Official Report 379KB pdf
The next item of business is a statement by Angela Constance on national health service capital projects. The cabinet secretary will take questions at the end of the statement, so there should be no interventions or interruptions.
16:35
I am grateful for the opportunity to provide an update to members on NHS capital projects, specifically on the current position and next steps for the Monklands replacement project.
I begin by being absolutely clear: the Government will deliver a new Monklands hospital. That commitment has not changed and it will not change. However, having carefully considered the full business case that was submitted by NHS Lanarkshire, I cannot approve it in its current form within our current financial landscape. That is not a decision that I have taken lightly. The case for replacing Monklands is well established. The current hospital estate is ageing, it presents ongoing operational challenges and it constrains the delivery of modern models of care. Staff have worked in difficult conditions for many years and they deserve better. Patients deserve better.
There have been active campaigns by members across the chamber to represent the views of constituents in Lanarkshire, including by my colleagues Neil Gray and Fulton MacGregor. I fully appreciate the strength of feeling on the need for a new Monklands hospital. However, it is also my responsibility to ensure that major investment decisions are affordable, deliverable and aligned with the future direction of our health and care system. The proposal that is before us has an estimated cost of around £2.1 billion and would represent an unprecedented concentration of capital investment in a single health project. For context, it would cost an estimated £5 million per bed to deliver and would exceed the cost of delivering Scotland’s largest hospital, the Queen Elizabeth university hospital, and the new HMP Glasgow. Proceeding in that cost envelope would significantly limit our ability to invest in services and infrastructure across the wider NHS. I have carefully weighed the opportunity cost against our objective on improving public services.
The current proposal also raises important questions about value for money. It is significantly more expensive than comparable programmes. Investment of that scale must be fully justified before it can be approved. Just as importantly, the current design is heavily reliant on large acute hospital provision. That is not the direction in which our health service is moving. Across Scotland, we are shifting towards delivering more care closer to home, strengthening community services, making better use of digital technology and ensuring that hospitals are focused on those who need specialist and complex care. To proceed with the current proposal would risk locking us into a model that does not represent the best use of public investment in the years ahead. Finally, the project is approaching a point where continued design development would lead to further cost escalation and reduce our ability to consider alternatives. It is therefore essential that we act now.
Today, I am announcing that we will undertake a formal reset of the Monklands replacement programme. It is a reset and not a stop. It will involve pausing progression of the current design and commissioning a comprehensive redesign, which will be led jointly by the Government, NHS Lanarkshire and partners across the west of Scotland. It is not delay for its own sake and we are not stepping back from our commitment. The new design will take a whole-system approach, bringing together acute care, community services, diagnostics and digital provision in an integrated model. Importantly, the work will take place at pace from the summer and will be focused on designing a modern hospital with a more efficient footprint.
I recognise that the announcement will raise concerns locally, and I will address those directly. First, we remain fully committed to building a new hospital at Monklands. Secondly, this is not about downgrading services; it is about delivering the right service in the right place. Core services, including accident and emergency, will be retained. Thirdly, I recognise the challenges that staff and patients in the current hospital face, and I can announce today that we will invest in addressing immediate infrastructure risks, including known issues that affect patient experience. That will ensure that safe, high-quality care continues while the replacement programme is taken forward.
I pay tribute to the staff at Monklands for their dedication, patience and professionalism. They have been waiting a long time for a new facility, and the project team has worked hard to progress this important project. I am committed to working closely with NHS Lanarkshire to move the project forward at pace.
I am committed to ensuring that the new Monklands hospital plays a core role in designing how we deliver services in the future. That means ensuring that Monklands acts as the blueprint for how we deliver better services in the community, building on the work that is being taken forward by our subnational planning partnership. For example, I am open to the prospect of Monklands not only being an acute hospital but delivering specialist services for communities across the central belt and west Scotland. Alongside the reset of the Monklands programme, we will use this opportunity to rebalance investment across the wider system. The scale of the original proposal would have concentrated a significant proportion of our capital budget in a single project. By taking a different approach, in addition to investing in services that serve the people of Lanarkshire, we can invest more broadly.
Central to that will be investment in community health hubs, which will bring together services such as general practice, community nursing, mental healthcare, diagnostics and out-patient services in modern facilities closer to home. The hubs will make it easier for patients to access co-ordinated care in a single place, reducing the need to travel to hospital. We have set out the first phase of investment in the hubs in Port Glasgow, Cowdenbeath and Lochgelly, and East Calder. We will use those projects to deliver a standardised model for further centres, including in Hamilton, Cumbernauld, Edinburgh, Ayr, Kincardine, Inverness, East Dunbartonshire and Glasgow. For patients, that will mean quicker access, earlier intervention and more care delivered in the community. For the wider system, it will reduce pressure on acute hospitals, allowing focus on those who need specialist care most.
I can announce today that, as part of the programme, specifically for Lanarkshire, we will begin with a new general practitioner walk-in facility in Lanark—transforming an old shop front and a retail park in the town centre into a GP walk-in centre. We will also deliver a new walk-in GP service in Shotts.
By rebalancing our investment, it is my intention that we will deliver on other NHS capital projects that are priorities for communities across our country. For example, if further investment is required to ensure that the Baird hospital and ANCHOR—Aberdeen and north centre for haematology, oncology and radiotherapy—project in Aberdeen can be delivered safely, ministers will consider that carefully.
Under the reset approach, we will move at pace to complete the redesign over the next year and bring forward revised options by the middle of 2027. Subject to ministerial decisions, the design will then progress, with an ambition to begin construction in 2028. We will set clear milestones, including completion of the redesign, agreement of the final scheme and the start of construction. We will ensure demonstrable progress during this parliamentary session.
This is a difficult decision, but it is the right one. I want to reiterate three key points: we will build a new Monklands hospital; we will do so as part of a wider transformation of care across Lanarkshire and the west of Scotland; and we will ensure that the investment meets the standards that are required for managing public money by delivering the best possible outcomes for patients, staff and the people of Scotland.
I commit that the Government will work as quickly as possible with NHS Lanarkshire to ensure that there is a redesign that is affordable and, crucially, that reassures the local community that vital services will not be lost or downgraded.
I am happy to answer any questions that members have. I will also reach out directly to offer a meeting to any local MSPs who have further issues that they wish to discuss.
There is great interest in the statement. I request that members ask succinct questions and that the cabinet secretary gives succinct answers. Those who wish to ask a question should press their request-to-speak buttons.
I thank the cabinet secretary for the advance copy of her statement.
First, there is no doubt in my mind that the people of Lanarkshire and the hard-working NHS staff at Monklands hospital will be bitterly disappointed by the cabinet secretary’s announcement. It does not sound like a reset; it sounds like an indefinite halt. Can she tell us when a new Monklands hospital will actually be built?
Secondly, in the cabinet secretary’s answer to a parliamentary question on replacement general practices, she said that there will be no spades in the ground until 2031. Can she advise whether that timeline is correct?
Finally, it has taken a mere seven weeks for the Scottish National Party to ditch its manifesto commitment. Is it not the case that the SNP was economical with the truth in its manifesto when it promised all those things, knowing that there was no budget to deliver any of them?
This Government will deliver a new hospital for the Monklands. This is not about ditching; it is about delivering. I made a decision that I believe, as I have reported to the Parliament, is in the best interests of the people of Lanarkshire and provides a credible plan to deliver the new hospital that they require. The plan will deliver more than a new acute hospital. It will deliver the transformation of care that we all know is required. Ms Baillie has listened—I assume—to the information about the timetable that I gave in my statement. I assure her that I will keep her duly informed about it.
I read every party’s manifesto very carefully. I saw no commitment in the Labour Party’s manifesto to the good people of Lanarkshire in relation to a replacement for the Monklands hospital. I can say, hand on heart, that if I had not intervened at this stage on a project that would have required in excess of £2 billion, Ms Baillie would have been asking me far harder questions than she is asking today.
I thank the cabinet secretary for her statement. She says that this is a whole-system approach, that the old approach of having a large acute hospital is not now the answer and that there will be better services that bring together acute care, community services, diagnostics and digital provision. We have seen before good intentions from the Scottish Government for more integrated care. One smaller example, in relation to GP services and care, is Pitlochry community hospital, which was built and opened to some fanfare by Nicola Sturgeon. That hospital has been plagued by a lack of staff and wards being closed due, partly, to issues with funds.
Where will the money come from? If a new hospital would be too expensive but the cabinet secretary is going to deliver the many things that she set out in her statement, can she assure us not only that capital funding will be included—obviously, that will be less than the £2.1 billion—but that resource funding is already being allocated in budgets now and in the future? Can she estimate when the facility will open?
For the record, I have written on this matter to Ms McDade in her capacity as the convener of the Health, Care and Sport Committee.
Let me be clear: we still need acute hospitals. The good people of Lanarkshire still need and will get a new Monklands hospital. However, Helen McDade’s point about the stewardship of public finances is crucial. We cannot spend £2.1 billion—nor, indeed, more—on one project and meet all our other commitments relating to the aspirations that we all share across Scotland. We know that we need to do things differently, and I know that, in quieter moments, the majority of MSPs acknowledge the need for public service reform and to do things differently. To deliver on the many commitments that I have outlined today, we have to make hard decisions, and I am prepared to make hard decisions about affordability and what is best for future health and care services.
If I have missed anything, I will happily follow up with Helen McDade in writing. We are investing £22.5 billion across the health and care portfolio, with additional investment in many areas.
As one of the two Monklands MSPs, I cannot stand here and say that I am happy with today’s announcement. As the health secretary will be aware, Monklands hospital urgently needs to be replaced. Various concerns have been raised about the ageing infrastructure, water contamination and asbestos. The people of Monklands and wider Lanarkshire have been promised a new hospital for some time, and the road that has led us to where we are today has long been documented. Therefore, I do not fully understand how we have arrived at this point.
NHS Lanarkshire has been developing its plans for a long time. It has kept MSPs and all stakeholders—including, I presume, the Scottish Government—up to date. Its plans have been public and have included visits from MSPs and MPs. At what point did the Scottish Government deem that the cost outlined in the business case was too high? What discussions did it have with NHS Lanarkshire to try to resolve issues earlier? In addition, although I acknowledge and welcome the fact that the Government remains committed to a new hospital, how will it work with NHS Lanarkshire to deliver that hospital speedily and ensure that there is in no way a downgrading of services?
First and foremost, I want to reassure Fulton MacGregor, who has been an unashamed and powerful advocate for his constituents and for that project, because he has expressed disappointment. I want to be in the business of delivery; I am not in the business of aspirations. A single project costing in excess of £2 billion is unaffordable. Given that it is unaffordable, there would be an almighty battle to deliver it, if that could happen at all. The issue is about having a credible plan, with the timescales that we have to date, to deliver for the benefit of the people of Lanarkshire and people elsewhere in Scotland, with that shift in the balance of care.
I have made the decision very early in my tenure as Cabinet Secretary for Health and Care, because I think that it is important to do so. I do not want people hanging on—I have never been in the business of leading people up the garden path.
The Government received the full business case some months ago, at the turn of the year. I expect my officials to scrutinise any full business case. Clearly, some decisions cannot be made until such scrutiny has been completed. However, it would not be responsible to ignore the risks of not delivering as a result of that business case. We need to make a decision now—as I have done—because, otherwise, we would end up proceeding by default and not delivering for either Lanarkshire or the people of Scotland, and neither scenario would be acceptable to me.
The statement refers to a shift towards bringing care closer to home, which we welcome.
Figures that were published by Macmillan Cancer Support show that nearly a quarter of Scottish cancer patients lack specialist support. In my region, Edinburgh cancer centre improvements remain paused, due to constraints on capital funding. Will the cabinet secretary provide a timeline for those in the east of the country who are still waiting for updates and specialist care?
As would be expected from the health secretary, I recognise the importance of cancer care. We still need to overcome many challenges in that care, notwithstanding the fact that the risk of dying from cancer in Scotland is the lowest that it has ever been. There is a list of projects that we have delivered in the past five years, there are projects under construction and there are projects in development. I should afford the member a very detailed response to her serious question, and I will do so in writing as soon as possible.
The Sunday Mail reported on 26 April that ministers had failed to sign off on the business case for the new Monklands hospital prior to the election, so it is important that the cabinet secretary publishes the information that Scottish ministers knew during that period and that she explains why there was no statement to the Parliament before the election so that voters would have the opportunity to judge the Government on that.
Minutes from NHS Lanarkshire board meetings suggest that any delays to building a new Monklands hospital will cost almost £4 million a month—an estimated £45 million a year—in maintenance. What contingency plans has the cabinet secretary seen that will ensure that there is a plan B if the hospital closes because of any system failure? What are the estimated costs of the delay?
It was always going to be the case that the old hospital would continue to be used while the new hospital was being built, which means that important investment is required in that regard.
I hope that I may say to Mr Briggs that any commitment to the Monklands replacement project was absent from his party’s manifesto and that he has also been a powerful advocate for the eye pavilion in Edinburgh. The cost of the Monklands project is currently estimated to be £2.1 billion, and there is a risk that the final outturn costs will increase. If I were to allow that to happen, I think that Mr Briggs might be worried about another project that we are committed to. We will deliver for the people of Lanarkshire, but we are also going to deliver for the people of the Lothians and people elsewhere in Scotland.
I am happy to furnish Mr Briggs with further information about the process. When we deal with any full business case, it is important that that is thoroughly examined and scrutinised, out of respect for those who have compiled it. Final decisions are not made until the final business case has been thoroughly scrutinised by the Government, and I hope that Mr Briggs, and other members, will take heart from the fact that I have come here very early in my tenure as Cabinet Secretary for Health and Care to put all of that on the record.
It is not a great look that the Government has waited until after the election and until the very last moment before recess to deliver what will be bitterly disappointing news to people who rely on Monklands hospital.
I welcome the investment in community health clubs, including in my constituency in East Dunbartonshire. The cabinet secretary also said that that rebalancing will allow for the delivery of other capital projects in the NHS. How will that impact the building of the new Belford hospital in Fort William? Will the Government fully commit to a replacement for the Gilbert Bain hospital in Lerwick?
I say to the member that this is a parliamentary day—it might be the last day before recess, but it is still a working day. I do not know about him, but every day is a working day for me, so he will get no sympathy from me if he is complaining about the day or time. I put that on the record.
We have a number of projects that are in construction, and we have a commitment to the Belford project, which was in the infrastructure investment plan and in our manifesto. We do not currently have the same level of commitment to the Gilbert Bain hospital in Shetland, but we will have when we take our new whole-systems approach to NHS infrastructure planning, because we are not just delivering for particular board areas—we need to deliver for Scotland as a whole so that those other projects can be considered in due course.
If we are to get through all members who want to ask a question, we will need shorter questions and answers, please.
I thank the cabinet secretary for her update on NHS capital projects and the future delivery of the Monklands hospital, and for the direct and transparent way in which she has come to the Parliament to communicate on that at an early stage.
GP walk-in centres and out-of-hours clinics, such as the excellent Douglas Street service in Hamilton, play a vital preventative role in delivering care at the point of need while relieving pressure on our A and E departments and helping us to continue to bring down waiting lists. Before the election, I campaigned relentlessly for a GP walk-in centre in my constituency. Will the cabinet secretary work with me to explore a future GP walk-in centre in Hamilton, Larkhall and Stonehouse, looking at sites such as the out-of-hours service in Douglas Street and the now-vacant bank in Larkhall, in order to better support my constituents and our wider NHS across Scotland?
I appreciate Mr Kerr’s advocacy on the issue. It is important to recognise the fundamental and basic point that investing in good primary care, improving access and expanding community resources helps to reduce the pressures on our hospitals and acute services. As a Government, we have made a clear commitment to expand GP walk-in services, including in Lanarkshire. That is part of improving access to care and reducing pressure on accident and emergency services.
I am keen that NHS Lanarkshire develops proposals that reflect local need and make best use of available sites, and I would be happy for Mr Kerr to engage with the board as that work progresses. I am sure that the suggestions that he has put forward will be part of that consideration. Our focus is on ensuring that communities such as Hamilton, Larkhall and Stonehouse benefit from improved access to services in the most appropriate locations.
People in Kincardine, in Fife, desperately need a new health centre. The existing practice was condemned as not fit for purpose in 2016. A decade on, can the cabinet secretary provide any indication of when we might see the first wave of community hubs and when spades will finally be in the ground in Kincardine?
I know that there is great interest in primary care in terms of GP services and local health centres. We have made a number of commitments with three pilot areas, which I mentioned in my statement, and which will help us to develop a standardised approach to replacement projects. We have identified 12 projects, which were in our manifesto, and, after the delivery of those projects, other areas will be able to be considered. However, I would be more than happy to receive more detail about the area that the member is championing.
I thank the cabinet secretary for her statement and I note her remarks on the Baird and ANCHOR in Grampian. Will she set out how the Government is supporting NHS Grampian to also invest in infrastructure at Dr Gray’s hospital? Can she provide an update on plans to open Moray’s GP walk-in clinic, which will undoubtedly ease pressure on A and E and GP services in my constituency?
I recognise the importance of services at Dr Gray’s hospital and access to primary care for Laura Mitchell’s constituents. I reassure her that I will work closely with NHS Grampian to support investment across Moray, including strengthening the role of Dr Gray’s within that regional network of care. I confirm that plans are being developed to establish a GP walk-in facility in Moray, which will help to improve access to services and reduce pressure on both general practice and A and E.
I declare an interest as an employee of NHS Lothian.
I thank the cabinet secretary for the advance sight of her statement. In the light of the decision to pause the replacement of University hospital Monklands and implement sub-acute community health hubs in supplementation, can the cabinet secretary provide more detail of the funding timeline for the hubs? Given that a replacement for the hospital is needed, what contingency plans have been put in place for the current hospital to maintain current standards of care and ensure that acute cases and emergency pressures are not simply displaced to the nearest hospitals?
The member makes an important point about taking a whole-system approach. We cannot address issues in one part of the system without being cognisant of pressure or potential consequences elsewhere.
I outlined the timing in my statement. I want a reset that will deliver a new Monklands hospital and community services so that Lanarkshire can lead the way. Some of the reforms that need to take place across Scotland will still be made, and we will work at pace on those.
Although this is perhaps a change of plan—I would not describe it as a pause—we need to reset on the basis of deliverability, affordability and what is best for patients.
Can the cabinet secretary provide any details about when funding will be in place to replace the Port Glasgow health centre with a new health hub? Can she advise when there will be investment to improve the fabric of Inverclyde royal hospital?
I recognise the importance of investment in facilities such as the new Port Glasgow health centre and of improvements to Inverclyde royal hospital. Planning work on a replacement health centre continues, and I will ensure that local members are kept up to date on that.
The decision that we have made on the exterior of Inverclyde royal hospital creates more flexibility in the capital programme and allows us to accelerate that work. Officials are meeting with NHS Greater Glasgow and Clyde on Monday to discuss how we can move that work forward at pace.
Our broader approach is focused on balancing investment across Scotland to improve access, modernise infrastructure and support high-quality care in hospital and community settings.
There are lessons to be learned from this situation, but that will be of little comfort to the staff and patients who are dealing with an old hospital. Right now, it is 30°C in some parts of Monklands hospital, wall trims are held on with duct tape and there are historical issues with asbestos in the building.
The cabinet secretary said that immediate infrastructure risks will be addressed. How quickly will those infrastructure risks be dealt with? Will the cabinet secretary meet unions and staff representatives to ensure that the hospital is a safe place to work?
I declare a voluntary interest, as I am a member of Unite the Union.
I agree with the member that there are always lessons to be learned in every journey travelled. I assure her that, in this instance, lessons will be learned. I am more than happy to meet staff and union representatives.
In the interest of expediency and time, I will write to the member in more detail, because there are detailed concerns here and now about Monklands, and they need to be addressed. As we have always said, the current hospital will have to continue until the new one is built—and there will be a new Monklands hospital.
I thank the cabinet secretary for her statement. I will pick up on investment in community health hubs and, specifically, the replacement of Lochgelly health centre. Can the cabinet secretary advise whether a decision will be made on the funding model—for example, the potential use of the mutual investment model—in the coming months?
In-depth work is continuing around the revenue-based funding model to enable the three pilot areas that I mentioned in my statement to proceed; that includes the project in Mr Barratt’s constituency. The focus is on a standardised approach so that we can make best use of public money for best effect, for Mr Barratt’s constituents and for all the people of Scotland.
The focus now, post the statement, is on taking forward modern facilities that support multidisciplinary working to improve access to services for local people. I can assure the member that I and my officials are continuing to work closely with NHS Fife and partners to progress the proposals and ensure that they reflect local need, and I will keep him up to date on the matter.
That concludes questions on NHS capital projects.
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