Royal Victoria Hospital
The final item of business today is a members' business debate on motion S2M-4530, in the name of Margaret Smith, on the Royal Victoria hospital site.
Motion debated,
That the Parliament welcomes NHS Lothian's decision to relocate the majority of its geriatric in-patient beds to the Western General Hospital in Edinburgh, as part of its Improving Care: Investing in Change programme, where modern facilities are better placed to provide quality care for older people; seeks the best possible provision of care for the elderly services in Lothian; acknowledges the current range of measures being put in place to ease parking and congestion problems for visitors and residents in the vicinity of the Western General; believes that the current site of the Royal Victoria Hospital remains ideally located for the provision of a range of care for the elderly services, including adapted housing, clinics, a care home and day-hospital facilities for the benefit of older people in north-west Edinburgh, and believes that NHS Lothian should consult fully and effectively with Edinburgh residents and key local groups such as Queensferry Churches Care in the Community Project, Pilton Elderly Project and the Almond Mains Initiative to determine their priorities and the perceived needs of older people in the capital and how the Royal Victoria site might be used to meet these needs.
I thank members who have signed the motion. I am sure that my next motion will get even more signatories now that members know that my members' business debates mean that they get an hour off. I also thank members who will take part in the debate and the people from the Queensferry Churches Care in the Community Project and the Almond Mains Initiative who have joined us in the public gallery to hear the debate about the Royal Victoria hospital.
The debate is topical. As a result of the decision to close the Royal Victoria hospital, NHS Lothian is about to consult local MSPs, residents and groups on services for older people with a view to proposing costed options for the site in September. Right now, a variety of services are provided on site, but I make it clear at the outset that the debate is not about preserving what the Edinburgh Evening News described on Tuesday as "a crumbling OAP hospital". I do not seek a debate about bricks and mortar, or one that panders to narrow nimbyism; I seek a debate about the best way to provide a range of care of the elderly services in and out of hospital and how to use the Royal Victoria site to do that in the best way possible.
All members who represent Lothian seats are aware of the important issues about care of the elderly services that were raised in Ann Jarvie's recent report, which followed incidents of serious lack of appropriate care for frail elderly patients at Edinburgh royal infirmary and Liberton hospital. Therefore, in discussing care of the elderly services in Lothian, I acknowledge the work that the health board and staff have done to learn some of the lessons that had to be learned from those incidents and to improve care of the elderly services and I ground the debate in the fundamental desire that we all share for NHS Lothian and its partners in the local authorities to deliver care that respects the dignity of each elderly patient.
The need to consider older people's needs holistically is clear. Although we may say with some justification that the Executive, supported by the Parliament, has delivered many benefits for older people, there remains a need for vigilance and continual improvement in the care that older members of our community receive as in-patients and out-patients, in care homes or in their own homes. There is clearly a great deal to be done, and the demographic situation means that the issue must be addressed.
Most of us would agree with the Kerr report and the general philosophy that, where possible, national health service care for older people should be provided in the community. However, there are times when it is necessary to access services in hospital and, for many years, a range of in-patient and out-patient services, including day hospitals and clinics, has been available at the Royal Victoria hospital.
In 2004, NHS Lothian published "Improving Care, Investing in Change 2004", which contains its plans for the redesign of key services in the Lothians. A number of issues are covered in that document, but one of the most important proposals was the plan to move 200 patients from the in-patient wards at the Royal Victoria. The hospital's age and design meant that it was no longer fit for purpose. I have had a number of critical reports from constituents, many of whom had been greatly inconvenienced by having to travel to other sites, particularly the Western general hospital, while they were in-patients at the Royal Victoria.
The board's decision—which the Minister for Health and Community Care has now ratified—to move 112 assessment and rehabilitation beds and 45 orthopaedic rehab beds to the Western and 40 assessment beds in psychiatry of old age to the Royal Edinburgh hospital was correct. It represents an opportunity to improve the in-patient care for elderly patients. However, it also means a drop in the number of care of the elderly beds that are available, and I trust that the community services and necessary funding that are needed to replace those beds in the community will be available. I refer not only to community services that allow NHS Lothian to continue its good work on tackling delayed discharge but to the types of service that we must provide to keep people out of hospital in the first place.
Funding needs to be expanded for the excellent community services that are provided not only by community groups such as the Queensferry Churches Care in the Community Project and the Almond Mains Initiative but by general practitioners and local clinics.
Now that the decision has been taken to close the hospital, it is essential that we address the consequences of that decision. My motion seeks to do that. First, we must ensure that there is enough space on the Western general hospital site to accommodate the new services while allowing that hospital to retain its position as a tertiary centre of excellence for a range of other services. Making the best use of space will also involve tackling the continuing parking problems. I am sure that we all applaud NHS Lothian for its innovative scheme to introduce valet parking for cancer patients, but there is a need to build new, possibly tiered parking facilities for the many thousands of patients, visitors and staff who journey to the Western general.
Secondly, and crucially, decisions must be taken about the use of the Royal Victoria site. The minister has signed off NHS Lothian's plans, which include selling off the site, but with the caveat that the board will consider the possibility of retaining some services on site and might make that case to the minister in due course. I argue that the board should make that case. We must achieve a balance. I would strongly resist any attempt by the board to sell off the entire site for housing. The site has a long association with the care of the elderly and we have an ideal opportunity to use the site to take forward such care in an innovative, modern way as part of the older persons strategy in Lothian.
This is not the time to be prescriptive. The board is undertaking work to consider a range of options for the site. However, today's debate gives us an early public opportunity to examine some of those options. NHS Lothian will have to consider the possibilities of the site, local needs and the needs of the health care system, and then decide what services might remain on—or be introduced to—the Craigleith site.
We have been told that the cost of relocating the in-patient beds from the site will be about £10 million. I accept that there will be a need to pay for new, improved in-patient care at the Western general and that the most likely way to raise money for that is from housing receipts, but it is important that the board considers the opportunity costs and considers using the Royal Victoria site for the provision of health care services such as a day hospital and local clinics. The board has a duty to achieve best value for the site, but I urge it and the minister to make sure that best value is not seen simply in financial terms. If it was, there would be a total sell-off, which would represent a lost opportunity to tackle wider health and social care needs.
It is important to articulate not only the needs of elderly patients, but those of NHS Lothian and the City of Edinburgh Council. There must be a community planning approach that works alongside the need to build capacity in health and social care for older people. That will involve consideration of a broad range of service requirements. The needs and priorities have not yet been articulated clearly.
Clearly, as we are taking away a medical day hospital and a psychiatric day hospital, it is reasonable to think that there will be a need for a day hospital for north-west Edinburgh on site, with access to clinics and therapy. That means, for example, NHS Lothian taking on board the council's affordable housing policy but working within that to deliver affordable housing for NHS staff, or the technological advances in smart housing that have been in operation in West Lothian for many years. Such housing allows older people to live independently in their homes for as long as possible.
There is also a pressing need for care home places in north-west Edinburgh. Having walked the site with officials recently, I can say that there is scope for a 60-bed care home on the site. There is also a possibility that the Napier University building on Crewe Road could be adapted for that purpose. More scoping work is required on that, and there is a real need for on-going work on which parts of the site are most useful for retention in terms of access and so on.
I hope that the board will genuinely listen to local people's views in the coming weeks during its consultation on the matter. I look forward to presenting the case for continued health care services on the site at Craigleith. I have known the site for many years because I used to attend Flora Stevenson primary school, which is just beside it, and I used to walk past the site on my way home. Also, my mother used to work at the Royal Victoria, so my knowledge of the hospital goes back many years, although not quite to the days when it was a tuberculosis hospital.
The Royal Victoria site has a long tradition as a health care site. I hope that the board will listen creatively and sympathetically to those of us who want that tradition to continue. I hope that the board will make changes to the site that help to deliver modern, innovative and effective care for the elderly people of north-west Edinburgh.
I thank Margaret Smith for lodging her motion. The Royal Victoria hospital site is an important issue not simply because of the services that are provided there but because of the site itself. The member was right to say that it is appropriate not to be too prescriptive. It is fair to say that, although we are not dealing with a moving situation, matters have still to be resolved. To an extent, all that we can do is lay down parameters.
The latter part of the motion causes the Scottish National Party no concern and we fully support it. However, we think that much of the first part concerns changes that we wish to see or is perhaps a simple wish list. We hope that parking issues and other arrangements will be resolved; only time will tell whether that works out. Similarly, we require to be assured that the Western general hospital can cope with the changes.
I will make two points at the outset about the Royal Victoria hospital. As Margaret Smith said, it is to an extent an institution in Edinburgh. I do not recollect the time when it was a TB hospital, either, but I have visited relatives who were in-patients at the hospital. Whatever the problems with bricks and mortar—to which Margaret Smith was correct to testify—which mean that the buildings are rather dilapidated and lack fitness for purpose, the hospital has served the community well. The hospital's staff have given great support and sterling service to many elderly people in Edinburgh.
The hospital's location in Edinburgh is helpful for many who go there. It is in an area that has been easy to access by bus, which is important when we are dealing with elderly patients whose spouses want to visit them or whose friends want to maintain contact. Edinburgh royal infirmary was relocated to a site for which transport is a significant problem, but the Royal Victoria site does not suffer that problem, as it is slap-bang in the heart of not only the north, but the west of Edinburgh. It is exceedingly central; that must be maintained.
The Royal Victoria site is extremely sensitive. Great pressures exist for housing in Edinburgh and great pressures are on the health board. It is not rocket science to join the dots and realise that some sites can be viewed as cash assets. However, the site should be used first and foremost for the benefit of patients and not simply as a way to obtain ready cash.
As I said, the situation is developing. Margaret Smith was correct to lay down parameters on where we wish the health board to go. The matter will have to be debated in the city of Edinburgh and its environs and not simply in the pages of the Edinburgh Evening News. We must make some clear commitments. The first is that the site should be maintained as a hospital site because of the sterling service that has been given, its location and the fact that other options are not necessarily beneficial. However, we accept that some change is required and that the bricks and mortar are unfit. Secondly, the site and its facilities should remain pivotal to the city. Changes that would move away from that would be detrimental to the area.
I pay tribute to Margaret Smith for lodging her motion. The situation will require to be monitored. We must give those in the health board and elsewhere some parameters, but we should remember that the site has served us well in years gone by—patients and staff will testify to that. We must ensure that it will continue to serve Edinburgh and its citizens in years to come.
I warmly congratulate Margaret Smith on her success in securing the debate on the Royal Victoria hospital site, on her thorough treatment of the subject and on her call for good forward planning. Kenny MacAskill has just made some valid points, too.
In some respects, it is remarkable that the debate is needed, as much of the Royal Victoria hospital was built in the 1980s. For some months, the health board did not have sufficient revenue resources to open the hospital while the Bruntsfield hospital remained in existence, which was a shaky beginning for a centre of excellence that should have had a high-profile opening.
We now learn that, relatively few years after its opening, the hospital is scheduled for closure with plans to move services elsewhere. I accept that priorities in the national health service change very rapidly indeed, but the Royal Victoria hospital building's opening and closure has not exactly been a case study in how to obtain best value for the electorate. With some humility, I suggest that lessons need to be learned from the experience.
For the future, frankly, I have every sympathy for Josie Sawyer of the Almond Mains Initiative. She made a very appropriate point when she said:
"We don't want more luxury housing around here and I think it's more important to retain this site for the care of the elderly. There's a growing number of older people here and we have the highest number in north-west Edinburgh and we don't have nearly as many services as in other areas of the city. What I would like to see is a resource centre for older people which concentrates on preventative work and can provide information to older people about their health."
Similarly, Liz McIntosh, who is general manager of the Queensferry Churches Care in the Community Project, is concerned about the future of older people's services. Her project concentrates on those who are in danger of becoming isolated in their homes. She is, if I may say so, absolutely right to express concern about what will happen if services are broken up, as it could lead to major problems for older people and their carers.
By the same token, I believe that Margaret Smith is right to bring forward this timely motion today, because the pressing need for care for the elderly is now greater than it was in the 1980s. There is a vital need for care for the elderly provision to ensure that we have a sufficiency of beds in the area.
It is no wonder that sections of the community are extremely uneasy with Lothian NHS Board's decision to close the Royal Victoria hospital and are especially worried about a decline in service for old-age pensioners. Our position is that there must be a sufficiency of all necessary services and a continuity of quality provision for the elderly in north-west Edinburgh. Retaining more care in the community services would be in the spirit of the recent Kerr report and in the public interest.
The Royal Victoria site is ideal for retaining some provision for care for the elderly. We must retain enough spaces so that the elderly are not left waiting for care packages and places. We earnestly hope that such provision for the elderly at the current site will be urgently considered alongside other options, such as a resource and day centre, which would allow the elderly to get out and about and carers to access support and advice, or even a day care hospital.
We are pleased that the health board has given assurances that it will consult widely. It is essential that that happens in the best interests of our elderly who have served their country so well.
I, too, congratulate Margaret Smith on securing this evening's debate. In the near future, between a quarter and a third of the country's population will be elderly. I draw members' attention to my entry in the register of interests, as I am treasurer of the cross-party group on older people, age and aging.
I want to make two important points. First, the central point in Margaret Smith's motion is that there is a need for proper consultation with the community and with older people and those who are involved in their care. Secondly—the motion is strengthened by the fact that it is careful to avoid being prescriptive—the motion points out that there are clear advantages, as Lord James Douglas-Hamilton has explained, to keeping at least some services for older people on the Royal Victoria site.
The advantage of having a proper consultation is that we will not end up with the kind of mistakes that were made at the ERI. If we had had consultation, the Women's Royal Voluntary Service might still be serving teas and coffees at the ERI at a quarter of the price that is currently being charged. In addition, huge sums of money would not be extorted from people for parking at the hospital. Proper community consultation on any health service development is absolutely essential.
My other, more general point is a personal gripe. Often public bodies such as the NHS and education departments that for some reason notionally own land—I think that it should be thought of as common land that belongs to the community—are forced to sell it not in the best interests of the community but in their best interests, because that is the only way in which they can find the money to do the things that they would like to do. For example, the Astley Ainslie hospital site in Edinburgh would be ideal for a school, but it is highly unlikely that a school will be built on it. It will probably be sold for housing.
I close by congratulating Margaret Smith and saying that I strongly support the tone and content of her motion. I hope that the NHS and the minister will give very careful consideration to what she has said.
I join colleagues in congratulating Margaret Smith on getting her motion before us this evening. This is not a new debate for anyone in the chamber. Over the past couple of years, we have had several discussions with Lothian NHS Board about the future of this site. It is entirely appropriate that one of our last debates before the summer recess should be on this topic. The debate gives us the chance to air some of the choices and issues that all of us have discussed with Lothian NHS Board over the past couple of years.
It is appropriate that we debate the issue in Parliament because, as local MSPs, Margaret Smith and I are very conscious of the concerns that have been expressed, especially by older people's groups, about the future of the site. Older people are nervous about what will happen to the site, so the reassurance that Lothian NHS Board has given us that it will think about how the site might meet the needs of older people is helpful. Margaret Smith's motion concentrates our minds on what the options might be.
We all know that the hospital was not of the physical quality that older people deserve. In years gone by, issues were raised with me about the quality of equipment and the quality of care that my constituents received at the hospital. Like Margaret Smith, I welcome the fact that there has been a range of discussions about the future of the site. My concern is that the site should be used in a way that makes the most of this opportunity.
I am conscious that in Edinburgh precious few sites come up for redevelopment. Given the property pressures and the huge range of social needs that exist in the city, every one of those major sites is of huge importance. I suspect that in other communities in Scotland there is not the same range of pressures. That issue comes to the fore when we consider what Lothian NHS Board will do when it sells the site and the pressure on the board to get the maximum capital receipt for it. We must be cautious about that approach, which I have questioned with Lothian NHS Board and the previous health board structures in Edinburgh and the Lothians. The difficulty with going for the maximum amount is that it could mean that some very worthwhile services are ruled out of the equation.
Lothian NHS Board wants to reinvest capital receipts in other services. We have seen and welcome the recent investment that has been made in the Western general hospital and new cancer services. However, we have a chance to pause for thought to think about the maximum opportunities that the Royal Victoria hospital site offers. Margaret Smith has outlined some of those in her motion. I would like to place greater emphasis on the issue of accommodation for older people and linking that to research and future services for that group. Provision of affordable housing is an issue in Edinburgh. It would be a pity if the site went for the maximum receipt and was used for housing at the highest possible cost. That will not serve our constituents as well as an alternative approach might. We should think about how safe, secure accommodation that would give older people maximum independence, but as part of a wider community that would offer them support, possibly with co-location of other older people's services, might be developed on the site.
We may want to consider whether we have a chance to do more. Over the past couple of years, I have talked to Brian Cavanagh about the issue of research for older people. We have a population that is growing older. How do we ensure the maximum quality of life for older people? The opportunity of conducting research alongside the provision of older people's services is something that should be considered by the health board.
How do we maximise the opportunity that is provided by the site? I want to raise the issue of affordable housing generally. From talking to nurses and key members of the NHS team in Edinburgh, I know that they find it incredibly difficult to find affordable housing. We know that property prices are racing ahead in the city. The Executive has created some opportunities, such as those that are available through the homestake project and shared equity. However, I think that the matter that we are discussing might provide an excellent opportunity for NHS Lothian to look at providing housing for its own staff, which has been mentioned by others this afternoon. That is worth considering as it would deliver not only the maximum capital receipt but also the maximum social and economic benefit for the city. It cannot be good that NHS workers in the Lothians have to travel long distances to get to work in our city-centre hospitals and facilities. It would be much better if people had an alternative choice.
From statistics that I have been given by the City of Edinburgh Council, I know that, under the choice-based letting system, there are on average 50 applications for each unit of affordable housing and that, in popular areas such as the one that I represent, there can be 300 or more applications for some units. There is a huge unmet demand that will not be met by the current funding for affordable housing. We will have a gap of 7,500 houses over the next decade. That demand could not possibly be met by the site that we are discussing, but I think that there is an opportunity for NHS Lothian to engage in the debate and consider whether part of the solution might come through creative thinking about the site.
My main points are about the need to provide some affordable accommodation for NHS Lothian staff and affordable accommodation for older people that is linked to services; and the need to take advantage of the opportunity to expand research into older people's services in order to secure the excellence that we urgently need. As Margaret Smith said, the Jarvie report, which relates to research into the quality of older people's experience of hospitals, needs to be slotted into this discussion as well.
I congratulate Margaret Smith on raising this issue. The debate will need to continue. We need to ensure that NHS Lothian keeps its promise to consult and that our discussion this afternoon can be part of that consultation process and will have some influence on the board.
I congratulate Margaret Smith on securing this debate on the best way in which to provide a range of quality health facilities for elderly people in the Lothians. We would all agree that the provision of those services in the Lothians is an increasingly important matter, given the rise in the population of the city, the greater longevity of the population and the general health challenges that follow from that.
This debate dovetails with the Parliament's on-going consideration of our services for the care of the elderly. I am sure that all members would agree that one of the most popular achievements of the Parliament remains the introduction of free care for the elderly, regardless of the pressures that that commitment has come under in recent times, which have left it compromised somewhat by waiting lists and charges being made for various aspects of that care by various local authorities. Nonetheless, the support for that commitment demonstrates the strength of feeling behind the idea that there is a need for dignity in retirement and in the health care that is provided for people who have worked their whole lives for this country.
I am struck by a remarkable theme that has been evident in the speeches that we have heard this afternoon. As Lord James Douglas-Hamilton said, when the Royal Victoria hospital was built in the 1980s, the NHS did not have the money to open it at first. Sarah Boyack is right to say that this debate is about choices that must be made about the future use of the site. There is a choice between the needs of the elderly population in the Lothians and, quite frankly, money and profiteering. There is a danger that the latter option might be more attractive to the health board.
Margaret Smith knows that I opposed the closure of the Royal Victoria hospital. To me, the decision was based not on what was in the best interest of patients but on financial concerns. I campaigned with many other people to keep the hospital open on the basis that it was popular—it was clearly a hospital that patients liked. More important, I felt that the closure plans would mark a decline in the quality of service provision to people in the Lothians. It remains to be seen whether the Western general can provide quality care and whether it earns the same reputation.
I respect the member's position on the closure of the Royal Victoria hospital, but my views on it are tempered by constituents' comments on its services. I have to say that I received far more complaints about the provision of care and facilities at that hospital than I received about any other hospital. A recent survey by, I think, Dr Foster Intelligence concluded that the elderly were receiving poor care at many hospitals in Scotland, but the Western general came out of the survey very well. I believe that moving services to that hospital will prove to be good for in-patients, as it will allow the link with diagnostics to be made. I have heard horrible stories of older patients having to wait many hours at the Western general for a diagnosis before being taken back to the Royal Victoria hospital.
I thank Margaret Smith for her intervention. I hope that in due course the Western general's reputation for patient care matches the reputation that the Royal Victoria earned—deservedly, I think—across Edinburgh.
Of course the petition that I supported wanted the Royal Victoria hospital to be upgraded with the right amount of investment. Although no one would be happy to hear the horror stories that Margaret Smith, I and others heard, the question was whether the closure plan would improve services or whether it would be a retrograde step for the city. According to the health board, the closure was nothing to do with money; instead, it argued that the Royal Victoria was simply no longer fit for purpose and that the building was inappropriate for the intended range of services.
As a result, I imagine that all members who received NHS Lothian's briefing will be concerned by its statement that money is indeed an issue and that a significant capital receipt from the sale of the RVH site will be essential to ensure that there is new upgraded accommodation of geriatric services at the Western general and other hospitals. There is an immutable connection between money and care for the elderly and, all too often, one clashes with the other.
I am sure that we all accept the point in the motion that we need "modern facilities" that "provide quality care" for older in-patients and out-patients. After all, for far too long and in far too many parts of the country, care for the elderly has been a Cinderella service. Earlier, Margaret Smith expressed the hope that the health board will genuinely listen to the population in the on-going consultation. I hope so, too; I felt that, in its consultation a year ago on services in the city's general hospitals, the health board did not take on board either the results of the consultation exercise or the public's views and simply did what it was going to do anyway.
I share the view expressed in the motion that this site must retain a connection with the provision of quality care for the elderly, either through day hospitals or through some other facility. I would be loth to see the site developed for housing or to see the health board simply make money by selling it to the private sector. Instead, it should continue to provide quality NHS services and facilities for the care of the elderly. That would be the best way of remembering the Royal Victoria hospital.
I, too, congratulate Margaret Smith on securing the debate. Like other members who represent various parts of Edinburgh and the Lothians, I am familiar not only with many of the concerns that she has expressed about the Royal Victoria hospital site but with the many wider issues that she has raised about the provision of health services in Lothian, particularly with regard to the elderly. In that respect, the debate is very welcome and timely.
As the member who represents the east side of the city, I hope that the member who represents the west side of the city will forgive me for using my remaining time to focus on one or two related and parallel issues in other parts of the NHS Lothian area. I think that my points will be germane to the debate.
The overarching issue in this debate, and many others like it, is how we can embrace change and manage it effectively in a way that goes with the grain of local communities. We have to take the major national and local policy statements on what the national health service should look like—statements that we have heard year on year—and translate the rhetoric and aspiration into practice.
I have listened to Margaret Smith and others and have reflected on the debates that surrounded the closure of the Eastern general some years ago. Many of the concerns that arose then have not come to fruition, I am pleased to say. On the site, we now have a modern 60-bed unit for the elderly—Findlay House—which is a welcome asset to the area. Other developments are also taking place. However, progress has been slow and many lessons can be learned about the way in which the NHS, planning authorities and others handle such projects.
In other parts of my constituency—I am now moving across the city boundary—progress has been even slower. Periodically, I raise my concerns with NHS chiefs and ministers, and I will not miss the opportunity to do so again tonight.
Musselburgh, which is the biggest population centre in East Lothian, is still waiting for the primary care centre and 60-bed unit for the elderly that were supposed to have become operational around four years ago. Not a brick is in place. The NHS has made a huge effort and has continually restated its commitment to the development, but complex land and planning issues are holding up progress. However, that is small comfort to the people who need services or to those who have to provide services in crumbling buildings or in crowded general practices. Anything that can be done to accelerate progress would be enthusiastically welcomed by this MSP and the people who she represents in the Musselburgh area.
I end by highlighting four lessons. First, we have to accelerate the pace of change. It is in nobody's interests for decision-making processes to go on for as long as they often do, and for uncertainty to hang over facilities, staff, patients and local communities. I am convinced that the decision-making processes could end more quickly than they do at present.
Secondly, we have to ensure that, during those decision-making processes, old facilities are not allowed to fall into disrepair because of uncertainty over their future. I am thinking, for example, of Edenhall hospital in Musselburgh, which, as is widely recognised, provides wonderful care. Because of uncertainty about a move to a new facility, there are concerns over whether the building has been maintained to an appropriate standard.
Thirdly, and as many others have said, we must involve staff and communities effectively in the design of new facilities and the use of old sites.
Last but not least, I echo my colleague Sarah Boyack: we must be creative in our future thinking about what can go into new health centre facilities. I often think that the limitations on what goes into community-based health facilities are not financial or practical limitations but limitations on ambition and aspiration. So much more could and should be provided close to people in their communities. That is especially true for elderly people, but is also true for the general population. I hope that we can all work together to make greater progress in that regard.
I begin by congratulating Margaret Smith on securing this debate on a matter of such obvious local interest. I also acknowledge the positive contributions that other members have made.
I am aware of the extensive discussions between NHS Lothian and local elected representatives on the board's plans for the Royal Victoria hospital site. I expect that approach to continue. As has been said, the context is set by the Kerr report and our response to it, "Delivering for Health". Our approach of setting a national framework for service change throughout the NHS over the next 20 years has attracted broad support. We expect any proposal for change in the provision of services that NHS boards develop to be in line with the principles that underlie the Kerr report and "Delivering for Health". Those are that services should be delivered as locally as possible and should be as specialised as necessary; that sustainable and safe local services should be delivered; and that, where possible, those with long-term conditions should have their conditions managed at home or in the community.
Our aim is to ensure that health services for older people are delivered in ways that improve the lives of older people throughout Scotland, including the Lothians. As has been mentioned, the proportion of older people in the population will continue to increase in the coming 25 years. The proportion of those who are over 65 will increase to one person in four and the proportion of those who are over 80 will increase to one person in 12. Despite the continuing improvements in health care, older people are more likely to have a long-term illness or a combination of such illnesses; to be admitted to hospital; and to stay there following admission.
Those demographic changes mean that we must change the way in which health services are provided. Compared with the past, we are now better at preventing people from becoming unwell, we can treat them faster and better and we can treat more people in their homes or closer to their homes rather than in hospitals. The document "Improving Care, Investing in Change 2004", which has been mentioned, was the subject of a rigorous consultation process by NHS Lothian. The major service changes that were proposed affected older people's services, acute services and mental health services throughout the area. I have listened with interest to the broad support for the plans to relocate the majority of geriatric in-patient beds from the Royal Victoria site to a modern, fit-for-purpose facility at the Western general hospital, which has the added advantage of reducing the need for patients to travel between sites for diagnostic tests.
It is important that NHS Lothian and other boards should provide the best possible care for elderly people, in accommodation that is fit for purpose, whether in Edinburgh, Musselburgh or elsewhere. NHS Lothian acknowledges the difficulties to which Susan Deacon referred and is doing its best to resolve them as quickly as possible. Since Andy Kerr approved NHS Lothian's proposals, further planning work has been undertaken on the reprovision and relocation of the various services that are based at the Royal Victoria hospital. Preliminary discussions have been held with a range of interested people, including local elected representatives.
Members will be interested to know that a programme of structured meetings with groups and representatives from a wide range of stakeholders groups is being planned and will take place in the coming two months. Among the groups that will be contacted in the first tranche of consultation are the Pilton Elderly Project and the Almond Mains Initiative, both of which have been mentioned. I have no doubt that the Queensferry Churches Care in the Community Project will also be consulted, along with similar groups. When their views have been canvassed, more detailed site and service planning will be undertaken and a business case will be prepared for consideration by the board early next year.
It is acknowledged that the hospital is no longer fit for its current purpose and is inappropriate for the range of services that are required for the care of the elderly in the 21st century. It has been said, correctly, that the board intends to use the capital receipts that it acquires from the outcome of its determinations to invest in patient services throughout Lothian. The board has given an assurance that, when the planning work to identify possible options begins, consideration will be given to the future provision of services for older people. Margaret Smith and other members have mentioned some of the options that have been considered, which include the development of a care home, jointly with the City of Edinburgh Council; an older people's resource centre to integrate social day care and day hospital provision; and a housing with care project for older people, perhaps provided by a voluntary organisation or a housing association with expertise in the matter. A further option is the development of affordable housing for key workers such as essential NHS staff.
The board is clearly considering a range of options. Mention has also been made of the measures relating to car parking at and travel to the Western general, which will be helpful. I hope that members will agree that the board's continuing engagement with them and with others in the community will allow proper consideration to be given to all those options, so that the board can make a decision about the proposals that it wishes to develop to provide a solid basis for meeting long-term elderly care needs in this part of Scotland.
Meeting closed at 16:55.