National Bed Assessment
The final item of business is a members' business debate on motion S2M-4525, in the name of Jean Turner, on national bed assessment. The debate will be concluded without any question being put.
Motion debated,
That the Parliament notes that NHS Greater Glasgow and Clyde now has responsibility for a population of approximately one million; considers, therefore, that an urgent assessment is required of all numbers of beds, including high dependency and intensive care beds and those set aside for barrier nursing, since availability of every type of bed is crucial to the best clinical decisions and nursing care, as well as to the smooth and easy flow of the patient journey from one area of a hospital to another as their medical condition changes for better or worse; recognises that not having appropriate beds of any kind, in any speciality at any one time, can mean that a patient may have to stay in intensive care longer than necessary and thus block a bed for a patient who should be transferred from a high-dependency bed or theatre to an intensive care unit bed; acknowledges that delays to admission from casualty, accident and emergency or trauma departments may also be due to a lack of all types of beds being available, thus resulting in the discharge of patients in the evening in order to free a bed for an emergency admission; recognises that important elective procedures and operations may have to be cancelled at short notice as a result of no appropriate bed being available because of a general bed shortage, and therefore, in light of an increasingly ageing population with more complex conditions and in anticipation of a further rise of medical admissions including all types of infections, in particular MRSA, winter and summer vomiting viruses which often close wards, considers that work should be done to address our present problems within such a large NHS board and as a result decrease waiting times and lists.
I thank everybody who has managed to stay in the chamber for the debate. As I have found when trying to get here for debates, there can be great pressure on people's time. I am very sad that Sandra White, who was going to speak, has had to leave because of a family bereavement.
I thought about busing folk through to fill the public gallery tonight, because I thought that their presence would underline what I have to say on their behalf, but then I thought that that would not have been fair on a winter's evening.
There is a great deal of uncertainty among the staff of NHS Greater Glasgow and Clyde and among the people who are served in its catchment area. That is partly due to the changes intended by the acute services review and the anxieties created by NHS Greater Glasgow taking in NHS Argyll and Clyde, as well as the uncertainty around the future role of the Vale of Leven hospital. There is also uncertainty about what is happening outwith NHS Greater Glasgow and Clyde. For example, the closure of the Monklands accident and emergency unit will have a massive impact on the Glasgow royal infirmary, as will the intended closure of in-patient beds at the Victoria infirmary and at Stobhill hospital.
I remind members that the Glasgow Western infirmary is to close completely and that the size of Gartnavel general hospital has still to be determined to cover in-patient beds for admissions from primary care and for critical care required by the new Beatson cancer hospital on that site. Yorkhill hospital is being transferred to the site of the Southern general hospital—
Excuse me, Dr Turner. I am sorry, but I can hear members' conversation.
The Southern general hospital, in Govan, will be the only accident and emergency/trauma and general hospital on the south side of Glasgow until Hairmyres hospital, beyond Newton Mearns, because there will be only out-patient and day surgery facilities at the Victoria infirmary. Patients who do not travel by blue-light 999 ambulance will make their way to the hospital of their choice by whichever transport is available to them—not necessarily to the hospital that the health board managers think that they should attend.
I was reminded by a member of accident and emergency staff that a minor injury is only a minor injury once it is diagnosed. Such injuries will be treated on all national health service sites. The see-and-treat model is being tried and is found to be helping with waiting times at accident and emergency and casualty departments. However, tonight I will speak about the importance of having enough in-patient beds.
Last September, the bed modelling assessment for the health board had to be completed before the final business case for the new Southern general hospital could be submitted. Despite asking Robert Calderwood for the result of that, at the north monitoring group in Glasgow, time after time we have received no answers. In the 21st century, we still have patients lying around for hours on trolleys. However expensive and comfortable they are, that is shameful. If we had enough beds, that would not happen.
Recently, one of my constituents spent 13 hours lying around on trolleys while being transferred between Stobhill hospital and Glasgow royal infirmary. A general practitioner friend was allowed to transfer her from Stobhill to Glasgow royal infirmary, but that did not make any difference to the length of time that it took for her to be treated. Why can we not get bed numbers right for those who are unfortunate enough to be sick? What confidence can people have for the future if we cannot get it right now? Will we get it right in future? People are advised that we do not need beds because we have new technology and because the NHS works differently: more people are treated as day patients or in primary care in the community; therefore, we do not need so many beds.
GPs are encouraged to make great efforts to keep elderly people out of hospital and to prevent readmissions. To my knowledge, primary care has always tried to do just that, but more highly trained staff will be required to cope with the number of patients who are discharged early into the community as well as those who are not admitted to hospital.
Years ago, it would have been a disgrace for someone to come out of hospital with a bed sore, but that happens more frequently now. Such a sore is very painful for the patient, it is open to infection and it makes more work for the nurses.
We know that 98 per cent of all NHS work is in primary care. An out-patient department will deal with 85 to 90 per cent of the 2 per cent of patients who go to hospital. In-patient work makes up a very small proportion—10 to 15 per cent—of the work of NHS hospitals. Bedblocking happens when people are fit to leave hospital but there is no bed for them in the community. Intensive care beds are frequently blocked because there is no other bed in the hospital that can take the patient—not even a high-dependency bed. Patients cannot be admitted for elective procedures if there is no bed; nor can a free high-dependency bed or intensive care bed be lined up for them for post-operative care. That means that clinical decisions are compromised, and there may be serious delay in rescheduling theatres and beds for another day.
One of my constituents was caught up in that. She was to have a serious operation, but it was cancelled at very short notice because an emergency case took her bed. The psychological work-up to her operation and the preparation that she had done to have her job covered for the three months of her recovery period were shattered.
NHS staff are saddened by the fact that slack never seems to be factored into the system, despite research that indicates that infection rates rise if hospitals run at more than 82 per cent bed occupancy. The same is true if wards are short staffed and if patients are transferred around or between hospitals. Intensive care units work best at 75 per cent bed occupancy.
Some of our intensive treatment units—one at the Southern general and one at the Glasgow royal infirmary—are short of beds. By that I mean that they have the beds but not the staff to cover them. Clinicians are worried about infection rates. If MRSA or one of the other common infections breaks out, there are not enough isolation beds or single rooms. I would like us to carry out low-risk surgery on high-risk patients and to add general and medical services, perhaps attached to intensive care beds and coronary care units, to the ambulatory care and diagnostic units at day hospitals. That would create more slack and relieve the strain on Glasgow royal infirmary, the Southern general and Gartnavel. I ask the minister to consider that suggestion.
Patients are sent home far too frequently from day surgery. The onus is then on the patient to find their way home. One of my constituents had to leave in a wheelchair. Instead of being able to go back to work, he had to get his son to help him out of the car and to the toilet that evening, because his wife was not well enough to do that. It is unfair for responsibility to be placed on the patient in that way.
I want the minister to realise that patients suffer because we do not have enough in-patient beds. That puts strain on hospitals and their staff, and has a knock-on effect on all areas of the NHS.
I am grateful to Dr Turner for raising this issue in the Parliament. She has made a lot of good points. One advantage that the Parliament has is that the debates that take place at 5 o'clock allow for a degree of input that is not normally possible in our other debates. In this case, a retired general practitioner has been able to speak from her experience, both current and former, of the problems that exist.
It is important for us to consider what the motion asks for. It does not ask for a lot more money to be spent or put up the barriers that usually arise in debates on the health service. To my mind, it is asking for something eminently sensible—namely, that there should be an assessment of available beds in NHS Greater Glasgow and Clyde, especially given the extension of the health board area.
Dr Turner mentioned the position of Glasgow acute services. On a number of occasions the chamber has heard me express serious concerns about the issue, because I fear that the provision that is being advanced as the solution to current problems is not the right way forward. I retain the view that, although the existing configuration does not need to be preserved in aspic, the reduction of acute services to, in effect, two and a bit units is problematic. That is the case especially south of the River Clyde, given the possible difficulties that people face in gaining access to the Southern general hospital at rush hour, with the Clyde tunnel in perennial half-closure, or when there is a football match at Ibrox or Hampden.
There are more and more complaints about delays in admission to wards. Like Dr Turner, I dealt with such a case recently. It involved an elderly lady who was left lying on a trolley at the Western infirmary for an inordinate amount of time because no suitable bed was available, at a time when there was no particular pressure on beds. I wrote to the minister and the hospital authorities on the matter and have received the appropriate apology on behalf of the patient. A review of bed numbers, which would require very little financial input from the Executive, should be considered.
We must also recognise that, from time to time, there will be situations in which the health service and hospitals will not be able to cope. Dr Turner's motion quite rightly mentions the effects of MRSA infections and viruses, which can temporarily close wards, and that is a problem. There could also be major incidents that result in large numbers of casualties, and problems would arise in such circumstances. I am not suggesting for one moment that the health service has got to budget for extreme situations, because I know that that simply could not be done. However, in respect of everyday situations, we must consider bed numbers.
It might be that a review of beds would lead to some adjustment and allow beds to be spread more evenly, so that resources could be allocated in a more logical fashion than appears to be happening in several of our hospitals at the moment—and there might be no additional cost involved. As Dr Turner said, a review of bed numbers could be conducted as a matter of common sense, consistent with the usual reviews that should be done from time to time, but particularly in relation to the extension of the health board area.
I thank Jean Turner for bringing the debate to the chamber today. It gives us a welcome opportunity to discuss a lot of health issues that affect communities throughout Scotland.
Jean Turner talked about lost beds. I have looked up some figures and found that 1,509 acute specialty beds in Scotland have been lost since 1998. Nearly one acute bed has been lost every week in the past year—a total of 47 beds. Greater Glasgow has lost 500 acute beds since 1998, and the Ayrshire and Arran area has lost 238 general beds in the same time, with 138 of them being lost in the past two years alone. There have been massive bed losses in ear, nose and throat, general surgery, gynaecology and urology.
The Scottish Executive is pushing centralisation to the five main centres in Scotland and it is downgrading other hospitals with accident and emergency services so that they will have no A and E services. There will therefore be more reliance on using paramedics and ambulances to get people to A and E facilities in centralised hospitals. A health official in Glasgow recently reassured people at a public meeting about their concerns about getting to A and E by saying that ambulances were mobile A and E units. Although we all acknowledge the fantastic work that paramedics do, we could be putting them under a tremendous amount of stress by expecting far too much from them—I suggest that we are probably doing just that.
Of the 15 A and E departments in Scotland, seven are under threat of closure: the Victoria infirmary, the Western infirmary and Stobhill hospital in Glasgow; Ayr hospital; Queen Margaret hospital in Dunfermline; Inverclyde royal hospital in Greenock; and Monklands hospital in Lanarkshire.
NHS Ayrshire and Arran is to shut down the A and E department at Ayr hospital, centralising all emergency services at Crosshouse hospital in Kilmarnock. Five community casualty units will be set up around Ayrshire to deal with minor injuries. A petition against the closure of the A and E unit at Ayr was signed by 55,000 people and more than 5,000 joined a march through the streets of Ayr against the closure. The health board said that the plans represented an investment of about £70 million over the next 10 years, but there was no listening to the community at all. The move will also see complex surgery provided at one specialist site, at Crosshouse hospital, with planned surgery at Ayr hospital.
The issue is patient safety. We hear doctors talking about the golden hour, which is a concept that was described graphically at some of the meetings that I attended in Ayrshire. People who have suffered a traumatic injury have an hour to get to hospital for treatment. If patients who have such injuries have to travel further to A and E, that could put lives at risk. Given Ayrshire's geography and the current use that is made of local A and E facilities, there is a need for two A and E departments, one at Ayr hospital and one at Crosshouse hospital. The geography dictates that the A and E facility at Ayr should be kept open, as there are huge distances to cover—that is a particularly important consideration when there may be a serious, life-threatening incident.
As with the large numbers of beds being lost, there is no slack in the system, as Jean Turner said. The consultation on the A and E facility at Ayr was flawed from the outset yet, according to Dr Bob Masterton of NHS Ayrshire and Arran, it has been the most extensive consultation ever. Ayr A and E department is to close despite massive public opposition and despite the fact that the majority of consultants at Ayr hospital have said that closing the A and E department is not a good idea.
Switching to Crosshouse, which would be the only specialist casualty unit in Ayrshire, could add 30 minutes to some patients' journeys. That could put their lives in danger. Paramedics are not doctors. They cannot do anything in the case of stroke except get the person to hospital as quickly as possible. That is because a stroke can be caused either by a blood clot or by bleeding in the brain, so a scan must be done before treatment is given. If a stroke is caused by bleeding and the patient is given clot-busting drugs, that will kill them. The travel time to hospital is crucial to survival.
I thank Jean Turner for bringing the matter to the Parliament today. I will read out an e-mail that I recently received, because it is relevant to the debate. It states:
"Dear John, …
I'm wondering how typical my 85 year old mother's experience has been of the non-provision of services.
About four years ago, she was referred by her GP to a clinic to see if she needed a hip replaced (she'd already had the other one done in the late 90s). She was turned down. We went through the same procedure every six months until (a) she was in considerable pain and (b) she was losing so much weight as a result that we thought she wouldn't survive—period, not just as the result of an operation. We eventually dug deep and went private; the surgeon at the Murrayfield thought twice about operating because of her body condition … She left hospital with no support package in place which we had to find for ourselves.
She is now in the position where she needs a little extra support—dressing, bathing and that kind of thing. I approached Edinburgh Council Social Work Department some months ago; they took detailed notes and promised her an assessment but we've since heard nothing.
This week however, she had an accident and broke her wrist. I took her straight to the ERI A & E Department. They were very good but could not admit her for the night as there were no available beds"—
that is exactly what we are all talking about. The e-mail continues:
"We had to take her back to hospital for a major but non-invasive procedure early the following morning. Again, the doctor stressed there would be no support after the operation despite her being in plaster for the next six weeks. He said we'd have to get in touch with the Social Work Department … Again, the Social Work Department said something along the lines of ‘OK, she's slightly up the waiting list—but basically, why not choose a nursing agency out of Yellow Pages and check them against the Care Commission!' … in other words, you're on your own!
So I've been scrabbling about on the Internet trying to source something at short notice.
I can't help but wonder if this is typical of the Executive's much-vaunted ‘free care for the elderly'?"
Those are not my words but the words of the sender of the e-mail.
I honestly believe that health should not be used as a party-political football. Consensus should always be the order of the day in relation to health. Therefore, I read the e-mail with a heavy heart, because I am proud of our health service. It is seldom in receipt of praise for a job well done but receives severe criticism on the rare occasions when that is not the case, such as the circumstances outlined above. Basically, there have been too many cutbacks in hospital beds. It is time to reduce the number of managers, statisticians and bean counters and invest in more doctors, nurses and hospital beds.
Obviously, Sandra White would have liked to be here to speak about NHS Greater Glasgow and Clyde, but I will address the wider issues that are identified in the debate's title, "National Bed Assessment", and pick up on some issues that have been raised in the debate.
John Swinburne is right to reflect that, although in Parliament we by and large deal with management processes in the health service at a strategic level, ultimately it is about individuals and people. That must colour our perceptions of and discussions on the health service.
When I was first elected to the Parliament in 1999, my first question at my first meeting with representatives of Lothian Health Board was, "What are you going to do about MRSA?" They replied that the design of the new royal infirmary would cut down MRSA figures. Unfortunately, recent figures show that the incidence of MRSA at the Edinburgh royal infirmary is high—at a time, interestingly, when St John's hospital has made great progress in reducing it.
If we are to tackle the issue of hospital bed assessments, we need to learn from elsewhere. I am interested in hearing the minister's reasons for not carrying out a national bed assessment in Scotland, given that such an assessment took place in England as a means of directing resources.
The changes to A and E services that members have already highlighted also have implications. For example, in the Lothians, emergency surgery and orthopaedic trauma services were moved from St John's hospital to Edinburgh royal infirmary. Indeed, because of that decision, Edinburgh royal infirmary has to increase the capacity of its reception area by 40 per cent. Many requiring orthopaedic trauma treatment are elderly people who, for example, have broken bones. In the Lothians, they have to go to ERI for their initial treatment and either are sent home with a care package—which, in the case that John Swinburne highlighted, was obviously sadly lacking—or, if they need to remain in hospital for treatment, are sent back to St John's. I wonder whether elderly people should be shifted from pillar to post in that way.
We have rehearsed the arguments about those clinical arrangements, but I want to look at how the situation pans out across Scotland. I know that planning work has been undertaken on health board catchment areas and so on. However, with the closure of the A and E department at Monklands hospital, the ambulance services will have to make a judgment call whether to take people who live in the west of West Lothian to the ERI or to St John's. Of course, if people require emergency surgery or orthopaedic trauma treatment, they can no longer be taken to St John's. At the moment, my constituents are quite often taken to Monklands hospital but, if that A and E department is closed, where can they go? A hospital is planned for Larbert, but that in turn raises questions about the size of its catchment area. I also know that clinicians at St John's are concerned about the sustainability of some services if the hospital at Larbert begins to take some of the patients from West Lothian. As a result, bed assessments are important not only for individual treatments but for service sustainability.
Of course, hospitals tend not to keep people in for as long as they used to, but that practice has serious implications for patients who have had to travel great distances. Moreover, members have highlighted the impact of evening discharge on individuals and their families. It has become increasingly clear from my constituency case load that centralising services has led to patients being discharged at awkward times of the night. Of course, that is fine for patients whose families live in the immediate vicinity, but the situation can prove difficult for patients who live an hour away and have, for example, to negotiate the Edinburgh bypass.
I hope that we can reflect calmly and coolly on the reality on the ground. We know that the area is complex and that issues have become compounded but, unless we know what we are working with, we cannot make any judgments. The call for a national bed assessment, which the SNP supports, is probably the least that we can ask to take this matter forward.
I thank Jean Turner for securing this debate. As she knows, I have consistently supported the call for a national bed assessment. Indeed, the case of NHS Lanarkshire illustrates very well the need for an overall regional and national strategic view of the number of beds that we require. Rosemary Byrne referred to figures that I obtained a wee while ago from the Executive that show that, over a very short time, 20 per cent of beds were lost across Scotland and in NHS Lanarkshire with absolutely no national or regional consultation on such a fundamental shift in bed provision. It took place bit by bit without any public engagement or accountability.
Moreover, when we entered into the consultation on "A Picture of Health: A Framework for Health Service Provision in Lanarkshire", NHS Lanarkshire made it categorically clear at the outset that—even though it had carried out no work on bed modelling, workforce planning or cross-boundary flows—bed numbers would stay the same. The fact that it did so before consultations in the neighbouring health board areas had been completed and before plans had been implemented in those areas makes me highly sceptical about the science behind such commitments and about whether health boards are planning for the provision of need rather than cutting their coats according to their cloth—the resources that are available.
The issue of beds is not just about beds and the hospital estate; it is about the staff who go along with the beds and their skills mix. NHS Lanarkshire is either unable or unwilling to give figures on the number and skills mix of the staff whom they envisage being attached to the beds at Monklands hospital.
The motion involves so many issues that it is impossible to pick up on all of them. However, it is fair to say that communities throughout Scotland have no confidence whatever that the Executive or the health boards are planning future health care provision on any sound arithmetical, scientific or philosophical basis, or are taking into account the quality of care that will underpin that provision.
That brings me to my next point. Not long ago, Jean Turner and I both spoke at an NHS Consultants Association conference. The tendency to move towards subspecialisation is having a major impact on the availability of beds and on boards' ability to provide local health services, and it is distorting the patient journey. I speak from recent experience—Rosie Kane and I both have recent experience of the patient journey in the NHS.
The fact that patients often have a number of conditions that do not come in neat packages gives rise to a significant issue in some areas where there has been centralisation. It is difficult for a person who is ill with two conditions to get holistic care if treatment of one condition has been centralised in one hospital while treatment of the other has been centralised in another. That will be a huge issue for the health service in the future. An overall assessment of the balance between generalisation and subspecialisation needs to be carried out in a way that takes into account the patient and their holistic needs. Sometimes patients do not need superspecialists; sometimes they need generalists who are able to look after their whole health rather than specialists who constantly refer them somewhere else and have them buzzing about all over the city.
I have spoken about the skills mix, but I want to finish on a point about the hospital estate, in which I include public-private partnership and private finance initiative new-build hospitals. The hospital estate is not kitted with enough beds to isolate patients who have hospital-acquired infections, which means that barrier nursing has been made extremely difficult in our old estate and our new estate. There is no sense that the problem has been acknowledged or that planning is being done for enough beds to be provided so that patients can be isolated.
You should be finishing now.
Our hospitals are not kitted out to cater for the needs of disabled patients; again, I have recent relevant experience of that. There is not enough investment in meeting the needs of disabled patients while they are in hospital. If there is anywhere in the world where the needs of disabled patients should be met, it is a hospital.
I congratulate Jean Turner on securing a debate on such an important subject. Although the motion refers to the situation in the NHS Greater Glasgow and Clyde area, we are talking about a national problem. Jean Turner spoke mostly about the medical, surgical and intensive care side of things, but the problem of a lack of available beds also occurs in mental health provision.
In the Highland NHS Board area, difficulties have been experienced in finding beds for people who have acute episodes of mental illness. A knock-on effect has been that the board has had trouble staffing the hospital that deals with mental illness because junior staff, when they have been asked to do extra hours as a result of the hospital being short staffed, have refused. They have refused not because they do not like their jobs or because they are not dedicated professionals, but because they could not stand any more of the frustration of spending hours trying to find beds for patients. That is not a good use of professional time, as I know from my time as a junior casualty doctor. It is clear that the situation is much worse now and is affecting not just the acute medical and surgical sector, but the mental health sector.
Of course, some of the beds in the NHS in Scotland are where they are for historical reasons and if we were starting from scratch, we would not put them where they are now. Although those beds might not be best placed to meet the needs of the present population, if they are to be got rid of—it is probably right that some should be got rid of—the alternative must be in place before that is done.
The same principle applies to service redesign. I agree that services should be constantly redesigned, but we need to put in place the services that we are moving to before we remove the services that are currently in place. We cannot leave a gap. Too often, we see closure and promises instead of closure and alternatives. That is what worries a lot of people.
On bedblocking by elderly patients, which Jean Turner mentioned, we all have experience of that—I have professional and personal experience of it. Elderly relatives of mine have been admitted, quite rightly, to an acute medical ward after an acute episode, but have then stayed in that ward for a long time because of a lack of beds in the geriatric rehabilitation unit, to which they had to wait to be moved. Clearly, there are blockages in various parts of the system. It is not right that patients, who might be receiving good care, should continue in wards that are geared to meet not their needs but the needs of others, who are being denied that care because the bed is blocked. Bedblocking occurs within the NHS as well as between the NHS and the facilities in the community out to which people are moved.
I was attracted by the Kerr report's recommendation on community hospitals. Although that proposal was welcomed when the report was published, it does not seem to have been developed and followed up. I believe that more consideration should be given to having some kind of last stage in the rehabilitation process before the patient goes home. Once an elderly patient's acute problem has been sorted, and perhaps after the patient has had a spell in a dedicated rehabilitation unit, there would be many advantages to having a final stage of rehabilitation in the patient's community where the patient can be visited and can meet the people who will provide care and support.
One problem in the Highland NHS Board area that the minister is aware of—I feel able to mention this because Jean Turner mentioned bedblocking—is that patients are sometimes discharged to a care home outwith their local area because no place in a local care home is available and there is great pressure not to block beds. That is inappropriate for elderly people because it is disorienting and distressing. It should not happen.
The Kerr report envisaged that much more care would be provided locally, but I am not sure that that is happening. We seem to be moving to closing facilities before the full development of alternatives, which takes time. I agree that we need to try to keep people out of hospitals by better managing chronic conditions and by caring better for our elderly population. That will stop some of the acute admissions, but it will not stop them all, so we still need the beds.
I very much agree with the points in Jean Turner's motion about the capacity of the NHS to respond to an emergency. An outbreak of avian flu or human flu might place greater demands on beds during the winter months, so we cannot run a health service that is working to capacity all the time: there needs to be some slack because demand fluctuates. My concern is that we have not thought things out properly by calculating what we might need and by at least having a contingency plan. For that reason, I very much support Jean Turner's call for a national bed assessment.
I congratulate Jean Turner on securing the debate.
As has been said, Greater Glasgow and Clyde NHS Board faces some major health and health care challenges that need to be tackled. Health inequalities are greater in that board's area than in Scotland as a whole and they rival the challenges that exist anywhere in the United Kingdom. That is partly why the board has undertaken a substantial and ambitious service modernisation task, which has been begun but needs to be carried through. Along with its staff and partners—including the local authorities—NHS Greater Glasgow and Clyde is committed to tackling those challenges. It has our support in doing so through the acute services strategy that was agreed some time ago.
It might be useful to consider the issues of acute bed numbers and capacity planning not just in the context of Greater Glasgow and Clyde but in an all-Scotland context. As several members pointed out, there are parallels between what is happening in Glasgow and what is happening elsewhere in Scotland. Some of the fundamental points apply equally across the country.
Prime responsibility for planning hospital services, including acute bed numbers, rests with NHS boards. As has been said, hospital beds are an important and expensive resource, but other resources are equally essential. Care also depends on appropriately skilled staff, modern diagnostic equipment, well-organised out-patient clinics, flexible and responsive primary care teams, trained mental health community teams and good-quality interventions that avoid the need for hospital admission in the first place. Every part of the health care system is linked to other parts and they are all essential in delivering patient care.
Planning bed numbers is not simply a matter of getting the volume right. Available beds must be in the right specialties and at the right level to meet clinical need. The number of intensive therapy unit beds in the NHS throughout Scotland has risen steadily, from 159 in 1999 to 177 this year. Those are the most expensive and highly specialised beds in the NHS. As has been mentioned, at the same time, the number of beds in surgical specialties has reduced, which reflects the fact that more and more patients are being treated as day cases. The rate of day-case surgery has risen from 57 per cent in 1997 to 66 per cent now, which is very nearly two cases in three. Our ambition, which is based on clinical advice, is for that figure to continue to rise and to reach 75 per cent, or three cases out of four, by the end of the decade.
I suspect that it will be scarcely believable for many members to hear that, in 1990—only 16 years ago—the average length of a hospital stay following cataract surgery was more than five days. Nowadays, most cataract patients are treated successfully and discharged on the day they go to hospital. The NHS now carries out more treatment in out-patient departments and GPs' surgeries, which avoids the need for admission to hospital at all.
Jean Turner's motion refers to the importance of waiting times. We agree with her about the importance of decreasing those times, but it is important to say that having fewer surgical beds does not mean less treatment and nor does it mean longer waits; it simply reflects the more modern and effective ways of delivering surgical treatment. As members will know, the figures show that, as surgical bed numbers have come down, waiting times have come down. For example, compared to 1997, 11 per cent more principal operations, 250 per cent more angioplasties, 104 per cent more knee-joint replacement operations and 58 per cent more cataract operations are now undertaken in the NHS. In the context of that significant rising level of surgical treatment, waiting times have come down to a point at which no patient with a guarantee now waits more than six months for treatment and the NHS is on target to deliver a maximum wait time of 18 weeks.
Jean Turner said that she would like the NHS in Glasgow and Clyde to keep acute bed numbers under review. I assure her that the board is doing that and will continue to do so throughout the enlarged area. That is essential if the board is to deliver its acute service strategy successfully. That strategy, which is for the modernisation of the way health care is delivered in Glasgow and Clyde, will result in a total investment of about £950 million in modern hospital facilities throughout the city and region by 2013. The investment will deliver a range of improved services for residents and patients in the area. Work on the new Beatson oncology centre—a project that involves £85 million of capital funding—is nearing completion and the centre will begin to admit patients early in the new year. There will be 170 in-patient beds at the new Beatson and 45 day-case beds, which will replace similar numbers of beds in existing oncology units.
Work has started on the new diagnostic and day-treatment hospital at the Victoria site and work will commence soon on the developments at the Stobhill site. Together, those projects, including equipment, involve an investment of about £200 million. The hospitals, which will open their doors to patients in spring 2009, will be able to treat more than 80 per cent of patients who are currently treated at the existing Stobhill and Victoria hospitals. However, they will do so with a lot fewer in-patient beds. Again, that has been decided on the basis of clinical need. There will be only 12 short-stay surgical beds at each of the new hospitals because day-case patients do not require acute hospital beds.
Does the minister agree that 80 to 85 per cent of hospital treatment has always been out-patient treatment? Most hospital work is done in out-patient departments, and that will be no different at the new ACADs.
I agree that that has always been the aspiration. The difference is in the way in which health services are designed and delivered. Henceforth, far more patients will be successfully treated without needing to be admitted to hospital.
The demand for beds will also be reduced if we successfully implement the Kerr report's recommendation to stream and separate planned care and emergency care. That recommendation lies behind many of the changes that have been referred to in the debate. Separating those streams will allow clinical teams to concentrate their core skills, maximise productivity and significantly reduce the risk—to which Jean Turner referred—of planned surgical admissions having to be cancelled because of peaks in emergency demand.
We aspire to an NHS that is fit for the 21st century. We realise that, in many respects, it will look different from the service that was created 60 years ago. One of those respects is that there will be fewer general acute beds but more support from intensive care.
The changes are all about how we deliver for patients and, to deliver for patients, the NHS must change and continue to change.
Meeting closed at 17:51.