Emergency and Unscheduled Care (Ayrshire and Arran)
The final item of business today is a members' business debate on motion S2M-4008, in the name of John Scott, on the future provision of emergency and unscheduled care services in Ayrshire and Arran. The debate will be concluded without any question being put.
Motion debated,
That the Parliament notes the public consultation on the future provision of emergency and unscheduled care in Ayrshire, which closed in December 2005; expresses concern that this consultation only included options to downgrade the existing accident and emergency unit at Ayr Hospital, and expects NHS Ayrshire and Arran to abide by the spirit of the report, Building a Health Service Fit for the Future, by Professor David Kerr by listening to the views of both the public and health professionals in Ayrshire and taking full account of these views before reaching a decision on the future of accident and emergency care provision in the county.
I thank members who supported motion S2M-4008, in my name, on the future of emergency and unscheduled care in Ayrshire.
For members who do not live in Ayrshire, I will explain what NHS Ayrshire and Arran proposes to do. On 24 August 2005, the board of NHS Ayrshire and Arran voted by 20 votes to two to consult publicly on two models for the future delivery of accident and emergency services, both of which recommended the closure of the A and E unit at Ayr hospital. At that time, the board chose specifically to exclude from the public consultation a further proposed model, which in essence recommended the maintenance of the status quo of two A and E units—one at Ayr hospital and one at Crosshouse hospital—and the creation of community casualty units at Girvan, Cumnock and Irvine.
The effect of restricting public consultation to just two models was to narrow the choice to a pair of options, both of which were predicated on the closure of Ayr hospital's A and E unit and the centralisation of emergency and unscheduled care at Crosshouse hospital, near Kilmarnock. That was not a reasonable choice to give local people, and the approach was unworthy of being described as a consultation.
Since that decision was taken, 19 public meetings have been held throughout Ayrshire, at which an overwhelming majority of people have spoken in favour of the retention of a full A and E service at Ayr hospital. In addition, as part of the consultation process, some 58,000 local people signed a petition that calls for the retention of the A and E units at Ayr and Crosshouse hospitals, and an estimated 5,000 people demonstrated on the streets of Ayr on 25 February against the proposal to close their local A and E unit.
Members may wonder why there is such local opposition to the proposal when it had the support of most, although not all, of NHS Ayrshire and Arran's board members, who claim that centralisation of accident and emergency services will lead to
"better, quicker, closer and safer"
provision of emergency care. The simple answer is geography. Journey times by car or ambulance—after an ambulance arrives—from the south of the county can be up to an hour to Ayr hospital. Crosshouse hospital is 18 miles further north, which will add 25 minutes to what is already a long journey. We are all familiar with the concept of the golden hour. Accident and emergency consultants based in Ayr and local ambulance staff maintain that survival of a major accident or emergency is dependent on the time that is taken to reach hospital. Quite simply, the addition of nearly half an hour to the patient journey will cost lives. That is not my view, but that of the consultants, ambulance drivers and paramedics who run the service. I am inclined to take their professional advice on the matter. As one accident and emergency consultant observed during the consultation process, if outcomes are not time dependent, why bother to have a blue-light service at all?
That is the key question in the public's mind. The answer seems obvious: time and distance are critical factors. Therefore, notwithstanding the amended proposals that were tabled at yesterday's board meeting, a credible case has not been made for the closure of Ayr hospital's accident and emergency unit and the centralisation of the service at a single site at Crosshouse. The proposals will not deliver
"better, quicker, closer and safer"
care to the 42,000 people a year who use the service at Ayr.
NHS Ayrshire and Arran carried out the review of emergency and unscheduled care in isolation from the review of elective care in Ayrshire, when the two should have been carried out in tandem. For that reason, the process is further flawed. The board now accepts that point, which was made cogently by Sandra Osborne MP at a public meeting in Girvan on 25 November last year. To consider the matter strategically, if Ayr's accident and emergency unit closes, there will be no unit between Kilmarnock and Dumfries, which will leave many people in south-west Scotland much further from their nearest accident and emergency service than they are at present.
I am not against changes to the delivery of health care in my area simply for the sake of it or as a knee-jerk reaction to an unpopular proposal. I appreciate the need for change to improve service delivery and I see the logic in centralising some specialist services. However, I do not accept that the same principle should be extended to the provision of accident and emergency services—that should certainly not happen in the case that is under consideration in Ayrshire. That is why I welcome NHS Ayrshire and Arran's decision yesterday to delay deciding on the matter until 4 October. However, I want to know that that is more than simply a six-month stay of execution for Ayr hospital's accident and emergency unit. The delay must herald the start of a review process that takes into consideration the enhanced status quo model that was excluded from the health board's public consultation and which would keep accident and emergency units at both Ayr and Crosshouse. The majority of local people clearly favour that option, which is the one that I have argued for from the outset and which has the support of local front-line health workers and parliamentary colleagues.
It is time for NHS Ayrshire and Arran to think again and to accept that its handling of the exercise has, regrettably, been little short of disastrous. Health board officials have claimed repeatedly that they have taken no decisions on the future of Ayr's accident and emergency unit. Whether or not that is the case could be debated endlessly, but what matters is that local people do not believe it to be true; they believe that the board has already taken a decision, as it consulted only on options that were based on the loss of Ayr's accident and emergency unit. Against that background, it is impossible to see how anyone can have confidence in the process unless the range of models is broadened. Most people in my constituency and thousands more in the rest of Ayrshire believe that NHS Ayrshire and Arran's consultation process was fatally flawed. Notwithstanding the assurances that no decisions have been taken, local residents feel that they are being force fed a predetermined position by the board. It is hard to see how that matches the required standard of genuine public engagement and consultation.
I hope that colleagues will join me in urging NHS Ayrshire and Arran to think again, to use the coming six months genuinely to re-examine all the options and to regain the public's trust, which I am afraid has been all but destroyed in the past nine months.
Once again we have an opportunity to discuss future health provision for the people of Ayrshire and Arran. The motion recognises "Building a Health Service Fit for the Future" by Professor David Kerr, but—there is always a but—only in regard to consultation and the options as they affect the accident and emergency department at Ayr hospital. The motion does not recognise the changing world in which we live and the advances that have been made and continue to be made to deliver safer and more appropriate health care, nor does it recognise that communities that currently do not have casualty services stand to gain from the review of services. It is unfortunate that the motion focuses only on one part of health provision in Ayrshire and Arran and on one particular building. It does nothing other than give fuel to those who continually wave shrouds. It is much better to work in partnership to find a solution than to lead a march.
I thank my colleague Cathy Jamieson, the member for Carrick, Cumnock and Doon Valley, for arranging a meeting recently with Professor Kerr, to give all Ayrshire MSPs the opportunity to discuss with him their concerns about the consultation. That positive and meaningful dialogue is the way in which we can influence Ayrshire and Arran NHS Board, and I believe that we have influenced it. I am delighted that yesterday the board agreed with us that it should embark on a widespread consultation on the future of elective and rehabilitative care and that it agreed to postpone its decision on emergency and unscheduled care until October. It has also accepted the offer from Professor Kerr and the Scottish Health Council to work with it on the consultation. I was one of those who responded to the health board's consultation and I took the opportunity to reiterate my previously stated concern that it was inappropriate to engage in a staged consultation process on the review of one particular part of the service when the full picture was not available to the public of Ayrshire and Arran.
The board now needs to drop its use of jargon—its health service speak—and to engage fully with the people of Ayrshire and Arran in explaining how the changes will serve them better. I urge John Scott to consider how far we have travelled in the delivery of health care in Ayrshire and Arran in the past 25 years. What kind of health service would we have today if we had not taken the decision to close the Victorian buildings of Kilmarnock infirmary and Ayr county hospital and move to buildings that are fit for purpose? Ayrshire and Arran took the bold step all those years ago to centralise maternity services and we are now looking forward to the next phase, when the new maternity unit opens on the Crosshouse site in August this year. None of those decisions was easy, but the decisions were made in the best interests of the people of Ayrshire and Arran. It is now for us to engage in the wider consultation and to build a better health service, fit for the future, for all of the people of Ayrshire and Arran.
I congratulate John Scott on securing this evening's debate and on his efforts to represent the views of his constituents on this issue. The debate is timeous, given Ayrshire and Arran NHS Board's decision yesterday to pause to consider feedback from consultation on proposed changes to planned and rehabilitative care—a move I welcome; indeed, I advocated it to the board several months ago.
As John Scott indicated, the proposal by Ayrshire and Arran NHS Board to close the specialised accident and emergency unit at Ayr hospital has united the local community in south Ayrshire and the Doon Valley in opposition in a way that, in my experience, is unprecedented.
The health board's consultation process served only to exacerbate the general feeling that the key decisions had already been made and that it did not matter what the public thought. The board acted as if it had been given a green light by its political masters and was determined to push its proposals through regardless of the strength of local opposition—not least of which was the dissident professional opinion among medics and paramedics across Ayrshire. The chairman of the board remarked on more than one occasion that he was not conducting a referendum. That is perhaps just as well for him, because his proposals would have bitten the dust.
I urge the minister, in the light of this experience, to review the guidance on public consultation that is issued to health boards. I am sure that the Scottish Health Council's evaluation will reveal that fundamental flaws in the emergency and unscheduled care consultation in Ayrshire have led to a major loss of confidence in the direction of travel of the national health service in the area.
I turn now to the involvement of Professor David Kerr in the review of Ayrshire and Arran NHS Board's proposals, and to what the motion calls the "spirit" of the Kerr report. We can all broadly agree with the prescription for the reconfiguration of the NHS in Scotland away from a reactive crisis-intervention service and towards a proactive and preventive service that provides continuous care in the community, especially for elderly patients. However, the way in which we get from here to there is fraught with difficulties.
The problem with the mantra "as local as possible, as specialised as necessary" is that it can be interpreted differently according to one's perspective. The public are not daft. They see the creeping centralisation that is associated with increased specialisation in the medical profession, and they see the impact of workforce pressures that have been brought about by the likes of the European working time directive and the new contracts for general practitioners and consultants, hence the public's scepticism about the idea that the desire to meet patient need is driving reform.
The public view accident and emergency units as their safety net in the current system. Unless community services are put in place and can demonstrate their worth, accident and emergency services must be retained. I urge the minister to provide such a guarantee to the people of Ayrshire and Arran and to consider a moratorium on all closures of accident and emergency services until public confidence is restored.
I welcome the debate and I thank John Scott for bringing it to Parliament and for the work that he has done in representing the views of his constituents in Ayrshire on the matter. It is impressive that 5,000 people turned out for a demonstration in Ayr and that 50,000 people signed community council petitions opposing the closure. The feeling of the people in Ayrshire and Arran is strong and we should not undervalue it.
I agree that the consultation has been flawed; there were concerns about it from the start. When there is no transparency, people get suspicious. It is unfortunate, but that is what has happened in this case. Ayrshire has many outlying villages and rural areas. Some of the roads are not of the best quality and it will be extremely difficult for people to go from Girvan over to Crosshouse hospital.
Confusion has surrounded the views of some of the people who work in the service, which is interesting. At some of the meetings that I have attended, people from Ayrshire and Arran NHS Board have given assurances that the proposals met with the agreement of everyone in the service who was consulted. However, statements by members of ambulance crews and paramedics who provide the service in Ayrshire show that they do not agree with the bland assurances that the general manager of the Scottish Ambulance Service has given that the extra journey time to Crosshouse will pose no extra risk to patients from South Ayrshire. Along with other health professionals, those staff members made their views clear at a public meeting on the board's proposals.
At one meeting, Sandra Osborne said to Bob Masterton:
"You gave me an assurance that your consultants were not only on board but were driving these proposals. Now I find them saying that people will die and attacking the proposals."
People in Ayrshire and Arran have had to deal with such confusion. When the new accident and emergency unit at Crosshouse was opened just over a year ago, Malcolm Chisholm, who at the time was the Minister for Health and Community Care, was asked whether that represented any threat to accident and emergency services at Ayr hospital. He categorically denied that there was any such threat. He said:
"There are no proposals in place to downgrade A & E services at Ayr Hospital."
What is going on?
Consultant anaesthetist Ian Taylor has stated:
"We're told it's 15 minutes from Ayr to Crosshouse but it's 18 miles and 11 roundabouts … If there's no hurry to get someone to hospital after a serious accident or illness then why have they given ambulances blue lights?"
The NHS board claims that the proposed closure of Ayr hospital's accident and emergency unit has everything to do with patient care and nothing to do with cutting costs, but I believe that it has more to do with a shortage of consultants and qualified doctors—there are not enough of them to be on the job when they are needed. We should have known about that situation and planned for it a long time ago. The health board knew that new contracts were going to be implemented, so why have such issues not been dealt with? It is appalling that there has been so much confusion.
I am happy that there will be a delay until 4 October and I hope that the minister will take on board the issues that have been raised today.
As other members have done, I congratulate my colleague John Scott on securing the debate. As the one member present who does not have a relevant connection to Ayrshire—other than that I used to live there—I am grateful for being allowed to speak.
I commend the motion, but although we are discussing the provision of emergency and unscheduled care in Ayrshire, I do not entirely agree that the only views to which we should listen are those of
"the public and health professionals in Ayrshire".
One could argue that I should have taken that up with my colleague when he lodged his motion. I take issue with that position because the proposal will affect the western half of my constituency of Galloway and Upper Nithsdale. Many constituents from Wigtownshire are privileged to be able to use the facilities that are provided by Ayrshire and Arran NHS Board, especially those that are available at Ayr hospital.
From my perspective the issue is, as John Scott said, entirely one of geography. From Stranraer and Newton Stewart, it is exactly 50 miles to Ayr. From Stranraer, it is more than 72 miles to Dumfries and Galloway royal infirmary, which represents an almost 50 per cent increase in the length of journey along what is, as members will have heard me say on several occasions, a thoroughly unsatisfactory road. Drummore, which is the most southerly point on the Rhinns of Galloway, is a further 17 miles from Stranraer, so we are talking about an extensive journey of 67 miles to Ayr or 82 miles to Dumfries. If the facility at Ayr was to move to Crosshouse, that would add another 18 miles. With a journey of such a distance, the golden hour would begin to look more like a silver two hours.
Similarly, the Isle of Whithorn at the very south of the Machars is 20 miles from Newton Stewart, which is 50 miles from Ayr. That represents a journey of 70 miles; it is the same distance to Dumfries. If a patient had to get to Crosshouse instead of Ayr, that would add on at least another 25 minutes. A number of my constituents face a big problem and I believe that it will be hugely disadvantageous to them if the proposal is carried through.
I commend Adam Ingram's speech, in which he made some excellent points, one of which concerned interpretation of what the Kerr report means by a community hospital. It seems to me that individual health boards are quite free to choose an interpretation that most benefits them. However, that is an issue for a different debate.
I believe that health service delivery should be maintained as close as possible to the patients who are likely to benefit from it. I am afraid that the board's proposal would do the opposite; services would be centralised yet further, which would be to the considerable disadvantage of some of my constituents. On that basis, I thoroughly commend the motion to the chamber.
I start by acknowledging the importance that John Scott and other members in the chamber this evening attach to these matters. I assure members that I will feed back to Andy Kerr the views that have been expressed in the debate. As the Minister for Health and Community Care, he will be involved in the decision-making process, as and when NHS Ayrshire and Arran submits proposals to him for his consideration and approval.
What I will not do this evening is comment in detail on the proposals. I do not want to do that before the Executive has had the opportunity to consider the board's proposals in their final version. The local consultation and decision-making process must take its course before ministers can come to any final view.
Several members have said how important it is that NHS Ayrshire and Arran listens to the views of the public and health professionals before it reaches a decision on the future of accident and emergency provision in Ayrshire. Members have also commented on the decision that the board took at its meeting yesterday not to move to a decision until it has consulted on the future provision of elective care. That appears to be a very sensible decision and I note that has been welcomed on all sides of the chamber this evening. I understand that the board made that decision in response to public comment and to the views that were expressed by the Scottish Health Council. I will return to the matter of the council in a few moments.
The decision also follows the recent visit of Professor David Kerr. I understand that that visit was organised at the invitation of Cathy Jamieson and that it allowed a fairly full discussion in which a number of members who are in the chamber this evening were involved. The board has listened to the views that have arisen from consultation responses and those discussions. I understand that a second phase of consultation will be carried out over the next few months. At the end of that consultation period, the board will consider the responses to both consultation exercises and agree recommendations for the future configuration of health care services. It will then submit its recommendations to Andy Kerr for a final decision.
Some of the comments that have been made in the debate, particularly those directed at ministers, are about how boards consult on proposals and how such proposals are made available to the public for comment. It is absolutely right that boards make transparent the process of reaching decisions on what services can best be delivered locally and on how that will be done.
In developing its proposals for the redesign of services, it is essential that NHS Ayrshire and Arran demonstrates that it is putting patients' interests first. It also has to show that every reasonable effort has been made to explain the impact of service changes on patients and local populations. The board must fully involve patients and the public in the consideration of options for change. That has to be done in a meaningful way.
Given the decision that NHS Ayrshire and Arran took yesterday, I imagine that it has considered carefully the lessons of its earlier engagement and consultation on the proposals and that it will apply them in taking forward the next part of the process. In doing so, the board must define the issues clearly. It must explore and examine all possible options in an open way and on the basis of evidence.
We also take the view that those who were consulted must receive feedback that demonstrates that their views were listened to, understood and acted upon where that can be done in a way that delivers the best practicable outcome. In other words, the board must be able to show that public participation in the redesign of services has been real and meaningful.
The Scottish Health Council was mentioned and I was asked whether the requirements that the Executive places on health boards are sufficient to achieve the level of transparency that I have described.
The Scottish Health Council has the specific task of ensuring that consultation processes are effective and meaningful. It is actively monitoring the process that is going forward in Ayrshire. It has been working with the board to ensure that consultation is meaningful and that the views of patients and the public are listened to and responded to. It will continue to work with the board in discussing the design and roll-out of the next phase of consultation on elective services.
Given that the proposal affects people outwith NHS Ayrshire and Arran's immediate area, will the minister inform me whether it is competent for a health board to consult outwith its area and into another health board's area?
That is a fair question. The Scottish Health Council will certainly expect NHS Ayrshire and Arran to show that it has considered cross-boundary implications and impacts as part of the process of reaching decisions. I expect that that will be the case, just as it is with NHS Lanarkshire, as patients in Lanarkshire may use hospital facilities that are outwith the area.
Adam Ingram made a point about improving guidance to health boards on how to arrive at a decision. As is becoming clear throughout Scotland, it is necessary to resolve the conundrum of what to do when a board puts decisions out to consultation and its recommendations are roundly rejected. Given the emphasis that the Kerr report places on consultation, how do we resolve that conundrum if the consultation comes to a view that is diametrically opposed to the proposals that are on the table?
The point was also made that the health board has said that the consultation is not a referendum. That is an important and accurate point and the health board is right to take that view. Its duty is to consult and to take into account the views of the public and patients but, as was stressed at the board meeting yesterday, the final decision on what to recommend to ministers lies with members of the board. They must demonstrate that they have taken into account the public's views but, at the end of the day, the decision that they recommend to ministers must be balanced and take into account the best means of delivering services for patients in future. That is their responsibility, and we expect them to do precisely that. They should do it in the context of the national framework of "Delivering for Health" and the Kerr report.
In further answer to John Scott's question, we expect that the proposals that are submitted to ministers will be firmly set in the context of the national framework and demonstrably consistent with what the Kerr report and "Delivering for Health" set out as the proper way to deliver health services in future.
Adam Ingram asked whether there is a contradiction in the Kerr report and whether it is too open to interpretation. The report is clear that change is necessary if we are to deliver the future high-quality health care that is set out in "Delivering for Health". It is also clear that that change must be made through genuine dialogue with communities. When the consultation responses come in, Andy Kerr, as the minister responsible, will consider carefully that evidence as well as the evidence on how best to deliver the health services—including accident and emergency services and elective services—that people are entitled to expect from their NHS.
I ask the minister to address the point that I made in my speech about the fact that people in Ayrshire and Arran—and elsewhere in Scotland—regard accident and emergency units as the safety net that will catch them if they have an accident or there is an emergency.
The point has been made that the consultation was poor and that the health board could not convince the population of Ayrshire and Arran that what the board proposed to put in place of that service could serve the same purpose. Until services are delivering on the ground in the community, people will not accept the centralisation of accident and emergency services. Will the minister address that point?
NHS Ayrshire and Arran, like any health board that proposes to redesign services, must be able to demonstrate that the new services will be put in place in time and that they will deliver the quality of service that people reasonably expect. Members mentioned the community casualty units and the other provision that is planned as part of the proposals. If the proposals go ahead, ministers will look for a clear indication that the new services will be put in place in good time so that patients have a safety net, as Adam Ingram describes it, and are assured a quality service.
Andy Kerr will consider all the available information, all the representations that have been made and all the points that we discussed this evening. In closing, I assure members that ministers will not endorse any proposal that fails to fit with national policy and guidance or fails to secure a safe, high-quality and sustainable health service for the people of Ayrshire. Equally, we will not pretend that it is possible to develop a health service fit for the future simply by standing still. We must subject the proposals for the redesign of services to the test that I described this evening.
Meeting closed at 17:46.