Maternity Services (Aberdeenshire)
The final item of business today is a members' business debate on motion S2M-4689, in the name of Mike Rumbles, on maternity services in Aberdeenshire. The debate will be concluded without any question being put.
Motion debated,
That the Parliament notes with disappointment the decision of NHS Grampian to recommend to the Minister for Health and Community Care the closure of maternity units at Aboyne, Huntly, Fraserburgh and Banff; commends campaigners who have fought to retain these units on the positive way in which they have engaged in the board's consultation process on the issue; continues to agree that these units are 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, and believes that the Minister should reject the board's recommendation and retain these units to give expectant mothers a genuine choice.
Members will recall that last November we debated Grampian NHS Board's intention to close the Aboyne maternity unit in my constituency. Tonight we debate NHS Grampian's final recommendations on the maternity units in Huntly, Fraserburgh, Banff, Peterhead and Aboyne. Maureen Watt will concentrate on the Banff and Buchan units. The Huntly unit is not operational, of course, and the board's decision to close it formally does not seem to be contested. Therefore, I will deal exclusively with the plans to close the Aboyne unit.
The Aboyne unit is part of the local community hospital. It is in a modern setting, which was opened just three years ago by the Princess Royal. Although everyone welcomes plans for new diagnostic and treatment services and services for the elderly, the community of Deeside is outraged at the prospect of having our maternity unit closed for births and at being told that mums will have to have their babies at home or travel into the city of Aberdeen to have them. People from Braemar will have to make a 120-mile round trip to Aberdeen royal infirmary, in all weathers. Tonight's debate is not about having services for the elderly or maternity services—it should not be a case of either/or; we should have both those services locally, in line with the recommendations of the Kerr report.
When NHS Grampian consulted local people on its proposals, it received a clear and unequivocal message: "Hands off Aboyne maternity unit." It certainly did not listen and has pressed on with its plans regardless. How often have we heard that about health board consultations?
In response to the demands of the Scottish health council to reconsult, NHS Grampian altered its plans for the north of Aberdeenshire—it has accepted that the unit in Peterhead can remain open. People in the north of Aberdeenshire will be able to use the unit in Peterhead and those in central Aberdeenshire will be able to use the unit at the hospital in Aberdeen, but the people of west Aberdeenshire will have no option at all. Women in that part of the county will have to have their babies at home or travel to the city of Aberdeen.
That is where we get into all kinds of difficulties. Many of the campaigners—some of whom are in the public gallery—are convinced that if mums are asked to choose between a home birth and travelling to the city, inappropriate choices will be made. What will happen when the unit is closed and mothers have complications? We do not need to use our imaginations.
A week last Friday, MSPs for the north-east had one of our regular get-togethers with Grampian NHS. In preparation for tonight's debate, I asked the board to clarify its reasons for closing the Aboyne unit. Colleagues who are present will confirm that, in its response, the board was all over the place. It could not tell me why the unit is to be closed. It said that the reason was not really to do with money or best practice; it was to do with sustainability. We were told that it was not sustainable to keep the unit staffed 24 hours a day for the few births that took place there. The board promised to write to us before tonight's debate to outline the main reasons for the closure, but I am still waiting for its letter.
The problem is that the proposals are flawed. The board members did not seem to know anything about the hugely successful pilot scheme that the Aboyne unit has pioneered, which uses community midwives much more effectively and does not have 24-hour staffing when there are no mums in the unit. Having to deal with arguments from the board that are simply inaccurate and based on ignorance is incredibly frustrating.
I have a copy of the board's submission to Andy Kerr. It says:
"As part of the consultation a significant amount of correspondence was received, particularly from the communities of Fraserburgh and Aboyne."
Too right. Jim Royan, who is the chair of NHS Grampian, says:
"It is my belief that the processes we have used to date have been comprehensive, open and inclusive."
There was nothing wrong with the processes—they were fine. It is just that NHS Grampian totally ignored the strength of feeling of the Aboyne and Deeside community, who will now have nowhere to go, other than to the city of Aberdeen.
The final paragraph of Jim Royan's letter to the Minister for Health and Community Care is a real cracker. In it, he says:
"The Board of NHS Grampian has concluded that this package reflects the feedback we have received over the last 12 months."
If that does not belong in the realms of George Orwell, I do not know what does. What can he mean by "reflects the feedback"? I urge the minister to examine the feedback that the health board has received over the past 12 months. If he does, he will see that that statement is simply inaccurate.
That sort of thing is typical of what we have encountered throughout our discussions on this sorry state of affairs. Inaccurate information has been presented to decision makers as fact. I might have expected the members of NHS Grampian to ask searching questions of the proposals, but they did not. I might have expected members of NHS Grampian to ask what proposals are in place to deal with maternity emergencies in Deeside when they close the maternity unit in Aboyne. They have not asked those searching questions. I would like to thank Malcolm Bruce, the MP for neighbouring Gordon, who did ask searching questions of the board—questions to which we have still not received a reply.
I say to the minister that, with the failure of members of NHS Grampian to do the job that we expected of them, we are left with a backstop—I am sorry to call the Deputy Minister for Health and Community Care a backstop, but that is what he and the Minister for Health and Community Care, Andy Kerr, are. We turn to them because they are where public and democratic accountability come in.
Whatever happens, it is not sufficient to rubber-stamp the proposals from NHS Grampian. If accountability means anything, I hope that the minister will ask the board to think again. The campaigners are not asking the minister simply to overturn the decision; they are asking for a chance to prove that the Aboyne unit should be reprieved. When Andy Kerr supports midwife-led units in Highland and Tayside, it would be bizarre for him to support the move by Grampian to close all bar one of such units in Aberdeenshire.
I am grateful to Andy Kerr for agreeing to meet me and the campaigners next week so that he can hear about the issue at first hand. The campaigners want him to recommend that NHS Grampian promote the Aboyne unit in the same way as NHS Tayside has promoted its maternity unit in Montrose. I ask the ministers to give the Aboyne unit 12 months. Let the people there implement the business plan and let them prove that the Aboyne unit is a goer.
The people of Deeside are relying on the minister. This is about democratic accountability in decision making. I urge him, please, not to let them down.
I congratulate Mike Rumbles on securing this debate, which will be crucial in determining how NHS Grampian configures services throughout the region—not only maternity services but services for older people and diagnostic and treatment services.
I expected my colleague Stewart Stevenson to be back from Georgia for this debate. I am still hoping that he will come through the door, but if he does not, my remarks refer to Fraserburgh and the north of Aberdeenshire as well as the south.
Mike Rumbles has invested a huge amount of time and effort in this campaign and I am aware of the emotional toll that it has taken on him. At times, dialogue with NHS officials has been fraught—as he has just said. Their unwillingness even to listen to a reasoned argument has made his job very difficult. Therefore, I am pleased to be here to help to secure the future of the maternity units in rural Grampian.
I know that Mike Rumbles appreciates that the Scottish National Party is fighting alongside him on this issue. He cannot rely on his own party, whose local government representatives on the health board voted for closure. That was especially lamentable in the case of Councillor Bisset, whose council—Aberdeenshire Council—had voted to keep the units open.
I, too, welcome the presence of the save Aboyne maternity campaigners in the public gallery. I hope that the minister will be able to tell us that he has read their business plan for Aboyne maternity unit, which aims to develop and expand the unit along the lines of the Montrose unit. A few years ago, the Montrose unit also faced closure, but now 52 per cent of local babies are born there. It is unfortunate that NHS Grampian has not even thought fit to reply in writing to the proposals that the campaigners have made.
I am sure that other members will focus on the long distances, and I am sorry that Andy Kerr declined the invitation to visit the units to see for himself the distances involved. Last week, the Parliament debated the closure of accident and emergency services in Lanarkshire, which will require people to travel distances of fewer than 30 miles. The people who will be affected by NHS Grampian's proposed closures will have to travel twice that distance or more, on much poorer roads. I recall helping to fight in a by-election in Fraserburgh one January, when I was eight months pregnant. As we drove back to Aberdeen and beyond in deteriorating weather, my fellow activist, Kevin Stewart, became increasingly agitated that I might deliver in the middle of nowhere on a stormy, snowy night. The distances that people must travel are a serious issue.
There are stark inconsistencies in NHS Grampian's recommendations, which fly in the face of many objectives. The Kerr report called for health services to be delivered locally and regionally. NHS Grampian says that a community health unit is needed for the north of the area, but proposes nothing similar for the centre and the south.
There is a clear economic case for keeping the maternity units open. Last Friday, members of the Scottish Parliament received a briefing from Scottish Enterprise Grampian on proposals to increase tourism on the east side of the Cairngorms national park, around Deeside and Donside. The ambition is to increase the value of tourism in the area by 66 per cent—to £86 million—by 2015, which will generate an increase in jobs from 1,223 to 3,076. Many jobs have already been taken up by young migrant workers and many more jobs will be taken up as migrant workers bring their wives and families to the area. I do not expect that the Minister for Enterprise and Lifelong Learning has told the Deputy Minister for Health and Community Care about that—I have yet to find any joined-up government in the Executive—but I urge the Executive to start doing joined-up government and to keep open maternity units that are needed now and will be needed in future.
I am truly sorry that we are again debating maternity services in Aberdeenshire, particularly the unit in Aboyne, because I had hoped that by now the campaign to safeguard the unit's future would have had a happy outcome.
During the more than 40 years in which I have been involved in the health service, change has been the only constant. As medical techniques and treatments increased in complexity, more and more services were centralised in major and teaching hospitals and cottage hospitals began to lose beds or close. The Kerr report and the strategy that followed it, "Delivering for Health", have brought back a welcome focus on the community and include proposals to deal with as many health needs as possible locally and to use district hospitals to deal with more highly specialised needs.
NHS Grampian's health plan fits well with "Delivering for Health" and the public warmly welcomed many of the board's proposals during the extensive consultation that was carried out in the past year. There are welcome advances to do with access to diagnostic tests on one's doorstep, the availability of minor surgery or chemotherapy close to home and the availability of renal dialysis in Inverurie. The only contentious area has been planning for maternity services.
Fashions in midwifery change. At one time, home births were more popular. Later, mums were more likely to use Aberdeen maternity hospital and then midwife-led units began to thrive. As birth rates have fallen, early discharge from hospital has become the norm and it has become more usual for older women to have babies, sadly many smaller units have been forced to close because there are not enough births to enable midwives to retain their skills.
We witnessed such change in central Aberdeenshire. Despite a major campaign, the unit at Insch war memorial hospital closed. The midwife-led unit in Huntly remained, but the number of births fell off until the unit became unviable—it was unlikely that it would reopen. However, pregnant mums in central Aberdeenshire will have a choice, because they can go to Dr Gray's hospital in Elgin if they do not want a home birth or to go to Aberdeen. The situation further north is similar. Although I have great sympathy for people in Banff and Fraserburgh, at least they can go to Peterhead as well as Aberdeen if the units in Banff and Fraserburgh close. However, if the unit in Aboyne closes, people in west Aberdeenshire will be able to choose only between giving birth at home and giving birth in Aberdeen.
People in the area say that NHS Grampian has done little to promote the Aboyne unit. Indeed, many people think that the board has discouraged use of the unit. Women who have given birth in Aboyne or had post-natal care there are enthusiastic about their experiences and the help that they received in establishing breastfeeding and bonding with their babies in the early days of motherhood. They are keen to promote the unit to others, citing as their example the thriving unit in Montrose, which only four years ago was in the same position as Aboyne is in now.
The campaign to save and promote the Aboyne maternity unit has involved people of all ages, throughout the community. It has the backing of Aberdeenshire Council and it has been supported by MPs and MSPs across the political spectrum. However, instead of heeding local opinion, the health board has recommended closure.
As I said in last week's debate on accident and emergency services in Lanarkshire, if it becomes clear after protracted and widespread consultation that public opinion is solidly against a proposal, and if that view is backed by elected representatives from across the political divide, ministers should be wary of ignoring the weight of that opinion. I urge the Deputy Minister for Health and Community Care and Andy Kerr to think carefully about NHS Grampian's recommendation to close Aboyne maternity unit before deciding on its future.
I congratulate Mike Rumbles on securing the debate and all those who are involved in the save Aboyne maternity unit campaign. They have made a compelling case to Parliament and succeeded in bringing an important issue to public attention. Given that, I can understand why NHS Grampian's decision has been so disappointing for them.
In the previous debate on the issue, I made it clear that I did not criticise NHS Grampian for embarking on a process of consultation on and scrutiny of maternity services in the region. However, at the end of the process, aspects of the final decision cause me great concern. I am aware of the strength of feeling on the issue in other areas, for example in Fraserburgh, but I will focus on the decision about the unit in Aboyne, which raises particularly pressing concerns, including the issues of geography that Mike Rumbles mentioned. The points that he and Nanette Milne made on the geographical issues in west Aberdeenshire were particularly persuasive.
Other questions arise. First, I must ask why NHS Grampian has decided that the unit should be shut when, three years ago, investment was provided for a major refurbishment. That is undoubtedly a bizarre approach to forward planning. The second issue is the current use of the unit. In the previous debate on the matter, it was pointed out that the number of births at the unit had increased. We know about the development that is taking place in the locality and that the population in all such areas is predicted to increase. I do not feel that those key questions have been answered adequately. Concerns have also been raised about the consultation process that NHS Grampian carried out, which led to the Scottish health council's recommendation for a new consultation process. I have written to NHS Grampian on several occasions and to the Minister for Health and Community Care to highlight my concerns. It is vital that those matters are considered properly, as I am not persuaded that NHS Grampian has given them due consideration.
I have visited the maternity unit at Aboyne and met the parents who are responsible for the impressive campaign and who have made a compelling case. It is an indication of their commitment that many of them have made the journey down today and will make the journey again next week to meet the minister. I empathise with those of them who had to leave the public gallery earlier—I have a nine-month-old daughter and I understand what it is like to try to entertain and quiet a child at such events. The campaigners are to be commended on their determination to come to events such as this one and to meet the minister next week.
When I visited the unit, I could not have been more impressed with the facilities that are provided at Aboyne, the excellent environment in which mothers give birth and the staff's enthusiasm. Those are further reasons why the decision is bewildering and disappointing.
It is now up to the Minister for Health and Community Care to scrutinise the health board's decision. Of course he will be aware of the strength of feeling on the issue, not only among those who are involved in the campaign, but among members from all parties. I ask him to take fully into account the points that I and others have made in making the case for the retention of the maternity unit at Aboyne, as I fear that that has not happened so far. The unit is cherished by those who use it and is an excellent facility—that cannot be ignored.
I thank Mike Rumbles for introducing the debate. In a debate on the same issue in November last year, I said that we should not be having the debate. We certainly should not be rerunning it. Some things should be self-evident, which would make it unnecessary for parents with young families to spend so much of their precious time campaigning against something that should never have been on the agenda. It is important to acknowledge the extent of the effort that is put into campaigns against such closures.
I visited the Aboyne unit last Monday, when I was hugely impressed by the state-of-the-art facilities. It is unthinkable that the unit, which has been open for only three years, should be faced with closure when there is overwhelming support for the first-class service that it provides in the community. An opportunity exists for the facilities to be expanded and used as a family health unit.
As other members have said, the long journey to Aberdeen—especially in the winter months—could put expectant mothers and their babies at risk. Also, women should not be deprived of choice in respect of where their babies will be born. The continued provision of local and accessible maternity services should be seen as a priority by NHS Grampian and the Scottish Executive. Such a policy would keep faith with what was advocated in the Kerr report.
Giving birth is not an illness that requires hospitalisation: for most women, giving birth is straightforward, so they should have the choice to go somewhere with a home-from-home, relaxing and calm atmosphere, but which has expert help and the right equipment at hand, thereby giving them the very best of both worlds. Giving birth might happen only a few times in any one mum's life, but it is one of the most momentous experiences of her and her partner's lives. It should be an experience that provides positive and happy memories, not one of fear and tension, of racing along country roads or of getting stuck in traffic jams.
Having toured the unit and spoken to staff and campaigners, I know that deliveries at Aboyne are on the increase, which confirms that it is a well-used facility. More houses are being built in the town, so demand is likely to accelerate in the coming years. Furthermore, it is clear that the environmental impact of unnecessary additional journeys to and from Aberdeen, as NHS Grampian seeks to implement cost-cutting measures, has been completely overlooked. We have only to look over the NHS border to Montrose to see a successful community maternity unit. It was threatened with closure a few years ago, but it is now one of the best used and most highly respected maternity facilities in Scotland.
I am concerned that the short-term focus on cutting services and centralisation will lead ultimately to lower breastfeeding rates and poor health among babies and their mothers. A reduction in breastfeeding is already apparent in Aboyne. More resources need to be available, not fewer, so that mums can access drop-in services and get much-needed local support before and immediately after their babies are born.
It is vital that the minister be made fully aware of the long-term consequences of the health board's closure plans. I remain 100 per cent behind the campaigners, and I argue forcefully for the minister's direct intervention to save the Aboyne unit from NHS Grampian's axe.
I welcome the debate and the opportunity that it affords to articulate some of the voices that have perhaps not been heard so loudly. I will read part of a letter that I received from a constituent earlier this week. She writes:
"I understand that there is to be a debate in parliament next week about proposed changes to NHS Grampian maternity services. This is part of a package of service changes planned by NHS Grampian, which also includes proposals for older people's services and diagnostic treatment services, as no doubt you are aware … The campaign on behalf of Aboyne and other maternity units has been very well organised by very articulate people. My concern is that if the maternity services remain untouched as a result of these high profile campaigns, then the proposed changes for older people and diagnostic treatment services will suffer through inadequate resourcing."
Will the member take an intervention?
I do not have time—I have a lot to get through.
That is very disappointing.
The letter continues:
"I am writing primarily from my personal experience as a carer for an older relative who finds travelling to Aberdeen for hospital appointments exhausting and difficult and would welcome more local access to services. I also know from my job working for a voluntary organisation, which campaigns with and for older people, that many others can also see the benefits to them of NHS Grampian's proposed changes. These would deliver many of the services they use closer to where they live.
I hope that their views will not be overlooked in the debate next week, and that Andy Kerr's final decision will take into account that older people have just as much right to choice and high quality local services as young mothers."
I turn now to the maternity units at Inverurie, Insch and Huntly in my constituency. The Inverurie unit was lost—it was closed many years ago because its retention was not supported by local general practitioners. More recently, there was a debate about whether the Insch unit or the Huntly unit should be retained. I did battle for retention of the Insch unit, which I judged to be the more viable of the two, but we lost that battle. The next development was the decision to mothball Huntly. It was hard to disagree with that decision because mothers were exercising choice in that at least half of those who could have delivered in Huntly chose to go to Aberdeen. Midwives were left sitting looking at four walls, waiting to deliver one baby per week, if that.
Will the member take an intervention?
No. I do not have time and I have a lot to say.
Now that the midwives are not tied to that unit, they are giving much better prenatal and postnatal care to the mums in the area.
The whole package of measures is not all about taking services away from mothers-to-be. One element of the qualified midwifery time in in-patient delivery services at Aboyne, Huntly, Fraserburgh and Banff will be redirected to create capacity within the community midwifery service throughout Aberdeenshire to enhance antenatal and postnatal care.
Community midwifery teams will be able to provide one-to-one advice, support and counselling. They will be able to provide more frequent and accessible group sessions closer to patients' homes, and to undertake health promotion activity in schools. Specific service developments include the creation of a dedicated midwife post in north Aberdeenshire to support substance misusing mothers; dedicated time in all teams to support teenage pregnancy, address child protection issues and target at-risk families; and dedicated midwife-led ultrasound scanning sessions. Those developments must be weighed against the needs of healthy young mums.
I have a lot of sympathy for the case for a stay of execution for Aboyne for a number of the reasons that have been articulated this evening. A stay of execution would enable the community to demonstrate whether promotion of Aboyne can make it a viable unit. In many ways, that would be the fairest course of action.
We have to remember that although there were 270 responses on the maternity unit side of the debate, there were also more than 200 responses arguing for diagnostic services and enhanced services for elderly and chronically ill people who, as my correspondent said, also require services close to home.
I should explain that although my constituency is in the west of Scotland, I am a graduate of the University of Aberdeen and worked in Aberdeenshire, so I know the area well.
Given that the Kerr report has pushed for services to be provided comfortably near to people's homes, I cannot understand why NHS Grampian is recommending that maternity units be closed. It is not uncommon for units to be upgraded before the board wastes the money that has been spent by closing them or turning them into something else. I cannot see why we cannot have elderly and diagnostic services as well as the maternity service.
The campaign has never been about maternity services as opposed to elderly services. As Dr Turner said, we need both.
I am glad that Mike Rumbles has clarified that for me.
We have very good antenatal care nowadays and we can usually tell when terrible things might happen. Therefore, ladies who are waiting for their babies to be in the right place are in hospitals. However, if going to the hospital is the only option and women do not have the comfort of knowing that they can go to units such as Aboyne, those who have their families close to them and do not want to leave them might put off going, so emergencies could arise.
We cannot ignore the weather conditions and the road conditions. I have had to go out from Aberdeen with an emergency service to deal with a retained placenta—I will not go into the details. It does not make sense to me to close down a maternity unit when we are hoping to sustain and develop a community. If we do not have health services in the community, we cannot expand it.
As has happened on so many occasions, the health board has held a consultation, but it is not listening and it certainly has not provided a good reason why the units should close. I have not heard anything that makes me think that it would be dangerous not to close them or that they do not have the staff. Why cannot staff be rotated while we are in a time of transition? It is not unusual for doctors and midwives to rotate in order that they can keep their skills up.
Mr Rumbles talked about Montrose. The local health board tried to do something equally bad in Caithness and Thurso. It wanted to take all the consultant cover services away from there and have people travel on a horrible road. Whoever is trying to rearrange maternity services for women does not have a clue how uncomfortable they might be if they have to travel on such roads when they are pregnant and anxious and have not thought about the safety issues.
The situation in Caithness and Thurso has been overturned and I sincerely hope that the one that Mike Rumbles talked about will also be overturned, especially given that the health board is keen to have midwife-led maternity units. If people's skills are kept up, there is no reason why that should not be possible. Mr Rumbles said nothing about how to retain the service with other diagnostic services, which would make sense.
I apologise for the fact that I have to leave to go to another meeting.
I congratulate Mike Rumbles on securing the debate and acknowledge the work that he has done.
I want to talk about matters that many of us who are here tonight were involved in during the early days of this Parliament. In the first two years, I was convener of the Parliament's Rural Affairs Committee. With me on that committee were Lewis Macdonald, who is now the Deputy Minister for Health and Community Care and is with us this evening, and Mike Rumbles.
At that time, all members of the committee said that it was important that we did not make the mistake of allowing that committee to become the agriculture and fisheries committee. Mike Rumbles worked hard and, with my support, secured resources in the committee to conduct a detailed inquiry into the broader issues of rural development. During that inquiry, it became clear that the provision of rural services and the consideration of rural development in a cross-cutting way were essential to sound rural development in the long term. The provision of health services—including specific health services such as maternity services—was seen as being key to the future of rural Scotland.
During the inquiry, the Rural Affairs Committee conducted a number of consultations. Of course, as many people will be aware, it was found that in some of the more sparsely populated areas of Scotland there is a need to provide local services. However, sometimes, genuine deprivation in some of the economies in Scotland can be disguised. It was a great disappointment to me when, in justification for its decision, representatives of NHS Grampian said that resources could be better targeted at areas of social deprivation. That is to assume that areas such as Aboyne do not require targeting of resources for that reason.
One of the clearest conclusions of the Rural Affairs Committee's inquiry all those years ago was that, in areas such as the north-east of Scotland, we should never make the mistake of assuming that, because there is some wealth, there is not also deprivation. For that reason, we must take into account the fact that areas such as Aboyne and the whole of Deeside as far as Braemar also suffer from deprivation in terms of public transport and a great many other things. For that reason, I encourage the Executive to take the view that was supported by ministers some six years ago, which is that rural development is important across a broad range of services, and that we should never allow the priorities of those who wish to centralise services and target resources on our cities to affect the provision of services for some of our most deprived communities.
I think that Aboyne has a good case for the defence on those principles. I encourage the minister to take the opportunity to espouse that view.
I congratulate Mike Rumbles on securing the debate. I know that he has doggedly pursued this issue. More important, I congratulate the campaigners and the mums, children and families who are here today. They have put up a sterling fight and have done a lot of work to pick apart the arguments of NHS Grampian, none of which is substantive.
There is a lot about NHS Grampian's proposal that depresses me. There does not seem to be a consistent philosophy underpinning the plans for maternity services throughout Scotland and the justifications for changes or closures. On the one hand, health boards argue for moves from general, consultant-led units to midwife-led units and they use that philosophy to justify closures. On the other hand, successful midwife-led units are closed and women are forced to access consultant-led services even though, perhaps, that would not be their choice. That seems to be NHS Grampian's approach.
There is a consistent factor in health boards' approaches that depresses me. When they want to close a facility, they stop filling vacancies and run the service down so that they can turn round at a later stage and say that it was not viable. In that way, they justify the closure that they were trying to bring about.
According to the mums who I met this afternoon, breastfeeding rates have reduced by 15 per cent in six months. Surely there should be a consistent philosophy to underpin the proposals. Where does health promotion figure in NHS Grampian's proposals? I hope that the minister will take that into account, because we should have an interest in promoting breastfeeding. I believe that the Aboyne maternity unit has high breastfeeding rates but, because of the dispersal of mums that is happening already, they are not getting the support that they could get in a smaller unit. As we all know, urban units are under pressure.
Does the member agree that, with the best will in the world, midwives cannot be there at crucial times for women who are at home—for example, if they have problems with latching on? It is best to ensure that the process is going well when they are still in the maternity unit rather than at home. Does the member agree that NHS Grampian's proposal to have mothers in and out in six to 12 hours is not conducive to that?
No mum should be forced to have care that she does not want. It is fine for a mum to be discharged in six hours if she is confident about establishing breastfeeding, particularly if it is her second child, but if women feel pressured to leave early before they have established breastfeeding, that is a problem.
I also hear that mountain rescue services are being trained up to conduct precipitate deliveries. That is absolutely outrageous. Having a child—
Will the member take an intervention?
I do not have time.
Having a child is not a situation that women need rescuing from; it requires a supportive environment with skilled professionals and an environment that can be predicted. Still, that is my information; perhaps the minister can confirm that that is not happening, because I would be horrified if it was.
Mums have done an awful lot of work and put forward viable proposals for the retention of the Aboyne maternity unit and they should be listened to. I am concerned that there do not seem to be any proposals to increase the number of community midwives. I do not see how home births will be made a more available and realistic choice for mums if there are not enough community midwives to deliver them.
What is the philosophy that underpins NHS Grampian's proposals and the Executive's proposals on maternity care? I refer members back to the report by the expert group on acute maternity services. From what I hear of NHS Grampian's proposal, it does not fit consistently with the philosophy in the EGAMS report. I thought that we had moved on so that we treat childbirth as a normal life event but also provide women with emergency back-up where and when that is necessary.
The proposal seems to take us back decades. It gives women only the option of having their baby in a consultant-led unit without the right to control what happens to them in childbirth. It puts the control mainly back in the hands of men rather than putting it in the hands of women who are having babies. That is a backward step. I hope that the minister will reject NHS Grampian's proposals.
I congratulate Mike Rumbles on securing the debate and am delighted to support him, as I have done since the issue first arose. More important, I congratulate the ladies and their families who have come down from the north because doing so is a challenge for them. They have been persistent in Fraserburgh, Peterhead and elsewhere in the north-east, where families have marched in the streets and received support from the press and almost every member of the Scottish Parliament.
We are supposed to have a national health service, so, within reason, one should have a high level of services and choices regardless of where one lives. Unfortunately, Nora Radcliffe missed the point. It is not a case of either/or. If older people need to be supported or diagnostic tests are required, the health board also has a responsibility to deliver such things. There is no simple choice.
The health board has talked about sustainability. It is simply saying that it needs money. It must be responsible, but the question of sustainability is difficult. When the minister gets round to the next stage of the Arbuthnott process—or whatever it is to be called—I ask him please to consider the underfunding of some of our health services. In particular, I refer to NHS Grampian, which is poorly supported, but he should also consider NHS Lothian. We need to ensure that enough resources are available to deliver the care that is required.
The Kerr report made it clear that people should get access to services and support in the community. Choices should exist. Women might prefer home births or to give birth in the local maternity unit, or they may need to go into hospital because they have a problem. As Jean Turner rightly said, problems can be picked up early in hospitals.
We are supposed to live in a democratic country; if so, why have a consultation in which responses will be totally ignored? The health board says that it listens, but it does not even respond. I was at the meeting at which people were told that we would receive a quick response from the health board that would give its opinions, but we have not received that. That is a nonsense in this day and age.
If the health board has a problem because it cannot get staff or it does not have enough resources, it should be honest and tell us so—it should not faff about and say, "We'll close this and that." The birth rate in the Aboyne unit has doubled. Popular demand for the service exists—the statistics speak for themselves. People want the support that is provided—they want to use the unit. Why should it be taken away when people perceive it to be an absolutely super unit with dedicated staff? I have never met a mum who has delivered a baby in the unit who has been unhappy with the service that she has received. In fact, I have met mums who have wanted to deliver in it, but have had to go to Aberdeen for one reason or another, such as an emergency occurring.
I turn to the issue of Aberdeenshire's roads. There has been classic underestimation by the health board. Once, during a snowstorm, I took an hour and three quarters to drive from Peterhead to Fraserburgh in a big four-wheel drive. What chance would an ambulance have in such circumstances? The same comment applies to Deeside. In emergencies, the distances are too great. If paramedics came part of the way, that would help, or at least there would be an oasis of calm and support if a woman got into a maternity unit, which would help her family. I ask the minister to intervene vigorously in the matter and ensure that the people of Grampian get the services that they deserve. If they do not, there will be no young families in our rural areas.
I, too, congratulate Mike Rumbles on securing the debate. I have listened with great interest to what he and other members have said.
Alex Johnstone reminded us that the issues are important in the wider context of rural Scotland and because they relate to choices in health care and the provision of locally appropriate services throughout Scotland.
The motion highlights the consultation that NHS Grampian carried out on its proposals and how local people have taken part in the process. When I responded in a parliamentary debate last November, I emphasised my view that the opportunity to express views and influence decisions is an important part of an active democracy. That remains my view, and I am sure that all members share it. However, that engagement must include a willingness to consider all the relevant issues and to view issues and concerns within the wider picture.
Last year, the community health partnership in Aberdeenshire developed a range of proposals for service change and consulted locally on the matter. That is what we expect community health partnerships to do in building up locally responsive service developments from grass-roots level. Following the development of those proposals and that consultation, the CHP made its recommendations to the NHS board, which then carried out its own consultation and submitted its recommendations early last month. As has been said, those proposals will go to Andy Kerr and he will respond to them in due course.
It is important to recognise that NHS Grampian's recommendations are about the development in Aberdeenshire of a range of community-based services—including maternity services, as Nora Radcliffe stressed. They include proposals for extending and enhancing local services for older people and for moving a range of diagnostic services into communities where people will be able to access them more easily. They include specific targets for moving services out of specialist hospitals and into local communities. I believe that those measures will be broadly supported, and the principle behind them is in line with wider policy objectives.
I am glad that the minister has mentioned that, as my motion is focused on maternity services. Everybody is pleased with what NHS Grampian is doing with diagnostic and treatment centres and services for the elderly. Nora Radcliffe failed to understand that point.
That is a good cue for me to move on to the issues around maternity services. The debate has focused on NHS Grampian's proposals not to continue to give women the option of delivering at four out of the five community maternity units. Peterhead is the exception, as was mentioned. There, the existing range of midwife-led services will be enhanced.
In considering the matter, Andy Kerr will look at the basis for the board's proposals, as has been mentioned. The board's proposals are based on its view on changes in local demography, birth rates, and so on. Its conclusion is that the current service pattern is not sustainable and that the resources that are currently used to provide the service could be used more effectively elsewhere. That raises the question of choice for local communities—a question that has been fundamental in the local debate.
As Shiona Baird said, childbirth is not an illness; it ought to be one of the most positive experiences in a person's life. That means that the way in which maternity services are delivered should be centred on the women, and service planners should take the wishes and interests of mothers into account in planning services.
It is important to remember that pregnancy and childbirth are not always a positive experience and are not risk free. People's choice must be informed by the best available evidence, including the evidence of risk not only of extreme circumstances, but of the skills of staff being eroded by their being responsible for an inadequate number of deliveries.
I want to mention something that the minister has not referred to, and which nobody seems to be referring to because NHS Grampian has forgotten about it. A pilot scheme that was run by south Aberdeenshire community health partnership pioneered a new way of working with community midwives. It is not about having 24-hour cover in hospital.
That is a fair point. That pilot scheme was mentioned in our debate last November, as Mr Rumbles may recall. It replaced the previous pattern of 24-hour cover. In considering the board's proposals, Andy Kerr will want to consider the conclusions that were drawn from the experience of that pilot project.
The way in which NHS Grampian has addressed the balance between choice and risk is fundamental to the consideration that will be given to the proposals. That will include models of service delivery past and present. The proposals will also be looked at in the context of delivering for health and the work of the expert group on acute maternity services. We will consider in detail the views that have been put forward by individuals and organisations throughout the area who have expressed an interest.
The matter of the alternative business plan has been mentioned. That is among the papers that will be in front of Andy Kerr for his consideration and it will be taken into account by him. As has been mentioned, Andy Kerr will meet Mike Rumbles and representatives of the campaign next week.
In the context of Richard Baker's speech, members will be interested to know that the Scottish health council has reported on the later consultation and is now satisfied that the process was adequate. Andy Kerr must now consider all the evidence—the board's proposals and the views of those who take a different view—and strike a balance between the concerns that have been raised and the necessity for a sustainable and properly delivered service. He will take all those considerations into account in reaching a conclusion, at which time he will report as quickly as possible.
Meeting closed at 18:00.