Plenary, 17 Jan 2001

Meeting date: Wednesday, January 17, 2001

Official Report 439KB pdf

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Acute Services Review (South Glasgow)

We come now to members' business, on motion S1M-1474, in the name of Janis Hughes, on the acute services review in south Glasgow. I ask Janis Hughes to wait until the chamber clears and I ask those who are leaving to do so quietly.

Motion debated,

That the Parliament notes the current review of acute hospital services in the south of Glasgow and believes that there should be an option appraisal of all the sites considered by Greater Glasgow Health Board as part of their consultation process.

Greater Glasgow Health Board first produced its consultation document on the future of acute hospital services in Glasgow in April 2000. The central thrust of the proposals was rationalisation of services throughout the city; the redesigning of health provision while maintaining local access for as many patients as possible. The consultation process ended in September 2000 and much has happened along the way.

It is inevitable that any talk of rationalisation in the health service will lead one to think about bed numbers. In 1990, 11,918 beds were available in the greater Glasgow catchment area. The latest figures from the "Scottish Health Statistics" report reveal a reduction to 7,564. Greater Glasgow Health Board's own figures, as set out in the consultation paper, identify a reduction by 389 beds in the first five years of its plan. That must be considered in the context of continuing pressures on acute medical and surgical beds and the winter pressures that often extend much further into the year.

However, it must be borne in mind that rationalisation can lead to improved patient care. I stress that those of us who represent south Glasgow constituencies are fully aware of that. Nevertheless, the current hospital provision in the area is Victorian—both the Victoria infirmary and the Southern general hospital celebrated their centenaries long ago. In the opinion of many people in the south of the city, the hospitals are unsuitable for modern acute health care that befits the 21st century.

I worked in the health service in Glasgow for 20 years, so I am acutely aware that one of the main problems that we face is that a strategic view has never been taken of how to provide acute services in the city.

The issue that causes most concern in the current review is accident and emergency provision. A couple of years ago—long before the consultation process was considered—a decision was taken to reduce that service to two trauma centres in the city. There would be one centre at either end of the motorway network—at the royal infirmary and at the Southern general hospital. The trauma centre at the royal infirmary is being built and will soon open. That decision was taken prior to the acute services review, but it has a huge and important impact on how services are now built.

It has been recognised for many years that Glasgow has suffered underfunding in health provision. That is all the more poignant when one considers that the city has the worst heart disease rate in Europe. The Arbuthnott report sought to rectify that, but the legacy of previous years will take a long time to remedy. In recent years, many hospitals in the south of the city have closed, including the Samaritan, Mearnskirk, Philipshill and Rutherglen maternity. We may appreciate some of the reasons for those closures, but the fact remains that we in the south of the city are now left with hospitals that are well past their sell-by dates and which were built long before some of those that are closed.

It is no secret that Greater Glasgow Health Board strongly favours the Southern general hospital site for the main acute centre in Glasgow. There are many reasons for that, not least the one that I mentioned—accident and emergency provision. However, it is not just about what Greater Glasgow Health Board wants, but about what the people of south Glasgow deserve and what will best meet their health care needs.

The recent consultation process demonstrated that residents in south-east Glasgow in particular favour a more centrally located hospital that offers them the facilities that they expect from a modern health service. The arguments about closing the Victoria infirmary because it is not suitable for such provision might be understandable, but they are hard to swallow when we consider that the Southern general is even older, not to mention the fact that it is surrounded on most sides by a sewage processing plant.

However, the most important issue is provision of the very best health care that is available and how and where that can best be provided. We all agree that much more locally provided health care should be available. Much has been said in Glasgow about the provision of ambulatory care services. In the context of south Glasgow, there is a proposal to site an ambulatory care and diagnostic centre—or ACAD—adjacent to the current Victoria infirmary site. Under the preferred option of the health board, we are told that that would serve 80 per cent to 85 per cent of the population, who could attend for out-patient, diagnostic and minor injury services. Visits to the acute site would be necessary only for in-patient requirements.

However, concerns have been raised—not only by the public, but by senior medical colleagues—on the potential risks of ambulatory care facilities that are remote from their parent site. Indeed, Sir David Carter, in his 1999 review of acute services, said that the success of ACAD units

"depends on the willingness of clinicians to espouse new ways of working and set aside traditional boundaries between disciplines."

I take from that that he meant that the concept can only work if there is willingness on the part of the consultants who are involved.

The main issue is that if Greater Glasgow Health Board is serious about the extensive consultation process that concluded recently, the views of the public must be taken into account. Given the clear expression by so many of their wish for a new, purpose-built hospital in the south of Glasgow, the board must demonstrate willingness to go further in examination of that option. On behalf of my constituents in Glasgow Rutherglen, as well as those in many other south Glasgow constituencies, I ask that a full option appraisal be carried out of all the possibilities that were raised during the consultation process. The people of Glasgow deserve no less. On behalf of the people of south Glasgow, I urge the health board to ensure that the outcome of the process is in the best interests of all. I know that those views are shared by colleagues who have spoken to me on the matter.

The number of members who want to contribute to the debate is welcome. In that regard, I ask that the Presiding Officer consider extending the time that is available for the debate so that all members who want to show their concerns about the process can do so.

If the number of members who have indicated that they wish to speak remains about the same, it is likely that the debate can be contained within the allocated time of 45 minutes. If, however, it looks as though that will not be possible, I will indicate that I might be able to accept a motion to extend the debate.

I wish to be the first to congratulate Janis Hughes whole-heartedly on securing this welcome debate.

About 20 months ago, Janis Hughes, Ken Macintosh, Mike Watson, John Young, Robert Brown and I met a delegation from the Victoria infirmary and we agreed to form an informal cross-party group to consider the issues that are addressed in the motion. Since then, we have had 35 to 40 meetings with a variety of organisations, ranging from trade unions and the ambulance service to clinicians and—on two separate occasions—the Minister for Health and Community Care. I am pleased that the motion is, in many ways, a result of the work that has been done by that group.

Time is short and a number of areas of concern that Janis Hughes touched on will be dealt with in greater detail by Ken Macintosh, John Young, Mike Watson and Robert Brown, so I wish to comment specifically on some of the issues that were discussed with Greater Glasgow Health Board and South Glasgow University Hospitals NHS Trust. When colleagues and I met the board and trust in September 1999, we were presented with what was virtually a fait accompli in their proposals for south Glasgow hospital provision—I see that John Young is nodding vigorously.

We were presented with an open-and-shut case for why acute services for all south Glasgow should be concentrated on one site—the Southern general hospital—which is at the outer edge of the catchment area. The main reason for that was cost. We were advised that a new hospital on another site, such as Cowglen or Pollok, would cost £90 million more in capital cost and £7.3 million more in revenue than it would cost to refurbish the Southern general hospital.

In the 18 months since then, despite repeated questions about how such figures were arrived at, we are still no further forward. We have had merely to take the health board's and the trust's word for it. That would be fair enough if there were a wee bit of consistency from the trust and the board. However, as colleagues across the party divide will attest, we might be presented with one set of figures at a board meeting on Monday, and we could meet the trust on Friday of the same week, only to be presented with a completely different set of figures.

From the outset, we have met shifting sand. From £267 million, excluding an ambulatory care and diagnostic centre, the cost of a new hospital apparently ballooned first to £350 million, then to £440 million and now—this might give the minister a heart attack if it is true—to some £550 million. That increase has happened with no apparent significant change to the proposed hospital's size, specialty profile or patient services. Indeed, we were presented with completely different figures on different days and in successive weeks. We ended up in a very confusing situation in which nobody seemed to know where they were. Only the revenue costs—for some bizarre reason—appear to have stayed the same throughout the negotiations. That has caused concern to those of us who have been involved in discussions during recent months.

The sand also appears to have shifted when it comes to the time scale for construction. We were told that a new hospital would take five years to build and that refurbishment of a hospital would take 10 years. That seems to me to be an argument for a brand-new, all-singing, all-dancing hospital on a new site. However, miraculously—after a couple of further meetings with the board and trust—we were told that it might take seven or eight years to build a new hospital but only five or six to refurbish one. Perhaps we are being cynical, but we are concerned that the wool is being pulled over our eyes by Greater Glasgow Health Board and by the trust. I say that with great regret.

What is the trust offering us? First, we were offered a refurbished hospital, but people did not really like the sound of that, so the proposal has somehow been developed into a plan for a brand-new hospital. However, at a public meeting in Cambuslang last year—which was also attended by Robert Brown and Janis Hughes—I asked Bob Calderwood what his choice would be if a new hospital would cost exactly the same as a refurbishment on the Southern general site. What did he say? He said his choice would be a brand-new hospital.

The issue is cost, but we do not think that cost should be the overriding factor. That hospital might have to last 50, 60 or 70 years. We want a high standard of care for patients and the best possible working conditions for staff. The public demand a new hospital. We need an independent option appraisal to ensure that people in south Glasgow get the best.

I congratulate Janis Hughes on her excellent presentation of the case. I also congratulate my colleagues of all parties; we work well together and we have one aim.

The most recent report by Greater Glasgow Health Board has a total of about 200 pages. It relates to Glasgow's acute hospital services and draft health improvement programmes for 2001-05. Among the aims that are mentioned are the provision of modern facilities for a better patient experience, maintenance of local access as far as possible and the creation of a pattern of hospital services that makes sense throughout Glasgow. Nowhere in the report have I been able to find mention of population projections.

Let us examine those aims for a moment in the context of the Southern general hospital's finally being chosen. The report mentioned modern facilities. The proposal for catchment areas in south Glasgow and east Renfrewshire centralises virtually everything in the Southern general hospital, most of whose buildings predate 1890, as Janis Hughes said. That hospital is on a cramped site next to a sewage works and is prone to flooding from the Clyde.

The report also mentions maintaining local access. Public transport from Castlemilk and Rutherglen takes roughly two hours there and two hours back, because people have to take more than one bus.

From Muirend and Cathcart, the journey takes roughly one and a half hours. The taxi fare for the round trip is approximately £20. How many families can afford £20 in taxi fares? Traffic congestion is considerable, a bit like at the Glasgow royal infirmary on the other side of the river.

The health board said that another of its aims was to create a pattern of hospital services that made sense across Glasgow as a whole. Whatever decision is arrived at, the hospital will be with us for the next two generations—into the 22nd century. It will be with us for not only 10 or 20 years, but for 90 or 100 years. Population increases will be largely in the south-east and Eastwood areas. In south side areas such as Cathcart and Castlemilk—Europe's largest housing scheme—population projections show increases in the 0-4 years and over-65 age groups, which are the two age groups that require most hospital attention.

South-east Glasgow is the most deprived area in the UK in one major respect: excluding the smallish Rutherglen maternity hospital—which was closed after 20 years—no new hospital has been built there since 1890 when Queen Victoria was on the throne, Lord Salisbury was Prime Minister and William Gladstone was leader of the Opposition. A person would have to be 111 years of age to have been alive when the last major hospital was opened in south-east Glasgow.

No cognisance has been taken of population growth, modern facilities, easy access or adaptability to changing medical techniques—we must consider the modern techniques that might be developed in future. Annexe 2 of the report shows that some 97 per cent of respondents were against the board's views and that 95 per cent strongly support a centrally positioned, brand-new hospital. Page 2 states that Strathclyde Passenger Transport Authority has indicated that retaining work loads on Greater Glasgow Health Board's existing sites will do nothing to improve public transport access.

The accident and emergency sub-committee has stated that it is inappropriate to have two fully equipped accident and emergency centres in close proximity and that therefore, in its opinion, they should not be located at Gartnavel and Glasgow royal hospital. A postcode analysis of accident and emergency attendance in the 1998 one-week survey suggests that the majority of the additional work load would come from south-east Glasgow, when the Victoria loses its accident and emergency service. Paragraph 1.4 states that Greater Glasgow Health Board's proposals for change are not finance-driven, but must be financially realistic. Another point that is strongly made throughout the report is about under-investment.

Finally, the report states that any change should relate as far possible to modern treatment techniques. The board's current proposals point to the 19th century rather than to the 21st or 22nd century.

I do not want to go over the ground that has already so professionally been covered in my colleagues' excellent speeches. The central contentions of the all-party group of MSPs are that greater Glasgow has a legacy of clapped-out, Victorian hospitals, that the current review is many years overdue, that there is one chance and one chance only to get it right, that the Greater Glasgow Health Board's proposals are flawed because of the approach to change that has been taken and that the GGHB and the trust have failed to persuade the population of the south side of their case. I will concentrate on the consultation process.

There are two kinds of consultation: the kind in which the people affected are involved in ownership of the project and have effective choices between options and the outcome responds to concerns and accommodates them—the GGHB, not for the first time, has not engaged in that kind of consultation—and the other kind, in which the powers that be decide on a proposal, go through a procedure to ask people for their views, ignore them and then confirm the proposal that they wanted in the first place. That is what has happened in this instance.

Greater Glasgow is not within the area that I represent, but the Health and Community Care Committee has just considered Greater Glasgow Health Board's lack of consultation on Stobhill. Is the member saying that the board has not taken on board any of the recommendations of Richard Simpson's report, nor taken any cognisance of that report or of the humiliation that it suffered as a result of its lack of consultation on Stobhill? Has the board learned nothing?

I think that it has learned quite a bit; it has learned how to present itself more effectively. The consultation has been, in large measure, a public relations exercise. To address Mary Scanlon's point, the board, in fairness, has gone to some effort—it has produced wads of paper. In fact, it has probably produced too much—so much as to confuse the issue, as Kenny Gibson suggested.

My personal file on this matter is about 26in high. The board has made significant presentational concessions, possibly mindful of the report to which Mary Scanlon refers. The essence of the proposal for a reconstructed hospital at the far extreme of the south side, rather than a long-overdue new hospital in a more central location, remains intact—notwithstanding the volume of objection to it across the area. The public has made good-quality contributions on this matter.

Glasgow is not my area either, although it became so briefly during the Stobhill events. I want to be clear about this for the record. Was a single option presented to the people of the south side of Glasgow, or were they offered several specific options, including a new-build option—even if it was rejected?

When it began, it was a single option. During the consultation, it became—on paper—a double option: between the Southern general hospital and Cowglen hospital on a new-build site. As far as I understand it, Cowglen has never been in the frame—I am sure that my colleagues share this view—as anything other than a paper exercise. It has never been seriously studied by the GGHB.

I will give two examples of how matters have developed. The first concerns travel times to the hospital and paramedic procedures, which members will realise is crucial to where the hospital is sited. The MSP group discovered at an early stage that there had been no discussion with the ambulance service by the board, or the trust, prior to formulation of the proposals.

The second example is even more astonishing. In a letter to me of 9 January 2001, the chief executive of the board stated that my information that neither the GGHB nor the trust had had a meeting with senior officials of Glasgow City Council about the availability of sites on the south side was incorrect: they had in fact had such a meeting, but only on 7 November last year—long after the proposals were formulated, after the main consultation and a mere six weeks before the board considered the outcome of the statutory consultation.

That is why I am saying that this does not represent a genuine consultation. If we, as lay people, can identify this kind of difficulty, what is in the evidence base on which the medical aspects of the proposals were built? That too should be examined. It is proposed that a reference group should now be established to examine only the sites. It is not the option appraisal that we have been seeking, but at least it indicates some movement.

The position of the minister is important, because I assume that she liaises with board officials. She has to approve the funding of a business case; she must be satisfied that the proposal is acceptable, transparent and genuine. She could help a lot by considering—without prejudice to the alternative of an independent external review—how the rigour of the option appraisal and the outline business case procedure might be tested by, for example, an independent facilitator or independent technical adviser.

We must consider those issues. That is why I support the motion.

I thank Janis Hughes for securing this debate. I echo the comments made by all my colleagues in the cross-party group. I am sure that the minister is aware that it is not difficult to maintain cross-party consensus, even in this Parliament.

Location, location, location sounds as though it should be a new Labour slogan, but it is the mantra of estate agents. Location matters, but that lesson has not been learned by the Greater Glasgow Health Board. Despite the fact that it is considering the hospital services that will be required to cover south Glasgow, parts of East Renfrewshire and South Lanarkshire for the next century probably, the location of the hospital seems to have been the least important of all the factors that were taken into account.

Location is crucial because a hospital is a vital and intrinsic part of the community that it serves. Ideally, it should be sited at the heart of that community. The trend is for many workplaces to become generic or depersonalised. There is a desk, a phone and a computer—frankly it could be anywhere. Businesses can move out of expensive city-centre locations to a functional business park on the edge of town. That is fine for places of employment, but it does not work for a hospital. The people who are most likely to use a hospital are the vulnerable: the elderly, the young and the poor. Those are exactly the sort of people who do not have a car to get around in, and who have to rely on public transport.

I do not have to tell any member exactly how difficult it is to get to the Southern general from almost anywhere on the south side. Perhaps an out-of-town shopping centre is a better comparison, because I think that the same thinking has gone into the plans before the GGHB. I am willing to bet that the people initially responsible for the plans have not been on a bus in the past 10 years.

That is not a personal attack, but a criticism of the board's approach and its lack of consideration for the people who will end up using the hospital. The plan has been drawn up by doctors and administrators for doctors and administrators; although it might look good on paper to some, this is—as Robert Brown pointed out—not a paper exercise. How on earth someone will be able to get to hospital or how long it will take them—either to receive treatment or to visit relatives—has not troubled the minds of planners.

Those who have made known their objections about the removal of services to the Southern general have sometimes been dismissed as parochial; I am sure that the board would argue that we need to consider the bigger picture. Although I agree with that to some extent, the board has distanced itself so much from the different communities across the south side that it has lost touch with the problem it is trying to solve. The board is so busy considering the bigger picture that it cannot see the needs of the people it is supposed to serve.

There are further concerns about the location of the big hospital—perhaps many people's biggest worry is access to accident and emergency and how long it will take to get to casualty in an emergency. Although there might be an intention to make a paramedic available in every ambulance, we know that that does not happen in practice and the issue needs to be examined very closely by the Scottish Executive and the ambulance service. Indeed, it is very worrying that it was not until the cross-party group raised the issue that the Scottish Ambulance Service was consulted, which is evidence that the process in which we are engaged is not a real consultation.

We must also consider where ambulances will take people in an emergency. It is good medical practice to take people to the nearest hospital. For the people who live in my area, that means Hairmyres hospital, which certainly raises the question of what will happen to their medical records.

Although I have many more points to make, I will end by telling the minister that he should not get the impression from my or my colleagues' objections that we are luddites. I am not interested in obstructing what might be described as progress, but we need a level playing field and access to all information so that we can make a fair judgment. Although there are many costs to consider—I have emphasised the social as well as the financial cost—it is only through a full option appraisal that we will be able to address people's many concerns fairly and justly.

I thank Janis Hughes for securing this debate. I remember that, at one of the meetings the two of us attended at the sick kids hospital—I think it was last May—our jaws began to drop when we found out that the ambulance service had not been consulted before these plans were drawn up.

We know the problems that are associated with basing everything on the idea that a monstrously large hospital must be created on the Southern general site. For the benefit of members who do not know Glasgow, ambulances would have to go through the tunnel, parts of which can be closed for repairs for weeks at a time. Furthermore, they would have to thread through the crowds going to football matches on the south side, putting health—and, on occasion, lives—at risk.

I am reminded of the title that a friend of mine used for his column about the bizarre things that happen in life: "You Couldn't Make It Up, Could You?" Well, no one could possibly make up a health authority in Britain—or, perhaps, no health authority other than Greater Glasgow Health Board—being determined to create a huge new hospital next to a sewage works. Janis Hughes, who has hands-on experience of the health service, knows how nauseous it can get down at the Southern general, yet the board will add child patients, pregnant women and mothers with newly delivered babies to the sufferers already down there if it goes ahead with its plans to remove the two major hospitals from the Yorkhill site.

We should be aware of the fact that some of the buildings in the Southern general were constructed in the 1880s, before the Victoria infirmary was built. Furthermore, it is one of the most cramped sites anyone could visit. Thank you very much.

John Young is right. Let us face it, the land around there would be cheaper for the board than in other areas. There are other options, but once again the Hobson's choice form of consultation has been offered to the public, MSPs and all other interested parties—it is take it or leave it. No other options have been explored fully, not even the preferred options of umpteen people on the south and north sides of Glasgow: the creation of a brand-new hospital at Cowglen or—the preferred option of the friends of the Victoria—the rebuilding of the Victoria hospital on its present site, plus an extension of land.

I have nothing against ambulatory care and diagnostic units in principle. It seems a good idea to have a hospital for so-called minor problems—such problems being minor only to those who are not suffering them—but there is only one ACAD in the whole of Britain and it is next to a major general hospital. I urge the board to show a bit of sense, as it could be pursued by ambulance-chasing lawyers if people are assigned to the wrong hospital. Seriously, that is the sort of thing that will worry them. The board should think again and it should consult properly.

I congratulate Janis Hughes on securing this debate and on the way in which she presented the case.

There is immense cynicism in Glasgow about how this consultation process has been carried out. How could it be otherwise? In all the meetings, the correspondence that I have seen and the opinions that have been expressed, no one has endorsed the proposed site as a sensible solution for the future of health services in the south side of Glasgow. Clinical opinions and the opinions of potential patients are against it. How could they be otherwise?

Let us consider the logistics. An emergency case coming from Ken Macintosh's constituency would have to thread their way by ambulance—possibly at rush hour in the morning, which I understand is a favoured time for coronaries—through the traffic in the south-west of Glasgow, which could easily take 15 to 20 minutes. A similar situation could arise on a Saturday afternoon, if there was a football match at Ibrox. The logistics of the proposition are crazy.

Dorothy-Grace Elder was correct to say that adopting the ACAD system is a fairly sensible approach, but everyone else who has adopted that approach has done so on the basis of the ACAD being beside a major hospital. Many of the routine operations and procedures that are carried out at ACADs could not possibly, of themselves, result in fatalities, but someone who is having an endoscopy may begin to bleed—that can happen. If there is neither resuscitation equipment on the spot nor someone with a specialist ability to deal with matters of haemorrhage, a fatality could occur. Clearly, the siting of ACADs must be taken into consideration as well.

The sewage argument may sound quite amusing but, when I was a councillor—I represented Jordanhill, which is a mile from the Southern general, on the other side of the river—I constantly received complaints about the smell from the sewage works. Obviously, that is another argument against that site.

The only argument in favour of the Southern general solution is the financial argument, which may be factually correct—that site may be the cheapest option. In many respects, and on many occasions, we have to consider the cheapest option. We are talking about public money and substantial investment, but in this instance there must be a better solution. As John Young said, the Southern general already looks like a building site, with bits having been added on, from Victorian buildings to portakabins. It could not be regarded as a solution.

Furthermore, the cynicism that has resulted from the health board's approach to the matter can hardly be underestimated. When the people are saying one thing and the doctors are saying the same thing, how can it be that the health board ends up with exactly what it wanted to begin with? The simple answer is that the Southern general solution was pencilled in in biro at the start.

Janis Hughes has done well to secure the debate and I congratulate her on the content of her speech. When talking about accident and emergency units, she mentioned the fact that not only what Greater Glasgow Health Board wants but what the people of south and particularly south-east Glasgow want should be taken into account. That is what the cross-party group has been arguing for. That group has been cohesive.

Kenny Gibson mentioned what he called the shifting sands—maybe that should have been the shifty sands—of the inconsistent figures and the unrealistically increasing costs of the building. John Young talked about the fact that there has been no new build of an acute hospital facility in the south-east of Glasgow for longer than anywhere else in Scotland. What he did not tell us about the 1880 buildings at the Southern general hospital is that, as a small boy, he was shooed off the site by the clerk of works. He has personal experience of the buildings.

Robert Brown said that the Southern general is the only site that was seriously considered by the health board. That is absolutely right. I like Kenneth Macintosh's analogy about location. In fact, however, it is dislocation, dislocation, dislocation that will affect the people of the south-east of the city if the plan goes ahead.

I do not want to repeat the arguments, as they have been well made, but one issue has not been touched on at all, although accessibility has been dealt with in general terms. Two groups deserve credit for the work that they have done as part of the campaign that has been going on for the best part of two years—ever since the Scottish Parliament was formed: the Glasgow health forum south-east and the friends of the Victoria infirmary.

In the middle of last year, the health forum commissioned an eminent chartered civil engineer and transport expert to carry out a travel-time study into south-side hospitals. It showed some startling facts, one of which was that almost 100 per cent of the population of the south-side catchment area reside within a 15-minute car journey or a 50-minute bus journey of the Victoria. For the Cowglen site, 80 per cent of the population are within 15 minutes by car and 65 per cent are within 50 minutes by public transport. For the Southern general site—the option that is being pushed hardest of all—only 30 per cent of the population live within a 15-minute car journey or a 50-minute bus journey.

I should say that this argument is not only about the south-east of Glasgow: residents in the Southern general catchment area would get to the Cowglen site more quickly than they would get to the Southern general site. Such considerations must be taken into account, but there is no evidence that the health board has done so. There are also environmental considerations. The additional transport, time, vehicle hours and pollution must be borne in mind.

In the same survey, environmental factors were costed as adding an extra £85 million to the cost of choosing the Southern general site. Such arguments must be given weight before the final decision is reached. That is why we want an option appraisal that considers all the sites. The option appraisal that was offered to MSPs from the south side of Glasgow includes, bizarrely, the do-nothing option. Nobody is advocating that option, so why bother costing it? Another option is the Cowglen site, with or without the ACAD unit. We do not know exactly what is being said.

There seems to be smoke and mirrors, which is not helpful for we politicians or for those who are likely to use the health care facilities in the south-east of the city for many years. Not only do we MSPs for the south side of Glasgow represent the area, we live in the area and have a direct personal interest.

There must be a proper option appraisal and it must include the Victoria site. We do not know whether new build on the Victoria site is feasible. It is fair to say that most of us in the group have been advocating Cowglen as the best site. Although there is a great deal of argument in favour of the Victoria site, we do not know whether it is possible. That is why we must have a proper option appraisal. We will push until we get one because, although this debate has been running for a long time, it is about health care for many years into the future.

If there has to be a slight delay for us to get this right, that would be a small price to pay for the people of south-east Glasgow.

I would now be prepared to entertain a motion that we should extend the meeting by up to 10 minutes.

Motion moved,

That the debate be extended for up to 10 minutes.—[Mr Kenneth Macintosh.]

Motion agreed to.

I have constituents in the west of Scotland who use every hospital in the Greater Glasgow Health Board area. Ken Macintosh has already made many of the comments that I was going to make about the constituents whom we share in East Renfrewshire, so I will confine my remarks to my experience of an option appraisal by Greater Glasgow Health Board for the siting of the secure care centre at Stobhill hospital. I want to bring that experience to the minister's attention in particular.

Mary Scanlon and Richard Simpson have mentioned their concern about what they have been hearing. Their concerns are well founded. I was at the Health and Community Care Committee when it inquired into the effectiveness of Greater Glasgow Health Board's consultation on the secure care centre. Robert Brown is right. The lesson that the health board learned from that grilling by the Health and Community Care Committee was to do more by way of smoke and mirrors.

I will supply some examples, which I hope the minister will take to heart. Twenty-eight meetings were planned to discuss the acute services review. That sounds wonderful, but only 17 of them actually took place. That was because 10 of them were cancelled through lack of attendees, which in turn was because the health board did not properly publicise the meetings. It did not let folk know and it did not hold the meetings in the right places. That is what I mean by smoke and mirrors.

Several members have mentioned consultation. As Fiona McLeod said, the way in which the health board undertook its consultation looks correct on paper. Does she share my concern that the public are being asked about so many issues in the review? One issue is whether a new hospital should be built; another is whether there should be two or three accident and emergency services; and a third is whether there should be children's services at the Southern general—and I have not even mentioned maternity services. All that is contained in the document that Greater Glasgow Health Board is asking the public to think about. That may be the reason why the health board is not getting enough responses—the review lacks focus and people are being asked to consider too much at once.

Pauline McNeill has a point, although the health board has in fact had plenty of responses. According to its own documentation, it has received more than 500 written responses, which is an exceptional number from the public.

Consultation is about presenting the information in a way that people can understand. It was not exactly helpful to the public for 22 different leaflets to be circulated. Furthermore, the content of the 22 leaflets needs to be considered. We have already heard about the innumeracy of Greater Glasgow Health Board's case, which someone described as an option for doctors and administrators. None of the medical associations in greater Glasgow's hospitals likes the process that has been conducted and none of them likes the options that have been presented. Most important, the associations do not like the fact that the evidence is not being presented to them in a way that allows rational decisions to be made.

Does Fiona McLeod agree that the consultation process appears to be more about selling the ideas that had already been decided on by trusts and by the health board than about a genuine attempt to consult and to address the issues that the public raised?

I am glad that we are labouring the point. I hope that the minister is picking it up, because it is what this is all about. There has not been a consultation process—there has been a public relations process for the minister's consumption and nobody else's.

Greater Glasgow Health Board did not learn the lessons of the secure care centre at Stobhill; we in the Parliament have to ensure that we represent the opinions of the patients and of the health professionals throughout greater Glasgow. I hope that the minister will ensure that there is an inquiry into the whole process that Greater Glasgow Health Board has gone through.

If my voice holds out, I will extend my congratulations to Janis Hughes and all those who helped to secure this debate.

I acknowledge that the focus of the debate is on Glasgow, but we all know that acute service reviews are generating great concern across Scotland. For example, there is concern about services at the Rankin maternity unit at Inverclyde royal hospital.

The review has a direct impact on my constituency, Greenock and Inverclyde. We spend £35 million of our health board budget in the Greater Glasgow Health Board area and 24 per cent of our in-patient day care activity takes place in Glasgow hospitals. However, we have no real say in the Glasgow review. It seems that it is okay for money and patients to cross health board boundaries, but not for consultation or a real say to do so.

Surely there must be greater co-operation across artificial health board boundaries. That would prevent us from being presented with proposals that mean that maternity services in Glasgow will be delivered in the south side and that, although Argyll and Clyde Health Board's specialist maternity unit will be four miles away, there will be nothing between Paisley and Crosshouse in Kilmarnock. That is complete nonsense and it is unacceptable to the people whom I represent.

The lack of consultation and co-ordination, and the duplication that is required because of artificial boundaries, need to be addressed seriously. I call on the health board bosses to put their reviews on hold until we can be assured that the boards and trusts will work together effectively and in the interests of the people of the west of Scotland, who demand access to quality services.

I congratulate Janis Hughes on securing this debate and on all the work that she has done on this issue, along with her colleagues who have spoken today.

The Glasgow acute services review is taking place in the context of a national review of acute services, which provides the framework within which local acute services reviews are taking place. The purpose of the reviews is to ensure that people across Scotland have access to modern, high-quality services and that there is the correct balance between hospital and community services. The reviews offer an opportunity to assess strategically and objectively how the location of services balances local access with the scope and delivery of specialist services

Inevitably, there are difficult choices and decisions to be made in the Glasgow acute services review, as in most other reviews. Where real benefits and quality improvements are clearly demonstrated, the Executive is prepared to back them. Ultimately, the outcome of an acute services review must be investment, quality and the development of excellence.

However, as we have said on numerous occasions, decisions affecting local communities are best taken by those who provide the services locally in partnership with those who use the services. Therefore, it would be inappropriate for me to become too embroiled in the details of the Glasgow situation.

Malcolm Chisholm was a member of the Health and Community Care Committee when it dealt with the petition on Stobhill to which Paul Martin spoke, so he will know that one of the conclusions of Richard Simpson's report was that, although MSPs and others were not satisfied with Greater Glasgow Health Board's consultation, the health board was obeying all the guidelines for consultation. Given that a national acute services review is taking place, is a national set of guidelines necessary to ensure that health boards and trusts keep in touch with the people and do not just inundate MSPs with their proposals?

I will come to that point shortly. The principles that I am following are consistent with the principles outlined by the Health and Community Care Committee, whose members made it clear that they were interested in the processes rather than in the detailed proposals that were being made.

The role of the Executive is to ensure that national frameworks are in place to encourage the development of modern NHS services. The document, "Our National Health: A plan for action, a plan for change" sets out our clear determination to ensure universally high national standards in Scotland. To that end, we will establish an expert group to support and advise health boards in managing changes in the configuration of services and to advise the Scottish Executive health department on the appropriateness of local reconfiguration.

Will the minister give way?

I do not mind giving way, although the Presiding Officer will remind me if my time is running out.

Will the minister reflect on Duncan McNeil's point that health services on the south side of Glasgow are provided for a much wider geographic area? We are suffering from a lack of strategic vision and co-ordination in the planning of health services. The reviews do not fit into the minister's aspirations because they examine health in a narrow, parochial way. We need a more strategic approach to the planning and delivery of health in Scotland.

I have acknowledged that there is a problem, which is one reason why we are setting up the expert group.

Mary Scanlon and other members mentioned consultation. Concerns have been expressed about the consultation process in this and in other acute services reviews. Improvement brings change, but the idea that it can be imposed without the support and involvement of the many different stakeholders is unsustainable. It is vital that the public and interested organisations are genuinely involved, which is why we made several proposals in "Our National Health: A plan for action, a plan for change" to address that issue. In particular, and to answer directly the point raised by Mary Scanlon, one of the plan's proposals is to

"review statutory guidance on formal consultation to ensure that it meets the needs of modern healthcare systems and takes into account the changes to NHS planning announced elsewhere in this Plan."

I remind members of a second proposal, which is to

"provide guidance, training and support to local NHS leaders to enable them to involve the public effectively in the management of changes to local services".

Will the minister give way?

How am I doing for time, Presiding Officer?

You have spoken for five minutes.

Does that mean that I have two minutes left?

Yes.

I will have to move on. If I am quick, I will take an intervention from Margaret Jamieson at the end.

Janis Hughes reminded us that clinicians and patients in Glasgow have to make do with buildings that are coming towards the end of their usefulness and that are often difficult to negotiate. In five to 10 years' time, we want state-of-the-art health services that provide the people of Glasgow with the services that they need and deserve. It is important that the health board and its planning partners make progress on the acute services review within a reasonable time scale.

I have some information on funding in Glasgow but, in view of the Presiding Officer's comments on the time, I will simply remind members of the fact that the GGHB's allocation is increasing by 7.7 per cent, on top of the extra £73 million that it has received this year.

Will the minister give way?

As I have not taken an intervention from Margaret Jamieson, I will certainly not take one from Kenny Gibson.

I must move on. Janis Hughes called for an option appraisal of all the sites considered by GGHB as part of its consultation exercise. An option appraisal of some kind is always required to support the eventual proposal that the health board will make to the Executive. I understand that the health board decided at its meeting on 19 December that detailed option appraisals would be carried out on three possible options for acute services south of the river. I am also told that the board is proposing that a reference group—including MSPs, a local health council representative, NHS staff, and board and trust senior managers—will oversee that work.

Robert Brown asked how robust the option appraisals would be. There may be a role in that for the reference group, but it will clearly be for MSPs to decide whether they want to be involved in it. There will certainly be a role for the Executive, because the outline business case must demonstrate robust option appraisals.

I am pleased that we have had the opportunity to have this debate. I am sure that the health board will have listened carefully to the views that have been expressed.

Meeting closed at 18:30.