Meeting of the Parliament (Hybrid) [Draft]
Meeting date: Tuesday, October 25, 2022
Agenda: Time for Reflection, Business Motion, Topical Question Time, Energy Prices Bill, Moray Maternity Services, Hunting with Dogs (Scotland) Bill: Stage 1, Decision Time, The BIG Project (20th Anniversary)
- Time for Reflection
- Business Motion
- Topical Question Time
- Energy Prices Bill
- Moray Maternity Services
- Hunting with Dogs (Scotland) Bill: Stage 1
- Decision Time
- The BIG Project (20th Anniversary)
Moray Maternity Services
Colleagues, the next item of business is a statement by Humza Yousaf on Moray maternity services. The cabinet secretary will take questions at the end of his statement, so there should be no interventions or interruptions.14:50
I committed to come back to the chamber to provide an update on Moray maternity services, and I am pleased to be able to do that today. I intend to set out the progress that has been made to date, my initial response and, crucially, what the next key milestones will be. Before I do that, however, it is important for me to reiterate this Government’s absolute commitment to the delivery of a consultant-led maternity service in Dr Gray’s hospital. While model 4 will deliver improvements for families in Moray, it is model 6 that very firmly remains the destination.
Members will be aware that I started this process in December last year when I was considering the report of the independent review of Moray maternity services. I proceeded to meet and engage with senior teams in boards, clinicians, local community campaign groups and elected members from right across the political spectrum. It was important to do that and it helped me to come to my final decision, which I announced in the chamber in March. That was to progress with model 6, which is a full consultant-led maternity unit at Dr Gray’s, with model 4, which is a networked maternity model linked primarily with Raigmore hospital, as part of the development towards that final destination.
I also announced, in line with the recommendations of the independent review, that I would bring some level of independent assurance to the process, and I was delighted to announce in July that Professor Linda de Caestecker would lead that work. Since then, Professor de Caestecker has identified further clinical support and expertise to work with her to provide that external assurance. The team that is working with Linda includes representatives from relevant specialties such as paediatrics, anaesthetics, obstetrics and midwifery.
The external panel will be a sounding board and a critical friend to both NHS Grampian and NHS Highland and, crucially, it will provide assurance and reassurance to the community and to me in Government. That has already begun through meetings and email exchanges, providing me with a further level of scrutiny and advice on progress and plans.
Members are aware of the NHS Grampian and NHS Highland draft joint plan, which was submitted to me on 1 July. I welcomed the plan, but at that time I expected further information before giving my response to it. The model 4 plan is an important step in the journey towards model 6 and I was pleased to see the ambitious timescales in it. What I can say here today is that I am very clear that further work is required before I give approval to model 4 plans, and there are elements to be worked through locally and nationally to deliver for families in Moray.
At local level, clinical teams in Highland and Grampian need to develop the safe pathways of care to bring reassurance both to the women involved in Moray and to clinicians. At national and local levels, there is work to be done to address the on-going challenges of recruitment. I have asked both NHS Highland and NHS Grampian to share their recruitment plans to meet the 2023 deadline in the model 4 plan.
There are key elements in the model 4 plan to which I wish to draw the Parliament’s attention. First, the intention for NHS Grampian to introduce increased obstetric antenatal care to Dr Gray’s is welcome. It could result in at least 1,000 antenatal appointments a year being delivered in Dr Gray’s, thus reducing the amount of travel for pregnant women.
The other element that I want to highlight today is planned caesarean sections. As we know, that is not included in the model 4 plan due to its dependency on other services and skilled staff being available. I expect planned caesarean births in Dr Gray’s to be covered as part of the model 6 plan, which I expect at the end of this year, and I expect ambitious progress to be made to deliver that. I will ask Linda de Caestecker and her external assurance panel to look at that issue in further detail.
Essentially, we should view the interactions between models 4 and 6 as a continuum. We will not wake up one day and suddenly switch from model 4 to model 6. I expect model 6 to be phased in over time. I am clear that elective sections should be given priority within that phasing process.
Concerns have been raised with me by local campaign groups and by clinicians about the projected numbers in the NHS Highland draft business case for women giving birth in Raigmore. I have asked the external assurance panel that I have just spoken about to take that forward and to investigate with boards, and clinicians, at pace. The ambition is to achieve choice for women living in Moray to birth in Raigmore if they wish to go there, where clinically appropriate.
I understand that there are concerns, including that progress is not being made quickly enough and that clinicians do not feel that the proposed changes are safe. I hear those concerns and I take them very seriously. I commend the steps that NHS Highland is taking to engage with the clinical teams to identify and address those concerns. That takes time, and I have always been clear that change will not happen overnight. We must work with clinicians in Grampian and Highland and, where there are legitimate concerns, those must be addressed.
I understand that the priority for women in Moray is that they have access, as soon as possible, to the widest range of maternity services that can safely and realistically be delivered as close to home as possible. The independent review of maternity services in Moray proposed, and I agree, that the first step in achieving that is to implement a networked maternity model, linked mainly to Raigmore.
I have already announced funding of £5 million to support improvements in Raigmore. To be clear, when I visited Raigmore earlier this year, I saw for myself that investment was much needed. The investment in Raigmore was not contingent on taking women from Moray. However, improved maternity services at Raigmore will benefit all women who give birth there. The redevelopment in Raigmore is key to improving the environment both for women giving birth and for the clinicians who work there.
I know that there are doubts around model 4. I have heard them from clinicians and from community members and campaign groups. However, the real prize from implementing model 4 will be in opening up scope for more pre and post-birth appointments at Dr Gray’s, and enabling more women to have their labour and birth in a hospital closer to where they live. That will be delivered by having the clarity of a safe model 4 as an interim solution, with robust pathways of care, providing care closer to home and an increased choice of place of birth. Until consultant-led services are returned to Dr Gray’s, women who need obstetrician-led care will have the choice of Raigmore or Aberdeen for the birth of their baby, and it is critical that we continue to have a parallel focus on the implementation of model 6 as the final destination. National health service care should be not about board boundaries but about working across boundaries to deliver the best care for all women who choose to birth in a given area. That is key to a networked model.
Back in March, I was clear that I expected plans for model 4 and model 6 to run concurrently. NHS Grampian has begun the process of planning what it requires for model 4, and to lay the foundations for model 6. As I have already made clear, I view model 6 as a continuum from model 4—an improvement journey that has a focus on safety and is led by clinicians. Oversight of that work is provided through the chief officers group, which is jointly chaired by NHS Grampian and NHS Highland. I expect the model 6 plan by the end of December. I expect to see evidence of collaborative working and joint plans from boards—for example, around the pathways of care. As part of the next phase of the work, monthly meetings will take place between the boards, Professor Linda de Caestecker and my officials.
I will talk a little about engagement. I reinforce in particular the importance of on-going engagement. I am pleased to note that connections are already being made with the external assurance lead, and that that includes community groups such as Keep MUM and the Moray and Banff maternity voices partnership. Their views have been instrumental in getting us to this point, and their challenge will help us to shape the way ahead. I have spoken to the Keep MUM campaigners just this week, and have given them a cast-iron guarantee that I remain absolutely committed to model 6: a return to a consultant-led midwifery unit at Dr Gray’s.
Finally, I would like to outline what I see happening over the next six months or so. In November, I expect to have advice from the external assurance panel on the NHS Highland business case and on the numbers of women giving birth in Raigmore, which I know is causing some concern.
In December, I expect to meet NHS Highland and NHS Grampian to discuss my expectations for the model 6 plan and its interaction with model 4. I expect to receive the model 6 plan by the end of December. Of course, I will keep Parliament updated in that regard.
For all our differences, I am certain that everyone in this chamber wants to see women in Moray being able to give birth as close to home as possible. We will endeavour to make that a reality and always ensure that the priority is the safety of women and their unborn children.
From January to February, I expect to have a response from the external assurance panel on all the plans received. That will be fed back to NHS Highland and NHS Grampian.
I hope that my statement gives some reassurance to members, clinicians and the community groups who have raised concerns. Work to return consultant-led maternity services to Dr Gray’s is progressing. Yes, Covid-19 has undoubtedly impacted on delivery timescales, and the context continues to be the most challenging time that our NHS has faced since its creation. However, the chairs, chief executives and executive teams at NHS Grampian and NHS Highland continue to assure me of their commitment to deliver both model 4 and, crucially, model 6—the final destination.
I reiterate my and this Government’s absolute commitment not just to model 6 but to ensuring that we return to consultant-led midwifery care at Dr Gray’s, to ensure that as many women as possible in Moray can give birth as close to home as possible.
The cabinet secretary will now take questions on the issues that were raised in his statement. We have slightly overrun, but I intend to protect around 20 minutes for questions, after which we will need to move on to the next item of business, as time is tight across the afternoon. It would be helpful if members who wish to ask a question could press their request-to-speak button now or as soon as possible.
I know that it is customary in the Scottish Parliament to thank the Scottish Government for making a statement, but I just cannot. I cannot, on behalf of Moray mums and families, thank the cabinet secretary for that statement, because I share their anger, disappointment and frustration that we are no further forward, months after he came to this chamber and said that he would make the matter a priority. We are no further forward on restoring consultant-led maternity services at Dr Gray’s than we were more than four years ago, when we were told to put up with a temporary downgrade for just a year.
In his previous statement to this chamber, in December last year, the health secretary claimed that he understood the urgency and importance of the issue, but the statement that he just read out does not understand the importance of the issue. There is nothing of comfort for Moray mums and families in that statement, because the agonising worry and concern about being transferred in labour, be that to Inverness or Aberdeen, is still there and shows no signs of ending.
Quite frankly, model 4 is a red herring. I am pleading with the health secretary to listen to local representatives, Keep MUM and other campaigners, to scrap model 4 and to move directly to model 6. He should not listen only to local people and local politicians. He should listen to the clinicians who wrote to him today. [Interruption.]
I am sorry, Presiding Officer. The health secretary overran. For how long can we speak about this issue? We have been waiting for months for this statement, and I know that people are watching today to hear crucial points put forward—
Mr Ross, I have given you some latitude. I am giving you some latitude, but—
So how long?
You had 90 seconds. You are at around two minutes; I will give you two and a half minutes.
What does the health secretary say to the 22 clinicians from NHS Highland who wrote to him today to say that model 4 remains “fundamentally flawed”? They say:
“Model 4 must therefore be rejected and the consultant-led service at Dr Gray’s Hospital re-established as a matter of urgency.”
Will the health secretary do that? Will he say today that model 6 has to go forward?
On elective caesarean sections, last December, the health secretary said in this chamber that there should be a
“rapid reintroduction of elective caesarean sections ... at Dr Gray’s”.—[Official Report, 7 December 2021; c 36.]
Now, we are hearing that that is going to be part of model 6.
In addition, on model 4, the health secretary says that we should celebrate the fact that there will be more pre and post-birth appointments at Dr Gray’s. I have never had one concern raised with me by local women or families about pre or post-birth appointments at Dr Gray’s. They want to give birth at Dr Gray’s, and there was nothing in the statement that will help them to do that.
On a point of order, Presiding Officer. Would you accept an emergency motion to ensure that a longer discussion can be had on this issue?
You have suggested such a motion in the past. I accepted it in the past; I do not see the need to do so on this occasion. I gave you additional time, and you have used that additional time and more. I have already explained that we are tight for time across the afternoon, and I have called the cabinet secretary.
Given the limited time that we have this afternoon, if Douglas Ross wants to discuss these issues in more detail, I am happy to commit to a meeting with him.
I take on board the concerns that clinicians have expressed to me. As Douglas Ross probably knows, I met those same clinicians when I travelled to Raigmore. That is why I have not stood up in this chamber and said that I am, in principle, giving agreement to model 4 plans. It is why—[Interruption.] Douglas Ross is speaking from a sedentary position. I will come to his suggestion about scrapping model 4.
Professor Linda de Caestecker has a panel consisting of a range of specialists in the field, including a paediatrician, an obstetrician and a midwife. I have asked Professor de Caestecker to engage with the clinicians, particularly around the concern that there seems to be a gulf between the numbers that the clinicians are suggesting will be giving birth at Raigmore and the numbers in NHS Highland’s draft business plan.
On Douglas Ross’s suggestion about scrapping model 4, if I do that, we will not have the additional prenatal and antenatal care at Dr Gray’s in the timescales that are being suggested by NHS Grampian and NHS Highland. In addition, many Moray mothers would be unable to give birth closer—[Interruption.] I ask Douglas Ross to listen instead of shouting from a sedentary position; I promise that I will meet him if he wishes.
As we get model 6 up and running, model 4 will, in the intervening period, allow more Moray mothers to give birth closer to home, at Raigmore. I hope that Douglas Ross appreciates the reality that getting model 6 up and running—which I am committed to; I give a cast-iron guarantee that we want to get there—will take time. [Interruption.]
Douglas Ross is shouting “When?” from a sedentary position. If he had listened to my statement, he would have heard me say that the joint plan for model 6 is due to me at the end of December. I plan to give an update to Parliament then. [Interruption.]
Douglas Ross continues to shout from a sedentary position. If he wishes to raise those issues with me directly, given the constraints on time in the chamber, I am happy to meet him separately.
I thank the cabinet secretary for providing prior sight of the statement.
My constituents in Moray are extremely concerned that model 4 is unsafe and is, at best, a distraction from delivering model 6. At worst, it could become the permanent solution. Those concerns are backed up by the clinicians at Raigmore hospital, who tell us that the service at Raigmore is currently unsafe and cannot take an additional 190 patients, far less the 650 to 900 that they predict. The gulf in those numbers is because the Government’s estimate is based on United Kingdom-wide figures and not remote and rural figures, which demand a more risk-averse approach, given the distances that patients have to travel in an emergency.
The cabinet secretary is saying that he hears those concerns, but he has given no indication in his statement of how they will be resolved. He will have a plan at the end of December, but can I ask for the detail of how and, more importantly, when model 6—not just the plan—will be delivered?
I cannot tell Rhoda Grant when model 6 will be delivered, because I must wait for the detail of the plan that will come to me in December. I will be happy to update Parliament then on how long model 6 will take. Like everybody, if I could have had model 6 in place yesterday, I would have done that, because I have an absolute commitment to return consultant-led maternity care to Dr Gray’s—no ifs, no buts, no maybes, no possiblies. That is the final destination, and what we are doing is working back from that final destination.
What I would say, which I should have said in response to Douglas Ross’s question, is that Covid will impact on delivery timescales. I cannot get away from that. In fact, since the independent review was published in December last year, we have had the omicron wave, the BA.2 wave and the BA.4 and BA.5 wave. There will be impacts, but I promise that there is—certainly on my part—no shortage of pace or urgency to get model 6 delivered.
As far as Rhoda Grant’s question is concerned, I am happy to reiterate what I said in my statement. I acknowledge the concerns of clinicians—I do not dismiss them, by any stretch of the imagination. That is why I have asked Professor Linda de Caestecker, who is leading the external assurance piece of work, to report back to me next month with her initial advice and, I hope, reassurance on those concerns. I will respond to the clinicians in very short order, and once I receive Professor de Caestecker’s external advice, I will be happy to update members who have spoken in the chamber today.
How will the Scottish Government continue to keep the invaluable voices and lived experience of the women and families of Moray central to its decision making as we move forward?
I can be brief and say that that will absolutely be part of our engagement as we go forward. That is not just from my point of view. Yesterday, I met members of the Keep MUM campaign group and other groups from Moray and Banff, including the maternity voices partnership. I have also met a number of local elected members and will continue to do so.
I reiterate that it is not just about my engagement, although I certainly pledge to continue with that; I have asked that the external assurance lead continues those conversations. My expectation is that the health board will also continue to engage with local campaign groups, which will be absolutely central to the process, however long it might take.
I have twice met members of the maternity team at Raigmore. I listened to them—I really listened, cabinet secretary—and they are worried about the safety of mothers and babies. The £5 million that has been promised to Raigmore will rectify some of the 15 years of underinvestment, but it will not buy even one extra bed space. The cost of providing extra beds and additional staff for Moray mums might be double that or even more. Will the Scottish Government guarantee to provide whatever funds are required and get staff in place before—and I mean before—approving a move to option 4?
I also listen to and hear the concerns of clinicians. [Interruption.] I notice that the Conservatives are often shouting from a sedentary position. If they want to have further meetings, I will be more than happy to do so, but we should treat the issue with the seriousness and respect that it deserves. [Interruption.] If Edward Mountain had read the NHS Highland draft business plan, he would have seen the important and crucial line that says:
“It is understood that further investment will be required for an alongside maternity unit or Inverness based Community Midwifery Unit which will require additional capital investment”—
I have read the plan. It is rude to suggest that I have not.
Presiding Officer, I can only make progress on the statement if the Conservatives do not barrack from a sedentary position. If Edward Mountain will let me read from the draft business plan, I will add that it says:
“which will require additional capital investment along with revenue which will need to be encompassed with our current capital allocations.”
Of course we will continue to work with NHS Highland on the required revenue and capital. If Mr Mountain goes back and reads the draft business plan, he will see that that that has been acknowledged already.
How does NHS Grampian aim to cultivate a positive and supportive workplace culture at Dr Gray’s and its other sites?
That is crucial. We will not make progress to our final destination of model 6 unless we take staff, the clinicians and the local community with us. NHS Grampian is prioritising engagement with its staff and has undertaken detailed work to understand colleagues’ current experience. It is active in promoting best practice and developing a positive workplace culture, and has a collaborative group that includes colleagues from Dr Gray’s hospital. I have been told—and have been given assurances—that there is extensive staff engagement at Dr Gray’s right now to co-produce the new strategic intent for the hospital, which will include development of the maternity services that we have been discussing.
Women in Moray are being let down by a lack of services close to home. However, they are also being let down by the Scottish Government’s sheer inability to value our NHS workforce properly and to fill vacancies across the country, particularly in rural communities. It is clear that Scotland needs a women’s health champion to lead and push on such issues. In June, the First Minister told the chamber that the appointment would be made in the summer. In early September, the Minister for Public Health, Women’s Health and Sport told me that the appointment process was almost complete. Will the cabinet secretary tell us when Scotland will finally have a women’s health champion and show women in Moray and across Scotland through action rather than words that the Government is listening and taking their concerns seriously?
I respect Carol Mochan very much, but I disagree vigorously with her on that point. We value the NHS workforce—we do not just talk the talk on that, but put our money where our mouth is. That can be seen by the final pay offer that we put on the table for our NHS staff, which is worth almost £0.5 billion, thus ensuring that NHS Scotland staff remain better paid than NHS staff anywhere else in the UK. I hope that that offer is accepted, although I respect the fact that the trade unions will go through their democratic processes in that regard.
Ms Mochan is right to say that the appointment of a women’s health champion was due to be announced in the summer. However, it is important that we get the right person for the role and, due to a variety of factors, there has been a delay, as Carol Mochan has outlined. However, we are looking to make an announcement on the women’s health champion imminently.
The concerns of the consultants and staff at the maternity unit at Raigmore are essentially that the business case that was prepared by NHS Highland management fails to address obvious issues. For example, it underestimates the number of patients who will come from Moray and makes no provision for decamp in the proposed refurbishment of the existing maternity unit. It is surprising that issues of fact seem not to have been resolved. That is unfortunate to say the least.
Will Linda de Caestecker meet the consultants and staff and give them enough time so that she can listen extremely carefully to their side of the case? I fear that, without that, it will not be possible to guarantee safety, which is something that the cabinet secretary has said is the sine qua non of going ahead with model 4.
In short yes, she will. That is why I have asked Linda de Caestecker to look at the concerns that were raised in that open letter from clinicians. I have not come to the Parliament to say that I have given final approval to the model 4 plans. I could not do that in good conscience, because of the concerns that have been raised. When such clinical concerns are raised, it is important that we ask other clinicians, as part of the external assurance process, to investigate the claims and to provide additional advice.
When I get that advice and have had time to read through it, analyse it and give it detailed consideration, I will ensure that I update Parliament.
It is clear that considerable effort has been put into finding a workable solution to improve maternity care for women in Moray. However, I am aware that, until model 6 is up and running, women in Moray will still have valid concerns about their care at such a crucial time in their lives. What support will be in place to help women to make informed, independent choices about their birth plans, even though options may be limited until model 6 is fully operational?
I have tended to agree with most members of the Scottish Parliament that the situation that Moray women face is far from ideal. No one in the Government, or I suspect from any party in the Scottish Parliament, would suggest that the situation is ideal or even the safest one that we would want to see for ourselves—if we are able to give birth—or for our own families.
I want to give an absolute assurance that any model that we implement—I am absolutely committed to model 6 as the final destination—will have to be safe. The issue about caesarean sections was already referred to. We have not included C-sections in model 4, because we are told by clinicians that it would be unsafe to do so given that even a so-called “low-risk” elective section can turn into a high-risk one very quickly. Therefore, we need to have the appropriate facilities in the event that someone haemorrhages and needs a blood transfusion and so on.
I want to give Ariane Burgess an absolute assurance that, for any woman who accesses information, support or care at Dr Gray’s hospital, the feedback that I get on the informed choices that they are enabled to make is very positive. However, Ariane Burgess should be in no doubt whatsoever that there is no one in the Government, including me, who thinks that the current situation for women in Moray is ideal—far from it.
We have just more than two minutes left and three colleagues who want to ask questions, so I ask for briefer questions and answers.
How will NHS Grampian adopt robust clinical governance arrangements in the maternity service that fulfil the requirements of the clinical and care governance framework?
NHS Grampian has a clinical governance committee in place. Its role is to oversee quality and clinical governance for the board to ensure that quality standards are being set, being met and are continually improved in appropriate areas of clinical activity, and that effective arrangements for supporting, monitoring and reporting on quality and clinical governance are in place across NHS Grampian.
Families in Moray have at least received an independent review into maternity services. Patients in Caithness have been calling for such a review in their area since 2016 in response to the similarly unacceptable circumstances that have prevailed there. Can the cabinet secretary outline whether an independent review into maternity services in Caithness will be commissioned by the Government, and if not, why not?
I am sure that Mr Halcro Johnston is well aware that I met the local campaign group CHAT—the Caithness Health Action Team. In fairness, we both found the meeting very constructive, and in fact, I have already started some conversations about how we can make improvements to the services that are provided for women and their families in Caithness.
In response to the member’s direct question, I say that he will know that the best start north review was paused due to the pandemic. That review encompassed a number of health boards in the north, and included NHS Highland and NHS Orkney in the conversation. That work has resumed and will include consideration of the issue of maternity in Caithness.
The north-east has struggled with staff vacancies for a considerable time, so my question is about targeted support for increased recruitment and retention of medical staff in Moray and across Grampian to ensure a robust service, particularly in midwifery and obstetrics as we move to model 6. I am concerned that we do not have the people in place. As that enhanced provision is being looked at, what are we doing to target support?
As briefly as possible, cabinet secretary.
That issue was also raised with me yesterday by our colleague Richard Lochhead, who is unable to be here because he is at a Scottish Trades Union Congress meeting with the First Minister. The assurance that I gave to him and which I give to Gillian Martin today is that I recognise that national and local actions will be needed to address those local staffing challenges. I have asked NHS Highland and NHS Grampian to share their recruitment plans to meet the 2023 deadline in the model 4 plans.
Extensive work is under way. Given the time constraints, I am happy to write in more detail to Gillian Martin about what is happening in relation to recruitment, but it will be a crucial part of those model 4 plans and, of course, of the model 6 plans in the future.
That concludes this item of business. There will be a brief pause to allow those on the front benches to change before the next item of business.