are for purely historical reasons, which might not reflect current needs. The modern drive to keep people out of hospital is desirable for many reasons, the emergence of hospital superbugs being only one. There are limits, however. We cannot reduce the need for hospital beds indefinitely, especially given the fact that the population is aging and, regrettably, getting fatter and less fit.
The Kerr report suggested that the NHS would need to be redesigned to meet people's needs and expectations. However, the expectations of local communities might not always accord with the plans of health boards. When a facility is earmarked for closure, the phrase that is often used is that it is "no longer fit for purpose", but there might not always be a shared understanding of what that purpose ought to be. The other issue to do with trust is that of what replaces any facility that is to be closed. It is fundamental that whatever replaces it must be up and running before the closure.
I will mention a case in my own region, of a care-of-the-elderly facility at Glencoe hospital in Lochaber. It is an old-fashioned building, and it is no longer considered, in the usual phrase, to be fit for purpose. Naturally, however, the local community does not wish the services that the hospital provides to be lost. At least NHS Highland has pledged not to close the facility until alternative accommodation is found for the patients who are currently cared for there. Talk of extra support to keep people at home, although that is welcome, does not quite sound like a replacement for the sort of facility the need for which—given the aging population—will not go away.
The drive to keep people out of hospital is welcome, as I have said, and so is the principle of treating people near home. People need reassurance, however, that the facilities to do that are in place. The Executive amendment mentions "high-quality, modern, specialist care". More modern health care would make much more use of tele-medicine, avoiding the need for patients to travel to specialists or vice versa. A modern NHS would have more specialist nurses and allied health professionals. For instance, there is currently just one cystic fibrosis physiotherapist for the Highlands and Islands, who is playing a vital role keeping patients out of hospital, but whose work is hugely overstretched—they are simply unable to cover a ridiculously large case load adequately.
Does the member accept that, in those areas that are further advanced with health care changes, such as Fife, the promises of increased investment in local facilities have been met and new technology is being used to prevent people having to move? Will she therefore accept that the Executive is meeting the trust that she mentions as necessary?
In rural areas, there is still a long way to go to convince people that they will not have to travel increasingly long distances to centralised facilities to get the specialist care that they need. Tele-medicine link-ups from general practices to central hospitals should be in place. That is the norm in lots of other European countries. It is the norm, for example, in northern Norway, as some members saw on a visit there to discuss remote and rural medicine. It is not the norm here, but it should be. I want us to go in that direction, but I am sorry to say that I see no evidence that it is happening.
The Executive amendment states:
"any necessary changes in the NHS in Scotland should be based on the needs of local communities."
That brings me back to the point about trust that I made earlier. Sometimes, it is necessary for the architects of service delivery to learn to trust communities to know what their own needs are. We have to remember, after all, who the NHS is there for.
I will speak more within the terms of the Executive amendment, very much in the style in which Eleanor Scott has just addressed the issues. The debate is about change. Three or four years ago, there was a big question mark over accident and emergency services in Caithness. There has been change since then. Like Christine May, I believe that it has been a change for the better. In response to what Eleanor Scott said, I believe that change is being delivered locally.
There have been improvements, including on the A and E front. There have been extra ophthalmologists, an expanded renal unit and a new computed tomography—CT—scanner at Caithness general hospital. Minor surgery services and enhanced service contracts have been put in place. That is what the minister and others have been talking about: trying to deliver services in the general practitioner's clinic, rather than clogging up acute beds in hospitals. I think that that is working.
In Caithness, there has been a change since the time when there was a question mark over A and E services. There is now a greater sense of ownership of A and E services in the far north. Referring to the NHS team that is headed up by Sheena Craig, I believe that the community health partnership is delivering. There has been improvement, but we must build further on that improvement—I could not continue without noting that, and I continually make that point to ministers. That is very much to do with something that is close to my heart: the better the medical services and the more they improve, the better the economy of Caithness.
I listened to John Scott discuss transport and communication problems. Members can imagine the bigger challenges that exist in my constituency. John Scott would be more than welcome to come north, and I could gladly show him, as a friend, what is being done there.
One big problem that I will bring to the attention of ministers is that, in Sutherland, the Scottish Ambulance Service seems not to be going the right way at all. There has been a change from double manning to single manning of ambulance services there. If I had a heart attack in Tongue, the ambulance would probably come from Kinlochbervie and it would take quite a long time to get to me. If one member of the ambulance crew was on leave, it might just be a single person who would come. That would be no good for getting me to hospital in Wick, so another ambulance, from Bettyhill, would need to be called out. Sandy Mackay, who is a councillor in north Sutherland, was caught in that trap. He had a nasty heart attack, and he had to wait for an excessive amount of time.
Doctors have been making a point that The Northern Times conveys eloquently:
"‘Bean-counting' is putting north lives at risk".
Jamie McGrigor and Eleanor Scott will be acquainted with that article, which was published on 1 December. The doctors in Sutherland have put the matter concisely, saying that the backwards step that has been taken in relation to ambulance services could be life threatening. That is pertinent to the issue of transport that has been raised.
On other fronts, there has been a genuine improvement in services. It is a matter of change, as I have said, and I believe that, as MSPs, we are right to recognise the necessity for change and to work with that change. At the end of the day, services are better, and I believe that my constituents know that.
I will pick up on a couple of issues that I did not manage to address during my opening speech. I will at some stage during this speech let Phil Gallie intervene on me, if he is so minded.
My amendment refers to the private finance initiative situation in Lanarkshire, where the health board has the second-biggest expenditure in Scotland in terms of its commitments to fund PFI projects—it comes to a total of £42.7 million due in 2006-07 alone. Much of that money goes in dividends to shareholders, rather than being invested in public services. It is no wonder that, in the words of three Unison colleagues who recently wrote to Tim Davison, chief executive of Lanarkshire NHS Board, NHS Lanarkshire is fast becoming the private sector "jam pot" of Scotland, given the threatened takeover of general practice by Serco.
The concerns are genuine. It has been demonstrated that PFI sucks resources from the NHS, and I believe that it has compromised the ability of NHS Lanarkshire properly to plan services on the basis of need, rather than on the basis of predetermined financial commitments and contracts that last for many years. Elaine Smith has done a lot of work in that area, and I concur with some of Karen Whitefield's comments on the subject. I, too, have written a letter to the Auditor General and I have supported Elaine Smith in her efforts. I am pleased that she is confirming her commitment to opposition to, and reversal of, the decision to close Monklands hospital. My amendment refers to reversing the decision. I hope that Karen Whitefield will support it, but if she will not, why did she not lodge her own amendment to make it clear that the decision should be reversed—if indeed that is her position?
I thank Carolyn Leckie for her generosity in giving way.
On the closure of the accident and emergency units, John Scott laid out a series of facts about what is happening on the ground and Carolyn Leckie has referred to capacity issues. Why does she think the minister closes his ears and eyes to the facts of the matter?
The minister should answer that. He should be well warned not to close his ears to the voices of patients and staff. What is being said is not hyperbole but reflects what is happening, which has been reported in the papers in the past few days. The minister should get his information directly from staff, rather than accept the advice that he is being given, which is wrong.
Karen Whitefield quite rightly had a go at the Tories about their market-based reforms and the problems that they have caused, but I find it astonishing that she does not understand that the Executive has brought in its own market-based reforms of the NHS. Is she aware that it has brought in practice-based commissioning via the Kerr report and implemented joint ventures and local improvement finance trusts through the Smoking, Health and Social Care (Scotland) Act 2005? Unfortunately, she did not oppose any of those market-based reforms. The Labour-led Executive is still punting the ideology that the Tories introduced.
I return to the current short-term situation and the crisis that we face. The minister attacked the Tories for the time that they have allocated to the debate, but is he prepared to provide more time for Parliament to discuss the matter? Is he prepared to make a statement to Parliament on issues associated with the projected increase in the incidence of flu, which has not peaked yet? Judging by my sore head and aches and pains, it is about to peak in me.
Where is the planning? In Stobhill hospital, ward 13B used to be allocated for overflow in winter, but it was not available this year, because it has been stripped down and is being prepared for closure. All the equipment has been removed and the sluice has been stripped, so the ward is not available to meet the increased demand. Why? I look forward to discussing the matter in more detail, because it needs to be addressed urgently. I emphasise that the minister must provide more time in Parliament and that he must at least make a statement on the matter.
The last time we debated this issue, I mistakenly thought that if I and some other people voted in a particular way, it would allow the position at Monklands to be improved in the future. That proposition unravelled, as clever schemes often do—I should be old enough to know that. I was left voting in a way that made me extremely unhappy. Today, we will have a re-run of that.
The minister quite rightly sets out his stall about his strategy and all the good things that he is doing. One can have a good strategy but, within it, make bad decisions. Lord Raglan's strategy to defend his base at Balaclava was sound, but particular decisions caused the light brigade to charge the wrong lot of guns. NHS Lanarkshire is busy closing the wrong hospital; it is making a bad decision.
The minister's amendment states:
"any necessary changes in the NHS in Scotland should be based on the needs of local communities."
We all agree with that. The question is to what extent the wishes of communities are taken into account in assessing their needs. As Eleanor Scott said, we should pay more heed to the wishes of local people.
Will the member clarify the Liberal Democrat policy? Are the Liberal Democrats opposed now to the closure of Monklands accident and emergency unit, or are they opposed to the closure of any accident and emergency unit in Lanarkshire?
Euan Robson quite rightly argued that, whether we like it or not, the decision has been made and we should get on with doing things as well as possible in Lanarkshire. As Alex Neil knows, some people argue for keeping three accident and emergency units in Lanarkshire and some argue for keeping two, of which Monklands would be one. I could support either argument. I support having a unit at Monklands because the unit there works well. It is efficient and it is in the right place, given that it is in an area of maximum ill health. It is clear to me, as an elected representative, that there is widespread feeling throughout the parties, which Karen Whitefield articulated, against the closure. The question is what we should do about it. If we feel that a bad decision has been made, how do we set about trying to improve the situation?
There are issues surrounding how we run our health services. Apparently, nobody who was involved in making the decision paid any heed to the potential effect on the new hospital in Larbert and hospitals in Glasgow. We regard each health board area as an island—we have to sort that out.
We also have to give some thought to our procedures in Parliament. It is difficult to vote against Andy Kerr's amendment, but if it is agreed to, that will prevent Parliament from voting on whether it thinks the two accident and emergency units should close. It might be beyond the wit of man to come up with a rule to the effect that amendments must be relevant to the motion, but we should consider it, because the public expect us to have a view, whatever it may be. I am not in any way accusing Andy Kerr of doing something wrong. Amendments are worked out for party-political reasons, but they often have little to do with the motion and can prevent people voting on the issues that they raise. We should consider that procedural issue. There is a problem for those of us who think that Andy Kerr's amendment is sensible, but who are unhappy about the closure of Monklands or Ayr accident and emergency units. We will have to sort that out individually.
We now know that the Liberal Democrat position is that they are, having been hoodwinked in the previous vote, prepared to be hoodwinked in this vote. From the tone of the minister's opening remarks, it is clear that he is still smarting from having lost the campaign to keep Rhona Brankin out of the Cabinet.
When the Labour Party was elected in 1997, the message in its final campaign press conference was that we should vote Labour so that we could save the national health service by Friday. In the run up to the Scottish Parliament elections this year, the slogan must be, "Vote to save the Scottish health service on 3 May." Although Donald Gorrie said that the decision to close the accident and emergency units has been taken, a new Administration after 3 May could reverse that decision and keep both Ayr and Monklands accident and emergency units open. That is why Alex Salmond, Nicola Sturgeon, Shona Robison and the rest of the Scottish National Party have given an unequivocal commitment that if we form the Administration, possibly with other parties, after 3 May, we will keep both Ayr and Monklands accident and emergency units open. We will do that for the simple reason that we, unlike Labour, are not prepared to risk life and limb in the name of PFI.
People ask me on their doorsteps about all the extra money that is supposed to have gone into the health service in the past 10 years. The boast, which is quite right, is that the amount of taxpayers' money that is going into the health service has doubled. The budget for the health service in Scotland is edging quickly towards £10 billion a year, so how is it that, on the one hand, all that extra money is going into the health service, but, on the other hand, the Executive is proposing to close six of the 15 accident and emergency units in central Scotland?
The answer is that so much of that money is wasted on PFI and on profiteering. As "Frontline Scotland" pointed out four weeks ago in its programme "In Sickness and in Wealth", the decision in Lanarkshire has nothing to do with consultants' capacity or bed capacity, and it certainly has nothing to do with the wishes of the people of Lanarkshire. Their wishes have been articulated not just by me but by my good friend John Reid and his good friend Tom Clarke, both of whom will have to vote SNP on 3 May if they want the accident and emergency unit at Monklands to remain open. The decision had nothing to do with health policy and everything to do with finance and PFI. If the accident and emergency unit at Monklands had been funded through PFI, it would not be closing. The decisions that have been made are all about the need to protect PFI—a profiteering policy that was introduced by the Tories and which is now sustained by the Labour party in government.
For 30 or 40 years, Labour lived off its reputation as the creator of the national health service, but Nye Bevan must be birling in his grave when he listens to Andy Kerr. Nye Bevan created the national health service, but, as far as accident and emergency units are concerned, Andy Kerr is butchering it.
I will tell Alex Neil what I am going to say to Nye Bevan if I get the opportunity to speak to him somewhere else. I will tell him what we have done under our leadership of the NHS. Under the Tories, 10,981 people in Scotland waited more than six months for treatment, but now no one waits that long. Under the Tories, more than 20,000 patients waited more than 19 weeks, but now there are only 3,300, and they will soon be gone from the list.
I will tell Nye Bevan that cataract operations in Scotland are up by 62 per cent, that angioplasty operations are up by 260 per cent, that hip-replacement operations are up by 41 per cent and that knee-replacement operations are up by 113 per cent. I will tell him that the number of consultants is up by 29 per cent, that the number of doctors in training is up by 26 per cent, that the number of registered nurses is up by 13 per cent, that the number of student nurses in training is up by 47 per cent and that the number of allied health professionals is up by 34 per cent.
I will tell Nye Bevan about the £850 million programme that is rebuilding the Glasgow health service. I will tell him about the specialist accident and emergency centres in the city and the five minor-injuries units that will provide services for communities. I will tell him about the new Victoria hospital that we are building and the new Stobhill hospital that we are building. I will tell him that Labour is delivering for our health service.
I will tell Nye Bevan about the new £87 million Beatson centre, which will open soon and will deliver for patients in Scotland. I will tell him that, although members in the chamber say that a hospital in Lanarkshire is closing, it is not. There is £100 million of investment in that hospital for the community.
I will tell Nye Bevan more. I will say that the Labour-led Executive is worried not about the bricks and mortar but about the health of the nation. I will tell him about the primary care initiatives that have people on aspirin to reduce possible heart attacks. I will tell him about the interventions that we are making through GPs that will change the focus of health care in Lanarkshire, prevent people from dying and stop them coming to the accident and emergency unit in the first place. That is what the national health service should be about. It is not about the bricks and mortar, as Alex Neil argues. It is he who is putting patients' lives at risk in Scotland. I have to say that that applies equally to John Scott.
Ayr hospital is not closing. There is a £40 million investment in Ayr hospital. It will have a 24-hour, seven-days-a-week community casualty facility. It will have orthopaedic, ophthalmic and neurology services. It will offer general surgery, dermatology inpatient services, specialist services such as a minimally invasive surgery unit, and diagnostic services that it did not previously have. There will be five community casualty units, which will mean that 60 per cent of patients who normally use the accident and emergency service will be able to access services more locally.
Members should not talk about closures—they should take on board Eleanor Scott's point that the matter is about trust. How can people trust the SNP and the Tories when they choose to put people's lives at risk? The Executive has delivered. Professor Sir George Alberti, the national clinical director for emergency access—in England, I have to say—said:
"We have to be upfront and tell the public that, in terms of modern medicine, some of the A&E departments that they cherish are not able to provide this type of care and cannot and will not be able to provide the degree of specialisation and specialist cover that modern medicine dictates the public deserves",
and that
"In a range of very serious emergencies … it may be better for patients to bypass the nearest local hospitals and be taken by highly-trained paramedics straight to specialist centres".
He agrees that that will mean long ambulance journeys, but states that
"long ambulance journeys do not lead to more deaths. If they did, patients in America and Australia, where ambulance journeys are much longer, would have higher mortality rates."
We will provide a better service. Lives will be saved as a result of the interventions that we make, because we will have specialist centres that provide those services.
Let us consider some of the content of the debate. I am not unhappy that Shona Robison told me to calm down, because I am passionate about saving patients' lives here in Scotland. Many points were made about current pressures in our health service and I want to try to address them in my closing remarks.
I know how hard NHS staff in Scotland are working, given the current pressure around respiratory and flu conditions, but the service model that is set out in "Delivering for Health" and in the Kerr report is exactly why we need to change the circumstances that we have today, so that tomorrow we can handle such situations more effectively and staff can care for patients more effectively. The community casualty units will divert patients away from accident and emergency units and allow trauma and accident and emergency services to continue more effectively. That is how we will provide specialist accident and emergency services.
There is significant international evidence—which is borne out by pages 36 and 37 of "Delivering for Health" and by the Kerr report—that the separation of elective and emergency care can reduce waiting times for operations and cut the number of elective patients' operations that are cancelled due to emergency patients' taking precedence. Community casualty facilities not only ensure that more care is provided locally, but allow larger specialist emergency teams to provide more effective care for patients who need it the most. The community casualty units will deal with some 70 per cent of people who currently attend accident and emergency units and they will enable the majority of people to be treated close to home. At the same time, the units will free up specialised accident and emergency services for those who need them the most.
In the clinical community, the evidence base is overwhelming. It comes from international examples and from elsewhere in the UK. We need to respond to that evidence to ensure that what we do in Scotland is right. All Adam Ingram talked about was votes, but I am talking about patients' lives and about the families of Scotland living together for longer. That is what we think about when we make changes in our national health service.
The Executive has continued to invest in our health service and to build up its professional base, but all the SNP can talk about is closures. I refer the SNP to my answer to Colin Fox's written question about the closure of hospitals, which refers to the changes that we have made to ensure that services are supplemented. The investment that we are making, the differences and the changes that we are making were all welcomed by everyone in the chamber. When it comes to tough decisions, the SNP is just not up to it. SNP members are not fit for government—they are not even fit for opposition.
On a point of order, Presiding Officer. The minister said in his winding-up speech that the Executive's reforms were welcomed by all parties in the chamber. That is not true, so will you ask the minister to withdraw that comment?
That is not a point of order. Perhaps you should speak to the minister.
It is perhaps not surprising that the debate has travelled some distance from the provision of accident and emergency services in various parts of Scotland. It is hardly surprising that, in an attempt to cover up the fact that the minister has weak arguments on the matter, he and his colleagues should seek to expand the terms of the debate.
The usual suspects have been wheeled out to point out what happened in the days of the Tory Government. It is true that, as the minister says, no hospital has been closed yet. Some are marked for closure—we are not arguing about those—but let us look at the record.
It is not the wicked Conservatives who are planning to close the accident and emergency unit at Ayr hospital—it is Labour and the Liberals. It is Labour and the Liberals who have transferred all major trauma cases and medical and surgical emergencies from Falkirk to Stirling royal infirmary. It is because of Labour and the Liberals that Monklands is set to lose its accident and emergency unit, and it is Labour and the Liberals who have downgraded accident and emergency services at Queen Margaret hospital in Dunfermline. It is Labour and the Liberals who have taken away the orthopaedic trauma unit from St John's in Livingston, and it is Labour and the Liberals who have created the mess at Stobhill hospital and will take away the accident and emergency facility from the Victoria infirmary in Glasgow.
I do not accept Euan Robson's argument—which was, to be frank, facile—that we should not revisit decisions that have been taken. When decisions are palpably and manifestly wrong, we should revisit them. I return to the question of the Glasgow accident and emergency facility. I accept the minister's point that nobody seriously argues that five units should be retained, but two units are too few, and their locations are too disparate to be other than a potential life-loser for many people.
The minister lives fairly near Glasgow and knows what the traffic is like in the south-west of the city. At rush hour, or if a game is on at Hampden or Ibrox, how on earth will we transfer a trauma case—for example, a patient who has had a coronary—from the Cathcart or Newlands areas of Glasgow to the Southern general? I do not know whether the minister has recently travelled through the Clyde tunnel at rush hour, when it is wall-to-wall metal. Such issues have never been addressed.
The consultation process was also appalling. As Margaret Mitchell and Alex Neil said, it was clear from point 1 that the solutions were pencilled in in biro. The consultation process was nothing but a total sham.
In Glasgow, opinion was not split: it was always exclusively recognised that problems would exist under the new proposals. The minister may describe the Opposition's views as "jaded" and "ill-informed", but does he apply that description to the views of the hospital consultants who queued up to point out the dangers of his proposals for the Glasgow area? The minister lacks credibility in that respect.
Like Alex Neil, as I listened to the debate unfold, my mind went back to 1997, when there were only 72 hours, 48 hours then 24 hours to save the national health service. We must accept the minister's argument that investment now is much higher than it was then, because the figures are there. However, if the units had closed in the days of the Conservative Government, Andy Kerr, Hugh Henry, Karen Whitefield et al would have patrolled up and down outside hospitals to demonstrate against the evils of the hospital closures. The stench of hypocrisy that surrounds the debate is palpable.
John Scott said that there would be blood on the hands of Andy Kerr—
Those are not my words.
Or that people would die as a result—
Those are not my words.
John Scott said that in the chamber. He said that people would die as a result of the move—
I said—
I am making an intervention. John Scott cannot intervene on an intervention.
John Scott said that people would die as a result of the move from Ayr to Kilmarnock. People said the same when the Conservatives decided to move Law hospital's facilities to Wishaw. Has what they said been true?
I seem to be responding to the intervention as a third party. John Scott did not use the phrase "blood on the hands", but he made the point that deaths could follow. That is a fair summation of what was said. The fact is that people could die as a result of delays in transferring them, although I do not for one moment suggest that the minister must budget and plan on the basis of extreme events—of course he should not. However, the figures to which Jean Turner referred show clearly that in Glasgow, two accident and emergency units and the hybrid facility that is being considered will be totally inadequate and that problems will be inevitable.
I ask the minister to examine the situation again. We are far from satisfied that the information on which the decisions were based—in good faith, I have no doubt—was accurate. It seems to be wide of the mark. As I said, the events at Stobhill hospital earlier this week show that clearly.
I will end with a quotation that appeared under the heading, "Cuts are accident waiting to happen".
"The irony is that in England, John Reid has produced an excellent strategy paper, Keeping the NHS Local, which challenges many of the centralising assumptions behind health policy in Scotland".
Who do members think that came from? It was certainly not a Conservative health spokesman. The quotation was from the late Robin Cook in an article for the Edinburgh Evening News shortly before his death. I need say no more.