Health
Good morning. The first item of business is a debate on motion S2M-4784, in the name of Shona Robison, on health.
The debate is not about saying no to any change. It is not about refusing to recognise some of the real challenges that face our health service and it is not about rejecting the Kerr report. The debate is about Parliament sending out a clear message that it believes that the process involved in Lanarkshire Health Board deciding to downgrade accident and emergency services at Monklands hospital was fundamentally flawed and that that has resulted in a deeply flawed decision.
Monklands is 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 it is the most cost-effective unit: it has had the lowest cost per attendance and the lowest increase in cost over the past five years.
Only four years ago, the facility at Monklands received a £4 million investment and it has developed some effective and innovative ways of delivering its accident and emergency services, which is all to the benefit of patients. When I visited the unit I was struck by the dedication and loyalty of its staff. They are a credit to the health service, which makes the decision all the harder to understand.
The hospital serves some of the poorest communities in Scotland, which have some of the lowest levels of car ownership. That makes it difficult for people to jump in their car and travel to the proposed alternative sites, which will have a consequent effect on the ambulance service in the area. More than 17,000 emergency admissions were made to Monklands in 2005. The fact that many of those people will have to be transported across Lanarkshire by ambulance will put the ambulance service under enormous pressure.
The move will have serious knock-on consequences for the other Lanarkshire hospitals, which are already experiencing pressures. Monklands A and E is the busiest unit. Under this proposal it will join the second busiest unit, at Wishaw, which will result in huge pressure on the service.
In June the Scottish National Party released figures that showed that Wishaw general hospital was running at more than 20 per cent over capacity. It was designed to treat 50,000 people a year, but more than 61,000 patients passed through its doors last year. Furthermore, back in April it emerged that Wishaw's A and E department had clocked up one of the longest delays recorded in Scotland when a patient was held up for almost 20 hours. It is clear to me that further reducing A and E capacity in Lanarkshire will serve only to make the situation worse, which is why we believe that there is a case to be made for the retention of all three A and E departments.
The decision betrays a lack of joined-up thinking and planning and it will lead to added pressures on Glasgow royal infirmary and the new-build hospital at Larbert. Given that NHS Greater Glasgow and Clyde is in the middle of a beds review process, the decision will impact heavily on its estimations of what is required. Furthermore, the new hospital at Larbert, which might be expected to bear the burden of referrals from the Cumbernauld area, would need to expand by 20 per cent to do so effectively. The preferred bidder has already been selected for Larbert, based on the tender needs of NHS Forth Valley alone. Best value can no longer be guaranteed if the proposed A and E services need to expand, as the preferred bidder now has an effective monopoly on any change to the plans.
What about the process? In the new post-Kerr world, the bad practice of health boards consulting on plans when they had already made their mind up was supposed to be a thing of the past; there is a duty on health boards to consult properly. The Minister for Health and Community Care stated during the debate last year:
"I expect people to be consulted about the case for change, and the options for change, long before a preferred solution is reached."—[Official Report, 25 May 2005; c 17155.]
However, it seems that the bad old days are as much with us as they ever were. NHS Lanarkshire has had a preferred solution right from the start. The consultation process was a sham that sought to sell a predetermined option to an increasingly sceptical public. The decision is unacceptable to the people who use the hospital and is viewed with concern by many who work in it. It is high time that some democracy was put back into health boards. The SNP will do that by making health boards directly elected bodies.
Why did the set of so-called options put forward by the health board all lead in one direction: to the closure of Monklands A and E? As we all know, the reasons had little to do with clinical priorities and everything to do with finance. NHS Lanarkshire is running an £8.4 million deficit, which is the worst financial performance of any board in mainland Scotland. It is clear that that deficit has been one of the driving forces behind the decision.
The other key issue concerning finance is the fact that the other two Lanarkshire hospitals were built under the private finance initiative. The fact that managers are tied into the remaining 25 years or so of the PFI contract has grossly distorted the decision-making process. All things have not been equal when the options have been weighed up in this case.
The inherent inflexibility of the PFI contracts means that the hands of policymakers are tied for years to come. The Hairmyres contract alone runs to 350 pages and it governs everything from how many porters will be employed, to getting a light bulb changed. That squeezes out flexibility, abandons common sense and ensures that any proposal to reorder services around PFI facilities becomes from the outset an exercise in financial damage limitation.
All those factors are considered in private well before the issue that matters most: the good of the patient. All are considered before the conjuror's three-card trick that passes for a consultation even sees the light of day.
The decision is a bad one, which the Executive must re-examine and reverse. We have no problem with Karen Whitefield's amendment but, in order to get to vote on it, she and others who support her amendment will have to defeat the Executive amendment. Otherwise, her amendment will be pre-empted. I am sure that Karen Whitefield understands that point and will vote accordingly.
Today is an opportunity for Parliament to make a stand against bad decision making and the erosion of local services. I urge members to put the interests of patients first and foremost by supporting the motion in my name.
I move,
That the Parliament does not accept the case put forward for the downgrading of the accident and emergency unit at Monklands Hospital and calls on the Scottish Executive to re-examine its decision to approve this downgrading.
The debate is about how to modernise the national health service in Lanarkshire, how best to provide emergency services for patients and the future role of Monklands hospital. Those issues must be addressed in the context of our national policy for Scotland's NHS, on which, as Shona Robison indicated, members of this Parliament have already had a say.
As Shona Robison indicated, the publication of the Kerr report was broadly welcomed in the chamber last year. In October, members supported the Executive's response to that report, "Delivering for Health", by a substantial majority.
When we debated "Delivering for Health" there was widespread understanding of and agreement on the key principles on which we needed to base future services. Those include the need to shift the balance of care, so that we rely less on acute hospitals and provide more local services geared towards the management of long term conditions; the need to tackle health inequalities by anticipating and preventing problems, rather than waiting until a person is seriously ill; the need to streamline emergency care and provide the majority of such care in community casualty units while developing more specialised A and E departments that can concentrate on the most serious cases; and the need to separate planned from emergency care so that we can make the best use of facilities, cut down on cancellations and reduce waiting times for patients even further.
Will the minister give way?
Will the minister give way?
I will give way to Mr Gorrie.
Can the minister give an assurance on two points, which might help to ease local concern? First, could the Executive ask the audit authorities to examine the various figures that are being quoted about the costs of either keeping Monklands A and E department open or closing it, as compared to the other two hospitals? Secondly, can the Executive guarantee a much improved bus service to help patients and their relatives from the Monklands area who would have to continue to attend Wishaw general hospital and Hairmyres hospital after their initial A and E treatment?
I understand that Elaine Smith, whose constituency is in the area, has asked the Auditor General to consider the matter. His response is of course a matter for him, but if he chooses to take up her invitation all appropriate figures will be made available to him.
The answer to Mr Gorrie's second point, on transport, is yes; we will ensure transport provision.
The minister said that we should rely less on acute services and make more of local delivery. Will he comment on that in the context of maternity services in the NHS Grampian area, where the trend appears to be entirely in the opposite direction?
I will resist the temptation. No doubt Mr Stevenson will attend Mike Rumbles's members' business debate on maternity services in Aberdeenshire next week, when he will have another opportunity to ask me about the matter. In this debate we are discussing acute services—[Interruption.] We are discussing acute services in Lanarkshire, as Mr Stevenson and Mr Swinney know. It is clear that, throughout Scotland, NHS boards must embed the principles of "Delivering for Health" in the design and delivery of local services. As happens when there is any significant change in the way in which public services are delivered, we recognise that turning those principles into reality will involve hard choices that will sometimes be difficult for communities to accept. That is why I wanted to see for myself what was happening in Lanarkshire, so that I could understand the issues and choices.
Communities would find decisions easier to accept if they thought that they had had meaningful involvement in the consultation process. Why did NHS Lanarkshire and the minister ignore the views of the thousands of people in Cumbernauld, Kilsyth, Coatbridge and Airdrie who signed petitions in support of the retention of A and E services at Monklands hospital?
I assure Cathie Craigie that I did not ignore those people's views—far from it. As I will explain, I have attempted to strengthen the proposals that relate to those parts of Lanarkshire, to ensure that people's concerns are fully reflected as we go forward.
When I visited hospitals in Lanarkshire in June, what struck me most was the poor quality of primary care in North Lanarkshire, which meant that many people were bypassing primary care and presenting directly to hospital A and E departments. People often presented to A and E very late in the development of a long-term condition, although their conditions would have been far better managed through early intervention by their general practitioners.
Like Mr Stevenson and other members, I use health services in NHS Grampian. On close examination of the services in Lanarkshire it was clear to me that there were areas in which significant improvement and modernisation was required. The test that I applied to NHS Lanarkshire's proposals was whether they would deliver the improvement and modernisation that is needed. I am conscious of NHS Lanarkshire's commitment to use the proposals in its document, "A Picture of Health", as the basis for a better quality health service than Lanarkshire has ever had before. I will hold the health board accountable for that commitment.
During his consideration of the issues, why did the minister ignore the views of the tens of thousands of people in Lanarkshire who are utterly opposed to the board's daft proposal? Many of those people attended public meetings and at every meeting, people universally opposed the daft proposal.
Far from ignoring the views that were expressed at those meetings and elsewhere, I have taken those views into account in my response to the board's proposal. I have imposed a number of additional requirements that NHS Lanarkshire must put in place before it makes any change to A and E provision at Monklands hospital and elsewhere.
First, the necessary investments in primary care must be brought forward. I made it clear to the board that I expect early progress on new primary care premises, in Airdrie and in Coatbridge in particular. I am pleased to report that initial agreement on Airdrie resource centre has been reached, which is a necessary first step. We have brought forward capital funding to facilitate such developments.
I also made it clear that I expect the board to focus on reducing avoidable A and E admissions in the most deprived communities of North Lanarkshire, as part of the prevention 2010 initiative. I agreed to the early deployment of 43 additional paramedics and ambulance technicians by the Scottish Ambulance Service in Lanarkshire. I also required the provision of a shuttle bus service between the three Lanarkshire hospitals.
I made it clear to the board that necessary additional capacity at Hairmyres hospital and Wishaw general hospital, which Shona Robison mentioned, must be in place before any changes are made to the service at Monklands hospital and that the community casualty unit at Monklands should operate 24/7. I also required that community casualty units should be in place in Cumbernauld and Lanark. I also set expectations for regional planning by NHS Lanarkshire and other health boards in the west of Scotland.
Finally, in order to make crystal clear my expectation that Monklands hospital will continue to provide a full range of appropriate services as an integral part of NHS Lanarkshire, I announced that up to £100 million would be provided in the NHS Scotland capital programme, for the regeneration of Monklands hospital.
That programme of action requires NHS Lanarkshire to deliver measures to ensure that necessary improvements are in place before changes are made to A and E provision. The programme guarantees the future of Monklands hospital and provides the step change in improved health care that the people of Lanarkshire need and deserve.
I move amendment S2M-4784.2, to leave out from "does" to end and insert:
"reaffirms its support for Delivering for Health as the basis for service change in NHS Scotland; commends its commitment to shifting the balance of care to provide more safe and sustainable local services including the separation of scheduled and unscheduled care; notes the commitment of local communities to their health services and natural concerns when long-established services are changed, and remains committed to an NHS Scotland which responds to changes in the demands placed upon it."
I welcome the opportunity to speak to the amendment in my name, not least because I want to speak out against the crass political opportunism of the Scottish National Party.
The SNP's approach to the reconfiguration of hospital services in Lanarkshire and throughout Scotland gives a new, rather desperate meaning to the term, "ambulance chasers". It saddens me that SNP politicians such as Shona Robison and Alex Neil treat the recent decision by NHS Lanarkshire as nothing more than an opportunity to score cheap political points.
Will the member give way?
No. Only a year or so ago, the SNP acclaimed the recommendations in the Kerr report, but the party now appears to oppose some of the report's central tenets, such as the separation of planned and emergency surgery and the introduction of casualty units to take the strain away from A and E departments.
Will the member give way?
In the debate on "Delivering for Health" on 27 October 2005, Shona Robison said:
"The Scottish National Party welcomes the broad thrust of the Kerr report and the Executive's response to it."
She went on to say:
"We agree with Professor Kerr that there has to be a separation of scheduled and unscheduled care."—[Official Report, 27 October 2005; c 20035-37.]
Will the member give way?
Sit down, Shona, you have had your chance and all you did was parrot my words—[Interruption.]
Order. Let us get back to the core purpose of the debate.
Alex Neil, in his press release on 28 March, said:
"In no way is … the complete centralisation of planned care a positive thing."
Shona Robison shed crocodile tears this morning and she visited Monklands hospital yesterday—she did not even do me the courtesy of telling me that she was in my constituency—but where was she during the consultation? Alex Neil would show up at consultation meetings but he would not stay until the end, because he had other things to do. He did not even bother to make a submission to the consultation. That is what passes for conviction politics in the SNP, but I have another name for it: contradiction politics. It is the politics of hypocrisy—[Interruption.] No matter how much SNP members shout, they will have to listen.
I understand and accept the need for change and modernisation in our health service. I welcome the minister's commitment to invest in Monklands hospital and to ensure that a shuttle bus service is put in place between Monklands hospital and the other two hospital sites. I welcome his commitment to have the Airdrie resource centre built as soon as possible and to recruit additional ambulance staff. I will hold the minister to his commitment that no changes will be made to A and E services in Lanarkshire until the necessary additional emergency care capacity is in place at Hairmyres hospital and Wishaw general hospital. Given the continuing capacity problems at the A and E departments at Hairmyres and Wishaw, I am not convinced that the minister's commitment can be delivered.
I make clear this fundamental point: the decision that NHS Lanarkshire took and that the minister endorsed is flawed and wrong. The decision to downgrade Monklands A and E is contrary to the core principles that Professor Kerr set out. The board and the minister have decided to downgrade Lanarkshire's most efficient and effective A and E department and to relocate the service within two hospitals that are struggling to cope with current demand. They have chosen to remove an accident and emergency department from the heart of a large community that has some of the worst health statistics in Scotland and suffers from some of the worst deprivation in the country. They have failed to take into account the serious effect that the decision will have on Wishaw, Hairmyres and Glasgow royal infirmary.
My constituents do not understand the decision and neither do I. That is why, with my colleagues Cathie Craigie, Elaine Smith and Donald Gorrie, I firmly believe that the wrong decision has been made on downgrading and I call on the minister to reverse his decision and maintain full accident and emergency services at Monklands hospital.
I move amendment S2M-4784.3, to leave out from "and calls on" to end and insert:
"supports the need to modernise our National Health Service as outlined in Delivering for Health; acknowledges the investment and commitment of the Scottish Executive to improve health services across the country, and calls on the Scottish Executive to reverse its decision to approve the downgrading of accident and emergency services at Monklands."
The fact that I speak in support of the SNP's motion is a clear indication of concern across the parties about the continuing reconfiguration of NHS services in Scotland. The debate focuses on the concerns of people in Lanarkshire about the provision of accident and emergency services in their area, but it also opens up the issue of service redesign in the NHS. Communities throughout Scotland face major changes in provision, some of which are welcome and others of which provoke sustained anger and opposition of the kind that we have witnessed on the proposed closure of the accident and emergency unit at Monklands.
As a North East Scotland member, I am not familiar with the detailed geography of Lanarkshire, so I intend to speak in more general terms and leave the detail to my colleagues. Some months ago, I took part briefly in the debate on the Lanarkshire united health for all campaign, which was brought to the chamber by Carolyn Leckie. During that debate, it became clear not only that there was concern about the proposals to close the busiest accident and emergency unit in the most deprived part of Lanarkshire, but that there was fury that the consultation that was under way at the time did not even allow consideration of the status quo.
At that time, there was cross-party support from local members—Elaine Smith, Cathie Craigie, Karen Whitefield, Margaret Mitchell, Carolyn Leckie and Alex Neil—who all made their concerns and opposition to the closure of the Monklands accident and emergency unit clear to the minister. They did not do that lightly and they had significant backing from medical opinion in the area. Then the announcement came that the Monklands unit was to close.
More recently, I sat in on a similar debate about NHS hospital provision in the Borders. Again, there was cross-party support that was backed up by medical opinion and a strong case for the retention of services was put to the minister. The announcement that Coldstream and Jedburgh cottage hospitals face closure came weeks later.
In Grampian, we have a continuing campaign against the health board's decision to close the midwife-led maternity units in Fraserburgh and Aboyne and to focus instead on community midwifery. Again, there has been major community involvement and cross-party support and, next week, there will be a debate on the subject in the name of Mike Rumbles. In that case, campaigners felt that the consultation process was merely cosmetic and, in their support, the Scottish health council initiated further consultation. NHS Grampian's proposals are currently with the minister, and we await the outcome with interest.
There is also massive opposition to proposed changes in the accident and emergency services in Ayrshire. I have no doubt that John Scott will deal with that when he speaks later on.
There clearly have to be changes in NHS provision to meet the demands of modern health care, and health boards throughout the country are having to redefine their services. Some older and cherished hospital buildings may have to go because they are no longer fit for purpose, and people will mourn their loss. However, if there is serious concern about proposed changes, if whole communities genuinely feel that consultation is not meaningful and if responsible elected members across the parties are totally supportive of local opinion, ministers must be wary of taking decisions that go against that opinion.
Consultation is all very well but, if the weight of public opinion is set aside at the end of it, the public will rapidly become even more cynical and disillusioned than they are at present. The public perception of the health service is that it is becoming far too centralised. People are extremely worried about the loss of facilities close to home and, far from feeling that they are involved in service redesign, they feel that they are simply being ignored and brushed aside. Monklands seems to me to be a classic example of that and, to use the terms of the motion, I urge the Scottish Executive to re-examine its decision to approve that closure.
As has rightly been said, the debate takes place in the context of the Kerr report. It is helpful to have on record Shona Robison's opening remarks on that report, which, to be fair, were a repetition of what the SNP said when the Parliament debated it and "Delivering for Health". As the minister said, the Kerr report was accepted by the Parliament.
I have no problem with repeating what I said about the Kerr report. I understand it as backing the provision of local services. If Euan Robson interprets it somewhat differently, I am afraid that we have different interpretations of what Kerr said.
I do not dissent from the point that Shona Robison made—that the report is about delivering more services locally. Of course, it is also about service redesign, and Kerr envisages change; we cannot escape that conclusion. In fact, I would go so far as to say that redesign of services would take place even if there had been no Kerr report and the subsequent Executive response. We know full well that there are a number of buildings in the NHS that are no longer fit for purpose. We know full well that there is major population change in some communities, which means that services have to be redesigned, and there are also changes in medical practice. It is right that more local services should be more locally delivered and that there should be an emphasis on anticipatory care. Indeed, as specialism develops, there will be more specialised A and E departments, which will mean that there will have to be fewer of the highly specialised departments than in the past.
The consultation process in Lanarkshire is said to have been flawed. I have experienced in my constituency a consultation process that was said to be flawed. There is a common denominator in some of the consultations: a strong suspicion in the local community that the relevant board has made up its mind beforehand. If a board is minded to decide in one direction or another, it would be far better for it to say so up front. The consultation would then be about what the board wanted to do, the other options that were available and the reasons that the board had chosen one option rather than another. The Scottish health council, which has been set up to monitor such consultations, must make that clear.
The Grampian consultation has been mentioned. There is nothing wrong with that consultation; it has been really good and effective and has engaged the local community. The point is not that the consultation process is wrong, but that the board pays no attention to the results of the consultation. That is the problem.
That is precisely the point that I am trying to get at. There have been exhaustive consultations, endless meetings and endless documents but—let us come to the point—the board has made up its mind in advance. However, if it had said at the outset what its proposal was, rather than saying that no conclusion had been drawn and that the consultation was open, consultees would be clear about what they were dealing with. I defer to Mike Rumbles's greater experience of the Grampian consultation.
I would be grateful if the minister would clarify whether the deliberations took account of the Monklands closure's potential knock-on effect on other authorities' accident and emergency units. We have had a lot of discussion about the Monklands unit being one of three accident and emergency units in Lanarkshire, but Lanarkshire is not an island. There are other, neighbouring health authorities and I would be interested to know precisely what was said in the deliberations about the knock-on effect in Forth Valley, Glasgow and further afield. If it is the case that there will be serious implications elsewhere, there is a duty on the Executive to recognise that and, perhaps, intervene in the form of investment. The minister can deal with that in his summing up.
I welcome the investment that has been made in the community, the transport infrastructure, the shuttle bus service, the additional ambulance staff and the additional capacity that has been put in place. I also welcome the £100 million regeneration money for the hospital. That is a significant sum of money in anyone's language.
I believe that the Auditor General should have a look at these figures. It would be helpful if the minister were to express more enthusiasm for that. If, at the end of the day, the figures are seen to be robust, that is fine and we can proceed on a sound basis. If they are not, there are implications.
I was absolutely appalled by Karen Whitefield's rant. It merits no reply from me. The people of Lanarkshire can reply to her; I have no time to do so today.
With all due respect, I say to the minister that his amendment is one of the most insipid that I have ever seen. It does nothing to alleviate the fears of the people of Lanarkshire about the downgrading and eventual closure of Monklands.
Will the member take an intervention?
No; I was not allowed to intervene earlier.
As Euan Robson said, this Government has continually avoided dealing with the impact of the downgrading of Monklands A and E unit on other areas, particularly on Glasgow royal infirmary. The decision to downgrade Monklands was taken without any studies being conducted into the effect that the decision would have on Glasgow. That is worrying, particularly as Glasgow is downgrading to a position in which it will have only two full A and E units. NHS Lanarkshire said that, during the consultation, it was able to tell patients what hospital they would go to in order to avoid overcrowding other hospitals. However, anyone who is in an emergency will go to the nearest hospital, which, for people in the area that we are discussing, is Glasgow royal infirmary. They will not be guided by lectures from the health board. One of my worries about the proposal with regard to Monklands is the impact that that will have on Glasgow and other areas. We must have a real debate on this issue so that we may re-examine the decisions that have been taken and—I hope—overturn them.
I said that Glasgow was downgrading to a position in which it will have only two full A and E units. It is also downgrading Victoria and Stobhill as well. That will take place in 2009. The redevelopment of Glasgow royal infirmary is not anticipated to take place until 2013. The decisions that are being made will put even more strain on our services in Glasgow and the wider area. The GRI is currently operating at 80 per cent of its capacity and Victoria and Stobhill will also have to cope with an influx of patients if Monklands closes down. Currently, Victoria deals with more cases than the GRI does, and Monklands deals with about the same amount of cases as the GRI. It does not take an expert to work out that a disaster is about to happen. I pointed that out to the minister in a question that I put to him on 4 May this year. Before Monklands hospital was opened, the GRI was running at 150 per cent of its capacity. We cannot possibly go back to that situation.
The "Delivering for Health" document, which has been mentioned, is all very well, but Glasgow royal infirmary cannot cope with the extra influx. I am not scaremongering when I say that lives will be put at risk if something is not done about the situation.
I find it incomprehensible that one of the most major impacts of the downgrading of Monklands—the effect that that will have on surrounding areas—was not mentioned until a week before the consultation closed. That makes me wonder whether there is a legal ground for challenging the health board's decision.
The minister has to consider the situation seriously. The views of the Scottish health council and the bodies that I would call quangos that this Government has set up are being taken into account. However, surely the public should have the final say. They are the ones who will suffer as a result of a bad decision being made.
The figures for the money that was spent by the health board on the hospitals—£56 a head at Monklands, £70 at Wishaw and £72 at Hairmyres—show that Monklands was the cheapest to run. Why, then, was a decision taken to close it down?
I ask the minister to address, in his summing up, the issue of the admissibility, or inadmissibility, of the consultation, given the fact that the major issue of the impact that the downgrading of Monklands would have on the rest of Scotland was not mentioned until a week before the end of the consultation.
I welcome the opportunity to speak in this debate mainly because I think that it is important to put the record straight with regard to the SNP's record on health.
As the Deputy Minister for Health and Community Care said, when we debated "Delivering for Health" last year, there was agreement in this chamber on its key principles. Indeed, when we debated the same issue earlier this year, Mr Swinney, speaking on behalf of the SNP, said:
"At the heart of the conclusions of the Kerr report are the aspirations of promoting local access to services and balancing local delivery with the need to have centres of excellence that provide high-quality, modern, specialist care. I do not think that that is a definition that anyone could disagree with if they believe in a health service that respects the desire of individuals to be treated as close to home as possible but which is clinically safe."—[Official Report, 18 May 2006; c 25747.]
Will the member give way?
I do not think that Mr Neil disagrees with his colleague. In any case, he will have a chance to make a speech soon.
I took Mr Swinney's words to mean that he is not averse to change. Indeed, we have heard from Ms Robison this morning that the SNP's motion is not about rejecting change. However, funnily enough, when change was proposed in Glasgow, the SNP objected to it as well, as we have heard from Sandra White.
Achieving change often means making difficult decisions. Having been through the acute service review in Glasgow some years ago, I understand only too well how emotive an issue this can be. In general, people like what they are used to and we have not been good at providing information in advance of any proposed change to explain why it is necessary and how it will benefit people.
I believe that the Kerr report helped a great deal with that, as it went a long way towards explaining why change is not always a bad thing. Change is often driven by necessity, and I do not believe that anyone on the Labour benches campaigned for the status quo on health provision in Lanarkshire, as Karen Whitefield said. Unlike some others in this chamber, we understand the serious point that change must happen and do not simply use it for political opportunism.
Month after month, the First Minister is challenged in this chamber on the issue of waiting times. Health spending is at an all-time high and investment in staff and diagnostic equipment is unprecedented. However, money alone will not deliver the improvement in delivery that the Opposition calls for.
Will the member give way?
No, I will carry on.
Changing the way in which we deliver health care to streamline the patient journey, establishing community casualty units where those with minor injuries and ailments will not have to wait for hours before being attended to, separating planned and emergency care so that cancellation of surgery will not cause the distress that it so often causes at present, introducing one-stop shops for care, so that assessment, diagnosis and treatment can be carried out on the same day—these are the things that will improve our health provision and make a difference to people's lives.
If this debate today is important, why are we devoting only half a morning to it? If the SNP is committed to the health of the people of Lanarkshire—and we have heard its members speak a lot about that in recent days—surely the party could have given all its time to the issue this morning. Instead, it has chosen to use a local situation for political gain. People will make up their own minds about that. Labour's record on health shows our commitment to the people of Scotland. Perhaps it would be better if the SNP told us what it would do better, instead of just criticising other people's decisions.
It is clear that all politicians defend hospitals and support campaigners. They all want to keep their hospitals open and we all know that change has to take place. I have worked in the NHS for 35 years and change constantly took place throughout that time, so I am used to it.
We have to be clear about what is best for the patient. We should never close a service or decide to shut something down until there is something better to put in its place. We must ensure that what is being provided is at least as good as what was there before, if not better.
Will the member give way?
I am sorry, but I have only four minutes and I have a lot of points to cover.
The service that is provided has to be accessible. Transport is essential. The proposal that we are discussing will have an impact on Glasgow. The Health Committee heard that it is easier for the people who currently go to Monklands to get transport to that hospital than it is for them to get to other hospitals. I do not know whether a shuttle bus will suffice.
What we have heard confirms my suspicion that overcapacity is a serious problem. No hospital should run at more than 80 to 85 per cent capacity. If they do, they run into difficulties, such as infection. At present, there is not enough capacity in our system—for example, we are putting into general wards people who should not be in those wards. The other day, I heard about somebody who had had a serious plastic surgery operation. They had a problem, were admitted to Glasgow royal infirmary but ended up in an ordinary ward. That is tantamount to disaster. The minister should listen to the people and to the consultants and others who work in the service. It is simply bad practice to run a hospital at over its capacity.
We have had innovative change. Stobhill hospital was cost effective and made lots of innovative changes, but that does not save hospitals. What comes into the equation is money. Health boards have to find the money for public-private partnerships before they find money for services elsewhere. I agree that Hairmyres should increase in size, because the Southern general will be the only general hospital in the south of Glasgow, from which Hairmyres is at the opposite end. There will be no services to the people in Newton Mearns. Lots of people, including people in my constituency, have already decided that they will go to the royal infirmary rather than through the tunnel to the Southern general.
We have managed to keep Stobhill's casualty department open despite the fact that Tim Davidson, who is the chap in charge of the NHS in Lanarkshire, wanted to accelerate the closure of the department. If he had done that, he would have changed the status of the general hospital and left himself without a hospital that he very much needs at the moment.
The minister is right to say that the consultation was okay, but what is the point of consultation if nobody is listening, if nobody takes things on board and if, financially, the only option is to spend the money in one direction? The minister is being dishonest with the people. He should not have consultation at all. The situation was summed up for me at one of the consultation sessions when a health board member in my group said, "It's so good to have you all here to consult. I think our problem has been that we haven't got our message across to you." I say to the minister that many of the people who live in Lanarkshire and greater Glasgow and Clyde may be deprived in some ways—in economic matters—but they are not stupid and they understand what the health boards are doing. They understand the need to have services close to home.
We cannot do everything in primary care. It is cheaper and better to do things in primary care, but we need to put in the services so that those things can be done. It is not safe to prevent staff from admitting people to hospital to cut down on accident and emergency admissions because that puts pressure on clinicians. The minister must rethink. We should not close anything until we have provided something better.
I call Margaret Mitchell, to be followed by Carolyn Leckie.
At the MSP briefing prior to the launch of the consultation "A Picture of Health", NHS Lanarkshire included as one of the options to be consulted upon the retention of all three accident and emergency departments, although it was made clear that that was not the board's favoured configuration. Subsequently, retention of the status quo was not included as an option when the consultation was launched, because it was becoming obvious, even at that early stage, that the status quo was the favoured option of the vast majority of people—and, crucially, users of the service in Lanarkshire.
Rather than keeping the option and persuading people by the power of its arguments, the board dropped the option and, in so doing, rendered the consultation nothing more than a marketing exercise and an attempt to sell a pre-determined option. For that reason alone, the minister should re-examine the decision to approve closure. The option to retain all three accident and emergency departments was not included in the formal consultation, yet the fact of the matter is that, at every public meeting, the public wanted to discuss that option.
The board's arguments for closure do not stack up. The assertion that it would not be financially viable to retain the departments fails to take into consideration the fact that a fully equipped, modern accident and emergency department at Monklands hospital would attract patients from Glasgow, where, as has already been stated, the five departments are to be reduced to two. I am disappointed that the board has failed to be proactive in that regard.
The claim that it would not be possible to attract appropriate clinicians to staff the three departments is simply not true. The necessary training could be put in place now to ensure that clinicians are available, and they would most certainly be attracted to a modern and well-equipped department.
Does the member believe that consultants should be forced to work every weekend?
That is, frankly, a pathetic excuse. I believe that we can put through enough consultants now if there is the political will to do it.
The assertion that a better standard of care would be delivered by retaining two accident and emergency departments and one elective department is irresponsible, for the following reasons. In the event of closure of the accident and emergency department at Monklands, there are no direct public transport links from communities such as those in Cumbernauld, Chryston, Stepps, Moodiesburn, Gartcosh, Kirkintilloch and Lenzie to the nearest accident and emergency department, which would be in Wishaw. It is not certain that the required public transport improvements can be delivered and the board acknowledges that, hence its fallback position to provide inter-hospital shuttle buses. That would be expensive and the board admits that it would take funding away from patient care.
Furthermore, anyone, from BBC camera crews to individual commuters, who has tried to negotiate the Shawhead flyover or the East Kilbride expressway an hour either side of peak travel times in the morning or evening knows that they will have a lengthy wait in the traffic, which is almost certain to be gridlocked. Despite that, a full traffic impact assessment has still not been carried out, yet it seems that the minister has unquestioningly accepted the health board's assurances about projected travel times for blue-light ambulance services.
Time constraints do not permit me to go into more detail, but it is already glaringly obvious that the case for closure has most definitely not been made and that closure should not be approved. Even at this eleventh hour, it is not too late for common sense to prevail and for Labour and Liberal Democrat coalition members to reject the closure decision. All that is required is the political will.
There has been a lot of competition during the summer for the title of the biggest villain in the Parliament, but I think that Lewis Macdonald pipped it at the end of the summer with his decision to endorse NHS Lanarkshire's decision to downgrade services in Lanarkshire. We should remember that this is not just about accident and emergency services—I will come back to that.
The minister would have been far more inclined to support the public—who are well-informed, by the way—if his Labour Party colleagues had managed to unite themselves across Lanarkshire, never mind uniting with other parties to defend services for everybody in Lanarkshire. We have the farcical situation of Labour Party members in East Kilbride defending Hairmyres hospital and Labour Party members in the Monklands area defending Monklands hospital. They are not honest enough to say that they support the NHS's proposals and it could not be made public that they accept that there should be only two accident and emergency departments in Lanarkshire. They have a completely dishonest position.
Will the member give way?
No, I will not. Speak to your pal.
On a point of order, Presiding Officer, the member has accused members of being dishonest. It is right that those members whom she is accusing have the opportunity to put her right and to show her dishonesty in the chamber this morning.
Your means of doing so is to offer to intervene, which you did, and that was declined. I am sorry. That is the end of it.
I think that everybody knows the facts about the Labour Party positions in various constituencies. The public know the facts and they will remind Labour members of that in May 2007.
The debate is not just about accident and emergency services. There are a lot of issues. I met the minister and I have been involved in the Lanarkshire health united campaign, whose position is the status quo plus.
The issues are about the geographical separation of elective and emergency services, which does not have clinical research support. I am worried about the impact of that on the education and experience levels and the skill mix and so on of hospital staff over several years. As the minister knows, evidence is coming out from England about geographical separation and the impact that it has on the quality of care.
From the beginning of the consultation, the main issue has been about PFI and the constraints that it places on the health board and the flexibility of its budget. We know that Monklands is the only public hospital with enough land left for flexibility. It could be sold—no doubt for housing development.
Will the member give way?
I cannot; I am sorry.
The member is in her final minute.
When we look to the future, I predict that, unless the minister reverses the decision, the trends of PFI will show that the decrease in capacity that we have already suffered in Lanarkshire will get worse, the decrease in the proportion of the budget spent on staffing will get worse and the ability of hospitals in Lanarkshire to cater for the demands placed on them will lessen. The people of Lanarkshire, particularly those who are most vulnerable, will have decreased—not increased—access to services.
The democratic deficit in this process is worrying and should send a warning to all the parties in the chamber: do not patronise the public by saying that they do not understand. A well-informed public is completely at odds with the health board, Government bodies and political parties. The public will vote with their feet. They have to be given democratic input into the decision on how their health service is configured. If that is not done, the current MSPs will be booted out.
Given that the Presiding Officer called Ms Leckie, I honoured that commitment, but I am unable to call anyone else in the open part of the debate. I express my regrets for that, but I must now go to the closing speeches.
It has been an interesting—if short—debate. To answer Sandra White's point, we would have had a better chance of a real debate if it had been a wee bit longer. Perhaps the SNP should have participated properly in NHS Lanarkshire's consultation process.
Unfortunately, there has been a lot of brinksmanship and political posturing this morning. Carolyn Leckie demonstrated some of that. Calling members of the Labour Party dishonest was utterly disgraceful. She then showed political opportunism by mentioning elections, because that is really what it is all about for her; for members on our benches, it is about health in Lanarkshire.
A key theme in the chamber is that all members are in favour of talking about change, but they are not in favour of any change at all when it comes down to it. Last October, when we voted on the Scottish Executive's action plan, "Delivering for Health", which has been widely mentioned, our vote was based on the service change proposals of the Kerr report. According to the motion, we were attempting
"to provide more safe and sustainable local services,"
for our constituents,
"to tackle health inequalities … in our most deprived communities … to benefit people wherever they live"
and to pursue "greater quality and productivity" in the NHS in Scotland. That is what we voted on, and Janis Hughes outlined some of the positive changes that came after we voted on the Kerr report.
However, we did not sanction the potentially fatal blow that has recently been dealt to Monklands general hospital, which is the busiest, most efficient and most effective hospital in Lanarkshire, serving areas that have some of the worst health and deprivation records in Europe. I was interested to hear that a lot of Shona Robison's speech was comprised of what Karen Whitefield, Cathie Craigie and I have said in the past. She could have said something new, but she said nothing new at all.
I agree with Carolyn Leckie on one point. We did not agree to the blatant asset stripping of the only NHS-owned hospital in Lanarkshire by a health board that is intent on justifying the exorbitant guaranteed incomes that it pays to its PFI partners. We did not vote on that.
Last October, we would almost certainly have rejected such a fundamental change to service provision, the result of which could mean that the most deprived communities in Lanarkshire become further isolated and socially excluded in relation to access to local emergency care. That shift of provision has been decided without proper access to detailed service planning, outline or full business cases, comprehensive research or costings. The minister's amendment says that the Executive wants an
"NHS Scotland which responds to changes in the demands placed upon it."
We have to be clear that downgrading Monklands hospital does not do that. The fact that Monklands faces that downgrading is a disgrace. It undermines the very principles of the Kerr report and "Delivering for Health". We have said that since the beginning.
This is fundamentally the wrong decision for the people of Lanarkshire. The overarching aims of "Delivering for Health" are right, and I acknowledge the commitment to invest in the area. However, the minister's decision to support NHS Lanarkshire's plans to downgrade Monklands is based on biased, flawed and insufficient information provided to him by the board. Further, NHS Lanarkshire has utterly failed in its responsibility to consult service users, because it presided over a lavish public relations exercise in which it told the people of Lanarkshire what it was going to do; it did not ask them. Even more shameful, the exercise was distilled into a six-month period, so a critical decision that will impact on Lanarkshire and, as Euan Robson said, on Forth Valley, Glasgow and wider areas for generations to come has been rushed through without adequate scrutiny and planning and in the absence of a rational evidence base.
As mentioned, the minister knows that I have asked the Auditor General for Scotland to review the decision. The minister also knows that Karen Whitefield, Cathie Craigie and I have asked for an independent review, in the absence of which we have little choice but to call for a reversal of the decision. It should never have been made and we want the minister to reverse the decision and to take decisive action to guarantee the long-term future of Monklands hospital.
From the contributions made in the chamber today, it is quite clear that this is a very difficult issue, particularly for local members. I feel their pain and difficulty. It is more than a decade since the closure of the accident and emergency department at the Western general hospital in my constituency and people still write to me trying to get it reopened, but the world has moved on.
It is worth remembering many of the issues and drivers behind the need to redesign services. Workforce issues have evolved over time, such as the training required by junior doctors, the critical mass of patients that is needed for clinicians to build up levels of expertise and for risk to be assessed, the introduction of the working time directive and changes in demographics. There are a number of drivers behind the decisions that are being taken, not only in Lanarkshire but across the country.
There is also the policy background of the Kerr report, which many speakers have discussed today. The Kerr report is a fundamental document but it takes a broad-brush approach and is open to interpretation, which is always important. Each individual case should be considered on its own merits and set of circumstances. From what the minister said, it is quite clear that he has taken on board many of the issues in Lanarkshire. I note the comments that he made about the need to invest in primary care. Janis Hughes was right. Change is always difficult. It is not always wrong and it is not always right, but it is always difficult.
The minister has been given lots of advice during this interesting debate. I particularly enjoyed the advice that he got from Carolyn Leckie, who gave him and Labour MSPs a bit of a lecture about unity and speaking with one voice. That was quite interesting.
The important comment in the minister's speech was the assurance that he gave about making no changes to accident and emergency provision until there is extra capacity at Wishaw and Hairmyres. Jean Turner made the point that people would feel much happier about change if they felt that changes were already happening on the ground before the old services were done away with. We really have to take that on board as we take Kerr forward.
Is it Margaret Smith's interpretation of what the minister said that no change will take place at Monklands hospital until such times as those provisions are firmly in place?
We will be able to hear that from the minister himself, but that is a question on which we would like clarification.
There has been a substantial investment of £100 million in Monklands, but one of the most important points that the minister made was about additional paramedics, which Margaret Mitchell talked about. Because of the centralisation of services at the new Edinburgh royal infirmary on the other side of Edinburgh, I have talked to NHS Lothian about the length of time that it takes people to get to a hospital. An important issue now is the length of time that it takes a paramedic to get to a patient. That is when health care starts. We need to ensure not only that there are enough paramedics but that they have the equipment that they need.
Will the member give way?
I cannot.
Transport has been mentioned by several members. I appreciate the point that the minister made about the provision of shuttle buses, but transport issues are important and cannot be lost sight of.
I end on the need for proper consultation and proper information. As local members, we are often bombarded with lots of information from clinicians who tell us lots of different things about these situations. We are lay people, not clinicians, so we always find it difficult to get to the bottom of the issue. I agree that further consideration needs to be given to the financial matters that Elaine Smith, Donald Gorrie and others mentioned. Perhaps the minister in his summing up can address those points about PFI. A more general point about which the Health Committee has had concerns for many years is that, going forward, we need to reform the way in which we consult on these matters. Otherwise, the public will lose faith completely in the NHS.
In today's debate on the proposed closure of the accident and emergency unit at Monklands, we have seen the Parliament operating at its best by holding the Government to account. We have seen members from all parties and all political views unite to express their concerns to the Liberal-Labour coalition about what they regard as flawed Government policy.
Entertainingly, we have heard Karen Whitefield both support and condemn her Government's policy in one paragraph of her speech. I suppose that we must reflect on Churchill's comment that consistency is the hobgoblin of small minds.
No one disputes the need to develop specialist services and centres of excellence in the west of Scotland, such as we have with cancer treatment at the Beatson, head injuries at the Southern general and heart surgery at Clydebank. That is accepted in the debate, as Shona Robison said in her opening remarks. However, where most people separate from Labour-Liberal coalition policy is in applying the concept of centralisation to A and E units. Nanette Milne, Sandra White and Jean Turner all made that point.
Health care professionals, including ambulancemen, paramedics, nurses and consultant staff all over the country, are telling planners that the policy will cost lives. That is what planners are being told in Lanarkshire, Glasgow, Ayrshire and elsewhere, as Sandra White also mentioned.
Regrettably, the people who will suffer most come from the areas of greatest deprivation. It is not a pretty sight to see a Labour-Liberal coalition Government disadvantaging most the communities that elected it to look after their health care needs. Shona Robison, Cathie Craigie, Margaret Mitchell, Carolyn Leckie and Elaine Smith all made that point in their remarks.
Consultation processes in Lanarkshire and Ayrshire have been a meaningless 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. Nowhere did that happen more than in Ayrshire and Lanarkshire, as Nanette Milne, Euan Robson and Jean Turner all highlighted.
Will the member give way?
No.
The Government is in danger of dogmatically following an inappropriate policy of centralisation of A and E services and ignoring the views of patients, medical staff and many of its erstwhile political colleagues. Politicians of all parties—including, most tellingly of the Government's own—have opposed the minister's view. Among those with the highest profile who have opposed the plans are John Reid, Robin Cook, Sandra Osborne and Brian Donohoe. Carolyn Leckie was correct to point that out.
Almost all the proposed closures of A and E units across the country are claimed to be justified in part by the fear that sufficient consultants may not be found to staff our hospitals in future. However, that is not a sustainable argument. Quite simply, if we trained more junior doctors in Scotland—and did so in our hospitals rather than just in universities—we would have more consultants available when we need them. The recent failure to address what is a workforce planning issue should not be used to close A and E units across the country today. I tell the minister that this is a solvable problem and it needs to be addressed forthwith.
Finding the key people to run any enterprise is always a business risk, but our Government is throwing in the towel long before a significant problem even exists. The can-do attitude that is so evident in Scots elsewhere in the world needs to be instilled into our Liberal-Labour coalition Government and its NHS planners. They need to deliver the health care services that people across Scotland rightly demand.
I hope that the minister will reflect on views that have been expressed in the chamber today before it is too late for our A and E units in Monklands and Ayr. He must reconsider whether the path that he is pursuing is in the best interests of patients throughout Scotland.
At the heart of the debate is the critical question of what members believed that the Parliament voted for when it supported "Delivering for Health".
Shona Robison said that the SNP supports the principles of the Kerr report, but the Kerr report is very clear about the fact that the way in which unscheduled care is currently delivered is unsustainable without reform. To maintain local services, we must
"develop … community casualty units … staffed by multidisciplinary teams to provide much of our urgent care needs 24 hours a day"
and create new centralised specialised emergency services.
In our submission to the Kerr committee, we were very clear that we regarded A and E not as a specialist service but as a core service that must be delivered locally. For minor injuries units, the best model is the one that currently operates at Monklands hospital, where the minor injuries unit works alongside the A and E unit to reduce pressure on the A and E services.
I am glad that Shona Robison has seen the operation of the separation of scheduled and unscheduled care at Monklands hospital. We want to build on the effectiveness of that separation and take it forward. Indeed, the Kerr report states that, for the delivery of emergency care,
"A potentially generalisable model already exists in NHS Grampian",
where Aberdeen royal infirmary is linked to local hospitals but provides focused A and E services for some 500,000 people. The Kerr report does not support the SNP position that such changes are okay in theory but that Lanarkshire does not need to change the way in which it provides emergency services.
In correspondence, the minister has told my colleagues and me that no changes will be made to A and E services in Lanarkshire until all necessary additional emergency care capacity is in place. Today, he said that no change "should" be made. That is a big difference. Will he clarify what he means?
I understand the point that Cathie Craigie makes, which was also made by Jean Turner. The commitment that I have given, which I give again today, is that the new services that I have instructed the board to deliver will be in place before there are changes to the provision of A and E services. Clearly, all of that is subject, as it always must be, to issues of clinical safety but, with that proviso, I make that clear commitment, which I have imposed on the board. I give the commitment to Parliament today that we will bring forward the additional primary care investments. We will bring forward the investment to improve capacity at Hairmyres and Wishaw and we will bring forward that £100 million of investment in future provision at Monklands before we get to the point at which the configuration of A and E services at Monklands and the other hospitals is changed. Those are important and clear commitments.
We recognise the central significance of deprivation and the clear connections between social and economic deprivation and poor health.
I give way to Mr Swinburne.
After about nine attempts, I am glad that my intervention has been accepted. Basically, Lanarkshire NHS Board is bankrupt. It has £818 million hanging round its neck like a millstone. Hairmyres hospital cost £67 million and Wishaw hospital cost £100 million, but the repayments will cost £1,080 million under this beautiful, pie-in-the-sky PFI/PPP deal.
Minister, you must watch your time.
Mr Swinburne gives me the opportunity to respond to points that were made in the debate about the financial figures, which are an important issue. I am satisfied that the financial issues have been properly addressed in the process and I am satisfied that the sums add up.
You have one minute.
It is fundamentally wrong to say that the changes are driven by cost; they are driven by the interests and needs of patients. I am happy to address the specific concerns that have been raised by local members, but it is critical to recognise that the purpose of the proposals, which ministers have endorsed with additional requirements, is to improve the quality of patient care. That alone is the driver of the changes and that alone was the deciding consideration for ministers' approval of the proposals.
Will the minister give way?
I am afraid that time does not allow me to accept a further intervention.
I wanted to ask about those future commitments—
No, the minister does not have time to accept an intervention.
I am happy to re-emphasise the point that I made in response to Cathie Craigie's intervention about my commitment to ensure that the services are in place to deliver the quality of care that people in Lanarkshire are entitled to expect and that these proposals, with our additional requirements, will deliver for the people of Lanarkshire.
I call Alex Neil to wind up the debate. You have the luxury of seven minutes, Mr Neil.
Thank you, Presiding Officer. It is probably the chamber that has the luxury of my seven minutes.
I will deal first with the Kerr report. It is consistent to be generally in favour of the principles of the Kerr report and—to quote Karen Whitefield—to say that this decision on Monklands flies in the face of the Kerr report. To hide behind the Kerr report, as the minister is trying to do, as justification for this dangerous and daft decision is nonsense. This is not about the implementation of the Kerr report; this is about the implications of PFI at Hairmyres and Wishaw. PFI is coming back to bite the Labour Party where it hurts.
I would be interested to hear how Mr Neil believes that the Kerr report should be applied in relation to emergency services in Lanarkshire.
I have always made it clear, in my submission and at every meeting that I have had with the health board and others—[Interruption.]
Order.
Unlike Karen Whitefield and others, I did not sell the pass on day one; I argued that Lanarkshire needs three accident and emergency units. Every Labour politician argued against that, with the honourable exception of Tom Clarke MP, who agrees publicly with me, Margaret Mitchell, Carolyn Leckie and others that somewhere with Lanarkshire's population and deprivation requires three A and E units. Those who immediately caved in and said that the number should be reduced to two sold the pass at that point, as it was then a case of divide and rule.
In East Kilbride, the Labour folk came to the meetings saying, "We've got to have Hairmyres." Then, the next night, in Airdrie, Karen Whitefield would be there with John Reid saying, "We've got to keep Monklands open." In Wishaw, although we did not see the First Minister, he sent his troops to say, "We've got to keep Wishaw open." The reality is that A and E is a core service. If the unit at Monklands is closed, that will endanger life and limb.
At the moment, in the health service in Lanarkshire on a typical Saturday night, there are so many people at the A and E units in Wishaw and Hairmyres that they have to be referred to Monklands. If the A and E unit at Monklands is not there, where will those people go? Will they go into Glasgow and make another journey to another A and E unit? Will they go to Stirling or Falkirk—or, eventually, to Larbert—even given the distance that that would involve? In a recent maternity case, a woman was sent from Wishaw to Dundee because Wishaw did not have sufficient capacity.
Can Alex Neil tell us the basis for his assertion that the loss of an accident and emergency unit would cost lives—not in minor accident or trauma cases but in serious medical cases? I believe that the evidence shows that paramedic and ambulance support is more important.
That is not the evidence. I am sure that even Karen Whitefield would accept that if someone in Airdrie had a heart attack, a stroke, an asthmatic attack or an attack of meningitis, by the time that they got to Hairmyres or Wishaw—especially at certain times of the day—at best, their position would be severely worse and, at worst, their life could be in danger. The transport infrastructure in Lanarkshire is such that, if the A and E unit at Monklands closed, the time that it would take for someone in Airdrie or Coatbridge to get to another accident and emergency unit would mean that, in some cases, lives would be in danger. That is what we are dealing with. That is why the debate is far too important for members to be scoring petty points about the timing of debates. There are substantive issues that need to be addressed.
Does Alex Neil welcome the minister's assurances about the number of paramedics? Does he agree that, as I said in my speech, we should ensure that paramedics have the tools that they need and linkages back to A and E departments so that the necessary care can be given eight or 10 minutes after someone has suffered a heart attack, not half an hour later, when they get to a hospital?
There are two issues. First, we received an assurance four years ago that there would be no threat to the A and E unit at Monklands. Any assurances from the Executive or NHS Lanarkshire are not worth the paper that they are written on. Secondly, the support that Margaret Smith says should be provided to paramedics should be provided irrespective of what happens to the A and E unit at Monklands. Those facilities should be in place anyway.
When the debate started, we were told that the driving force behind the proposed closure was the shortage of consultants in Lanarkshire and the inability of NHS Lanarkshire to attract consultants. It is ironic that around £100,000 of health board money was spent on hiring outside public relations consultants to try to sell the case to the people of Lanarkshire. Had that £100,000 been spent on recruiting NHS consultants, we might not be in the current position.
When it came to the final decision, contrary to what the minister said, the key factor at the board meeting was not the shortage of consultants nor the clinical reasons that have been given; it was all to do with finance. Because two of the hospitals are PFI hospitals, even if they do not have any patients, the health board still has to pay up the money for them to the private contractor. That is the real reason why Monklands A and E unit is closing.
The litmus test of whether members are genuine or just playing politics will come when the matter is put to the vote tonight. If they vote for the Executive amendment to the SNP motion, nobody in Lanarkshire will believe them in May next year.