Community Hospitals (Dumfries and Galloway)
The final item of business is a members' business debate on motion S3M-5289, in the name of Jim Hume, on community hospitals in Dumfries and Galloway.
Motion debated,
That the Parliament notes the contents of NHS Dumfries and Galloway's consultation document, Your NHS - Your Future Care; believes that the preferred option, which would result in the closure of Moffat, Langholm, Kirkcudbright, Lochmaben and Thornhill community hospitals, is widely unpopular with the respective local communities and fundamentally disregards the rural remoteness of parts of the region and the invaluable and high quality of care provided by these facilities; would welcome the involvement of other statutory bodies, private providers and voluntary organisations where necessary in the redevelopment of these hospitals, and hopes that NHS Dumfries and Galloway's preferred option for closures does not go ahead and, instead, that these vital, locally delivered community NHS services are redeveloped.
Tonight's debate is hugely important for the communities in Dumfries and Galloway that are affected by the health board's proposals, which will, if they are approved by the Cabinet Secretary for Health and Wellbeing, mean the loss of five community hospitals. I pay tribute to the local action groups and campaigners who have eloquently expressed the need to retain their hospitals.
I welcome the news that the cabinet secretary will meet Kirkcudbright action group members, but I believe that she should visit each of the communities that will be affected to speak to key people at first hand. I have invited her to Langholm and extend an invitation for her to meet action groups in Lochmaben, Moffat and Thornhill.
I have met patients, relatives and staff over the past few months. It is clear that community hospitals provide a vital link between the patient, the relative and a truly local, high-quality health service of which these communities are rightly very proud. However, I want to make it clear from the outset that this is not about misguided, emotional attachment to an out-of-date arm of the national health service; it is about the real prospect of losing invaluable, well-used, high-quality, face-to-face human care that many fear will simply not be replicated in the home.
Elderly and palliative care is second to none in these hospitals: it provides comfort not only to patients at the end of their lives but to the relatives. The hospitals also provide other primary services. As a general practitioner-led service attached to the local health centre, Kirkcudbright hospital treats patients of all ages. Provision includes physiotherapy, chest and limb X-rays, podiatry, palliative care, surgical pre-assessments, blood transfusions and rehabilitation. It has a minor injuries casualty unit and is very well equipped to deliver all those services. Crucially, the medical centre with GPs, nurses and community care staff is in the same building, which provides a direct link between staff and patients to ensure good co-ordination of all aspects of patient care.
Kirkcudbright is a good example of how community hospitals can be used for other services to maximise staff skills and to create a one-stop shop with multiple uses. I welcome the health board's wish to invest in the area but I would urge the health board, instead of building new facilities at the expense of other buildings, to rethink its plans and to think hard about reinvesting in the existing community hospitals. With some creative thinking, can these hospitals not become multifunctioning centres of excellence in each community, with integrated services to serve the whole population?
The health board talks about a dwindling workforce, but having high-quality, multiple-provision hospitals on one's doorstep is exactly one reason to stay and work in one's community as a health professional. Yes, people will retire, but let us give those entering the NHS a chance to work in their own communities. For example, could the health board not work with the local college to ensure a safer supply of staff? Let us not remove local employment opportunities.
These hospitals are crucial in ensuring that people get access to health care. If they are removed, there will be consequences for visiting relatives who cannot get to their loved ones because of lack of public transport. The logistics mean that visiting will just not be feasible for someone who does not have access to a car. That, together with a proposed cut in south west of Scotland transport partnership funding of £230,000, does not bode well for relatives who want to visit, which could have knock-on consequences for patient recovery.
Funding for the new builds is unclear. The health board has not secured the finance for the new builds that would replace the five hospitals, and it will have to make a business case to ministers. I cannot see how such a long-term project can be planned on the basis of bidding for money at different stages. If any part-funding bid fails, will we end up with a mix of services that ultimately costs more money because it is neither one thing nor the other? Will there be a loss of service provision in the transition from one state to the next? Those are all questions that constituents have asked me but which I cannot answer—I share their concerns. I wish to be clear that I and others welcome the health board's wish to invest in services but that money could surely be invested in existing buildings to maximise their potential.
On community care, there is no 100 per cent assurance that the local authority has the resources to cope with elderly care services that are transferred to it as a result of closures. How would the funding work for that part of the proposals, and can we be given a guarantee that elderly patients would receive the same quality of care in their home as in the community hospitals? There is no guarantee that a private sector provider could fulfil the staff requirements to take care of elderly people in the home.
I am glad that the NHS has reacted to my request to extend the on-going consultation, but I urge NHS officials to overhaul their plans radically and think creatively about investment in existing facilities. I ask the Cabinet Secretary for Health and Wellbeing and the Minister for Public Health and Sport to come to these communities to meet key local people and to consider the bigger picture before reaching any decision—the social impact on patients and relatives, the employment opportunities that community hospitals provide to local people and the need for and benefits of investment in these facilities, rather than a blanket closure approach.
The cabinet secretary gave geography as one reason to save the Monklands and Ayr accident and emergency wards. I ask her to consider carefully the expansive geography of Dumfries and Galloway. On Ayr and Monklands, the cabinet secretary stated at the time:
"the … boards did not in my view give sufficient weight to the concerns expressed by local people".
People in Dumfries and Galloway are concerned. They fear a loss of service and I share that concern. Removing community hospitals from that rural and remote area will be a backward step in the delivery of integrated health care across the region. I hope that the cabinet secretary in her deliberations will listen to those communities, too.
I congratulate Jim Hume on securing this debate on an extremely important issue.
It is important to acknowledge that NHS Dumfries and Galloway's proposals are not a cost-cutting exercise. The health board is attempting to respond to demographic change, medical advances and the need to bring Dumfries and Galloway royal infirmary and other community facilities up to the standards that are expected in the 21st century.
Five options were originally considered, and the number was then reduced to three. Option A involves the least change, but would still result in the closure of Moffat and Kirkcudbright community hospitals to in-patient care, which would require capital investment of £144 million and revenue investment of £5.9 million.
Under option B, the number of beds at Dumfries and Galloway royal infirmary would be reduced, more care would be provided by community hospitals and one hospital in each locality would operate as a community rehabilitation unit. That would require capital investment of £144 million and revenue investment would increase to £7.4 million.
The health board prefers option C, which is the most radical. It would involve the closure of five community hospitals, the creation of four larger community rehabilitation units and the development of enhanced community teams to support patients in their homes. It would require capital investment of £160 million and revenue investment of £7.8 million per annum, so it is the most expensive of the three options. The board believes that that option would give it the greatest flexibility in service provision and the most modern and flexible facilities.
It is important that the board's position be understood, but for several reasons Dumfries and Galloway's geography makes option C unrealistic, as well as unpopular and possibly unworkable. All the community hospitals provide in-patient assessment of adults, rehabilitation of people after they leave DGRI and palliative care. Lochmaben community hospital also provides an eight-bed ward for treatment of dementia and mental health problems in elderly patients.
The size of the local communities' responses to the proposals in option C shows how much those community hospitals are valued by the people whom they serve. For example, 400 people struggled through Arctic conditions to attend a meeting in Langholm two weeks ago.
The health board is a member of the south-west of Scotland transport partnership, but the problems of travel to the new facilities, which Jim Hume described, have not been considered adequately. For example, under option C a stroke victim from Moffat or Langholm would be treated in the new facility in Annan. Moffat is 29 miles from Annan and Langholm is 20 miles from Annan along a minor route. Both journeys are a 40-minute drive by car. If friends and relatives rely on public transport, they have one direct bus from Langholm to Annan at 5 to 9 in the morning and one return bus at 20 minutes past 12. From Moffat, one direct bus to Annan leaves at quarter to 12, but no direct service comes back.
Mental state—happiness and wellbeing—is important to recovery and rehabilitation, which are not just about treatment. Patients whom friends, relatives and loved ones visit in hospital are happier than those who are not visited. The ability to be visited is probably even more important for those who are at the end of their lives and who are receiving palliative care, which is currently offered in community hospitals.
My other concern about option C is that it depends on recruiting appropriately qualified specialists. Sadly, we do not have a particularly happy record on that—we have had shortages of medical specialists. I worry that that makes option C unworkable in practice.
Two weeks ago, the Cabinet Secretary for Health and Wellbeing assured me that she would listen to local people's views, as she did in Ayr and Monklands. I hope that she will come down to meet protesters. I thank my colleague Jackie Baillie for agreeing to meet protesters in my constituency and to meet—I hope—the health board to discuss our concerns. I hope that the cabinet secretary or the Minister for Public Health and Sport will be able to do the same.
I, too, pay tribute to the action groups across the region that have done much in the past few months to raise awareness of the practical problems that would arise from the health board's proposals. Elaine Murray has talked eloquently about some of those problems. A journey that might look reasonable on a map becomes a very different prospect when it is attempted by car and certainly when it is attempted by public transport.
I have an awful feeling that we are witnessing a depressing rehash of the debate about the continuing devaluation of community hospitals. The debate seems similar to the one that we had about Jedburgh and Coldstream during the previous session of the Parliament, in which the same issues were raised about a community's desire to retain a local service and about the apparent desire of a health board—and, in that case, the Government—to centralise services, for reasons that seemed on the face of it to be reasonable, but which went completely against the needs and wishes of the community.
There are particular problems with our debating the matter at this time. All members understand that ministers, in particular, are constrained in what they can say in such a debate, which I know is frustrating to the community. We have all tried to explain how the formal process works. I hope that the Minister for Public Health and Sport will be as forthright as she can be when she sums up, although I acknowledge the constraints that she is under.
Dumfries and Galloway is a special case for two reasons. First, it is one of the areas that will lose out under the new funding formula for health—in general, rural areas tend to lose out. Secondly, and which is perhaps more immediately important in the context of this debate, NHS Dumfries and Galloway is one of the test beds for health board elections. When elections to health boards were debated, concern was expressed about whether people would be interested in the issues and prepared to stand for election. In Dumfries and Galloway there is massive public engagement on the issue and people are looking in great depth at obscure health publications from various Government agencies.
There is no doubt that people in Dumfries and Galloway think that a decision has been made and that the health board is going through the motions—no one ever admits that, but they wouldn't, would they? The easiest solution to part of the problem is to say that there is about to be a significant experiment in Dumfries and Galloway, in the form of pilot health board elections, which will present an opportunity for people in the area to have their say.
It would be an outrage if there were the prospect of a substantive decision being taken prior to the health board elections, because if we are to engage the public on difficult decisions to do with health care provision via health board elections, we must allow people to debate and influence the decisions that will affect their lives. The forthcoming pilot presents an opportunity to marry the challenges of demographics and health care provision throughout Dumfries and Galloway with the challenge of bringing broader democratic accountability into the NHS.
It is not that people do not want change; I think that people accept that there must always be change and development in the health service. Perhaps what people want was most eloquently put in a document that members might have received last night from the Kirkcudbright hospital action group, in which the group simply said that people want
"a decision taken with us and not for us".
I do not think that the health service should stand still, but I also do not think that the public are so naive that they cannot understand sophisticated arguments about the need for change. The public should have a strong role in shaping their local health service, and if the public in Dumfries and Galloway take a view that is different from that of the health board, the public's view should prevail.
I congratulate Jim Hume on securing this important debate.
We have heard from local members about NHS Dumfries and Galloway's consultation on three options for service change, which would lead to varying degrees of change on the ground. I will concentrate on the board's preferred option—option C—not least because it is the most radical and involves the closure of five community hospitals. Option C also involves the creation of four community rehabilitation units, but the proposal is not gaining widespread support in communities in Dumfries and Galloway.
I appreciate that the decision is ultimately for the cabinet secretary and the minister and that, therefore, the minister's ability to comment is severely constrained. However, the Government has stated its intention to keep service delivery as local as possible, so I have no doubt that members will seek to test that commitment against the proposals that emerge from Dumfries and Galloway.
It is important for us to take a step back and to consider the context in which the cabinet secretary will operate. We have a current strategy for development, not closure, of community hospitals—"Developing Community Hospitals: A Strategy for Scotland", which the previous Scottish Executive published in 2006. It envisaged a new model for community hospitals, which were to fit into the vision of much more community-focused health services, as laid out in "Delivering for Health". That vision of "Delivering for Health" was based on the Kerr report, which talked about reconfiguration of services and helpfully tried to provide a sensible framework for service change that—if my memory is correct—the whole Parliament accepted.
In addition to that, the current Scottish Government produced a valuable report called "Delivering for Remote and Rural Healthcare: The Final Report of the Remote and Rural Workstream". It was published in May 2008 and specifically built on the agenda and model for community hospitals, but recognised the challenges of delivering health care in a rural setting.
We need to set what NHS Dumfries and Galloway proposes within that robust framework in considering how we move forward. Does its proposal sit comfortably in the policy context that we created? The jury is certainly out on that and local communities are possibly arriving at decisions about people's intentions in Dumfries and Galloway.
I value the work that the independent scrutiny panel did. I will raise three issues that it highlighted. It was sad that the panel had to remind the health board that it needed to set out a compelling vision for the changes that it wished to make. I would have thought that the first thing that the health board would do would be to set out that vision—to understand what it was trying to achieve and then follow through on it.
The other issues were transport in the context of geography and the financial assumptions. I will focus on them. I understand absolutely that the area is rural and that transport connections are challenging; the independent scrutiny panel also recognised that. From my experience at the Vale of Leven, I understand that sometimes—as Derek Brownlee said—a hospital's appearing to be geographically close takes no account of transport connections. Not everybody these days has a car, so some people rely on public transport. I am clear about the need to resolve such issues well in advance, otherwise we will find that people will not travel for hospital appointments, which is not what members would want.
I am also genuinely concerned about the financial assumptions.
The member is on a four-minute speech. I hope that she remembers that.
Indeed. I will be quick.
There are significant challenges in the NHS capital budgets. My understanding is—I would appreciate the minister's response on this—that funding for projects is being approved only when the business case has been finalised and there are no commitments to anything else, so I am curious as to how NHS Dumfries and Galloway intends to fund its proposal.
I am sure that there will be a very good turn-out in the health board election pilots in Dumfries and Galloway and I will be happy to visit the area to hear first hand from the board and, particularly, the local community how they want health services to be provided in their area.
I also congratulate Jim Hume on securing the debate, and have enjoyed listening to what members have had to say. I thought that I would return the favour that Jim Hume did me when he spoke in my members' business debate last week.
I will keep my comments brief and declare an interest, as a member of my family is an employee of NHS Dumfries and Galloway.
I understand, from my South of Scotland colleague Mike Russell, that there has been a strong community campaign on the matter. I congratulate all those who have been involved, as, I am sure, would Mike Russell.
We all agree that local services need to stay local. Indeed, it is when such local services are under threat that communities come together and look to retain the local focus. They quickly become informed and involved in the decision-making processes.
In any situation like this, it is important that people are listened to; they need to be confident that the NHS is for them and is responsive to them. I know that that is fundamental for the Cabinet Secretary for Health and Wellbeing and the Minister for Public Health and Sport in how they approach their brief. It is important as well, however, that issues are discussed up front with local people so that they are informed and made part of the decision-making process.
Rural areas are very important to Scotland and we need to look after them. Post offices and transport links have gone from rural areas, schools in such areas are often closed and other services are often quick to leave rural areas or are considered surplus to requirements. We all agree that rural areas need our support, as do the people who live in them and make those areas vibrant.
I congratulate Jim Hume on securing the debate and I congratulate the campaigners who have been so important in involving local people in their campaign to ensure that services remain local and focused on their area.
I, too, thank Jim Hume for bringing this issue before Parliament. The debate has been very constructive. Having chaired the NHS Dumfries and Galloway annual review meeting on 14 December, I am fully aware of the strength of local feeling about the board's clinical strategy proposals and how they may affect the configuration of local health care services. Before, during and after the annual review meeting, I took time to listen to the views of local people throughout the region about the proposals. I have heard some of those concerns again, in constructive tones, in members' speeches in the debate.
I should, first, be clear about the protocol in such matters, to which Derek Brownlee referred. As members will be aware, proposals for major service change in the NHS are subject to ministerial agreement. As the clinical strategy in Dumfries and Galloway is still subject to formal public consultation, I hope members will understand that it would be inappropriate for me to comment in any detail on the health board's service options. However, I can give members the assurance that I gave local people who gathered in Dumfries in December—that in coming to a final decision on the clinical strategy proposals, ministers will ultimately take into account all the available information, including of course issues of frameworks and policy contexts, and representations.
This Government has a proud history of putting patients' interests first when it comes to major service change in the NHS: it introduced a presumption against the centralisation of NHS services and, last year, put an end to a decade of damaging uncertainty by safeguarding the future of the Vale of Leven hospital. We also recognised the concern of communities throughout Scotland about how NHS boards managed the process of service change and how they engaged with and consulted local stakeholders on proposed changes.
The original service reviews failed to address the very real concerns of a significant proportion of local populations that the centralisation of services would not deliver clear benefits for patients. The Monklands and Ayr accident and emergency proposals are an example of that. There is little doubt that the original consultations in Ayrshire and Lanarkshire and the subsequent decisions that the boards and the previous Administration made compromised the trust, faith and confidence that local people had in their NHS. It was therefore a priority for this Government to rebuild confidence and embed trust in the NHS, not least in the major service change process.
We recognise that boards have to respond to many pressures and changes, and must plan effectively to maintain high-quality services in the future, but they also bear the responsibility to engage meaningfully with local stakeholders at the earliest opportunity. Local people rightly expect major service change plans to be robust, evidence based, patient centred and consistent with clinical best practice and national policy. We understood that, in certain cases, to build confidence in the process, the plans should be critically assessed and that that work should be done by an independent panel of experts. That is why we introduced the process of independent scrutiny.
Members will be aware that the cabinet secretary instructed that NHS Dumfries and Galloway's clinical strategy plans should be subject to independent scrutiny ahead of public consultation to give local people confidence that the board's planning assumptions were appropriate. That panel, the fourth that has been convened since we took office, was chaired by Professor Frank Clark, who was supported by Professor Gordon Peterkin and Professor Jane Farmer. The panel reported in August last year.
Time does not allow me to go into the detail of the ISP report, but members should be aware that the report is published in full on the independent scrutiny panel's website, as are the notes of the panel's meetings. NHS Dumfries and Galloway has assured ministers that it took full account of the ISP report in agreeing its proposals for public consultation.
I also welcome the board's decision to extend the current public consultation period until the end of February. That seems the right thing to do, given the recent extreme weather conditions. For example, I am aware that a public meeting in Thornhill had to be cancelled on public safety grounds. The extension offers local communities further opportunity to register their views on those important proposals—which is quite right and proper—and I certainly encourage local people to do that.
Following the conclusion of the public consultation process, the board will carefully consider all the evidence and representations and come to a view on the service options. The board will then submit its proposal to ministers for a final decision. In doing so, the board will be expected to demonstrate how it has taken account of the ISP's findings and of representations from local stakeholders that were made during the consultation. Ministers will receive a separate report from the Scottish health council on the adequacy of the public consultation process.
Ministers will continue to receive representations from members of the public and their representatives. Indeed, as Jim Hume knows, the Cabinet Secretary for Health and Wellbeing has already agreed to meet representatives of local groups to hear their views following the conclusion of the current consultation process. Obviously, that can take place only after the formal public consultation, not before it.
The final decision in this and in every other case of major service change in the NHS will be made by ministers, who will carefully consider all the evidence, information and representations and endorse only those decisions that are consistent with national policy. Boards must make the case that the proposed change is in the best interests of patients and local people. Indeed, should ministers ultimately consider that a board has not done that or failed to undertake material work or provide robust evidence to inform its recommendations, it is open to ministers to refuse approval and to instruct that that part of the public consultation—or, indeed, all of it—be carried out again.
I hope that, within the limits of what I have been able to say tonight, I have been able to assure members and local people that we take such matters very seriously indeed. There is a process to follow and ministers are part of that process. I hope that tonight's debate has been of use to members.
Meeting closed at 17:32.