NHS Lanarkshire
The final item of business is a members' business debate on motion S2M-3944, in the name of Carolyn Leckie, on the Lanarkshire united health for all campaign. The debate will be concluded without any question being put.
Motion debated,
That the Parliament notes NHS Lanarkshire's consultation, A Picture of Health; is concerned that the board has written off the status quo as "unsustainable" without giving the public the opportunity to make that judgement about their health service; believes that to consult on options which exclude the possibility of a community retaining emergency and planned services at their local hospital is no choice at all; questions the rationale and evidence that the consultation is predicated on, such as whether planned capacity will be sufficient; is concerned that health inequalities will not be addressed and may indeed be perpetuated; recognises the growing anger of communities throughout Lanarkshire, and believes that the board and politicians alike have a duty to explore all options and strategies required to meet the needs of Lanarkshire's citizens and unite with them to secure full and equal health services for all.
I thank the members who have stayed to attend the debate and those who signed the motion. There is cross-party support for the motion and I think that that indicates the strength of feeling and the concern about Lanarkshire NHS Board's current reorganisation consultation. A number of members who are present represent the Lanarkshire united health for all campaign, which has resisted the health board's strategy that was set up to pit one community against another in the consultation.
The consultation is clearly already flawed and I serve notice on the minister that at the end of the consultation, which is at the end of April, we will argue that that is the case—unless fundamental things change. The roadshows that are conducting the consultation are loaded. The DVD presentation gives only the health board's arguments. The health board hand-picks the consultation panels and no alternative arguments to the health board's strategy are put forward.
The communities have not been allowed to participate in identifying what problems are present in Lanarkshire or given the opportunity to explore alternative solutions. Whether the problems are the working time directive, which we all know has been with us since 1993, or filling vacancies, the communities have not been allowed to explore the problems and find solutions: they have been presented with narrow options by the health board. I will pick out some of those, because the consultation has an extensive impact, as it represents probably at least 30 separate consultations. Unfortunately, the consultation itself is not getting into and underneath the issues.
If someone is in East Kilbride or its environs, the consultation tells them that they can have either an accident and emergency unit and an intensive care unit there, or they can have planned care. It is the same for someone in the Monklands area: they can have either accident and emergency and intensive care, or planned care. Someone in the Wishaw or Motherwell area, however, can have an accident and emergency unit and an intensive care unit, but they have no choice of keeping planned care.
The evidence base for the geographical separation of planned and unplanned services is, in fact, a big, fat zero and there is mounting evidence against it, but the people of Lanarkshire are not being offered the opportunity to keep emergency and planned services on one site. That is no choice at all.
The glossy brochure that NHS Lanarkshire has unevenly distributed throughout Lanarkshire lists conditions that are appropriate for treatment in a minor injuries unit, which the board's preferred option suggests should be at Monklands hospital. The brochure lists the conditions appropriate for a minor injuries unit and those appropriate for an accident and emergency unit.
Under the minor injuries list come simple fractures; under the accident and emergency list come complex fractures. Who is supposed to determine which is which? Patients. For the first time that I am aware of, patients are being asked to self-diagnose so that they can refer themselves to the right unit. They are supposed to understand, when they are injured, whether they have a simple fracture or a complex fracture. That is absolute nonsense.
The common themes of the consultation are the paucity of evidence and information that is put forward by the health board in support of its narrow options, and its lack of answers to questions. It seems that it could instruct even the First Minister in the art of how to avoid answering questions.
Whether the questions are about demographics, ambulance services, workforce planning, bed modelling, cross-boundary flows or the detail of financial issues, particularly the impact of the private finance initiative, the board says things such as "we believe" and "we are doing work on that"—or it does not answer questions at all.
I gave the board a written list of questions two weeks before the consultation even started. We are now more than halfway through and I have not received one answer—nor have answers been given to the many hundreds of questions that have been asked at the public meetings.
The area with the greatest deprivation and the highest number of heart attacks—Monklands—is the board's preferred option for the removal of an accident and emergency department. No explanation of the logic for that has ever been presented. Out of the sky, Lanarkshire NHS Board has said that it will keep bed numbers the same—despite an acknowledgement that the ill and dependent constituency that requires the services is increasing, and despite the unpredictability of cross-boundary flows. Work on cross-boundary flows has barely started.
The board is silent on the proven impact of the private finance initiative on staffing levels, bed numbers and services. The fact that the consortia with their 30 and 40-year contracts at Wishaw and Hairmyres are guaranteed their money, whether or not one patient is treated in either hospital, must be the determining factor when the board decides on its options for services in Lanarkshire. Anyone who says otherwise is living in fantasyland.
The minister undoubtedly has a role to play in the general financial position. Lanarkshire NHS Board's deficit is £20 million, but the board is owed £40 million under the Arbuthnott formula, and that money has not been paid since 1999. The money would make a huge difference, especially for the people of East Kilbride, who have already contributed £1.5 million for a hospice that they are being denied. Throughout Lanarkshire NHS Board's consultation document are insidious references to increased privatisation.
I hope that other members will pick up on other issues. I congratulate the communities in Lanarkshire for campaigning to keep all their services—and everybody else's—and to improve them.
I would like to send a strong message to Labour members in the region. They should not accept Lanarkshire NHS Board's propaganda; they should look behind the issues, look at the detail and ask questions; and they should refuse to play the game of pitting one community against another.
In East Kilbride, we had the spectacle of Adam Ingram, the Minister of State for the Armed Forces, asking us to trust the health board because it has made a very strong case—oh no it hasn't—and asking us to keep an accident and emergency department at Hairmyres. No doubt John Reid, the Secretary of State for Defence, will be in Airdrie tonight to say, "Keep the Monklands service." I wonder whether they will be so keen to drop bombs in this phoney war as they have been before.
I appeal to Labour members to stop conning the public and to stop artificially setting communities against one another. Labour members should read the consultation document. For people to argue only for the accident and emergency department in their own back yard is to argue to shut their own planned services and to shut other people's accident and emergency departments. I ask members to support the motion.
I congratulate Carolyn Leckie on securing this debate. I am going from here to a public meeting in Airdrie on the future of Monklands and the other hospitals and accident and emergency departments in Lanarkshire. I have already given notice to the Presiding Officer that I may have to leave early—it depends on when the debate finishes—in order to get to Airdrie.
A great deal can be said about Lanarkshire NHS Board's consultation document, but in the time available I want to focus on the proposals for accident and emergency departments. For the record, I point out that three Labour MSPs who are supposed to represent Lanarkshire constituencies—Cathie Craigie from Cumbernauld and Kilsyth, Michael McMahon from Hamilton North and Bellshill, and Karen Whitefield from Airdrie and Shotts—are not even here to discuss this very important issue.
Lanarkshire NHS Board is proposing that the three accident and emergency departments that currently offer services in the area should be reduced to two. The health board has gone further and said that the accident and emergency department at Wishaw will remain open. Wishaw happens to be in the First Minister's constituency. I am sure that there is no coincidence there.
The board has therefore given us a choice over which accident and emergency department should close—Monklands, which deals with 36,000 cases every year, or Hairmyres. It is Hobson's choice. One of the options in the consultation document should have been to keep the three accident and emergency departments open. At no time has Lanarkshire NHS Board published any analysis or evidence to show why we need to take the option of having only two accident and emergency departments. I have requested that information under the freedom of information regime, but we are still waiting for an answer.
One thing that Lanarkshire NHS Board says at the public meetings is that it is short of consultants. There is no doubt at all that we are short of consultants throughout the health service, but opting for Lanarkshire NHS Board's proposal would mean that the hospital that would lose its accident and emergency department would still have an intensive care unit, which would need to be staffed by the very consultants the board says it is short of. There is absolutely no logic to its position.
Elaine Smith is the only Labour member who represents the area who is present—
Will the member take an intervention?
I apologise; Karen Gillon is here, as always.
I ask the Labour members who are going to East Kilbride to say, "Keep Hairmyres accident and emergency department open and close the one at Monklands," and are then going on to Monklands to say, "Close the Hairmyres accident and emergency department," to think again. That is an example of divide and rule; it is no way to plan for the future of the health service in Lanarkshire or anywhere else.
I could make 50 points about the stupidity of the board's proposals, but I will finish with one that is about the comments that the chief executive made in last week's Airdrie & Coatbridge Advertiser, which should be compulsory reading for everyone. He boasted that no costings had been done on the implications of closing the accident and emergency department at Monklands—or the one at Hairmyres—and that no research had been conducted on the impact that that would have on hospitals in places such as Larbert and Glasgow.
Lanarkshire NHS Board's handling of the situation has been pathetic. I hope that the minister will send it packing and tell it to go back, do its homework and start again.
I welcome the opportunity to discuss "A Picture of Health: A Framework for Health Service Improvement in Lanarkshire", which deals with an issue that is of great importance to my constituents, given that Monklands general hospital has been earmarked as the so-called clear preferred option for downgrading. I welcome the chance to outline the views of the local constituency members who, like me, are battling to retain acute hospital services at Monklands on behalf of the communities they represent.
As most members will be aware, and as has been mentioned, Lanarkshire NHS Board is holding its Airdrie public meeting tonight, as part of the consultation process. Given that Monklands hospital is in the constituency of my colleague, Karen Whitefield, and that she has urged thousands of her constituents to attend that forum, she has rightly decided to make that meeting her priority by ensuring that she is present for the full discussion. She is therefore en route to that meeting and has asked me to convey her apologies, to put on record her unequivocal opposition to the downgrading of the accident and emergency department at Monklands and to record her thanks to our local newspaper, the Airdrie & Coatbridge Advertiser, for supporting both of us in our campaign to save an essential service.
Will the member take an intervention?
I might do in a moment.
In addition, I want to put on record Cathie Craigie's apologies for not being able to attend the debate; she has suffered a family bereavement. Like Karen Whitefield, she wants the Official Report to show her opposition to the downgrading of Monklands accident and emergency department. Karen Whitefield, Cathie Craigie and I launched a petition against the closure of that facility in December and, so far, tens of thousands of signatures have been collected. Given those members' reasons for not attending the debate, I think Alex Neil's criticism was a bit of a cheap shot, so I will not take an intervention from him.
That is childish.
I turn to "A Picture of Health". There is a lot to commend in the vision that Lanarkshire NHS Board has laid out, but the consultation raises the serious and contentious issue of acute hospital services and the proposal to downgrade one of Lanarkshire's accident and emergency departments. The proposal is based on the health board's contention that it cannot recruit a sufficient number of clinicians to operate accident and emergency services over three sites; that moving to two sites for emergency in-patient care would concentrate expertise and make services more sustainable; and that reorganisation is necessary if the board is to react to legislative workforce issues.
According to the board's option appraisal exercise, the accident and emergency department at Monklands hospital has been earmarked as the preferred option for closure. If that department was closed, the hospital's emergency admissions facility and its ear, nose and throat, intensive care, renal and infectious diseases units would all be lost, which in my opinion would be a precursor to the hospital's closure. I therefore urge caution on the option appraisal findings. Many of the contributions were not impartial: the views of patient contributors were weighted more towards Wishaw and Hairmyres and not Monklands. That is despite Monklands being the busiest accident and emergency department, and despite its having the largest population base and serving the most deprived communities in Lanarkshire. The findings should perhaps have been weighted more equally.
Essentially, option appraisal is a private sector tool that is being employed by the public sector to evaluate the decisions it takes to contract out services, but the practice of using option appraisal as the basis for decision making of this magnitude is highly questionable; it is not robust enough for the public sector to use it in this way. If difficult decisions have to be taken, surely they should reflect the fundamental principles of the NHS and be weighted in terms of the impact that they will have on reducing social and health inequalities. Undoubtedly, if the option appraisal had been based on that principle, Monklands hospital would have been discounted as a candidate for downgrading.
As a constituency MSP and local person, I am utterly appalled by the suggestion that Monklands A and E should be closed. It is not only the busiest in Lanarkshire, but the most efficient: it lost only 24 hours due to closure last year. Furthermore, the appalling health record that the people in the Monklands area have historically suffered from means that there is a disproportionate need for emergency care in my community. North Lanarkshire Council, which is vigorously opposed to the proposal, has said:
"If NHS Lanarkshire elects to support the so-called ‘clear, preferred option' it would be downgrading the busiest hospital in its Board area, in its area of poorest health. There may be reasons for making such a decision, but they are not related to need, deprivation or ill-health."
Indeed, many of us are under no illusion about the reason that lies behind the proposal: quite simply, it comes down to the 30-year private finance initiative contracts that Lanarkshire NHS Board is bound by at both Hairmyres and Wishaw hospitals. At the first public meeting, which was held in Muirhead in my constituency, Ian Ross, Lanarkshire NHS Board's divisional chief executive for acute services, was unashamed in his admission that
"PFI hospitals are 30 year contracts. We have 25 years left so we have to use them as much as possible".
That shows that the decision is based more on the contractual obligations to and profits of PFI investors than on the actual needs of the people of Lanarkshire.
To add insult to injury, crucial factors seem to have been completely ignored in the process. For instance, the way in which the proposals would affect the ambulance service has been ignored and yet Coatbridge has the busiest ambulance station in Lanarkshire. I am informed that discussions are continuing in that regard. Surely all such discussions should have been exhausted and all eventualities costed before the consultation was even launched. The health board also does not seem to have taken account of the cross-boundary flow issues that stem from the downgrading of services in Glasgow.
The issue is clearly difficult and complex. No one in the chamber actively wants to see the closure of any of Lanarkshire's A and E departments. I am not saying that we should close Hairmyres A and E—I take exception to the suggestion that I am—but we have to consider the vulnerability of Monklands hospital along with the horrendous health record of my constituents and the legitimate arguments that surround the implementation of the working time directive. I make no apology for putting forward as robust a case as I can for the retention of services at Monklands hospital.
Members who have already spoken have made very good points on this issue. I am very pleased that Carolyn Leckie secured the debate.
First, I will focus on the general issue that our organisations, whether they are health boards, councils or governments, are still extremely bad at consultation. The public see organisations of whatever sort as biased, ill informed and, as Elaine Smith said, motivated not by the needs of people but by money. None of that may be the case, but a huge number of people think that it is. We all have to get our act together when we are undertaking consultation.
In this case, the status quo may not be an option. The world moves on. Lanarkshire NHS Board may find it very hard to obtain doctors, for example, for its hospitals. We have to do something about that. From personal experience, I know that minor injury services can be extremely effective. Although they are not a substitute for A and E, they can be helpful as an additional resource that does not cost as much to run as A and E departments.
It should be possible for the board to move forward with some sort of agreement, and not as it is progressing the issue in this instance. It is also going in for divide and rule, which is a favourite tactic of governments of all sorts. Any consultation in Lanarkshire—I hope that the minister accepts that he has a role in trying to achieve sensible consultation—has to take account of the situation in Glasgow and Forth Valley.
Forth Valley NHS Board is building a big hospital at Larbert. Completion is five years away, but the hospital might be able to play a part in due course. Certainly, if hospitals in Lanarkshire close, people who live in Cumbernauld, for example, might well travel to Falkirk or Larbert. Other people might find it more convenient to go to Glasgow. We must consider the whole area.
As I understand it, no proper impact assessment in relation to transport is carried out. During the 10 years or so in which I have been involved in Lanarkshire issues, I have repeatedly been struck by the bad transport arrangements. Transport is fine if someone wants to go to Glasgow, but it is not at all fine if someone wants to go anywhere else. There is simply no cross-country transport to more distant hospitals. If changes are to be made to the system, they must include proper, sustainable transport arrangements. The minister could insist that such arrangements be made.
We must acknowledge at local and at ministerial level that large parts of Lanarkshire have a poor health record, which is regrettable. It would be a mistake to reduce the number of hospitals in an area that needs more support. Moreover, the number of older people is increasing throughout the country. Older people are more prone to illness, so we should improve, not decrease, services. I hope that the people involved can get together and that Lanarkshire NHS Board learns from its incompetent consultation, so that it can work with interested parties to improve the situation.
The title of the motion refers to a campaign by Lanarkshire health united. I am a list MSP for Central Scotland and although I have never been notified of or invited to one of the campaign meetings, I am supportive of the campaign's objective to include in the consultation the option of retaining three A and E departments. I congratulate Carolyn Leckie on securing the debate, the subject of which is immensely important to everyone who lives in Lanarkshire and neighbouring areas and who currently uses the A and E departments at Monklands hospital and Hairmyres hospital.
As soon as the consultation document, "A Picture of Health" was mooted, there was a distinct and unambiguous message from residents of the catchment area for Lanarkshire's three general hospitals: Wishaw general hospital, Monklands hospital and Hairmyres hospital. No one wanted to deprive anyone in the area of full A and E coverage. Therefore, it was expected that the option to retain the A and E departments at all three hospitals would be included in the consultation. Indeed, at a pre-launch briefing on the consultation for list MSPs, which Carolyn Leckie and I attended, that option was still firmly on the table, albeit that the chief executive and other members of Lanarkshire NHS Board said that they did not support the option and favoured the retention of A and E departments at two hospitals and a focus on elective care at the third hospital. Their view was predicated on three assertions: first, that it would not be financially viable to retain three A and E departments; secondly, that it would not be possible to staff three A and E departments with the appropriate clinicians; and thirdly, that if only two A and E departments were retained, the board would be able to deliver a better standard of care throughout Lanarkshire.
I disagreed with those assertions at the time and my view has not changed since then, for the following reasons. First, on finance, Wishaw general hospital has apparently passed the test because maternity services are located at the hospital. Therefore, the hospital is not under threat, which is good. It has been accepted that Hairmyres hospital could attract patients from greater Glasgow, especially now that the M77 extension has opened, which would make that hospital financially viable. Monklands hospital could also attract patients from greater Glasgow if it was refurbished and brought up to standard, so I do not accept that the board members' argument about financial viability has been won in relation to Monklands hospital. Therefore, the argument that it would not be financially viable to retain all three departments does not stack up.
Secondly, there is plenty of time to plan for the increased number of clinicians that would be needed and to train more medical students. When they finished their training, those people would be attracted to work in improved services.
The third assertion was that the approach that the board favoured would deliver a better standard of care. I do not accept that. As long as it remains uncertain—as it does—how long it will take for a blue-light service to negotiate traffic congestion at peak travel times, either at the Shawhead flyover or on the East Kilbride expressway, if either of the Hairmyres or Monklands A and E units closes and becomes an elective unit, that most decidedly cannot be sold as an option that would deliver a better standard of care.
Even at this late stage, I call on the minister to add his voice to those of the people of Lanarkshire who want the option of retaining three A and E departments to be included in the consultation and to be fully discussed. That is particularly important to ensure that there is openness and accountability in the consultation process.
I start by apologising to members for having to leave before the end of the debate, although I look forward to reading the rest of the speeches with interest.
I very much welcome the debate on health services in Lanarkshire, partly because it very much concerns the process of decision making and the configuration of health services in an area. The Kerr report puts much emphasis on bringing health care closer to the community; treating people as locally as possible; investing more in community health and primary health care; and preventing ill health, particularly in the most deprived areas. I support all of that, while recognising the importance of Government policies other than those that pertain to the health service, as economic inequalities lead to health inequalities. I also recognise that the health service should strive to minimise existing health inequalities between social groups.
Lanarkshire continues to suffer from massive health inequalities. It may well be that doing nothing is not an option and that there needs to be some redesign or reconfiguration of the health service there, but communities in Lanarkshire, like other communities throughout Scotland that face a similar situation, are expressing fears that should have been listened to and dealt with at an earlier stage in the process. People have the right and the duty to participate, individually and collectively, in the planning and implementation of their health care. The overall structure for health services needs to enable much more input at community level.
The communities in question have expressed key concerns about the loss of the major accident and emergency and intensive care facilities at the planned care hospital. Many of the issues have been mentioned by other members. Will the accident and emergency units, which are already overstretched, be able to cope with the cut in their number from three to two units—albeit larger ones? Will they be able to meet the accident and emergency waiting time targets? Will the proposed new facilities help to bring those waiting times down? I have been reliably told that, since the Edinburgh royal infirmary moved to its new premises, waiting times in casualty have risen by 30 minutes.
In emergency situations, will people be able to judge which hospital to go to? Carolyn Leckie mentioned that issue. Will ambulances be able to get through rush-hour congestion? Will there be enough ambulances? With a larger catchment area, will they be able to maintain their target response times? People in rural areas, for example around Strathaven, will have to travel further for emergency treatment. If a simple planned operation goes wrong, will patients need to be transferred to a different campus for intensive care? Donald Gorrie mentioned another issue about transport: how will it be ensured that the facilities are actually accessible by everybody in the area?
Have the proposals taken into account population factors: the aging population in the area, with its greater needs; the higher levels of deprivation that have been mentioned; and the planned major expansion in the number of homes in the Clyde gateway, which will result in big population increases in towns such as Strathaven? Will the planned capacity be sufficient? Will the new developments incorporate local health care facilities?
It is good to have more services in the community, but are communities being engaged on the nature of those services? For example, there is currently a campaign for a hospice in East Kilbride. Lanarkshire NHS Board has proposals for a community palliative care resource, but is the board engaging with the hospice campaign group to ensure that the mix of hospital services, hospice care, care homes and support at home is right for the area? Only the community can say whether it is right for its area.
I cannot say whether NHS Lanarkshire's proposals are the best way forward. However, what is clear is that the affected communities—the people who matter—remain to be convinced.
I congratulate Carolyn Leckie on securing time for this important debate. Any reform of our NHS must be built on the important premise of improving services for people and thereby improving the health care that they receive. To date, Lanarkshire NHS Board has failed to demonstrate that any real health benefits will come from closing one of its accident and emergency departments. The reason why it has failed to come up with any detailed benefits for the people of Cumbernauld and Kilsyth from closing Monklands A and E is that the proposal would offer no health benefits to the people who live in that community. The reason why it has failed to demonstrate to the people of East Kilbride any benefit from closing Hairmyres A and E is that the proposal would offer no benefit to the people who live in that community.
The health board is conducting a consultation exercise and proposing to close one A and E department, but it has failed to demonstrate that the community should support that proposal because it will improve the community's health. The board tells us that part of the problem is that it does not have the staff; in particular, it does not have the workforce to maintain three A and E departments. Whose fault is that? The fault lies with Government, which has a responsibility to ensure that there is proper workforce planning for organisations such as our NHS. We have had a Labour Government for almost 10 years, but it has failed to ensure that we are planning properly. As the minister should be aware, it takes only five years to train a doctor. If we need more doctors, we should ensure that we plan for that.
The health board has also failed to demonstrate the real implications that closing one of the accident and emergency departments will have for the neighbouring health boards of Greater Glasgow NHS Board and Forth Valley NHS Board. It says that it is conducting that analysis at present and has been working on the issue for six months. However, if we ask the board for details, no details appear. We are told that Glasgow will be able to absorb some of the overflow of people from Cumbernauld and Kilsyth and that people will also be able to go to the new Larbert hospital that is planned in Forth Valley. That hospital will be on stream in three years, rather than five years, as Donald Gorrie suggested. I was involved in both of the consultation exercises for the new hospital at Larbert, and at no point was the need to ensure that we planned for additional overflow from the Lanarkshire area mentioned—that did not feature in the plans. This week, I spoke to a member of Forth Valley NHS Board, who advised me that at no point was there discussion of the implications of Lanarkshire NHS Board closing one of its A and E departments and patients being moved to Forth Valley.
Lanarkshire NHS Board has conducted its consultation without providing people with the information that they need to have a greater understanding of the implications of closing some of the acute facilities in the Lanarkshire area. Tonight I will not be drawn into the Dutch auction into which the health board would like us all to be drawn, playing one community off against the other: should Hairmyres A and E or Monklands A and E be closed? In my view, all three A and E departments in Lanarkshire have an important role to play in the local community. The health board has failed to put the case for closing any of them. Tonight the Parliament should say that it is united with Lanarkshire united in ensuring that we retain the three services.
I am happy to speak, albeit briefly, in support of Carolyn Leckie's motion. I still have pleasant memories of two summers, many years ago, that I spent as a medical student at Law hospital in Carluke, which at the time gave good service to many people in Lanarkshire and has now been replaced by Wishaw general. I am delighted that the A and E department at that hospital will remain.
I do not have detailed knowledge of the health services that are currently provided by NHS Lanarkshire, although I am aware of the issues surrounding the proposed cessation of A and E services at either Monklands hospital or Hairmyres hospital. I am also aware that there are local concerns about the consultation that is being carried out. My reason for taking part in this debate is that I think that Carolyn Leckie's motion contains a general point of principle that could be applied across Scotland, which relates to the need for local people to have timely and meaningful input into the development of NHS provision.
Health boards across the country are realigning and redefining their services. That is essential if they are to meet the demands of modern health care, particularly the recommendation of the Kerr report that care should be delivered as locally as possible. Any proposed service change will, inevitably, result in concern and apprehension among patients who have used their local hospitals over many years. It is extremely important, as I hope that the minister will agree, that open and thorough consultation is carried out before any change is made and that that consultation should consider all options, including the status quo.
It is the fact that the latter has not been included in NHS Lanarkshire's consultation that has prompted me to take part in the debate. By way of comparison, NHS Grampian is also looking at significant restructuring of services in the wake of the Kerr recommendations. Following a series of public meetings last summer, the board is continuing to consult local people where there are still serious concerns—for example, about the proposed loss of localised maternity services. The outcome at the end of the day might or might not be what those people want, but at least the board is listening to their point of view and debating the issues in a transparent manner. That is what appears to be lacking in Lanarkshire, where the board has unilaterally dismissed the status quo as an option without consulting the public. That is wrong and will inevitably result in people feeling aggrieved. That is why I am happy to join my colleague, Margaret Mitchell, in supporting the motion.
I acknowledge Carolyn Leckie's views and the concerns that have been raised by other members. As the minister who will make the final decision on whether to accept the board's recommendations, I will, of course, want to take into account the points that have been made this evening.
What I will not do this evening—indeed, what I might not do at all—as the minister with that decision-making responsibility, is comment in detail on the proposals or on some of the other specific points that have been made, because it would not be appropriate for me to do so before I have had the opportunity to consider the board's final proposals. It is important that the local consultation and decision-making process should take its course before I come to any final view.
I will address a general point that a number of members have made. In such a consultation, should boards consult on maintaining the status quo in the configuration of services? I can assure members that, in considering the final proposals, I will also consider the option appraisal exercise that NHS Lanarkshire undertook last year in order to arrive at the options for consultation. That was the stage at which it determined not to consult on the status quo.
I understand that the minister will not make specific comments about NHS Lanarkshire's proposal. However, can the minister give me any examples of a health board excluding the option for any community to keep emergency and planned services on one site? Is the minister aware of any other unit using the model of care that NHS Lanarkshire proposes to use in either Monklands or Hairmyres? There seems to be no evidence base for that at all.
It is not unique to say, as NHS Lanarkshire is, that separating out emergency care and planned care can improve the flow of patients through hospital services. That is the fundamental point that, I suspect, the health board would make with regard to the cases that have been touched on. I also suspect that that is a point that the board will put to me in its proposal.
It is important to say that we would not expect boards to consult on options that they cannot deliver, no matter how desirable people might believe them to be. It would be disingenuous for a board to consult on an option that it did not believe could deliver safe, sustainable and high-quality services for patients.
Members will, no doubt, already have made their views known as part of the on-going, three month consultation process. At the end of the consultation period, the board will consider the responses, agree recommendations on the future configuration of services in Lanarkshire and submit them to me for a final decision.
The minister said that he will consider the option appraisal exercise. Is he aware of any other consultation in which a board has briefed MSPs that it will consider the status quo as an option, but then changed its mind for some peculiar reason just before the consultation is due to be sent out?
I have not dealt with a consultation of this precise nature that has reached this stage, so the answer is that, from my experience, I am not aware of such a case. However, it is not unique for a board to consider in the first stage of an option appraisal an option that it subsequently does not take forward. Essentially, NHS Lanarkshire will argue that that is what it has done.
I turn to some of the speeches that were made in the debate. Elaine Smith argued passionately in support of Monklands hospital. I am, of course, well aware of the campaign that she and her colleagues Karen Whitefield and Cathie Craigie have mounted. It is important to say that, although the option appraisal identified Monklands hospital as the preferred option to become the planned care site, no decisions have been made—or can be made—until the consultation is complete. When the final proposals come to me for approval, I will want to ask the board to what extent factors such as social deprivation and disadvantage have been taken into account—and also the views of the public, of course.
At the end of the consultation, will the minister ensure that it was honest? Given the previous issues around paediatrics, my community has somewhat lost trust in the health board.
Certainly, yes. I will want to consider the range of evidence on the final proposals. In a moment I will say something about the consultation process, but first, in response to Elaine Smith's earlier comments, I assure her that I am aware of no plans to close Monklands hospital. She expressed concerns about that, but it is certainly not on the cards.
Obviously, the fear is that Monklands hospital would die by a thousand cuts if it lost all the essential services.
I understand the point. In considering the final proposals, I will look not just at the short-term plans, but at the longer-term plans that the board might bring forward as well.
In response to comments made by Donald Gorrie and others, I confirm that I expect to see evidence of effective engagement between the board and neighbouring boards where there might be an impact on the demand on services in neighbouring areas. The west of Scotland cardiothoracic unit is a good example of the co-operation that already exists in that part of Scotland and we expect to see that level of co-operation in any proposals.
One or two members mentioned "Delivering for Health" and the Kerr report. It is important to say that those documents set out the framework within which NHS boards must work when they plan service change. We asked Professor David Kerr and his group to consider the long-term health needs of the population and produce a national framework for service change and that is what they did. In "Delivering for Health", we responded to that and set out what we believe is necessary. I think that most members who are here this evening were in the chamber when we debated "Delivering for Health" last October. In that debate, Andy Kerr and I made it clear that we accept the analysis in the Kerr report and that we expect boards to use both the report and our response to it as a framework for developing proposals for service change.
I will resist the temptation to respond to the party-political points that were made, particularly by Scottish National Party members, but I will respond to the point that there will be no health benefits and there is no need for change. I think that there is a need for change. "Delivering for Health" and, before that, the Kerr report set out clearly the reasons why we need to change how we deliver services. We therefore expect boards to examine how they deliver services and to improve that where they can. We also expect boards to engage in genuine dialogue with patients and communities about how to do that in their areas.
I am sure that the minister recognises that nobody is arguing that we should not try to improve the health care service that is provided in Lanarkshire. However, is it not incumbent on the health board to show that its planned reforms will have a clear health benefit for the whole community?
I am glad that Michael Matheson assures us of his position, because that was not entirely clear from his speech. I am happy to say that we look to health boards to deliver health benefits and to make the changes that will improve the delivery of services. Boards must demonstrate that any proposals that they make will do that and I look forward to receiving such proposals from NHS Lanarkshire as a result of the consultation process.
As several members have said, NHS boards need to be transparent about decisions on what can best be delivered locally and what can best be delivered in existing or new ways. I expect NHS Lanarkshire to make patients' interests paramount in developing its proposals for the redesign of services and to show that every reasonable effort has been made to explain the impact of service changes on patients and local populations. NHS Lanarkshire is required to involve patients and the public fully in the consideration of the options for change. The public's views must be sought from the earliest stages and the issues must be defined clearly. All possible options must be explored and examined openly and on the basis of evidence.
Donald Gorrie and Nanette Milne, among others, asked a fair question about the credibility of consultation processes. I fully recognise the importance of that. NHS Lanarkshire will have to be able to show that the consultation process was meaningful and credible when it produces the proposals that arise from the consultation.
Ministers have given the Scottish health council the task of ensuring that the consultation process is effective and meaningful. The council is monitoring the roll-out of the process under "A Picture of Health" in Lanarkshire. It is available to advise the board to ensure that it achieves the objective and to listen to the views of patients and the public as the engagement process unfolds. The council will be keen to examine the process by which any option has been set aside and to ensure that the public have the information and explanations that they require.
As I have said, when the consultation concludes I expect the board to decide what proposals to submit to me for a final decision. I will need to be assured that they are in line with "Delivering for Health" and that the guidance that we have issued on public involvement, engagement and consultation has been followed. I will ask the Scottish health council to assess the consultation process against the guidance that was issued to boards.
I will consider the speeches that were made this evening and all the representations that have been made to me during the process. I assure members that I will not endorse any proposal that does not fit with national policy and guidance or which fails to secure a safe, high-quality and sustainable health service for the people of Lanarkshire.
I close the meeting.
On a point of order, Presiding Officer.
You were on your feet before I finished my last sentence, so I will take your point of order.
My point is about disparaging comments that Mr Neil made. I understand that my colleague Karen Whitefield felt that, as the issue was so important, it would be discourteous to Parliament to deliver a speech and then disappear. She also felt that to risk being late for an important public meeting in her constituency on the issue would be discourteous to her constituents. Does any standing order address such issues, or are they simply a matter of courtesy?
It is simply a matter of courtesy. I am not ruling that discourtesy was involved in this case, but I will look at the matter and get back to you.
Meeting closed at 17:54.