The next item of business is a members’ business debate on motion S4M-00930, in the name of John Scott, on the provision of orthopaedic trauma services at Ayr hospital. The debate will be concluded without any question being put.
Motion debated,
That the Parliament notes the proposals by NHS Ayrshire and Arran to close the orthopaedic trauma unit at Ayr Hospital; believes that this would be to the detriment of patient care in southern Ayrshire and constitute a particular danger to patients admitted to Ayr Hospital suffering from life-threatening neck or head injuries; is concerned that the closure of the unit undermines the long-term future of accident and emergency services at the hospital, and, therefore, condemns NHS Ayrshire and Arran’s proposals to close the orthopaedic trauma unit at Ayr Hospital.
12:32
I begin by thanking my party for allowing me to bring forward this debate on the continuing provision of orthopaedic trauma services at Ayr hospital. I hope that the Parliament, having survived the trauma of the collapse of the voting and sound system on 27 October, which was largely reinstated and restored yesterday, will welcome and take note of this debate.
I also thank the Parliament for its power and influence because, since the motion was lodged, NHS Ayrshire and Arran has withdrawn its proposal to move trauma orthopaedics from Ayr hospital, as announced recently in the local press. I should also thank the Cabinet Secretary for Health, Wellbeing and Cities Strategy for her influence and for the discussions that I know she had with NHS Ayrshire and Arran executives. I ask Parliament to take note that, once again, the wishes of the people have been respected.
Today, I want to reaffirm the need for a two-centre approach to hospital care and, particularly, accident and emergency services in Ayrshire, of which trauma orthopaedics is an integral part. I know that that view is shared by other colleagues such as Adam Ingram and Chic Brodie.
Centralisation of services has been a long-term agenda of NHS Ayrshire and Arran and, although we have stopped the process with trauma orthopaedics, it comes as no surprise that the intention existed following the desire of NHS Ayrshire and Arran and the then Labour Government to close the A and E department at Ayr hospital—a plan first disclosed to me in August 2005 at the NHS Ayrshire and Arran annual review, presided over by the then Labour minister Andy Kerr. Perhaps that is why no Labour members are taking part in this debate.
As members will recall, that plan provoked outrage in southern Ayrshire, with 55,000 people signing a petition against the proposals and 5,000 marching through the streets of Ayr in February 2006 in protest. I put on record my thanks to all those who helped in the campaign between 2005 and 2007. It is worth noting how correct that campaign was: the A and E units at Ayr and Crosshouse are both now busier than they have ever been. Attendances at Ayr hospital are peaking at 140 to 150 per day. On average, 30 medical patients, 11 of whom require surgery, are admitted daily.
In 2007, the need for a two-centre approach to be taken to A and E services because of Ayrshire’s geography was pointed out to NHS Ayrshire and Arran, as it has been since. The argument was, and still is, driven by the need to be within an hour’s distance of an A and E unit by ambulance or car.
That need will remain and grow with the ageing profile of Ayrshire’s community and the increase in admissions of elderly people, particularly those suffering from falls and, as a result, broken limbs. The growing incidence of osteoporosis, osteoporotic fractures and heart attacks demands that as little time as possible be spent in ambulances on Ayrshire’s far-from-perfect road surfaces.
The same arguments apply for trauma and orthopaedics. That is why I and others were so opposed to the most recent proposals.
It is self-evident that I am not a doctor, but doctors have advised me that the proposals to locate trauma and orthopaedics on one site at Crosshouse would have led to a loss of capacity and capability in the A and E department at Ayr hospital and may ultimately have posed a threat to the long-term viability of the A and E services there. That is why, once again, I found myself taking issue with NHS Ayrshire and Arran’s centralising agenda.
Where time is not of the essence for the treatment and survivability of an illness, there is a place for concentrating resources on one site. Over the years, services such as maternity and paediatric care have moved to one site at Crosshouse. On the other hand, urology and ophthalmology are located at Ayr. I welcome the fact that the new cardioverter defibrillator fitting service, which was previously provided in Glasgow, was located at Ayr hospital in July this year.
However, I am also aware that the centralisation of patient records at Crosshouse has not been a huge success thus far. Medical staff have expressed to me concerns about faults that have emerged in the TrakCare system, which is apparently being rolled out across Scotland before those faults have been fully ironed out. Perhaps, in his closing speech, the Minister for Public Health might make the Parliament aware of what is being done to make that system work better.
Again, I thank those who helped to see off the latest threat to A and E services at Ayr. However, I note that elected members of all parties will need to remain vigilant and protective of the facility if it is not to be placed under threat in future. After all, as Benjamin Franklin noted more than 200 years ago:
“A man convinced against his will is of the same opinion still.”
That applies to the decision makers at NHS Ayrshire and Arran, who were convinced against their will to adopt a two-centre approach to the provision of A and E services in Ayrshire following the election in 2007. I, and others, remain unconvinced that their view has changed, notwithstanding the clear instruction of the Cabinet Secretary for Health, Wellbeing and Cities Strategy. For as long as there is a breath in my body, I will watch to see that two centres are maintained in Ayrshire, and the minister and the cabinet secretary will have my absolute support in that regard.
12:38
I congratulate John Scott on securing the debate—it is better late than never. I also share his disappointment at the Labour Party’s apparent lack of concern for the debate and the important issues that it raises.
As the minister and members will know, John Scott has been a staunch defender of Ayr hospital since he was first elected, and I have joined him on many occasions to help protect the hospital’s services.
Four years ago, a great victory was won when, on taking office as Cabinet Secretary for Health and Wellbeing, Nicola Sturgeon immediately fulfilled a Scottish National Party manifesto pledge by reversing the previous Labour Executive’s plans to close Ayr hospital’s A and E department and centralise Ayrshire and Arran A and E services at Crosshouse hospital. To say that that decision was warmly welcomed in our local community would be an understatement and it certainly established trust and confidence in the new Government.
Unfortunately, the same cannot be said with regard to NHS Ayrshire and Arran, even though the board committed itself to maintaining full A and E services at both Ayr and Crosshouse hospitals. Back in February 2008, the board assured the cabinet secretary that it would do so and it continues to provide that assurance.
The local public’s mistrust of the board stems from senior management’s long track record of support for centralising hospital services, usually in favour of Crosshouse. For example, the closure of paediatrics at Ayr hospital predated the A and E issue. In addition, the board’s conduct of the consultation process on the A and E issue was a model of how not to consult, with its preferred option being presented on a like-it-or-lump-it basis.
As John Scott has pointed out, the issue took fire again when a stop-press bulletin from management to staff in early September seemed to confirm the public’s worst fears that the proposal was being considered again. The bulletin stated that savings had to be made in trauma and orthopaedics and that previously rejected proposals to develop a centre of excellence for in-patient trauma services at Crosshouse would be revisited. That would require a review of bed numbers and theatre provision at both hospitals—and, what is more, the plan was to be pushed forward as soon as possible to “avoid uncertainty”. Naturally enough, alarm bells immediately started ringing, given the range of implications that such a development would have not only for the provision of trauma and orthopaedics at Ayr hospital but also for the future of A and E services. One need look only at St John’s hospital in Livingston for an example of how such a move turns out.
Like John Scott, I have raised this issue as a matter of urgency with both NHS Ayrshire and Arran and the cabinet secretary and I have received assurances from the national health service that any service redesign proposals would require to demonstrate the service’s capability to deal not only with orthopaedic A and E cases on both sites but with any orthopaedic care following elective surgery on both sites. I have no doubt that the minister will confirm that the centralisation of trauma and orthopaedics in pursuit of savings was never on the Scottish Government’s agenda and that such a proposal would be given short shrift.
I would be grateful if the member could conclude.
I ask that, in his reply to the debate, the minister reflects on priority areas for efficiency savings. No doubt service redesign can play an important part, but I suggest that we would do well to start with corporate rather than clinical services and that NHS Ayrshire and Arran appears to many to be a suitable pathfinder.
12:44
I, too, thank John Scott for securing this debate. I am standing in for my colleague Jackson Carlaw, who is unable to attend Parliament today.
John Scott is, indeed, a worthy local champion for health services in his constituency—and rightly so. After all, it is the duty and responsibility of all MSPs to ensure that the constituencies and regions that we represent get their fair share and equality of access, irrespective of geographical location. John Scott’s campaigning to keep A and E open at Ayr hospital is well recorded, and I also acknowledge Nicola Sturgeon’s role in the process.
It is right to associate the threat to the orthopaedic trauma service with accident and emergency services. There is no doubt that a critical mass of services is required to maintain the level and diversity of staffing in hospitals. Over the years, we have all heard the saying “death by a thousand cuts” being used when one service goes and other services become unsustainable as a result.
As John Scott said, since the motion was lodged, NHS Ayrshire and Arran has withdrawn its proposal to move trauma orthopaedics from Ayr hospital. There is no doubt that it helps if MSPs work as a team locally—I note the support from Adam Ingram and Chic Brodie, although there is none from Labour, unfortunately. Adam Ingram made a very good point in highlighting the like-it-or-lump-it type of consultation. I am afraid that that approach is all too prevalent across Scotland. The people in Kilchoan in west Ardnamurchan are currently experiencing it.
The background to the threatened cuts at Ayr hospital should continue to cause concern, given that plans to cut local services and centralise elsewhere have been thwarted twice. The petition against the proposals that has been signed by 55,000 local people speaks volumes about how they value their NHS services. I am not normally partisan in such debates, but I hope that the same 55,000 people will be made aware that no Labour MSP who represents the Ayrshire area is present for this debate.
In Highland terms, the distance between hospitals that members have mentioned is not significant. The main difference lies in the greater density of population and the increased ageing population in the area, given that Ayr is such a popular retirement destination. The increased risk of osteoporotic fractures, treatment and recovery highlights the need for the retention of the unit. We are all painfully aware of the need to continue to make efficiency savings, and there is no doubt that efficiencies can be made in the NHS while the high quality of care that we expect is retained. As the minister will know from listening to recent evidence in the Health and Sport Committee, there is no doubt that efficiency savings targets have brought a more rigorous financial discipline to NHS boards than existed previously. I have also taken from oral and written submissions that efficiency savings are possible without cutting priority front-line services.
We can campaign against cuts to local services, but there is no doubt that we should always heed issues that medical staff raise, as John Scott highlighted.
I would be grateful if you would come to a conclusion, please.
Okay. I was going to mention that it is unfortunate that the TrakCare system has not been successful.
Again, I thank John Scott for bringing the debate to the Parliament.
12:48
As other members have done, I welcome John Scott’s motion. Above all, I acknowledge the key role that he and many others, including Adam Ingram, have played in keeping Ayr accident and emergency services open and, indeed, in preserving Ayr hospital as a hospital that serves the south Ayrshire community. I am less concerned about Labour MSPs not being here, because we will probably get more sense from their benches than we normally do.
Without the initiative that I have mentioned, 10,000 attendees a month who appear at Ayr A and E would have had to seek succour elsewhere, and nowhere near all of those outpatients—or 97 per cent of them—would be attended to within four hours or be served by a quality organisation that has achieved being fourth of the 14 health boards on attendance-rate measures. A high point in the hospital’s life has been the standards that were achieved throughout 2009. Some 99.3 per cent were regularly seen and attended to within four hours. We need no reminding that Labour and the Lib Dems wanted to close that department and service. As John Scott said, that particular horse—that is, the closure of orthopaedic trauma services—has bolted. When I met the chairman of the board only weeks ago, I was assured that orthopaedic services
“will be retained in Ayr”.
Although clinicians think that the services could be improved, and although Crosshouse hospital was perceived to be a centre of excellence, a complementary proposal was awaited from clinicians at Ayr hospital. The proposal has now been received and, as we know, the decision to centralise orthopaedic services has been overturned.
This is an exciting time for NHS Ayrshire and Arran. During the next few months there will be a new chairman of the board, a new chief executive officer, whom I have met, and three new board members. There will be a new regime and a new sensible strategy. I am sure that we will secure dual focus on A and E in Ayrshire.
There will be a more realistic relationship with general practitioners, a review of mental health care, which might involve moving in-patient services to Irvine, and greater care in the community, through community crisis teams. Further developments include the extension of telehealth scanning and diagnosis, a review of patient and visitor transport services, particularly for the likes of Arran and Cumbrae, competitive analysis of GP practices and drug provision, and a strengthening of community health partnerships.
All those initiatives bring a new and realistic dawn for the health board, but—there is always a “but”—although we must have a preventative spend regime and realistic resource productivity gains, we must be vigilant and ensure that we never again go down the road that was travelled some five years ago. Orthopaedic services will continue to be provided in Ayr and there will be a dual focus on accident and emergency. There will be no more unabated concerns for people in our constituencies who become ill, sick and injured: as John Scott said, not while there is breath in our bodies.
12:52
I congratulate my fellow Ayrshire MSP John Scott on securing the debate and bringing the matter to the Parliament’s attention.
As members said, the motion has been overtaken by NHS Ayrshire and Arran’s decision to withdraw its closure proposal and maintain orthopaedic trauma services at Ayr. It is a wee bit concerning that only in September we were dealing with the possibility of the unit’s closure and the ensuring public reaction, which reached the Parliament, and that only a month later it was announced that the unit would stay in place. We might never know whether the decision was the result of the response from the public and Ayrshire’s MSPs, who signed the motion that condemned the proposal. It seems to me that such proposals need more careful consideration before they see the light of day.
In March, the board advertised for a consultant in orthopaedics and trauma, who would be based primarily at Ayr hospital. Although the papers for the post mentioned the review of services that was taking place and the possibility of relocation of trauma services to Crosshouse, we must wonder why the board embarked on the recruitment drive if it wanted to close the unit.
A glance at the statistics tells us that the Ayr unit received more than 1,000 emergency in-patient cases in 2009-10. If that number of cases were transferred to Crosshouse, Crosshouse would deal with more than 3,500 cases per year, while Ayr would handle only elective orthopaedic in-patient services. Such an approach would mean that people, many of whom travel quite a distance from around the south of Scotland to get to Ayr, would need to make an additional 40-mile round trip to Crosshouse.
An unintended consequence could surely be that all accident and emergency cases would end up in Crosshouse. If a paramedic was not certain that an injured person would not require orthopaedic trauma support, a precautionary approach might be taken and ambulances might drive past Ayr to reach the trauma unit at Crosshouse, on every occasion.
That is why issues such as the one that we are debating upset the public. When proposals are drawn up, it is not clear to me whether a public impact assessment is carried out, so that the full implications can be properly set out against the suggested benefits of change. Equality impact assessments must be carried out, but does the minister think that they sufficiently assess the impact on the public, who might face much longer journeys to access health services?
Scotland’s health service is among the best in the world, and we take great pride in seeing it delivering for the people of Scotland. If this is an example of a proposal that never really was, I respectfully ask Ayrshire and Arran NHS Board to consider very carefully how it communicates its thinking on such issues to staff and the public in the future. If it takes the trouble to mention the possible relocation of trauma services to Crosshouse hospital in a job advert, the public and their elected members are entitled to express their concern. I sincerely hope that the minister will respond positively to members’ comments and the issues that have been raised in the debate.
12:55
I congratulate John Scott on securing time for the debate and on bringing an important issue before Parliament.
No one should be in any doubt about the importance of the issue to the Government. After all, it was the first act of the Cabinet Secretary for Health, Wellbeing and Cities Strategy, when she took up her post in May 2007, to reverse the previous Administration’s decision to close accident and emergency departments at both Ayr and Monklands hospitals. I will use the time that is available to me this afternoon to reinforce why that was and remains the right thing to do.
I make it clear from the outset that neither NHS Ayrshire and Arran nor NHS Lanarkshire will make any changes to the core A and E services that are delivered at Ayr and Monklands hospitals, including the key support services for those emergency departments along with orthopaedic trauma services. The Government has been consistent in its view that the service reviews of both NHS Ayrshire and Arran and NHS Lanarkshire, which culminated, in 2006, in the recommendation to close the A and E departments at Ayr and Monklands hospitals, were flawed. They failed to address sufficiently the very real concerns of a significant portion of their local population about the centralisation of those services. As the cabinet secretary said at the time, many of those concerns were based not on emotional attachment to bricks and mortar, but on a level-headed analysis of particular local circumstances and the needs of local communities both at that time and into the future.
Genuine concern was articulated at the time by many, including John Scott and Adam Ingram, that the health boards’ proposals would significantly inhibit access to A and E services and that, in particular, insufficient consideration had been given to the issues of geography, local transport and the ambulance infrastructure. There was also a recognition that the proposals would mean diminished emergency care provision in some of the most deprived areas of Scotland, where people need it most. Those concerns remained even after the consultation work had been carried out by the respective boards. Neither the boards nor—
Sorry—can I stop you for a moment, minister? The motion is about NHS Ayrshire and Arran. If they had known that you would widen it out, other members might have wished to take part in the debate. I ask you to address the motion in your summing-up.
With due respect, Presiding Officer, I am. The decision was made on both of those issues at the same time. I am trying to address both issues because they were dealt with in parallel.
Neither the boards nor ministers were able to make any convincing case that the proposal to centralise A and E services would be of benefit to local communities. The overwhelming feeling in the affected areas was that the boards’ processes and their subsequent recommendations—as endorsed by ministers—paid scant regard to the clearly expressed views in their communities.
The Government recognised the significant damage that the sequence of events had had on public confidence in the NHS change process. That is why we are absolutely determined not only to overturn those decisions, but to start the rebuilding of trust, which is critical to the development and delivery of a patient-centred health service. Alongside developing revised guidance to enhance meaningful public engagement and piloting direct elections to make the NHS more accountable to local people, we were determined to regain public confidence in the change process as a means of ensuring that health boards’ proposals are robust, evidence based, patient centred and consistent with clinical best practice and national policy.
That is why when the cabinet secretary charged NHS Lanarkshire and NHS Ayrshire and Arran to bring forward new proposals to maintain A and E services at Ayr and Monklands hospitals, she also—
Minister, again, I am afraid—can I stop you for a moment? The motion is quite specific about NHS Ayrshire and Arran; it is about orthopaedic services. It is a members’ business debate about that, so I would be very grateful if you could return to NHS Ayrshire and Arran.
With all due respect, I am doing that, but it does not preclude us from mentioning NHS Lanarkshire.
I think that the members’ business debate is about NHS Ayrshire and Arran. I would be very grateful if you would—
I respect what you are saying, Deputy Presiding Officer, but I think that you are being overly sensitive to the mentioning of NHS Lanarkshire.
The cabinet secretary said at the time that there would be independent scrutiny, which was undertaken by Dr Andrew Walker, who published his final report in January 2008. The independent scrutiny panel found that the board in Ayrshire and Arran had not made convincing cases for significant changes to emergency services. In other words, the report confirmed that this Government’s decision to reverse the closure of the A and E department at Ayr was the right one. The ISP recognised the very high quality of A and E provision at Ayr and it said that there was scope for further maintenance of the services and for further development in the future.
Ayrshire and Arran NHS Board took full account of the ISP report in coming forward with proposals to build on the strengths of its existing services. That meant that there would be no cutback in the A and E service that is presently provided. I want to be clear that that was the case in 2008 and that it remains the case today. The Government will not countenance any proposal from either of the boards that seeks to undermine that commitment.
What we have been doing is analysing exactly what the board was considering. It is right that the board is keeping its services under close review to ensure that it offers the highest quality of care for local communities and it is right that health boards keep services under review to ensure that they offer best value for the considerable taxpayer investment that goes into them. However, all boards know that any proposed service changes must be primarily based on enhancing the quality of patient care. This Government was re-elected on a commitment to keep NHS services local where it is appropriate and in the best interests of patients to do so.
NHS Ayrshire and Arran has been clear throughout the recent review of services that it remains absolutely committed to maintaining the full A and E service at Ayr hospital. Members should be in no doubt, and neither is NHS Ayrshire and Arran, that that commitment includes the retention of key support services for an A and E department of that size, including critical care, anaesthetic cover and orthopaedic trauma services.
In terms of future development at Ayr hospital, members will also be aware that this Government has sought to maintain a high level of capital investment through supplementing with revenue-to-capital transfers and a pipeline of revenue finance investment. In the face of an unprecedented level of cuts in capital funding from the Westminster Government, that decisive action by the Scottish Government will mean that progress can be made on a range of key local projects, including the development of front-door services at Ayr and Crosshouse hospitals—
Minister, I would be grateful if you could close now.
—which will be made before the end of the spending review. I can confirm that officials are engaged with NHS Ayrshire and Arran to identify options for the development of those projects and for the phasing of expenditure over the next few years.
With regard to the specific points raised by John Scott on the tracking system, I am more than happy to respond to the member in writing on that. I assure Adam Ingram that we are very clear with boards about having to target back-room functions in looking for efficiencies to ensure that resources are targeted more directly to front-line patient care.
In drawing my remarks to a close, I hope that members are reassured that there is no equivocation in the firm commitment of this Government to maintaining A and E services at Ayr hospital and at Monklands general hospital. Some 40,000 people attended Ayr A and E department in the past year and 65,000 attended the department at Monklands, which demonstrates the level of need for those services within those individual areas.
13:04 Meeting suspended.