Aboyne Maternity Unit
The final item of business is a members' business debate on motion S2M-3400, in the name of Mike Rumbles, on Aboyne maternity unit. The debate will be concluded without any question being put.
Motion debated,
That the Parliament welcomes the excellent work carried out by staff at Aboyne Hospital's maternity unit; notes that the number of mothers giving birth at Aboyne is increasing, with the number of deliveries rising from 34 in 2003 to 60 in 2004, and notes that the number of bookings has increased by 71 per cent for the coming year; agrees that the unit is an excellent example of health services being delivered locally as advocated by Professor David Kerr in his report, Building a Health Service Fit for the Future; further agrees that expectant mothers should have the option of giving birth locally, at Aberdeen Royal Infirmary or in the home; notes with concern the possibility of the unit being closed, and considers that NHS Grampian should work with local people to ensure that the unit remains open.
I have mixed feelings about raising this issue in a members' business debate. On the one hand, I am pleased to see cross-party support for the motion and I am delighted that the parliamentary authorities and the Parliamentary Bureau have recognised the issue's importance by allowing time for tonight's debate. On the other hand, I am disappointed that matters have come to this. If we had responsive health authorities throughout Scotland that were clearly and demonstrably accountable to the people that they serve, we might not be in the position of having to raise the issue in the Scottish Parliament.
I will outline some of the facts surrounding the issue that is before us. Aboyne maternity unit is part of Aboyne community hospital, which was opened in its modern refurbished building by the Princess Royal on 21 August 2003. Aberdeenshire community health partnership has launched a consultation on the future of five local maternity units, one of which is the Aboyne unit in my constituency. In that consultation, one option is the closure of the Aboyne unit. That has caused outrage among many people on Deeside, as the unit serves people who live as far away as Braemar. From Braemar, people would need to make a 120-mile round trip to the Aberdeen royal infirmary, which is the only other hospital that could possibly take mums-to-be.
The health authorities claim that Aboyne maternity unit is not fully utilised and that it has a problem with staff recruitment. However, when I visited the unit, I discovered some interesting facts, which I have incorporated into the terms of the motion.
To what extent might the reduced utilisation of Aboyne maternity unit be explained by the erroneous impression that has been created that it is less safe to give birth to a child in Aboyne than it is in Aberdeen?
That impression may have been created, but we should all know that the National Childbirth Trust makes the point that most births are safe and that people who want to do so should be able to give birth in their local community.
Given that there were 60 births in the unit last year—up from 34 in the previous year—and that bookings are currently up by 71 per cent, there is clear evidence that utilisation of the unit is increasing. On staffing, the unit is piloting a new way of working that should be successful in ensuring that it does not become short staffed. Indeed, the unit's staffing is at full strength.
When it became known that the health authorities were conducting a consultation on the future of the unit, people were galvanised into action. I have nothing but praise for the group of mums who got together to form an action group—some of them are in the public gallery to observe tonight's debate.
Members of the group have organised a petition to save the unit and they intend to present their petition to the Public Petitions Committee in due course. They also organised the public demonstration that was held on Aboyne green two weeks ago last Saturday. I was delighted to be joined at that demonstration by some of the regional list members of the Scottish Parliament. The organisers had hoped that about 200 people would appear, so I was amazed when some 500 people of all ages turned up to voice their support for the future of the unit. It was great to see so many people at the demonstration—elderly residents, young people, families with young children and even the middle aged—and to see such support from the whole community. It was clear to me that the community on Deeside was speaking with one voice and sending a clear message to our local health authority: hands off Aboyne maternity unit.
I know that the decision on the future of the Aboyne maternity unit lies with Grampian NHS Board and not with the Deputy Minister for Health and Community Care, who will respond to tonight's debate. However, one of the reasons for having the debate is to highlight to the minister the strength of feeling that exists in the community. I ask the minister to confirm in his response to the debate that the Scottish Executive's health policy has not changed and that it still ensures that
"Women have the right to choose how and where they give birth."
That quotation comes from page 51 of "A Framework for maternity services in Scotland", which was published by the Scottish Executive.
On page 206 of volume 2 of "Building a Health Service Fit for the Future", the Executive states, among many other things:
"Maternity services should continue to be delivered as locally as possible."
It is Scottish Executive health policy for health care, including maternity care, to be delivered as locally as possible. I hope that the minister will ensure that that message is delivered to the members of Grampian NHS Board, who are responsible for making the decisions.
It is essential that mums-to-be have a real choice about giving birth. They should be able to choose whether to have their babies at home, in their local community hospital or at Aberdeen royal infirmary. That choice for mums-to-be is supported by Belinda Phipps, who is the chief executive of the National Childbirth Trust. She has written to NHS Grampian to emphasise the point. If people are to have a real choice, facilities must be available locally.
Once again, I thank the Parliamentary Bureau for timetabling the debate. I thank my colleagues from all parts of the chamber who will participate in the debate and those members who turned up to show their support at the demonstration. I also thank the minister in advance. I trust that, when he sums up, he will confirm that our new and refurbished maternity unit in Aboyne fits in very well with the Scottish Executive's policy of delivering maternity care locally.
I have a full list of members who wish to speak, so speeches will be restricted to four minutes.
I congratulate Mike Rumbles on securing this important debate. As one of the MSPs who attended the rally in Aboyne on 29 October and spoke alongside Mike Rumbles and others from the area, I pay tribute to the organisers of the rally and the campaign. They have done a magnificent job in bringing the issue further up the political agenda—and, indeed, on to the Parliament's agenda today.
The campaign group comprises young mothers and expectant mothers. The fact that they have gone out to campaign to save their local maternity unit reflects the strength of feeling in the community in Aboyne, as does the fact that, as Mike Rumbles said, the turnout at the rally was fantastic.
The proposals that Aberdeenshire community health partnership put forward a while back were controversial, especially those on the future arrangements for older people's services, diagnostic and treatment services and, of course, maternity services. There is controversy over other units as well, particularly in Banff and Buchan; no doubt my colleague Stewart Stevenson will refer to that. However, tonight's debate is about Aboyne.
In the early summer, I had the pleasure of visiting Aboyne maternity unit and meeting the staff. I pay tribute to their professionalism. I was impressed by the fact that the unit is a modern facility and the figures show that it is no Mary Celeste. The number of births taking place there has increased by 100 per cent in the past year and there has been a 71 per cent increase in the number of bookings. Indeed, before the day of the rally, my office telephoned the unit to speak to the staff, but was told to call back because they were taking care of a delivery. That is an indication of how active the unit is at the moment.
There is talk of closing the unit and we must ensure that that does not happen. There is talk of other changes as well. One such change is what is called the DOMINO arrangement, whereby a midwife would go to the expectant mother's home, take them into the hospital for a few hours and return them to their home as soon as possible after they had given birth. That would represent a downgrading of the service and I would have concerns if that were to go ahead. We do not want to have any sort of downgrading along those lines.
As Mike Rumbles said, the issue is about choice. If Aboyne closes, in effect the choice of where to give birth will be between Elgin and Aberdeen. I draw the minister's attention to "We just can't let these things happen", the report from the maternity service provision policy group of the Scottish Women's Convention. The report states:
"Women should have informed choice about where and how and in what circumstances they have their babies. This choice should be available to all women in Scotland, regardless of where they live.
A ‘one size fits all' approach should not be applied to the provision of maternity services as women have different needs according to their location, their economic background, family circumstances and so on."
This debate takes place against that background; against the background of the Kerr report—which, we are told, has cross-party support—on the delivery of health services; and against the background of the rural development debate. Rural communities have experienced a loss of local facilities such as banks, post offices, shops and schools and the last thing that they want to lose is maternity services, especially in an area such as Aberdeenshire, where there is an aging population. Aberdeenshire has one of the most quickly increasing age profiles of any area in Scotland. If we want to attract young people to the area, we must make services such as maternity units available locally, as well as having schools, shops, banks and other community facilities. If we do not have such services, young people will not want to move to those areas.
I hope that the minister will respond positively to the debate and not just pass the buck to the local health board. I would like the minister to give a commitment that he will intervene and communicate the Parliament's thoughts and opinions to Grampian NHS Board.
I am happy to speak in support of Mike Rumbles's motion to save the excellent maternity service that is provided in Aboyne hospital in west Aberdeenshire. Along with several of my colleagues who represent North East Scotland constituencies, I was delighted to give my support to the rally on Aboyne green a few weeks ago. I was impressed by the large turnout and by the enthusiasm that exists throughout the community for the service, and by the obvious determination to convince Grampian NHS Board that the service must be continued.
It is important for women to be able to choose—within the limits of what is safe for them and their babies—where to have their babies. Clearly, there is a wish among west Aberdeenshire mums to have choice available in the form of local maternity services, which allows them to deliver close to home and to enjoy the peace and tranquillity of a small unit where they can get to know their new babies and receive one-to-one encouragement and support in establishing the breastfeeding routine that we all know gives babies the best start in life. In a small local unit, close relatives, other children and friends have the freedom to visit at less regulated times than those that apply in a big, bustling hospital unit. Furthermore, mother and baby are less likely to be exposed to the serious infections that, sadly, prevail in our larger hospitals.
Unfortunately, mums in other parts of Aberdeenshire no longer have that choice. A few years ago, it was decided that there were not enough births to support the retention of two units in central Aberdeenshire. After a big campaign, the Insch unit was closed and patients were directed to the Jubilee hospital in Huntly. That unit survived for a couple of years but, sadly, the birth rate there fell too, and reached a level at which the midwives did not feel that they were getting enough experience to maintain their skills. That unit withered on the vine and remains closed.
Aboyne is not like that; the birth rate there has been steadily increasing for the past year or two. It is no wonder that it has been, because there are many new houses in the area and young people are moving in from far and wide. The hospital, as we have heard, was totally refurbished a couple of years ago and is a modern and attractive facility in which mums feel welcome and well cared for.
Aboyne maternity unit is not only a good facility. As Mike Rumbles said, it is well placed to serve the needs of a fairly scattered and remote population in a part of the world where transport can be slow and hazardous, particularly in the severe winter conditions that can prevail in Braemar and beyond. It would be wrong for a thriving unit in such a situation to face closure, so I endorse fully the pressure that is being put on Grampian NHS Board to retain the unit. I hope that the minister will apply pressure, too.
I encourage former patients of the unit to spread the word to other mums and possible future mums so that people from upper Deeside and beyond have choice in where to give birth, which is no longer available to women in central Aberdeenshire.
I congratulate the save Aboyne maternity unit campaign on its magnificent efforts and I wish it well in its progress to what I hope will be a successful result. Well done, one and all.
I congratulate Mike Rumbles on securing the debate and I congratulate in particular all those who are involved in the save Aboyne maternity unit campaign on their success in bringing this important issue to public attention and to the Parliament.
I apologise to Parliament for having to leave for a prior engagement before the minister responds to the debate. I will read his response with great interest and I am sure that he will consider carefully the points that have been raised.
In no way do I criticise the national health service in Grampian for embarking on a process of consultation on and scrutiny of maternity services in the region. It is right to ensure that maternity services are structured in the best way to meet patients' needs. I look forward to discussing the issues with some of the people who are involved in the community health partnership when I meet them to follow up a letter that I wrote to NHS Grampian and to the Minister for Health and Community Care to highlight concerns that my constituents have expressed to me about some of the proposals for reorganising maternity services, particularly in Aboyne and Fraserburgh. I also look forward to meeting representatives of the save Aboyne maternity unit campaign tomorrow.
I have yet to have those meetings, but I am aware of the strength of the campaign's arguments, to which Mike Rumbles and others have referred. I will dwell on a couple of those arguments. First, it is bizarre to implement what is termed the most radical option—closure of the unit—only two years after a major refurbishment. That is not sensible planning.
The second issue is current use of the unit. As the motion says, the number of mothers who gave birth at the unit increased from 34 in 2003 to 60 in 2004 and the number of bookings has increased by 71 per cent. That should be compelling evidence for the health board and should dispel the idea, to which others have referred, that a facility that is located in a rural area will not be well used and will not experience an increase in use.
Tonight's debate reminds me of the discussion about closing rural schools, when councils say that schools should close because their rolls are likely to fall, despite the fact that rolls are increasing. Agencies such as health boards must consider the fact that many people are moving from urban to rural areas. Some trends suggest that demand for such rural facilities will increase, rather than subside. The figures suggest that that is the case with the Aboyne maternity unit.
I have no doubt that we will raise the issues again with the health board when we meet it next week. I look forward to the other meetings that I will have on the issue and I hope that the minister will do all that he can to ensure that NHS Grampian gives thorough and serious consideration to the points that have been made by those who have argued strongly the case for retaining the maternity unit in Aboyne.
Normally, we congratulate the member who secured the debate. I congratulate Mike Rumbles, but I take on board his concern that we should not be having the debate. Why should young families and mothers with babies spend so much of their precious time campaigning against something that should never be on the agenda? It is important to recognise the extent of the effort that is put into campaigns against such measures. Individuals throughout the country give up their time to campaign against such proposals.
Reference has been made to the Kerr report. Many of the points that I would like to make have already been made, but in debates of this sort it is important to repeat and constantly reinforce points. The Kerr report's recommendation for maternity services focused on improving access to maternity services for people who are excluded or disadvantaged through poverty or geography. Both factors apply in Aboyne. As Mike Rumbles said, the report also recommends that maternity services continue to be delivered as locally as possible.
Richard Lochhead referred to the report by the Scottish Women's Convention. I recommend that all members read it, because it makes some important points.
I am a mother of four—I mean five. I forgot one. I am also a grandmother of four, which is now more important. As a mother of five, I am well aware of the stresses and strains that surround giving birth. The time prior to giving birth is critical. Women need the support of their families and do not want to worry about travelling many miles, possibly in adverse weather conditions. They do not want to worry about whether their family has the ability or the money to visit them. It has been suggested that many ambulance crews are equally unhappy about having to take mothers, especially first-time mothers or women who are expecting high-risk babies, on long journeys to hospital in case they have to cope with an emergency birth.
Such issues need to be taken into account and addressed. Nanette Milne highlighted the need for close bonding at the time of birth—not just between mother and baby, but between the baby and other young children, in particular. There is a real possibility that travelling long distances can increase the incidence of the awful condition of postnatal depression. No one would undergo that if they could avoid it.
We must give women in Aboyne the real choices that have been highlighted. In particular, we must give them the choice to have babies at home. From questions that I have put to NHS Grampian, I am aware that it is not nearly as supportive as it ought to be. The NHS needs to look beyond its budgetary limitations to the wider picture and the issues of rural regeneration that Richard Lochhead highlighted.
I congratulate not only Mike Rumbles on securing the debate, but the mothers and children who are products of Aboyne maternity hospital who have joined us this evening.
I was delighted to be in attendance at the rally and to speak at it, along with colleagues who represent North East Scotland and the many councillors who turned up. Aberdeenshire Council has unanimously supported a motion to maintain the service in Aboyne. Other members have said that the building is brand new and fit for purpose, and that proper investment has been made in it. That decision cannot have been made lightly, so I wonder what is giving rise to queries.
Conservative members have always supported locally delivered health care. When Malcolm Chisholm was the Minister for Health and Community Care, he said that he wanted most health delivery to take place in the community. At a recent health debate, Andy Kerr, the current Minister for Health and Community Care, said clearly that he wanted the health service to meet demand. Demand that doubles year on year should be met, not ignored. Given that the Dee valley is becoming a major development area for new homes, especially starter homes and homes for young families, there is a need to ensure that people do not have to travel long distances or to take the risks that are associated with travel. The demand exists.
All the investment has been made, but still this uncertainty has come about. That is the case in other parts of Aberdeenshire. The Aboyne unit provides care before the birth, during the birth and after the birth; it obviously fits the need.
Ministers in the Executive appoint health board chairmen and I am told that the role of health board chairmen is to deliver Executive policy. It is incumbent on the minister in attendance this evening to say whether he and his colleagues on the health team feel that Executive policy is being delivered. I also raise the point that we are told by Grampian NHS Board that the Arbuthnott formula is an issue for it because it does not have the support to deliver rural services to the level that it would like to achieve. I leave it to the minister to come back—if not tonight, then on another occasion—with answers to that question.
We must consider the way that health care, particularly for expectant mums and their families, is delivered in rural areas. The father is often away during the day, so expectant mums need help and support. Ambulances are occasionally manned with only a driver; there is not necessarily a paramedic on board to help with a birth. I know that other members, such as Jamie Stone, have talked in the past about the fact that people do not want to deliver babies up in Caithness because there is risk in undertaking a bad journey on a very bad road—the same applies to the north-east. I wish that the minister would listen and I hope that he intervenes if he can; he does not have the power to intervene directly, but I presume that he can push the Executive policy.
I congratulate the mothers and all those who were in attendance at the rally and I encourage the campaign organisers to keep going in the knowledge that most of us are with them.
I congratulate the mums and the products of their efforts and, of course, the efforts of Aboyne maternity unit. I thank Mike Rumbles for the opportunity to discuss this important issue.
I come to the debate as an Opposition politician to speak in support of Executive policy, because it is clear what Executive policy is and it is clear that we support that policy, which has been articulated on many occasions. A year ago, the draft budget stated that, in the health service,
"investment priorities and service redesign will be matters for frontline staff in partnership with patients."
I know that the front-line staff and the patients at Aboyne are, as is the case at the other four maternity units, in favour of retaining the unit and developing and building on its success. Three of the other units—the ones in Peterhead, Fraserburgh and Banff—are in my constituency and they, too, sit under the black cloud of uncertainty that has been created by Grampian NHS Board.
This is a rural issue par excellence, but it is not only a rural issue par excellence. Fraserburgh is, in fact, a non-rural area with a population of 15,000; it is the biggest town in Scotland more than an hour away from an acute services unit. The issue goes right down and right through the implementation of health policy in the north-east.
Mike Rumbles gets it spot on in the motion:
"NHS Grampian should work with local people to ensure that the unit remains open."
That is also true of the units in my constituency. We have heard that 500 people were out on the street in Aboyne, 600 were out in Fraserburgh and a couple of hundred were out in Banff. Frankly, when we energise the women of the north-east, we men should take cover. I have little doubt about the ultimate success of the campaigns.
The Scottish National Party would, of course, make health boards more responsive to what is going on by including on them some elected members, but I do not expect the minister to respond to that point tonight.
Andy Kerr, in the debate on 27 October, re-emphasised the Executive's policy for
"health care to focus more on preventive and continuous care in local communities and to target our resources at those who are at the greatest risk of ill health."—[Official Report, 27 October; c 20029.]
I agree with that policy. If we transfer maternity services away from midwife-led units, we potentially increase the costs, as we will deploy more expensive and more specialised skills and resources at the centre to no purpose.
One of the principles of the report to which members have referred—"A Framework for maternity services in Scotland"—is that
"The consultation processes should involve … users of services, and the general public."
Involvement is not the end of the story; we have to respond to the needs of
"users of services, and the general public."
There are supposed to be maternity services liaison committees. I must confess that I am not personally aware of one, although there may well be such committees. However, I have not yet seen them come to the table with any great passion.
I will close with a little saying from a guru called Bernard Cox:
"The British Civil Servant … cannot be bribed to do wrong nor persuaded to do right."
On this occasion, persuasion must triumph and the civil servants must respond to public need and to mothers' and children's needs.
I am pleased to speak in the debate in support of Mike Rumbles's motion. He will know that such support from me is unusual.
I congratulate the women in the public gallery, who are fighting to keep the Aboyne unit open. They have babies with them and I hope that men are with them also. I am not familiar with the Aboyne unit, but I am familiar with the story that is unfortunately common throughout Scotland—women and families have to fight almost bare knuckled to hang on to services, which they know to be good-quality services that fit their community, because somebody on high has determined, without taking communities' wishes into account, that the services are no longer viable.
Members have referred to the national framework—the report by the expert group on acute maternity services—which has a number of standards, many of which are very good. However, health boards are picking and choosing which standards they want to deploy in the organisation of services. For example, the EGAMS report requires that all women should get one-to-one care when they are in labour, but that does not happen everywhere. We do not see health boards up in arms about that or coming forward with their plans to achieve that standard, but time and again we see them using other aspects of the EGAMS report to justify closures.
As a midwife, I want to put in context my support for maintaining units and my support for midwifery care. Childbirth is a normal life experience and, in the vast majority of cases, midwifery care is not only the most appropriate care but the best. My difficulty with many of the closures and rationalisations of maternity services is that they are about removing appropriate care from a cohort of women and removing those women from where it is safe and appropriate to have that care. My view on that is reflected in my support for the Wick maternity unit. The issue is not about saying that midwifery care is inferior; it is about where the care is delivered and about ensuring that women get the care that is suitable for them.
I want to pick up on what Richard Lochhead said about DOMINO deliveries. That is a completely appropriate method of delivery and care for women to choose. DOMINO stands for "domiciliary in and out"—women come into hospital in labour, the baby is delivered, they go straight home and there is midwifery care all the way through. Unfortunately, because of resource, staffing and rota problems, that option is not available to as many women as would like it. I argue that we should have more DOMINO services and that everybody should get access to home deliveries, if they so choose. They are safe if the risk has been assessed properly.
The debate on Aboyne maternity services is taking place in the context of an overall lack of confidence about what is happening to our maternity services in Scotland. My confidence about that has been seriously undermined by the Executive's response to three simple written parliamentary questions. Basically, I asked the Executive how many consultant-led maternity units and how many midwife-led units there are in Scotland, how many of each there have been in the past five years and how many consultant-led units are under consultation for closure. The answer to each of those questions was that the figures were not held centrally. The Executive cannot even tell us how many maternity hospitals there are, so how can we have any confidence that our maternity services are safe in the Executive's hands? The Executive cannot even answer basic questions.
I congratulate Mike Rumbles and all the campaigners. Their cause is close to my heart—and so is Aberdeenshire, because that is where I trained in medicine and anaesthetics before coming back down to Glasgow.
Much of my experience of midwifery involved seeing what can go wrong. However, I know that for the majority of patients—I say "patients", but giving birth should be a normal thing—who have their babies at home, the process is quite normal. I agree with all the points that have been made about that.
I cannot understand the crazy thinking behind our approach to medical services these days. How can we sustain communities if we do not provide NHS services that allow women to have their babies close to home so that they can also look after their other children and not neglect them? Very pertinent points have been made about postnatal depression.
I say to campaigners: why stop at fighting for Aboyne maternity unit? Why not also fight for consultant-led services? We should be supporting midwife-led services. When things go wrong, as they can on rare occasions, nobody should have to get into an ambulance and be rushed to Aberdeen. That is crazy. We should have trained consultants and anaesthetists, who could rotate. If we do not have enough of them, we should be working towards that. If there is difficulty with training, we should be finding out how to provide that training. There are many ways of doing that. People can go to other countries if the training services to help them learn are not available here. It is not impossible to sort that out.
We should fight for the maternity unit at Aboyne, fight for the excellent midwife-led service and fight for consultants and anaesthetists to come in. Why not do other things close to the community at Aboyne? Anaesthetists would be going there for maternity services, so elective work could be done. More could be done in Aboyne. That would help the community to grow. Everyone should not have to go into Aberdeen.
What is threatened is the silliest thing that I have heard. It is just like getting rid of the consultant-led services from Caithness and Thurso. If members have ever travelled up there, as I did recently, they will know that it is beyond belief that anybody could put someone else's life in danger in that way. Anybody who has been in medicine for as long as I have knows what can happen. Getting rid of services is wrong. We should stop doing so as soon as possible. Patients' safety must come first.
I think that I said in a previous debate that, when I was an anaesthetist in Aberdeen, I once had to go out to Dufftown a second time. A baby had been delivered safely but the afterbirth had not come away. It was an emergency and an obstetrician and an anaesthetist had to go out with a snowplough in front of them.
There are ways of providing local services for people and I wish that we could get our act together to provide the right workforce in the right places to provide the appropriate treatment. We should plan for the future instead of letting our services and our communities shrink. That is unforgivable, it really is. I hope that the minister will listen to what has been said.
I wish that ministers would do what they say they will do. I wish that they would listen to the people. We are always being told that they want public involvement, so let them listen to what the people want and let them get organised before forcing decisions on people. They should find out what the people want, but they never do. What they do seems to be a sham and I am sick of it.
The minister shakes his head, but most of us feel that we are never listened to. That is why there are so many campaign groups all over Scotland. Those people are yelling to keep their services.
It gives me no pleasure whatsoever to speak in this debate because it was with sorrow that I learned of the situation that Mike Rumbles and his colleagues face. In Caithness we know that situation all too well, as do others who have spoken.
The very last question that I put to Donald Dewar—which was, in fact, the last question he answered in the chamber of the Parliament's former residence—was about maternity services in Caithness. At that time, there was a question mark over maternity services in the far north. That was in 2000; Donald Dewar died shortly afterwards. I make no apology for raising the subject again; members would be surprised if I did not. We thought that the situation was safe, but in 2003 we had to revisit the possible downgrading of a consultant-led service to a midwife-led service. Many of the important points have already been made, so I can make my speech a bit shorter. If we downgrade a maternity service in such an area—or a dental service, as Jim Wallace said during the debate on dentistry—we fly in the face of economic development and discourage people from moving to some of the more remote parts of rural Scotland.
As Shiona Baird said, the people who will have to travel from Caithness to Inverness will face a round trip of well over 200 miles. That is simply impossible for those who will want to visit mum, such as children, sisters, grannies and friends who will offer peer support. Members who have children will remember what it was like when they had their first child. New mums need valuable advice from friends and family. The nurses and doctors can do so much, but there is nothing like a friendly face with a bunch of flowers and some warm and helpful advice.
I have said before to the Parliament and will say again that God made the geography and the weather of the northern Highlands. It does not lie at the hand of man to change that. A doctor in Caithness warns that the downgrading of the unit there will ultimately lead to the death of a mother, a child or both. The proposal is no good for the ambulance drivers, either.
We have gone through consultation before. We thought we had sorted the situation out, but we had to revisit it in 2003 and people in Caithness are still talking about it today. Uncertainty hangs over a vital service. The three locums who are there support the retention of a consultant-led service in the north of Scotland, as do 20 of the 23 local GPs in Caithness and thousands of mums, dads, grannies and grandas. Why does the agony continue? Why can we not move in the right direction, put a consultant-led service in place—which is what all thinking people agree on—and then, for God's sake, leave it? Let us stop revisiting that wretched part of the world.
From the bottom of my heart, I wish Mike Rumbles the best of success. I believe that his battle is my battle. During the debate, we have heard the welcome sounds of a young child in the public gallery. I am on my feet because I am concerned about the future of such young children. Good luck, Mike.
The debate has been full and constructive. I start by congratulating Mike Rumbles on securing this evening's slot. I fully appreciate why the work that is being done at Aboyne community maternity unit is valued by people in the Deeside area and am well aware of the value that local communities throughout the north-east place on such units. I have no doubt that the campaigners who are watching the debate in the gallery will continue to make the points that have been reflected so clearly in the speeches of members from all parties.
I am grateful to members—especially Mike Rumbles—for explaining the nature of the decision-making process in such cases, but there are a few points that I want to stress. First, it is important to note that NHS Grampian is some way from making any decision on the future of the Aboyne unit or, for that matter, on any other maternity unit in Aberdeenshire.
With respect to the Aboyne unit, it is worth noting that a new model of service delivery has already been developed locally and that the midwives who deliver the service have provided active leadership in that process. That model, under which the unit is open during the day and on-call coverage is provided during the night, is being piloted and the findings will be reviewed at a public meeting in March of next year. Whatever the outcome of the pilot, it embodies the creative approach to delivering services that we are strongly in favour of.
Although the main focus of the debate is deliveries, does the minister acknowledge that the Aboyne unit plays a valuable role in providing care before birth and after birth, even when the mum has given birth elsewhere? I feel that that point has not been given enough emphasis in the debate.
Indeed. I think that that is one of the factors that will be considered in the review of the present service.
Because the model of delivery at Aboyne is still at a pilot stage, the Aberdeenshire community health partnership does not intend to review the sustainability of the Aboyne maternity unit until after the process is completed in March next year.
As part of its change and innovation plan, the CHP is reviewing—or will review—community maternity services across the area. The process is still at a very early stage, however. The CHP is currently engaging with communities and exploring ideas about what might be done to deliver the right services safely and sustainably. If, after that process is completed, the CHP chooses to make proposals for service change, those proposals will be subject to a further, formal consultation.
All those processes must of course be completed before NHS Grampian comes to a view. If, after that process, the board decided to close Aboyne, or otherwise to make major changes to the service, it would have to satisfy the Minister for Health and Community Care that it had followed the proper procedure and had taken all relevant considerations into account. Because of the way in which services are delivered and decisions are made, the final decision would lie with the health board.
I wish to reflect on some of the points that have been made in the debate on the relationship between the type of service that is being provided and the broader direction of health policy. As has been mentioned, our framework for maternity services stresses our commitment to provide services that are family centred, locally accessible and, often, midwife led. The framework goes on to stress the importance of patient choice, with women having a greater say about where and when they want their child to be delivered. We want to develop that approach in the context of "Delivering for Health", our response to the Kerr report, which stresses the principle of services being "as local as possible" and "as specialised as necessary".
In response to a further point that arose in the debate, following on from our response to the Kerr report, we are establishing a ministerial advisory group to consider a wide range of issues, including the framework for maternity services and the work of the expert group on acute maternity services. From next year, NHS Quality Improvement Scotland will review all services in that context. We are committed to maintaining services as locally as possible while ensuring that we offer sustainable, high-quality specialist services.
We need to acknowledge the changing demands on the service as a whole. We cannot consider single services in isolation. For example, the birth rate at Aboyne has increased, but the birth rate is, more generally, predicted to decline over time, although we are seeking to do something about that, ensuring sustainable demographic growth over the longer term. One of the critical points in the Kerr report and in our response to it is the importance of recognising and accommodating the challenges of having an aging population and the growing incidence of chronic conditions, while looking to NHS boards to consider the best use of their resources and to respond to all the challenges that they face as locally as possible.
On the point that the minister has just made, and in relation to demands and the reporting of trends, would it not be better to postpone any review of services at Aboyne until after there is an indication that the birth rate is in fact falling off and that demand for maternity services is falling off?
Using that sort of principle, we could wait for ever to make any decisions. We would not want to encourage boards simply to put decisions off. We recognise that services must constantly evolve and that it is primarily the responsibility of individual NHS boards to ensure that that happens. In discharging that responsibility, boards must ensure that any changes are implemented with the active involvement of the local community and, as far as possible, with the support of the local community. The report of the expert group on acute maternity services highlights the importance of stakeholder engagement and that of achieving consensus in the development of new services.
Will the minister speak to representatives of Grampian NHS Board? When he does, will he reinforce the position that all members who have spoken in the debate have taken and copy the Official Report to the board's members so that they can see MSPs' strength of feeling on this matter?
I would be happy to ensure that NHS Grampian sees the Official Report. We are of course in regular contact with all NHS boards to ensure that they understand the implications of national policy for local service delivery, although we look to boards to make decisions on local delivery for themselves.
We are in no doubt that community maternity units have a key role in the future delivery of maternity services across Scotland. Equally, we recognise that there is no one model that will be appropriate in all geographic and demographic circumstances. Clearly, the situation of an acute hospital at the centre and community maternity around the spokes of the hub, so to speak, is in line with policy.
I agree with the point that Carolyn Leckie made: enabling home births with proper support should be regarded as a positive choice and not as a downgrading. Home births are another form of midwife-led service that works. I am happy to write to her on the distribution of consultant and midwife-led services across Scotland. As ever, my parliamentary answer to which she referred was a factual response; it is for health boards and not for ministers to design and deliver services on the ground and to maintain the statistical information to back them up.
It is right that NHS Grampian has undertaken this process of pre-consultation. The approach is to be welcomed. I do not fully accept Shiona Baird's view that service users should never have to campaign to secure the services they want; I think that the opportunity to express views and influence decisions should be welcomed as part of an active, thriving democracy.
In this case, the community has already taken the opportunity to make its views known. When the innovative service model at Aboyne is reviewed next year, and if a further formal consultation follows on from that, I encourage the community that uses the facilities to continue to make its views known. I have no doubt that it will do so.
Meeting closed at 18:01.